Lumbar epidural blockade for management of pain in interstitial cystitis.

Thirteen patients with interstitial cystitis (IC), whose predominant symptom was pelvic or urethral pain, were treated with a series of lumbar epidural local anaesthetic blocks over an 18-month period. Response was evaluated by interview and with voiding diaries and visual analogue scales (VAS) for pain. Of the 55 injections given, immediate pain relief (lasting longer than 24 h) was obtained from 41 (75%). The duration of subsequent pain relief varied considerably, ranging from 2 to 75 days (mean 15.1). Pain relief was accompanied by significant improvement in sleep habit and quality of life. A good correlation was noted between verbally expressed pain and the recorded VAS pain scores. Urinary frequency and average voided volumes were unaffected by treatment. Two patients failed to obtain any relief. Apart from minor transient backache at the injection site, there were no complications from the procedure. Lumbar sympathetic epidural blockade is an excellent means of providing pain relief in interstitial cystitis.

Crawford W. Long: pioneer physician in anesthesia.

Crawford W. Long first used ether as an anesthetic on March 30, 1842. This article examines factors in his education and practice that prompted his discovery. Included in the discussion are some of the circumstances that caused Long to delay publication of his experience with ether, as well as the impact of the "ether controversy" on his life.

Analgesic effect of picenadol, codeine, and placebo in patients with postoperative pain.

A double-blind, parallel study was conducted to evaluate the analgesic effect and safety of a single 25 mg oral dose of picenadol, a centrally acting analgesic, and to compare it with a 60 mg dose of codeine and a placebo in patients with postoperative pain. Two sites using similar protocols enrolled a total of 178 inpatients with postoperative pain. Pain intensity, relief, and adverse experiences were then measured for up to 6 hours after administration of the test medications. Both picenadol and codeine were significantly more effective than placebo in reducing pain intensity (mean sum of pain intensity difference scores: picenadol 5.21, codeine 5.19, and placebo 2.82) and increasing total relief (mean total pain relief: picenadol 10.21, codeine 11.07, and placebo 6.96). Adverse experience profiles were similar among the three treatment groups.

Influence of age on vascular absorption of lidocaine from the epidural space.

The purposes of this study were to evaluate the effect of age on the vascular absorption of local anesthetics during epidural anesthesia and to corroborate the clinical observations of other investigators with respect to age. Using the arbitrary definition of significance (P less than 0.05), the maximum serum levels of lidocaine (Csmax) did not differ significantly with age, however, P values were equal to 0.06. Furthermore, the time to Csmax was significantly faster in elderly patients (P less than 0.00001). In conclusion, the mass of local anesthetic solution should be reduced in elderly patients undergoing epidural anesthesia because there is a greater segmental spread, and serum levels of local anesthetics are increased.

Page kidney resulting from massive subcapsular hematoma. Complication of lumbar sympathetic nerve block.

The Page kidney is a recognized cause of hypertension. A massive subcapsular hematoma caused by a lumbar sympathetic nerve block resulted in a Page kidney. To our knowledge, this sequence has not been reported. Small hematomas may be treated conservatively, but massive subcapsular hematomas should be decompressed when the patient is clinically stable. Diagnostic features, therapeutic considerations, and pertinent references are discussed.