Until now, we do not have a definitive treatment for intractable postherpetic neuralgia (PHN). But, there is relatively strong evidence for the efficacy of intrathecal methylprednisolone injection in the treatment of intractable PHN. In spite of the effectiveness, many clinicians hesitate to use intrathecal steroids due to adverse effects such as adhesive arachnoiditis. We experienced two cases of temporary severe burning pain after intrathecal steroid injection for treatment of PHN. On the next day, the patients did not have any burning pain, and they were discharged with decreased pain associated with PHN.
Adhesives ; Arachnoid ; Arachnoiditis ; Burns* ; Humans ; Methylprednisolone ; Neuralgia, Postherpetic* ; Steroids

BACKGROUND: There is a growing need for precise blood coagulation tests in preparation for an operation, as a growing number of patients take aspirin during the run-up to their operation. Against this backdrop, we planned to find what effect aspirin has, if taken regularly prior to an operation, on primary hemostasis. We also attempted to determine the possibility of regional anesthesia in cases which the Platelet function analyzer-100 collagen-epinephrine closure time (PFA-100 C/EPI CT) is prolonged. METHODS: We examined three groups the impact of aspirin on the result of the PFA-100 C/EPI CT: Group A (n = 60) consisted of control; Group B (n = 54) who taking aspirin every day until surgery; and Group C (n = 60) was composed of patients who stopped taking aspirin for 7 days before surgery. PFA-100 collagen adenosine-5-diphosphage closure time were only performed on those with abnormal PFA-100 C/EPI CT. RESULTS: PFA-100 C/EPI CT of Group B was significantly longer than Group C and Group A. There was no distinction between Group A and Group C in terms of the PFA-100 C/EPI CT. CONCLUSIONS: PFA-100 C/EPI CT has better sensitivity and specificity than a bleeding test; moreover, it is an easy-to-use and point-of-care test. We concluded that regional anesthesia can be performed for those who taking aspirin until their surgery despite their prolonged collagen-epinephrine closure time except prolonged collagen adenosine-5-diphosphate closure time.
Anesthesia, Conduction ; Aspirin ; Blood Coagulation Tests ; Blood Platelets ; Collagen ; Hemorrhage ; Hemostasis ; Humans

BACKGROUND: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. METHODS: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n = 30), 0.15% ropivacaine + fentanyl 4 microg/ml] or IV-PCA [Group IV-PCA (n = 30) fentanyl 20 microg/kg + ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C)7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. RESULTS: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV- PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. CONCLUSIONS: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction.
Amides ; Analgesia ; Analgesia, Epidural ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia, General ; Blood Pressure ; Breast ; Catheters ; Female ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Ketorolac ; Mammaplasty ; Mastectomy ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis