BACKGROUND: Baclofen is a gamma-aminobutyric acid B-receptor agonist, which is usually used for patients with spasticity or patients with nerve injury inducing both spasticity and neuropathic pain. Both oral administration and intrathecal injection via a continuous infusion pump are common treatment methods. The aim of this study was to evaluate the effectiveness of a series of three individual injections of intrathecal baclofen for neuropathic pain without spasticity. METHODS: Thirty-one patients with neuropathic pain were treated with a series of three monthly individual injections of intrathecal baclofen without pump implantation A dose of 50 µg of baclofen was used. 10-cm visual analog scale (VAS) scores of spontaneous pain, allodynia, and hyperalgesia were recorded a week after each injection. Vital signs were monitored to detect any hemodynamic changes, and a myelogram was performed to detect any undesirable cerebrospinal fluid leakage. All patients were hospitalized for at least one day following each injection for close observation and to control any adverse effects. RESULTS: VAS scores of spontaneous pain, allodynia, and hyperalgesia decreased significantly (P < 0.001). The major complications were general weakness, sleepiness, and urinary retention; most of these resolved within one day without any further serious symptoms. CONCLUSIONS: A series of three individual intrathecal baclofen injections was effective for those patients who suffered from neuropathic pain without spasticity or dystonia; no serious complications were observed. However, the average satisfaction score recorded for spontaneous pain was lower than those for allodynia and hyperalgesia.
Administration, Oral ; Baclofen* ; Cerebrospinal Fluid Leak ; Dystonia ; gamma-Aminobutyric Acid ; Hemodynamics ; Humans ; Hyperalgesia ; Infusion Pumps ; Injections, Spinal ; Muscle Spasticity ; Neuralgia* ; Urinary Retention ; Visual Analog Scale ; Vital Signs

BACKGROUND: Motor weakness occurs frequently after piriformis injection and it could put patients at risk of falls. We investigated the appropriate concentration and volume of ropivacaine required to minimize motor dysfunction. METHODS: A total of 120 patients who received piriformis injection were included in this study. Piriformis injections of triamcinolone 10 mg in various concentrations (0.1%, 0.075%) and volumes (8, 10, 12 ml) of ropivacaine were administered in 20 patients, respectively. One hour after the injection, we compared motor function according to the concentrations and volumes of ropivacaine. RESULTS: There were significant differences (P < 0.05) in the occurrence of motor dysfunction according to body mass index (BMI) and the concentration of ropivacaine. No significant differences were found in terms of gender, age, weight, height, or the volume of ropivacaine. Logistic regression analysis showed that the likelihood of motor dysfunction with administration of 0.1% ropivacaine was 58.249 times greater than that with administration of 0.075% concentration (P < 0.001), while BMI did not have a significant effect on motor dysfunction. CONCLUSIONS: According to the results of this study, 0.075% ropivacaine rather than 0.1% ropivacaine is appropriate in terms of reducing motor dysfunction after piriformis injection.
Accidental Falls ; Body Mass Index ; Humans ; Logistic Models ; Piriformis Muscle Syndrome ; Triamcinolone

BACKGROUND: The optimal dose infusion of 0.125% bupivacaine via a femoral catheter after total knee replacement (TKR) has not been defined. This study examined various dose infusions of bupivacaine to determine the analgesic quality in patients receiving a continuous femoral nerve block (CFNB). METHODS: Patients were randomized to receive a single-injection femoral nerve block (SFNB) or CFNB performed with 20 ml of 0.125% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine in four groups (n = 20 per group): 1) 0 ml/h (SFNB), 2) 2 ml/h, 3) 4 ml/h, and 4) 6 ml/h. The pain intensity at rest and on knee movement was assessed using a visual analog scale (VAS) for the first 2 postoperative days. The cumulative bolus use of IV patientcontrolled analgesia (PCA) with a morphine-ketorolac combination was evaluated. RESULTS: A lower cumulative bolus of IV PCA was noted in all CFNB groups compared to SFNB on postoperative days (PODs) 1 and 2, respectively (P < 0.05). Lower VAS scores at rest were observed in the 4 ml/h and 6 ml/h groups than in the SFNB group on PODs 1 and 2, respectively, but only on POD 2 in the 2 ml/h group (P < 0.05). Lower VAS scores on movement were noted in the 4 ml/h than the SFNB group on PODs 1 and 2, but only on POD 1 in 6 ml/h (P < 0.05). CONCLUSIONS: The minimum effective infusion rate of 0.125% bupivacaine for CFNB after TKR appears to be 4 ml/h according to the VAS pain scores.
Analgesia ; Analgesia, Patient-Controlled ; Arthroplasty, Replacement, Knee ; Bupivacaine ; Catheters ; Femoral Nerve ; Humans ; Knee ; Passive Cutaneous Anaphylaxis

The transpetrosal approach to the anterior portion of a brain stem lesion with intact hearing is often limited by portions of the labyrinth. The technique of partial labyrinthectomy, by which the posterior and superior semicircular canals, maximizes surgical exposure while preserving hearing. We report the case of a patient who underwent a modified partial labyrinthectomy involving resection of the posterior semicircular canal only in the area of the labyrinth. Technical modification of the partial labyrinthectomy approach simplifies tumor removal while preserving hearing.
Brain Stem ; Ear, Inner ; Hearing ; Hemangioma, Cavernous* ; Humans ; Semicircular Canals

Background and Objectives: Although several studies have compared the characteristics of Ramsay Hunt syndrome (RHS) with Bell’s palsy (BP), the differences in comorbid symptoms and prognosis according to symptoms have not been determined. This study therefore evaluated the differences in otologic symptoms and prognosis between patients with these two conditions.Subjects and Method The medical records of 118 patients with RHS and 215 patients with BP were retrospectively reviewed. Factors compared in these two groups included otologic symptoms, general health condition, electroneurography (ENoG) and House-Brackmann grades. Results: Age, sex, body mass index, lipid profiles, ENoG, rate of diabetes, and side of palsy did not differ significantly between patients with RHS and BP (p>0.05). The rates of hearing disturbance, tinnitus, vertigo, and postauricular pain were significantly higher in RHS (p<0.05 each). Hearing disturbance was more frequent in patients with severe Bell’s facial palsy than with moderate Bell’s facial palsy (p<0.05). The prognosis of patients with BP and RHS who had otologic symptoms did not differ from those who had not (p>0.05). Additionally, in patients with facial paralysis, diabetes was associated with hearing disturbance and vertigo symptoms and dyslipidemia was associated with postauricular pain (p<0.05 each). Conclusion Otologic symptoms were more common in RHS than in BP. However, the prognosis of RHS and BP were not related to otologic symptoms. In patients with facial palsy hearing disturbance and vertigo were associated with diabetes and hypertension. Also, dyslipidemia was associated with post auricular pain.

BACKGROUND: Children and parents experience significant anxiety and distress during the preoperative period. This is important because preoperative anxiety in children is associated with adverse postoperative outcome. So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application, world-widely used. METHODS: A total 120 patients (aged 1-10 years old) who were scheduled for elective surgery under general anesthesia was included in this randomized controlled trial. We randomized the patients into three groups, with using intravenous (IV) midazolam sedation (M group), with using smartphone application program (S group), and with using low dose IV midazolam plus smartphone application program (SM group). And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) at holding area, 5 min after intervention, entrance to operating room. RESULTS: In all three groups, mYPAS after intervention were lower than the preoperative holding area (M group 52.8 +/- 11.8 vs 41.0 +/- 7.0, S group 59.2 +/- 17.6 vs 36.4 +/- 7.3, SM group 58.3 +/- 17.5 vs 26.0 +/- 3.4). A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group (P < 0.01), and the SM group exhibited significantly lower anxiety than the two other groups (P < 0.01). CONCLUSIONS: The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety.
Anesthesia ; Anesthesia, General ; Anxiety* ; Child ; Humans ; Midazolam ; Operating Rooms ; Parents ; Preoperative Care ; Preoperative Period ; Psychology

BACKGROUND: Dexmedetomidine, an α2-adrenergic agonist, can be used for sedation and as an adjuvant to anesthetics. This study aimed to evaluate the effects of preanesthetic administration of dexmedetomidine on the propofol and remifentanil requirement during general anesthesia and postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: Sixty patients were randomly assigned to group D or S (n = 30 each). Dexmedetomidine (0.5 µg/kg) and a comparable volume of saline were administered in groups D and S, respectively, over a 10 minutes period before induction. General anesthesia was induced and maintained with propofol and remifentanil; the bispectral index was maintained at 40–60. The intraoperative remifentanil and propofol dosages were recorded, and postoperative pain was assessed using a visual analog scale (VAS). RESULTS: In groups S and D, propofol dosage was 8.52 ± 1.64 and 6.83 ± 1.55 mg/kg/h, respectively (P < 0.001), while remifentanil dosage was 7.18 ± 2.42 and 4.84 ± 1.44 µg/ kg/h, respectively (P < 0.001). VAS scores for postoperative pain were 6.50 (6–7) and 6.0 (6–7), respectively, at 30 minutes (P = 0.569), 5 (4–5) and 4 (3–5), respectively, at 12 hours (P = 0.039), and 2 (2–3) and 2 (1.25–2), respectively, at 24 hours (P = 0.044). The Friedman test revealed that VAS scores changed over time in both groups (P < 0.001). CONCLUSIONS: Preanesthetic single administration of a low dose of dexmedetomidine (0.5 µg/kg) can significantly decrease the remifentanil and propofol requirement during short surgeries and alleviate postoperative pain.
Anesthesia, General ; Anesthetics ; Cholecystectomy, Laparoscopic* ; Dexmedetomidine* ; Humans ; Pain, Postoperative ; Propofol* ; Visual Analog Scale

Aged ; Anesthesia, General ; Bicuspid ; Epithelium ; Humans ; Incisor ; Male ; Mandible ; Odontogenic Cysts ; Periodontal Cyst ; Recurrence ; Transplants