Hyperekplexia (startle disease) is a rare non-epileptic neurological entity resulting from gene mutation. The onset of this disorder is usually in infancy, but can be delayed until early adulthood. Patients with this disorder usually have normal mental development. Patients with hyperekplexia may present with symptoms ranging from sub-syndromal anxiety, to symptoms of syndromal anxiety disorder. This case report is about two siblings with hyperekplexia, in whom phobic anxiety disorder was a prominent manifestation.

STUDY DESIGN: This was a prospective, randomized, controlled trial comprising 60 patients undergoing lumbosacral spine (noninstrumentation/nonfusion) surgery. PURPOSE: The purpose of this study was to evaluate the efficacy of 0.2% ropivacaine (20 mL) administered alone as a single, preoperative, caudal epidural block injection versus that of intravenous analgesics in providing effective postoperative analgesia to patients undergoing lumbosacral spine surgery. OVERVIEW OF LITERATURE: Various studies have shown the effectiveness of a caudal epidural injection (bupivacaine or ropivacaine) in providing postoperative analgesia in combination with steroids or other analgesics. This study uniquely analyzed the efficacy of a single injection of caudal epidural ropivacaine in providing postoperative pain relief. METHODS: Sixty patients who were scheduled to undergo surgery for degenerative lumbar spine disease (noninstrumentation/nonfusion) were consecutively divided into two groups, group R (Study) and group I (Control). 30 group R patients received a caudal epidural block with 20 mL of 0.2% ropivacaine after the administration of general anesthesia. 30 group I patients received no preoperative analgesia. Intravenous analgesics were administered during the postoperative period after a complaint of pain. Various parameters indicating analgesic effect were recorded. RESULTS: There was a significant delay in the average time to the first demand for rescue analgesia in the study group, suggesting significantly better postoperative pain relief than that in the control group. In comparison with the control group, the study group also showed earlier ambulation with minimal adverse effects. The requirement for intraoperative fentanyl was higher in the control group than that in the study group. CONCLUSIONS: Preemptive analgesia with a single epidural injection of ropivacaine is a safe, simple, and effective approach, providing better postoperative pain relief, facilitating early mobilization, and decreasing the intraoperative requirement for opioid administration.
Analgesia ; Analgesics ; Anesthesia, Caudal ; Anesthesia, General ; Early Ambulation ; Fentanyl ; Humans ; Injections, Epidural ; Pain, Postoperative ; Postoperative Period ; Prospective Studies ; Spine* ; Steroids ; Walking