Determining the Maximum Tolerable Concentration of Ropivacaine to Maintain Sensation of the Nerve Root in Percutaneous Endoscopic Transforaminal Lumbar Discectomy: Can Epidural Anaesthesia Achieve Pain-Tactile Separation Block to Avoid Nerve Injury?

Introduction: Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC) of ropivacaine concentration for epidural anaesthesia, is defined as the concentration that minimises pain while preserving the sensation of the nerve roots. This distinct advantage allows the patient to provide feedback to the surgeon when the nerve roots are contacted. Methods: We used a biased-coin design to determine the MTC, which was estimated by the 10% effective concentration (EC10), ie, the concentration at which 10% of patients lost sensation in the nerve roots. The determinant for positive response was lack of sensory feedback upon contact with the nerve root, and the feedback from occurrence of sensations in the innervation area upon contact with the nerve root was defined as a negative response. Primary outcome was the response from contact nerve root. Secondary outcomes were the type and number of statements of negative response and each patient's pain score during surgery. Results: Fifty-four patients were included in this study. The EC10 was 0.434% (95% CI: 0.410%, 0.440%) using isotonic regression in comparison with 0.431% (95% CI: 0.399%, 0.444%) using probit regression. Three type statements of negative response were reported including "tactile sensation", radiculalgia, and numbness. Conclusion: The MTC of ropivacaine used for epidural anaesthesia was 0.434% to avoid nerve injury in percutaneous endoscopic transforaminal lumbar discectomy.

Aneugenicity and clastogenicity in freshwater fish Oreochromis niloticus exposed to incipient safe concentration of tannery effluent.

Conventional effluent bioassays mostly rely on overt responses or endpoints such as apical and Darwinian fitness. Beyond the empirical observation, laboratory toxicity testing needs to rely on effective detection of prognostic biomarkers such as genotoxicity. Indeed, characterization of tannery effluent requires slotting in of genotoxic responses in whole effluent toxicity testing procedures. Hence, the prime objective of the present experimental investigation is to apply the technique of biological assay as a tool of toxicity testing to evaluate the induction of micronuclei (MN) in peripheral erythrocytes, and exfoliated cells of gill and kidney of O.niloticus exposed to Maximum tolerable concentrations (MTCs) of composite Modjo tannery effluent (CMTE) and to compare the sensitivity of each cells origin to the induction of MN. After 72h of exposure, cellular aberrations were detected using MN and nuclear abnormality (NA) tests. The induction of MN was significantly higher in exposed groups (P<0.05) when compared to the control group; moreover the tissue specific MN response was in the order, gill cells>peripheral erythrocyte>kidney. Total NA was found to increase significantly (P<0.05), when compared to the non-exposed group. NA was also further ramified as blebbed (BL), bi-nucleated (BN), lobbed (LB) and notched (NT) abnormalities. The result of each endpoint measured has demonstrated that at a concentration of total chromium (0.1, 0.73 and 1.27mg/L), a perceptible amount cellular aberration was measured, further implicating somber treat of genotoxicity to fishes, if exposed to water contaminated with tannery effluent. This further highlight that conventional effluent monitoring alone cannot reveal the effects expressed at cellular and genetic levels further demanding the incorporation of effluent bioassays in risk assessment and risk management/abatement programs.