Effects of the Volume of Local Anesthetic Used in Stellate Ganglion Block on the Elevation of Skin Temperature of Ipsilateral Upper Extremity / 대한마취과학회지

BACKGROUND: Horner's syndrome, including ptosis and miosis, is a sign of success following stellate ganglion block (SGB). However, it is not sufficient to ensure adequate sympathetic block to the upper extremity. There are numerous recommended local anesthetic volumes for SGB. The aim of this study was to evaluate the effects of differing volumes used in SGB on the elevation of skin temperature of ipsilateral upper extremity, and to find the volume required to elevate skin temperature most frequently. METHODS: Patients with sensory neural hearing loss underwent SGB, repeated daily in the paratracheal approach using different volumes (6, 8, 10, 12 and 16 ml) of 0.2% bupivacaine. Skin temperatures were checked in the hypothenar area before SGB, and 1, 2, 3, 4, 5, 10 and 15 minutes following SGB. Time intervals required for the elevation of skin temperature 1oC above the preblock level, and for the appearance of Horner's syndrome were recorded. RESULTS: Twenty-three patients repeatedly received SGB over 4 times at different volumes. The total SGB was 100 times, and all displayed Horner's syndrome. The total incidence of skin temperature elevation was 48%. Horner's syndrome appeared prior to the elevation of skin temperature (2.0 2.1 vs 5.3 3.8 min). There were significant differences in the incidence of skin temperature elevation, depending on the volume of the local anesthetics; 6 ml (17.6%), 8 ml (34.8%), 10 ml (52.2%), 12 ml (73.9%) and 16 ml (57.1%); greater volumes resulted in high incidences (pearson chi-square test, P = 0.005). The volume of twelve ml resulted in the highest incidence. Each patient needed different minimal volume to lead to the skin temperature elevation; 6 ml (13.1%), 8 ml (21.7%), 10 ml (17.4%), 12 ml (26.1%) and 16 ml (4.4%), and several patients (17.4%) did not have elevated skin temperature at any volumes. CONCLUSIONS: This study reveals that a large volume of local anesthetic (e.g. 12 ml) is needed in SGB for adequate sympathetic blockade to the upper extremity, and that each patient needs a different minimal volume for the skin temperature elevation to occur.

Effects of the Volume of Local Anesthetic Used in Stellate Ganglion Block on the Elevation of Skin Temperature of Ipsilateral Upper Extremity / 대한마취과학회지

BACKGROUND: Horner's syndrome, including ptosis and miosis, is a sign of success following stellate ganglion block (SGB). However, it is not sufficient to ensure adequate sympathetic block to the upper extremity. There are numerous recommended local anesthetic volumes for SGB. The aim of this study was to evaluate the effects of differing volumes used in SGB on the elevation of skin temperature of ipsilateral upper extremity, and to find the volume required to elevate skin temperature most frequently. METHODS: Patients with sensory neural hearing loss underwent SGB, repeated daily in the paratracheal approach using different volumes (6, 8, 10, 12 and 16 ml) of 0.2% bupivacaine. Skin temperatures were checked in the hypothenar area before SGB, and 1, 2, 3, 4, 5, 10 and 15 minutes following SGB. Time intervals required for the elevation of skin temperature 1oC above the preblock level, and for the appearance of Horner's syndrome were recorded. RESULTS: Twenty-three patients repeatedly received SGB over 4 times at different volumes. The total SGB was 100 times, and all displayed Horner's syndrome. The total incidence of skin temperature elevation was 48%. Horner's syndrome appeared prior to the elevation of skin temperature (2.0 2.1 vs 5.3 3.8 min). There were significant differences in the incidence of skin temperature elevation, depending on the volume of the local anesthetics; 6 ml (17.6%), 8 ml (34.8%), 10 ml (52.2%), 12 ml (73.9%) and 16 ml (57.1%); greater volumes resulted in high incidences (pearson chi-square test, P = 0.005). The volume of twelve ml resulted in the highest incidence. Each patient needed different minimal volume to lead to the skin temperature elevation; 6 ml (13.1%), 8 ml (21.7%), 10 ml (17.4%), 12 ml (26.1%) and 16 ml (4.4%), and several patients (17.4%) did not have elevated skin temperature at any volumes. CONCLUSIONS: This study reveals that a large volume of local anesthetic (e.g. 12 ml) is needed in SGB for adequate sympathetic blockade to the upper extremity, and that each patient needs a different minimal volume for the skin temperature elevation to occur.

Effect of Additional Epinephrine on Spinal Anesthesia with Bupivacaine / 대한마취과학회지

Background: Bupivacaine was introduced to be a long-acting spinal anesthetic agent. It has been argued about whether the addition of epinephrine prolongs the bupivacaine action or not. The aim of this present investigation was to find out the effect of additional epinephrine on spinal anesthesia with bupivacaine. Methods: 47 patients undergoing an operation on lower extremity were randomly allocated to 2 groups. All patients were anesthetized by subarachnoid block with 0.5% bupivacaine in 8% glucose, which was mixed with 0.2 ml of normal saline in group non-E (n=24) and 0.2 ml of 1:1,000 epinephrine in group E (n=23). We evaluated blood pressure and heart rate, the sensory and motor blockade and voiding time after spinal anesthesia. Results: The systolic blood pressure (SBP) at 8 and 10 min after anesthesia were lower in group non-E than in group E (p<0.05). The trend of decreasing diastolic blood pressure was similar in both groups. The heart rate(HR) at 2 min after anesthesia was lower in group non-E than in group E (p<0.05). The sensory block in T10 was produced faster in group non-E (7 min) than in group E (11 min)(p<0.05). And the maximal sensory block level and its reaching time was T7 and 14 min in group non-E, and T8 and 17 min in group E (p=0.12, p=0.11). Two segment regression time was 124 min in group non-E, and 184 min in group E (p=011). The onset time of motor block to Bromage scale 3 was 12 min in group non-E and 16 min in group E (p=0.06). The recovery time from complete motor block to Bromage scale 1 after maximal motor block was 263 min in group non-E, and 278 min in group E. The time at which patients voided after anesthesia was 469 min in group non-E, and 466 min in group E. Three patients urinated by using a urinary catheter in each group. Conclusions: The addition of epinephrine to bupivacaine for spinal anesthesia can slow the decrease in SBP and increase the HR at early stage of anesthesia, and slow the sensory block.

Intra-articular Morphine, Bupivacaine-Morphine for Pain Relief after Arthroscopy Surgery of the Knee Joint / 대한마취과학회지

BACKGROUND: Evidence has accumulated that opioids can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. Bupivacaine is potent analgesic with early peak onset in the postoperative period. The combination of intra-articular bupivacaine and morphine has been suggested as an ideal analgesic after knee arthroscopy. METHODS: Thirty patients scheduled for knee arthroscopy under general anesthesia were allocated randomly to two groups. Group 1 received morphine 5 mg in normal saline 25 ml, group 2 received morphine 5 mg in 0.25% bupivacaine 25 ml intraarticularly, and all solutions contained 1:200,000 epinephrine. Tourniquet was inflated above knee joint for 10 minutes after injection in each of the patients. Postoperative pain was assessed using the visual analogue scale at 1, 2, 3, 4, 6, 12 and 24 hours after the intra-articular injection. The need for supplemental analgesic was recorded. RESULTS: Patients in the group 2 had lower pain scores than group 1 at first and second hour. There were no significant differences from 3 hours to 24 hours postoperative period. Supplemental analgesic requirements were significantly greater in group 1 than group 2 for the first 3 hours. CONCLUSIONS: It is concluded that, after knee arthroscopy, intra-articular morphine 5 mg in 0.25% bupivacaine 25 ml results in satisfactory analgesia with small amount of supplementary analgesic.