BACKGROUND: The use of regional local anesthetics or opioids during laparoscopic cholecystectomy (LC), in combination with general anesthesia, has been investigated in several interventional studies. METHODS: We studied a total of 240 (n = 60, each) patients who were undergoing LC, and they received local infiltration and intraperitoneal instillation with normal saline or 0.25% levobupivacaine 60 ml. Group R (S) received infiltration of normal saline 20 ml before incision and at the end of surgery and then 40 ml intraperitoneal instillation after removal of the gall bladder under remifentanil-based anesthesia. Group R (L) received 0.25% levobupivacaine instead of normal saline in the same method like group R (S). Group S (S) received the same method as group R (S) under sevoflurane based anesthesia in place of remifentanil. Group S (L) received 0.25% levobupivacaine instead of normal saline with the same method as group S (S). Pain was assessed on a visual analog scale at 1, 6, 12 and 24 hours after operation. RESULTS: The pain intensity of Group R (L) was significantly lower than that of group R (S), and the the incisional pain of group S (L) was significantly lower than that of group S (S) in the first six hours. The time delay to first operative analgesics in group R (S) and group S (S) was significantly shorter than that of group R (L) and group S (L). CONCLUSIONS: Infiltration and instillation of levobupivacaine reduced the postoperative pain and remifentanil did not increase the pain severity and opioid requirement when performing the LC.
Analgesics ; Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Anesthetics, Local ; Bupivacaine ; Cholecystectomy, Laparoscopic ; Humans ; Hypogonadism ; Methyl Ethers ; Mitochondrial Diseases ; Ophthalmoplegia ; Pain, Postoperative ; Piperidines ; Surgical Instruments ; Urinary Bladder

BACKGROUND: Spinal stenosis and herniated intervertebral discs are the principal causes of lumbosacral radiculopathy. This study was conducted to compare the therapeutic value and duration of pain relief of fluoroscopic guided transforaminal epidural steroid injections (TFESIs) in patients with refractory radicular leg pain. METHODS: Between August 2006 and March 2007, 87 patients (H group: patients with herniated intervertebral disc, S group: patients with spinal stenosis) who met the inclusion criteria were treated with fluoroscopic guided TFESIs. Prior to treatment, the VAS and ODI scores were determine to evaluate the degree of pain and level of disability. The degree of pain relief was then assessed 1 month after treatment with the TFESIs and graded as excellent (no residual pain), good (improvement of pain symptoms by more than 50%), fair (improvement of pain symptoms by less than 50%) and Poor (no improvement of pain). In addition, the duration of pain relief was evaluated by regular outpatient visits for 6 months, and by telephone interviews after 6 months. RESULTS: The H and S group both had excellet results at 1 month after treatment with TFESIs showing improvements of 44.1% and 20.8% respectively. However this difference was not significant between groups. In addition, a duration of pain relief greater than 6 months was achieved in 32.4% of the patients in the H group and 37.7% of those in the S group. CONCLUSIONS: TFESIs had a similar degree of therapeutic effectiveness and duration of pain relief in patients with spinal stenosis and herniated intervertebral discs.
Humans ; Intervertebral Disc ; Interviews as Topic ; Leg ; Outpatients ; Radiculopathy ; Spinal Stenosis

BACKGROUND: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglion (SCG). The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats subjected to permanent focal cerebral ischemia. METHODS: Thirty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (control, lidocaine and ropivacaine). A brain injury was induced in all rats by middle cerebral artery occlusion with a nylon thread. The animals of the local anesthetic group received 30 microl of 2% lidocaine or 0.75% ropivacaine in the SCG. Neurologic scores were assessed 24 hours after brain injury. Brain samples were then collected. The infarct and edema ratios were measured by 2.3.5-triphenyltetrazolium chloride staining. RESULTS: There were no differences in the death rates, neurologic scores, or infarction and edema ratios between the three groups. CONCLUSIONS: These findings suggest that superior cervical sympathetic ganglion block may not influence the brain damage induced by permanent focal cerebral ischemia in rats.
Amides ; Animals ; Blood Vessels ; Brain ; Brain Injuries ; Brain Ischemia ; Edema ; Ganglia, Sympathetic ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Lidocaine ; Male ; Neuroprotective Agents ; Nylons ; Rats ; Rats, Sprague-Dawley ; Superior Cervical Ganglion

BACKGROUND: Experimental evidence indicates that ginseng modulate the nociceptive transmission. Authors examined the role of adrenergic and cholinergic receptors on the antinociceptive action of Korean red ginseng against the formalin-induced pain at the spinal level. METHODS: Catheters were inserted into the intrathecal space of male Sprague-Dawley rats. Fifty microl of 5% formalin solution was injected to the hindpaw for induction of pain and formalin-induced pain (flinching response) was observed. The role of spinal adrenergic and cholinergic receptors on the effect of Korean red ginseng was assessed by antagonists (prazosin, yohimbine, atropine and mecamylamine). RESULTS: Intrathecal Korean red ginseng produced a dose-dependent suppression of the flinching response in the rat formalin test. All of prazosin, yohimbine, atropine and mecamylamine antagonized the antinociception of Korean red ginseng. CONCLUSIONS: Spinal Korean red ginseng is effective against acute pain and facilitated pain state evoked by formalin injection. All of alpha 1, alpha 2, muscarinic and nicotinic receptors may play an important role in the antinociceptive action of Korean red ginseng at the spinal level.
Acute Pain ; Animals ; Atropine ; Catheters ; Formaldehyde ; Humans ; Male ; Mecamylamine ; Pain Measurement ; Panax ; Prazosin ; Rats ; Rats, Sprague-Dawley ; Receptors, Cholinergic ; Receptors, Nicotinic ; Spinal Cord ; Yohimbine

BACKGROUND: Because genetic manipulation is commonly accomplished in mice, mouse models for pain have advanced our understanding of the mechanisms of persistent pain. The purpose of this experimental study is to develop a mouse model for understanding incision induced postoperative pain. METHODS: A longitudinal incision was made at the hindpaw of male DBA/2 mice. The withdrawal frequency (WF) from applications of von Frey filaments and the response frequency (RF) to blunt mechanical stimulation were examined in an incision group and a control group. The withdrawal latency (WL) to radiant heat and a pain score based on weight bearing were also measured. Tests were performed 1 day before incision, and 2 hours, 1.3 days, 5 days and 7 days after incision. RESULTS: The WF for the strongest filament was 35.0 +/- 9.1% before incision and this increased to 100.0 +/- 0% at 2 hours and to 65.0 +/- 9.1% at 7 days after incision. The RF to the blunt stimulus was 4.1 +/- 4.1% before incision and 100.0 +/- 0.0% at 2 hours and 42.8 +/- 10.8% at 7 days after incision. The WL was 6.6 +/- 0.5 sec before incision and 2.4 +/- 0.3 sec at 2 hours and 5.9 +/- 0.6 sec at 7 days after incision. The pain score increased from 1.1 +/- 0.8 to 7.4 +/- 1.5 at 2 days after incision. CONCLUSIONS: A mouse model of acute postoperative pain was developing by making a surgical incision in the mouse hindpaw. Mechanical hyperalgesia and allodynia lasting for several days demonstrate that this model has similarities to the human post-operative pain state. Future studies will allow us to further investigate the genetic and molecular mechanisms of incisional pain.
Animals ; Hot Temperature ; Humans ; Hyperalgesia ; Male ; Mice ; Pain, Postoperative ; Weight-Bearing

BACKGROUND: Peripheral nerve injury induces up-regulation of the calcium channel alpha2delta (alpha2delta) subunit and TRPM8 in the dorsal root ganglion (DRG) which might contribute to allodynia development. We investigated the expression of the alpha2delta subunit and TRPM8 in the DRG of sympathetically maintained pain (SMP) and sympathetic independent pain (SIP) rat model. METHODS: For the SMP model, the L5 and L6 spinal nerves were ligated tightly distal to the DRG. For the SIP model, the tibial and sural nerves were transected, while the common peroneal nerve was spared. After a 7 day postoperative period, tactile and cold allodynia were assessed using von Frey filaments and acetone drops, respectively. Expression of the alpha2delta subunit and TRPM8 in the L5 and L6 DRG were subsequently examined by a Western blot. RESULTS: There were no significant differences between the two models for the thresholds of tactile and cold allodynia. Expression of the alpha2delta subunit in the ipsilateral DRG to the injury was increased as determined on a Western blot as compared to that in the contralateral or sham-operated DRG of the SMP model, but there was no difference in expression seen with the use of the SIP model. There was no difference in the expression of TRPM8 in the ipsilateral DRG to the injury and the contralateral or sham-operated DRG of either model. CONCLUSIONS: Up-regulation of the alpha2delta subunit in injured DRG may play a role that contributes to tactile allodynia development in SMP, but not TRPM8 to cold allodynia after peripheral nerve injury.
Acetone ; Animals ; Blotting, Western ; Calcium Channels ; Cold Temperature ; Diagnosis-Related Groups ; Ganglia, Spinal ; Hyperalgesia ; Organic Chemicals ; Peripheral Nerve Injuries ; Peroneal Nerve ; Polyenes ; Postoperative Period ; Rats ; Spinal Nerve Roots ; Spinal Nerves ; Sural Nerve ; Up-Regulation

Spinal joint pain syndrome is composed of atlanto-occipital, atlanto-axial, facet, and sacro-iliac joints pain. The syndrome is haracterized as referred pain which is originated from deep somatic tissues, which is quietly different from radicular pain with dermatomal distribution originated from nerve root ganglion. The prevalence of facet joint pain in patients with chronic spinal pain of cervical, thoracic, and lumbar regions has been known 56%, 42%, and 31% as in order. It is generally accepted in clinical practice that diagnostic blocks are the most reliable means for diagnosing spinal joints as pain generators. The sacroiliac joint has been shown to be a source of 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. The treatment of spinal joints ideally consists of a multimodal approach comprising conservative therapy, medical management, procedural interventions, and if indicated.
Arthralgia ; Ganglion Cysts ; Humans ; Joints ; Low Back Pain ; Lumbosacral Region ; Pain, Referred ; Prevalence ; Sacroiliac Joint ; Spine ; Zygapophyseal Joint

No abstract available.
Vitamin E ; Vitamins

No abstract available.
Acupuncture

No abstract available.
Phantom Limb