BACKGROUNDS: Pain can occur following acute noxious stimuli and tissue damage. The duration of such pain may outlast the stimulus and its amplitude may be exaggerated (hyperalgesia). This response comes from a sensitization of the peripheral nociceptor. Traditional thought has associated the antinociceptive effects of opiates with the activation of opioid receptors located in the central nervous system. Recently, however, opiate receptors in the peripheral nervous system have led to the hypothesis that analgesic action might, in part, result from a reduction in the response of peripheral nerve fibers thought to be concerned with signaling pain. METHODS: Twenty units were recorded from the strands of the hypogastric nerve innervating the urinary bladder of the cat. Nerve activity and intravesical pressure were monitored before and after the onset of an acute inflammation induced by the intravesical instillation of 2% mustard oil. The responses of afferent units to chemical stimuli by intra-arterially injected bradykinin (10 microgram/0.2 ml., i.a.) and potassium chloride (0.3 M/0.2 ml, i.a.) were compared each time at control, after inflammation, and after administration of morphine (2.5 mg/kg) and naloxone (5 microgram/kg) respectively. RESULTS: Polymodal receptors in the urinary bladder showed excitatory response to algesic substances such as bradykinin, potassium chloride and the urinary bladder contracted simultaneously, both the responses of the nerve impulse and bladder contraction to bradykinin and potassium chloride increased significantly after bladder inflammation induced by 2% mustard oil and the sensitization of the sensory receptors attenuated by morphine and naloxone reversed the effect of morphine. CONCLUSIONS: These observations suggest that morphine might have a peripheral effect.
Action Potentials ; Administration, Intravesical ; Animals ; Bradykinin ; Cats ; Central Nervous System ; Inflammation ; Morphine* ; Mustard Plant ; Naloxone ; Nociceptors ; Peripheral Nerves ; Peripheral Nervous System ; Potassium Chloride ; Receptors, Opioid ; Sensory Receptor Cells* ; Urinary Bladder*

BACKGROUNDS: In man, adding clonidine to local anesthetics results in an increased duration of spinal, epidural and peripheral nerve blocks such as femoral nerve block. The purpose of this study was to compare the effects of intramuscular or adding clonidine to mepivacaine on the duration of analgesia after brachial plexus block. METHODS: After informed consent, 30 ASA 1 or 2 adults patients scheduled for elective upper limb surgery under brachial plexus anesthesia were included in this study. Brachial plexus block with Supraclavicular approach was performed following paresthesia. 40ml of 1.5% mepivacaine was injected in the brachial plexus sheath in all patients. In group 2, 150 ug of clonidine IM, 30 min before the procedure. In group 3, 150 ug of clonidine added to mepivacaine in brachial plexus sheath. Onset of anestheasia and duration of anesthesia and analgesia were assessed. Blood pressure and sedation score was monitored. Statistical analysis was done with ANOVA. RESULTS: Duration of anesthesia were significantly increased in group 3 (217.0 +/- 56.2 min by pinprick) compared to group 1 (176.0 +/-26.3 min). Duration of analgesia were significantly increased (p<0.05) in group 3. (229.0 +/- 43.3 min) compared to group 1 (186.0 +/- 20.0 min). Blood pressure was not significantly different in the three groups. A sedation was observed in group 3, especially from 20 min to 180 min after injection of drug. CONCLUSION: 150 ug of clonidine added to mepivacaine for brachial plexus block increases duration of anesthesia and analgesia without any significant side effects.
Adult ; Analgesia ; Anesthesia ; Anesthesia and Analgesia ; Anesthetics, Local ; Blood Pressure ; Brachial Plexus* ; Clonidine* ; Femoral Nerve ; Humans ; Informed Consent ; Mepivacaine* ; Paresthesia ; Peripheral Nerves ; Upper Extremity

BACKGROUND: Induction of anesthesia with propofol is associated with decrease in blood pressure, but changes of heart rates are minimal. However the combination of two centrally acting vagotonic agents, propofol and fentanyl, decreased heart rates on induction, with concomitant decreases in arterial pressure. Thus we evaluated the effect of atropine on these hemodynamic changes. METHODS: Patients were randomly allocated to three group. Group 1 was given no atropine premedication. In group 2, premedication with 0.01 mg/kg of atropine was administered intramusculary about one hour before anesthetic induction. In group 3, pretreatment with 0.01 mg/kg of atropine was administered intravenously about 4 minutes before anesthetic induction. Anesthesia was induced with 1 microgram/kg of fentanyl, 2~2.5 mg/kg of propofol and 0.1 mg/kg of vecuronium and maintained with nitrous oxide, oxygen and enflurane. Heart rate and blood pressure were measured 1, 5 min before induction and 1, 2, 3, 5, 7, 9 min after induction. RESULTS: Heart rates are increased significantly(P<0.001) during the 3 minutes before induction in patients given atropine intravenously and remained significantly higher(P<0.05) during early maintenance of anesthesia than in patients receiving no premedication of atropine. The systolic and diastolic blood pressure weren't changed significantly between the three groups. CONCLUSIONS: Pretreatment of atropine intravenously before induction of anesthesia with propofol and fentanyl attenuates the decreasing the heart rates but does not affect the blood pressure before intubation.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Atropine* ; Blood Pressure ; Enflurane ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Nitrous Oxide ; Oxygen ; Premedication ; Propofol ; Vecuronium Bromide

BACKGROUND: The reduction is cerebral blood flow (CBF) caused by hypocapnia is an important element of anesthetic techniques for neurosurgery as well as for nonneurologic surgery in patients with reduced intracranial compliance. Accordingly, the impact of anesthetic agents on the CO2 responsiveness of the cerebral circulation has important implications with regard to anesthetic selection. The purpose of this study was to investigate the effects of isoflurane-N2O and propofol-N2O anesthesia on the CBF response to changes in end-tidal CO2 in healthy patients. METHODS: 19 healthy patients with nonneurological operation were selected. In group 1, anesthesia was induced with thiopental sodium 4 mg/kg, fentanyl 1 g/kg, succinylcholine 1~1.5 mg/kg and was maintained with isoflurane 0.5~1.5 vol%. In group 2, anesthesia was induced with propofol 2~2.5 mg/kg, fentanyl 1 g/kg, succinylcholine 1~1.5 mg/kg and was maintained with a propofol infusion of 10 mg/kg/h for 10 min and then 8 mg/kg/h for 10 min and then was reduced 3~6 mg/kg/h of the remainder of the study. All patients were ventilated with N2O in O2 (FIO2 0.5) and measured end-tidal CO2 (PETCO2). Mean blood flow velocity of middle cerebral artery was measured using transcranial Doppler in PETCO2 45, 40, 35, 30, 25, 20 mmHg. RESULT: CO2 reactivity of MCA flow velocity during isoflurane-N2O and propofol-N2O anesthesia was 5.1 +/- 1.8 %/mmHg, 4.4 +/- 1.0 %/mmHg respectively. CONCLUSION: The cerebral vasculature in healthy patients remains responsive to changes in PETCO2 during isoflurane-N2O and propofol-N2O anesthesia.
Anesthesia* ; Anesthetics ; Blood Flow Velocity* ; Carbon Dioxide* ; Carbon* ; Compliance ; Fentanyl ; Humans ; Hypocapnia ; Isoflurane ; Middle Cerebral Artery* ; Neurosurgery ; Propofol ; Succinylcholine ; Thiopental

Oral clonidine premedication appears to inhibit the outflow of sympathoadrenal activity and adrenocortical hormone release, thereby decreasing the minimum alveolar anesthetic concentration of inhaled anesthetics and stabiliring cardiovascular system. It has been reported that oral clonidine premediacation for spinal anesthesia, similar to intrathecal administration of clonidine, has prolonging effect of sensory and motor blocks. The purposes of this study are to assess the effects of oral clonidine premedication on the duration of tetracaine spinal anesthesia, and the hemodynamic changes during spinal anesthesia. Twenty patients undergoing hemorrhoidectomy, TURP, and device removal of lower extremity under spinal anesthesia (0.5% hyperbaric tetracaine), were given diazepam 10 mg orally (Group 1, n=10) or clonidine 150 ug orally (Group 2, n=10) 1 hour before tbe anestbesia. The results were the following, (1) No significant differences was noted between two groups in either the maximum level of sensory extension or time to maximum level of sensory blockade between two groups. In Group 2, the time for two-segment regression was prolonged compared with group 1, but not significant. The time for regression to L1 was significantly prolonged in Group 2 (238+/-37.74min) compared with Group 1 (167.6+/-25.85min)(P<0.05). (2) The number of patient in Bromage's scale score 3 of motor blockade between 180min and 260min after spinal anesthesia was 10 times higher in Group 2 compaired with Group 1 (P<0.05). (3) In Group 1, the lowest systolic blood pressure during spinal anesthesia was significantly low compared with that before premedication (P<0.05). In Group 2, systolic blood pressure before spinal anesthesia, mean systolic blood pressure during first 20mins of spinal anesthesia and the lowest systolic blood pressure were significantly reduced respectively comparing with those before premedication. Significant difference (P<0.05) was noted between Group 1 and 2 in mean systolic blood pressure during the first 20 mins of spinal ansthesia and in lowest systolic blood pressure during spinal anesthesia. In both groups, the lowest heart rate was significantly lower after than before premedication (P<0.01), but the difference in the amount of heart rate change between two groups was not significant. In conclusion, prolongation of sensory and motor blocks of spinal anesthesia with hyperbaric 0.5% tetracaine may be accomplished with oral premedication of 150 ug clonidine without serious clinieal complication.
Anesthesia, Spinal* ; Anesthetics ; Blood Pressure ; Cardiovascular System ; Clonidine* ; Device Removal ; Diazepam ; Heart Rate ; Hemodynamics ; Hemorrhoidectomy ; Humans ; Lower Extremity ; Premedication* ; Tetracaine ; Transurethral Resection of Prostate

BACKGROUND: Lumbar transforaminal epidural injections (LTEIs) have been utilized in the treatment of radicular pain, and LTEIs have the advantage of target-specificity. However, there have not been enough studies on the contrast patterns in LTEIs with using fluoroscopy. The purpose of this study was to evaluate the spreading epidural contrast patterns that are seen during real-time fluoroscopic guided LTEIs. METHODS: A total of 131 patients who underwent fluoroscopic guided LTEIs were studied. The inclusion criteria were those patients with low back pain and/or lower extremity pain that was caused by a herniated nucleus pulposus, lumbar spinal stenosis, failed back surgery syndrome, and herpes zoster-associated pain. We classified the contrast patterns in regard to the contrast flow spreading to the nerve root and/or the unilateral, bilateral or cylinderic type of epidural spreading on the AP view of the fluoroscopy and the ventral or dorsal epidural filling on the lateral view. In addition to the pattern analysis, we evaluated the range of contrast spreading from the cranial to the caudal epidural filling and the incidence of an intravascular flow pattern. RESULTS: Epidural spreading was seen in 126 cases (96.2%) of the total patients through the nerve root. Ventral spreading occurred in 120 cases (95.2%). On the AP view, a nerve root with unilateral, bilateral and cylinderic epidural filling was noted for 108 (85.7%), 9 (7.1%) and 9 (7.1%) cases, respectively. The contrast spreading to vertebral segments was smaller for the patients with lumbar spinal stenosis and failed back surgery syndrome than for the other groups (P < 0.0083). The incidence of intravascular injection was 11.1% (14/126). CONCLUSIONS: LTEIs using fluoroscopic visualization provided excellent assessment of the ventral epidural filling as well as nerve root filling. However, unilateral epidural spreading was prominent for the LTEIs.
Failed Back Surgery Syndrome ; Fluoroscopy ; Humans ; Imidazoles ; Incidence ; Injections, Epidural ; Low Back Pain ; Lower Extremity ; Nitro Compounds ; Spinal Stenosis

Peripartum cardiomyopathy(PPCM) is a relatively rare form of acute heart failure, which may result in severe cardiac failure and death. In part this may be due to late diagnosis and inappropriate treatment. Also diagnosis in the last trimester is complicated by the fact that the early symptoms of this disorder may mimic the symptoms of normal pregnancy. We experienced and reported a 35-year-old primigravida who was diagnosed with PPCM and undertaken emergency cesarean section with epidural anesthesia. PPCM must be considered in any patient who presents with newly onset of peripheral edema, dyspnea on exertion, or paroxysmal nocturnal dyspnea during late pregnancy or up to 5 months postpartum. We suggest that early and precise diagnosis is associated with a better outcome.
Adult ; Anesthesia* ; Anesthesia, Epidural ; Cardiomyopathies* ; Cesarean Section* ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Edema ; Emergencies ; Female ; Heart Failure ; Humans ; Peripartum Period* ; Postpartum Period ; Pregnancy ; Pregnancy Trimester, Third ; Pregnant Women*

Erythromelalgia is a rare disease characterized by palmar and plantar erythema, burning pain and local increase in temperature. Secondary erythromelalgia most commonly appears secondary to myeloproliferative disorders, essential thrombocytosis and polycythemia vera. The pain associated with erythromelalgia is often severe and recalcitrant. So far no properly performed therapeutic trials have been published. We present a case of erythromelalgia of both hands and feet in a 52 year old man. A twice daily cervical and lumbar epidural block of mepivacaine 0.5% and mexiletine 100 mg given orally resuletd in complete resolution of the syndrome. After 3 months, the symptom recurred mildly.
Bupivacaine* ; Burns ; Erythema ; Erythromelalgia* ; Foot ; Hand ; Humans ; Mepivacaine ; Mexiletine* ; Middle Aged ; Myeloproliferative Disorders ; Polycythemia Vera ; Rare Diseases ; Thrombocytosis

BACKGROUND: Chemical lumbar sympathetic ganglion block could potentially be used to treat plantar hyperhidrosis; therefore, we analyzed the outcome of lumbar sympathetic ganglion block using alcohol for the treatment of plantar hyperhidrosis. METHODS: Between March 1992 and June 2003, 356 patients with plantar hyperhidrosis underwent lumbar sympathetic ganglion block using alcohol. All 356 patients were followed up for 2 years and the results evaluated. There were 185 and 171 male and female patients, respectively, with a mean age of 25.1 years, ranging from 15.3 to 56.5 years old. Lumbar sympathetic ganglion block using alcohol was performed with fluoroscopic guidance under local anesthesia. RESULTS: The recurrence rate after 2 years was 34%. Compensatory hyperhidrosis, ejaculation failure, lower back pain and genitofemoral neuritis developed as complications in 132, 4, 12 and 2 patients, respectively. Of the 356 patients, 65% were satisfied. CONCLUSIONS: Lumbar sympathetic ganglion block using alcohol is an effective and safe method for the treatment of plantar hyperhidrosis, but more information about the complications and relatively high recurrence rates should be provided to the patient.
Anesthesia, Local ; Ejaculation ; Female ; Ganglia, Sympathetic* ; Humans ; Hyperhidrosis* ; Low Back Pain ; Male ; Neuritis ; Recurrence

BACKGROUND: Balloon kyphoplasty is the new technique that helps to decrease the pain and improve mobility as well as restore the vertebral body height and kyphotic curve in fractured vertebrae. We evaluated the outcome of balloon kyphoplasty in the reduction of vertebral body height, kyphotic curve and clinical improvement in the patients with painful vertebral compression fractures. METHODS: From July 2002 to February 2005, 84 levels of vertebral compression fractures in 66 patients were treated with balloon kyphoplasty. The assessment criteria were the changes over time in visual analogue scale (VAS) and mobility score. We evaluated the vertebral body height and kyphotic curve at preoperative 1 day and postoperative 1 day. RESULTS: Procedures were performed in 66 patients with a total of 84 affected vertebral bodies. The anterior wall height was restored in 74 / 84 (88%) levels with a mean increment of 2.9 mm, and the mid-vertebral body height was restored in 79 / 84 (94%) levels with a mean increment of 4.2 mm. Kyphosis correction was achieved in 60 / 84 (71.4%) from 10.1 degrees to 7.5 degrees. Pain intensity reduced by 60% in one day after operation and by 75-85% in later time. Mobility scores of all patients were improved immediately after the procedure. Cement leakage occurred in 3 levels but there was no clinical problem. CONCLUSIONS: Kyphoplasty is an efficient and safe treatment of painful vertebral compression fracture in pain relief, mobility improvement, and reduction of deformity.
Body Height ; Congenital Abnormalities ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Kyphosis ; Spine