Investigation of Optimal Needle Position for Radiofrequency Ablation-Based Blockade of Interspace between the Popliteal Artery and the Posterior Capsule of the Knee: A Cadaveric Study.

Background and Objectives: The interspace between the popliteal artery and the posterior capsule of the knee (iPACK) block has been widely used in perioperative settings to control posterior knee pain and can additionally be used for chronic knee pain. In this cadaveric study, we aimed to investigate the needle tip position and its proximity to the articular branch of the tibial nerve (ABTN) during an iPACK-targeted radiofrequency procedure. Materials and Methods: An ultrasound-guided iPACK block was performed on 20 knees of 10 cadavers. We injected 0.1 mL each of blue and green gelatinous dye near the tibial artery (point A) and posterior knee capsule (point B), respectively, and evaluated the spread of both around the ABTN. For a hypothetical conventional radiofrequency ablation (RFA) lesion (diameter, 2.95 mm) and cooled RFA lesion (diameter, 4.9 mm), we counted the number of specimens in which the ABTNs would be captured. Results: The percentage of specimens in which the ABTN would be captured by a cooled RFA lesion was 64.71% at point A and 43.75% at point B (p = 0.334). Meanwhile, the percentage of specimens in which the ABTN would be captured by a conventional RFA lesion was 58.82% from point A and 25% from point B (p = 0.065). Conclusions: When performing an RFA-based iPACK block, the needle tip may be positioned either lateral to the tibial artery or in the space between the posterior knee capsule and the tibial artery. However, more studies with larger samples are needed to verify these results before the clinical use of this procedure can be recommended.

Comparison of Polynucleotide, Sodium Hyaluronate, and Crosslinked Sodium Hyaluronate for the Management of Painful Knee Osteoarthritis: A Multi-Center, Randomized, Double-Blind, Parallel-Group Study.

OBJECTIVE: To compare the clinical effectiveness of sodium polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid for the management of painful knee osteoarthritis. DESIGN: Randomized, double-blind, parallel-group clinical trial. SETTING: Multicenter study. SUBJECTS: Patients with chronic painful knee osteoarthritis. METHODS: Ninety patients were selected and randomized into polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid groups (30 per group). Intra-articular injections of the viscosupplement for each group were administered to the patients three times at one-week intervals. The primary outcome was differences in changes of weight-bearing pain scores at 16 weeks between the groups. The secondary outcomes were changes in the intensity of knee pain during weight-bearing, walking, and rest, and functional disability, quality of life, and adverse events during the 16-week follow-up period. RESULTS: At 16 weeks, the polynucleotide group showed a higher reduction in pain score using a Visual Analog Scale score (0-100) than the classic hyaluronic acid (-17.6 [95% CI = -35.1 to -0.1]; P = .048) and crosslinked hyaluronic acid (-22.4 [95% CI = -41.5 to -3.3]; P = .016) groups. The polynucleotide and crosslinked hyaluronic acid groups showed an early-onset reduction in knee pain during weight-bearing, walking, and rest. All three groups showed reductions in functional disability and improved quality of life at 16 weeks without inter-group differences. No severe adverse events were reported throughout the study period. CONCLUSION: Polynucleotide significantly relieves pain more and relieves pain faster in patients with knee osteoarthritis than classic and crosslinked hyaluronic acid, with improved health-related quality of life.

Anatomical and Radiological Assessments of Injectate Spread Stratified by the Volume of the Pericapsular Nerve Group Block.

BACKGROUND: The pericapsular nerve group (PENG) block was recently suggested as a regional technique for managing acute pain after hip surgery. However, few anatomical studies have confirmed the spread of injectate during the PENG block. This cadaver study aimed to analyze injectate spread to the target nerves during single-injection ultrasound-guided PENG block. METHODS: Ultrasound-guided PENG block with 3 different injectate volumes (10, 20, or 30 mL) was performed in 18 cadavers. Injectate spread by the volume was first evaluated on computed tomography, followed by cadaver dissection. The spread of the dye over the pelvis and lower limb was evaluated. RESULTS: The articular branches of the femoral nerve were stained nearly sufficiently with 20- and 30-mL specimens. The femoral nerve itself was stained simultaneously in six of 12 (50%) 20-mL specimens and 12 of 12 (100%) 30-mL specimens. The accessory obturator nerve was observed only in three (9%) of 36 specimens. The articular branches of the obturator nerve were rarely affected, regardless of injectate volume (1/12, 10 mL specimens; 2/12, 20 mL specimens; 1/12, 30 mL specimens; P > .999). Rather, the obturator nerve was affected. However, the obturator nerve was not stained consistently even with 30 mL of injectate (50%). CONCLUSIONS: After combining the dissection and radiological findings, the single-injection ultrasound-guided PENG blocks with volumes of 10, 20, and 30 mL do not support motor sparing or selective anterior hip capsule innervation in a clinical setting. If early rehabilitation is needed, high-volume PENG block might not be the ideal option, and persisting pain after PENG block might be attributed in part to the lack of obturator nerve articular branches blockade.

Effect of Previous Caudal Block to Predict Successful Outcome after Adhesiolysis using a Steerable Catheter in Lumbar Failed Back Surgery Syndrome: A Retrospective Study.

Adhesiolysis is minimally invasive and commonly used for pain associated with adhesion after lumbar spine surgery. Caudal epidural block may be used for radiating pain due to failed back surgery syndrome. We evaluated the predictive value of response to caudal block performed prior to adhesiolysis in failed back surgery syndrome. Between January 1, 2013 and June 30, 2020, 150 patients with failed back surgery syndrome were treated with adhesiolysis using a steerable catheter at the pain clinic of a tertiary hospital after failed conservative treatment (including caudal block). Patient demographics, pain duration, and lumbar magnetic resonance imaging findings were examined. Response to previous caudal block was determined as a binary result (yes or no). Patients were followed up 3 months after adhesiolysis. Successful outcome was defined as a ≥2-point reduction in the numeric rating scale scores for radicular pain 3 months after adhesiolysis, evident in 81/150 (46%) patients. Multivariable logistic regression analysis revealed that caudal block response was an independent predictor of successful adhesiolysis (odds ratio = 4.403; p = 0.015). Response to prior caudal block is a positive predictor of successful adhesiolysis.

Celiac plexus block with botulinum toxin in severe chronic pancreatitis-A case report.

WHAT IS KNOWN AND OBJECTIVE: The botulinum toxin (BoNT) has been widely used for various conditions associated with pain. CASE DESCRIPTION: Here, we report a case where celiac plexus block (CPB) with BoNT relieved intractable chronic pancreatic pain without complications. CPB was performed at the L1 level under fluoroscopic guidance, and 50 IU BoNT was injected on each side. After 15 weeks, pain was decreased to 0/10 on a visual analogue scale, without opioids or tramadol. WHAT IS NEW AND CONCLUSION: Our case demonstrates the efficacy of CPB with BoNT in intractable pain due to severe chronic pancreatitis.

Efficacy of adjuvant dexmedetomidine in supraclavicular brachial plexus block for intractable complex regional pain syndrome: A case report with a 3-year follow-up.

WHAT IS KNOWN AND OBJECTIVE: Pain management for complex regional pain syndrome (CRPS) is challenging. When added to local anaesthetics, dexmedetomidine prolongs the duration of the block and improves analgesia. The effect of long-term dexmedetomidine use in the brachial plexus block (BPB) for CRPS is unknown. CASE DESCRIPTION: Here, we describe a case of satisfactory pain relief after supraclavicular BPB with dexmedetomidine every 1-3 months over 2 years (10 treatments), in a patient with severe upper extremity CRPS-related pain. WHAT IS NEW AND CONCLUSION: Repeated, long-term, perineural administration of dexmedetomidine with BPB may be suitable for alleviating refractory CRPS pain.

Anti-Allodynic Effects of Polydeoxyribonucleotide in an Animal Model of Neuropathic Pain and Complex Regional Pain Syndrome.

BACKGROUND: Spinal nerve ligation (SNL) model is one of the representative models of the neuropathic pain model. Neuropathic pain in a chronic post-ischemic pain (CPIP) mimics the symptoms of complex regional pain syndrome (CRPS). The administration of polydeoxyribonucleotide (PDRN), which has regenerative and anti-inflammatory effects, has been studied and is used in clinical practice treating various diseases. However, the analgesic effect of PDRN in a neuropathic pain or CRPS model remains unknown. METHODS: PDRN (3.3, 10, and 20 mg/kg) was administered into the subcutaneous (SC) layer of the hind paws of SNL and CPIP models. Mechanical anti-allodynic effects were then investigated using the von Frey test. In the immunohistochemical examination, dorsal root ganglia (DRG) and the spinal cord were harvested and examined for the expression of glial fibrillary acidic protein (GFAP) after the 20 mg PDRN injection. RESULTS: Mechanical allodynia was significantly alleviated by administration of PDRN in SNL and CPIP mice at all of the time point. As the dose of PDRN increased, the effect was greater. The 20 mg PDRN injection was found to have the most effective anti-allodynic effect. The increased expression of GFAP in DRG and the spinal cord of SNL and CPIP model decreased following the administration of PDRN than vehicle. CONCLUSION: SC administration of PDRN results in the attenuation of allodynia and activation of astrocytes in neuropathic pain or CRPS models. We propose that PDRN can have significant potential advantages in neuropathic pain treatment.

Clinical efficacy of transforaminal epidural injection for management of zoster-associated pain: a retrospective analysis.

OBJECTIVES: Transforaminal epidural injection (TFEI) has superior accessibility to the dorsal root ganglion, which is an essential location of pain signaling in herpes zoster. However, the effectiveness of TFEI for herpes zoster patients has not previously been studied. We retrospectively analyzed the efficacy of TFEI for pain control and prevention of PHN in patients with acute and subacute herpes zoster. METHODS: Medical records of 137 patients who underwent TFEI for zoster-associated pain (ZAP) were reviewed. The participants were divided into two groups: acute TFEI group (TFEI within 30 days after zoster) and subacute TEEI group (TFEI between 30 and 90 days). The efficacy of TFEI was assessed by a numerical rating scale (NRS), doses of medications, and time to relief of ZAP. Incidence of PHN at 1 week to 6 months after TFEI was evaluated. RESULTS: Time to ZAP relief was significantly shorter and the incidence of PHN was significantly lower in the acute TFEI group than in the subacute TFEI group. Rate of medication discontinuation was significantly higher in the acute TFEI group than in the subacute TFEI group. CONCLUSIONS: Early application of TFEI in the acute phase of zoster can be a useful option for ZAP control and prevention of chronic neuropathic pain such as PHN.

Clinical effect of the proximity of epidural blood patch injection to the leakage site in spontaneous intracranial hypotension.

BACKGROUND: Epidural blood patch (EBP) has been shown to be an effective treatment option for spontaneous intracranial hypotension (SIH). We investigated whether response to the EBP was related to the distance of the injection site from the leakage site in patients with SIH. METHODS: We reviewed patients with SIH who underwent EBP at a single hospital. Patients were assigned to group R (response after EBP) or group N (no response after EBP). We then analyzed the demographics, clinical characteristics, leakage site, leakage length, EBP injection level and distance from leakage site, and injected EBP volume. RESULTS: Sixty-two patients were included in the analysis. The overall response rate to EBP was 59.7% (37 patients). The leakage length and injection distance from the leakage site did not differ between the two groups. Age, gender, body mass index, leakage site, and EBP volume did not differ significantly between the two groups. CONCLUSION: The clinical effect of EBP in SIH was not affected by leakage length or injection distance to leakage site. Further large studies must be conducted to investigate the efficacy of targeted EBP for SIH.

The effect of humidified heated breathing circuit on core body temperature in perioperative hypothermia during thyroid surgery.

Purpose: During general anesthesia, human body easily reaches a hypothermic state, which is mainly caused by heat redistribution. Most studies suggested that humidified heated breathing circuits (HHBC) have little influence on maintenance of the core temperature during early phase of anesthesia. This study was aimed at examining heat preservation effect with HHBC in case of undergoing surgery with less exposure of surgical fields and short surgical duration. Methods: Patients aged 19 to 70 yr - old, ASA-PS I or II who were scheduled for elective thyroidectomy were assigned and divided to the group using HHBC (G1) and the group using conventional circuit (G2) by random allocation. During operation, core, skin, and room temperatures were measured every 5minutes by specific thermometer. Results: G1 was decreased by a lesser extent than G2 in core temperature, apparently higher at 30 and 60 minutes after induction. Skin and room temperatures showed no differences between the two groups (p>0.05). Consequently, we confirmed HHBC efficiently prevented a decrease in core temperature during early period in small operation which has difficulty in preparing warming devices or environments were not usually considered. Conclusions: This study showed that HHBC influences heat redistribution in early period of operation and can lessen the magnitude of the decrease in core body temperature. Therefore, it can be applied efficiently for other active warming devices in mild hypothermia.

The influence of epidural catheter on the incidence of intravascular injection during caudal block.

OBJECTIVE: The aim of this study was to analyze the influence of epidural catheters on the incidence of intravascular injection and to identify possible predictors of intravascular injection in patients undergoing a caudal block using fluoroscopy. METHODS: A total of 154 patients scheduled to receive a caudal block were randomized into group N (those without epidural catheter) or group C (those with epidural catheter). Demographic and clinical data were recorded and analyzed. RESULTS: The incidence of intravascular injection was 15.6% in group N, 6.5% in group C, and 11.0% overall, without statistical differences between the two groups (P = 0.105). Univariate analysis revealed that blood at hub (P = 0.047) and positive aspiration test (P = 0.045) were more frequently observed in group N than in group C. Quality of analgesia was significantly higher in group C than in group N (P = 0.029). Multivariate analysis identified older age (P = 0.024), blood at hub (P = 0.003), and positive aspiration test (P = 0.001) as predictors of intravascular injection. CONCLUSIONS: In this study, while the incidence of intravascular injection during caudal blocks was less frequent with epidural catheter use, it was not statistically significant. However, a caudal block using an epidural catheter provided a lower incidence of blood at hub, fewer positive aspiration tests, and superiority in pain improvement.

Ramosetron versus ondansetron for postoperative nausea and vomiting in strabismus surgery patients.

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common adverse outcomes after strabismus surgery. The primary outcome of this prospective, randomized, double-blind study was to compare the incidences of nausea or vomiting, and patient satisfaction of ondansetron and ramosetron after strabismus surgery under general anesthesia. The secondary outcome was to investigate whether the number of involved extraocular muscles (EOMs) in strabismus surgery was related to PONV. METHODS: One hundred and five patients (aged 18-60 years) undergoing strabismus surgery were allocated randomly to one of the three groups: placebo, ondansetron, or ramosetron. Patients received 2 ml placebo, 4 mg ondansetron, or 0.3 mg ramosetron at the end of surgery. Each of the three groups was subdivided into two subgroups according to the number of EOMs involved in the surgery: subgroup S, single-muscle correction; subgroup M, multiple-muscle correction. The incidences of nausea or vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as primary outcome. With regard to subgroups S and M in the placebo, ondansetron and ramosetron groups, incidences of nausea or vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as seconadary outcome. RESULTS: The incidence of nausea was significantly lower in the ramosetron group at 2 h (9.4 %) than in the placebo (45.2 %) and ondansetron (34.7 %) groups (P < 0.05). The incidence of nausea was also significantly lower in the ramosetron group at 24 h than in the other groups (P < 0.05). Patients in the ramosetron group were more satisfied at 2 h (8.11 ± 0.98) and 24 h (8.50 ± 0.67) after surgery than those in the other groups (P < 0.05). With regard to subgroups S and M in the placebo, ondansetron and ramosetron groups, there were no significant differences in either the incidence of nausea or patient satisfaction. CONCLUSION: Ramosetron has superior antiemetic activity to ondansetron in adult strabismus surgery patients. The number of EOMs involved in strabismus surgery was not related to the incidence of PONV. TRIAL REGISTRATION: Clinical Research Information Service (CRiS) Identifier: KCT0000688 . Date of registration: 27 February 2013.

The Efficacy of Lumbosacral Spine Phantom to Improve Resident Proficiency in Performing Ultrasound-Guided Spinal Procedure.

OBJECTIVE: To evaluate the efficacy of a lumbosacral spine phantom to improve novices' proficiency in performing ultrasound-guided facet joint injection and medial branch block. DESIGN AND SETTING: Prospective study in a university hospital. SUBJECTS: In total, 30 participants with no experience of spinal ultrasonography were included and were allocated to one of two groups (control group, N = 10 and training group, N = 20). METHODS: A lumbosacral spine phantom was prepared using a lumbosacral spine model embedded in a mixture of gelatin and psyllium husk. All participants were tested (test-1) following a basic education introductory program. Participants in the control group were then tested again after 1 week (test-2). Those in the training group received a further 3-h training, individually, and were tested again after 1 week (test-2). RESULTS: The mean performance scores on test-1 were 57.6 ± 6.0 in the control group and 57.3 ± 6.7 in the training group; and at test-2, 61.0 ± 8.6 and 91.7 ± 4.9 (P < 0.001), respectively. The median time of performance at test-1 was 158.3 ± 41.9 seconds in the control group and 185.3 ± 68.1 seconds in the training group; and at test-2, 146.9 ± 38.9 seconds and 69.9 ± 22.0 seconds (P < 0.001), respectively. In the training group, the mean self-rating level of proficiency scores were 2.2 ± 1.0 at pretraining, and 6.8 ± 0.8 at post-training, respectively (P < 0.001). CONCLUSION: Training using a gelatin-based spine phantom helped novices to acquire the skills necessary to perform ultrasound-guided lumbar facet joint injections and medial branch blocks.

The effects of intraplantar and intrathecal botulinum toxin type B on tactile allodynia in mono and polyneuropathy in the mouse.

BACKGROUND: Mononeuropathies (MNs: nerve ligation) and polyneuropathies (PNs: cisplatin) produce unilateral and bilateral tactile allodynia, respectively. We examined the effects of intraplantar (IPLT) and intrathecal (IT) botulinum toxin B (BoNT-B) on this allodynia. METHODS: Mice (male c57Bl/6) were prepared with an L5 nerve ligation. Others received cisplatin (IP 2.3 mg/kg/d, every other day for 6 injections). Saline and BoNT-B were administered through the IPLT or IT route. We examined mechanical allodynia (von Frey hairs) before and at intervals after BoNT. As a control, we injected IPLT BoNT-B treated with dithiothreitol to cleave heavy chain from light chain. We measured motor function using acute thermal escape and sensorimotor tests. RESULTS: MN and PN mice showed a persistent ipsilateral and bilateral allodynia, respectively. IPLT BoNT-B resulted in an ipsilateral dorsal horn reduction in the synaptic protein target of BoNT-B (vesicle-associated membrane protein) and a long-lasting (up to approximately 17 days) reversal of allodynia in PN and MN models. The predominant effect after IPLT delivery was ipsilateral to IPLT BoNT. The effects of IPLT BoNT-B in MN mice were blocked by prior reduction of BoNT-B with dithiothreitol. IT BoNT-B in mice with PN resulted in a bilateral reversal of allodynia. With these dosing parameters, hind paw placing and stepping reflexes were unaltered, and there were no changes in thermal escape latencies. After cisplatin, dorsal root ganglions displayed increases in activation transcription factor 3, which were reduced by IT, but not IPLT BoNT-B. CONCLUSIONS: BoNT-B given IPLT and IT yields a long-lasting attenuation of the allodynia in mice displaying MN and PN allodynia.

Ultrasound-guided Pararadicular Injection in the Lumbar Spine: A Comparative Study of the Paramedian Sagittal and Paramedian Sagittal Oblique Approaches.

BACKGROUND: Ultrasound-guided nerve root blocks and transforaminal injections are well established, and several procedural feasibility studies have been reported. However, the contrast dispersion pattern during ultrasound-guided pararadicular injection has not been reported. We hypothesized that the paramedian sagittal oblique approach provides a superior intraforaminal contrast-spread pattern compared to the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine. METHODS: Ninety injections were performed in 42 adult patients using pararadicular injections. Each injection was allocated to 1 of 2 groups. In the paramedian sagittal approach group, the transducer was positioned perpendicularly over the skin, and a bent needle was inserted using an in-plane technique. In the paramedian sagittal oblique approach group, the needle was advanced with the transducer tilted ~20 to 25° toward the pararadicular aditus plane. In both groups, the needle was advanced until the intertransverse ligament was punctured. Nonionic contrast media was injected under fluoroscopic guidance. RESULTS: The contrast was injected in the targeted pararadicular compartment in 83 of 90 injections (92.2%). Among the successful pararadicular injections, the intraforaminal contrast pattern was detected in 17 cases (39.5%) in the paramedian sagittal approach group and in 35 cases (87.5%) in the paramedian sagittal oblique approach group (P < 0.001). Both groups showed significant pain reduction compared to the baseline (P < 0.001); however, the visual analog scale for pain showed significantly lower pain in the paramedian sagittal oblique approach group compared to the paramedian sagittal approach group (P = 0.036). Rates of ventral epidural flow, intra- and extraepineural pattern of contrast, and intravascular injections were similar between the two approaches. CONCLUSION: The paramedian sagittal oblique approach delivered a superior intraforaminal contrast-spread pattern and significantly greater pain relief than the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine.

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation.

BACKGROUND/AIM: A lightwand is a stylet with a light bulb at its tip that can be used to guide intubation by confirming the illumination through the anterior neck. We aimed to determine the factors affecting the illumination intensity during lightwand endotracheal intubation. PATIENTS AND METHODS: We retrospectively collected data from 180 patients who underwent lightwand endotracheal intubation. We recorded illumination intensity on a 5-point scale. The patients were categorized into weak (score <3) and bright (score ≥3) groups based on the illumination intensity scale score. RESULTS: A total of 176 patients were analyzed, of whom 125 (71.1%) were enrolled in the bright group, and 51 (29.0%) were enrolled in the weak group. Multivariable logistic regression analysis revealed that an increased body mass index (BMI) and mask ventilation grade were associated with light intensity. For mask ventilation, moderate vs. easy (p=0.010) and difficult vs. easy (p=0.008) were associated with the weak group. Receiver operating characteristic curve analysis showed that BMI ≥24.6 kg/m2 was correlated with the weak group. CONCLUSION: BMI ≥24.6 kg/m2 or mask ventilation grade above moderate indicates increased odds of weak illumination intensity in lightwand intubation. Pre-intubation examination of these factors helps increase the chances of successful intubation.

Persistent hyperalgesia in the cisplatin-treated mouse as defined by threshold measures, the conditioned place preference paradigm, and changes in dorsal root ganglia activated transcription factor 3: the effects of gabapentin, ketorolac, and etanercept.

BACKGROUND: Painful neuropathy is a dose-limiting side effect in cancer chemotherapy. To characterize this phenomenon, we examined pain behavior and analgesic actions in a mouse model of cisplatin polyneuropathy. METHODS: Male C57BL/6 mice received intraperitoneal cisplatin or saline (2.3 mg/kg/d) every other day 6 times over 2 weeks for a total dose of 13.8 mg/kg. Thermal escape latencies, mechanical allodynia using von Frey hairs, and observation of behavior/morbidity and body weights were assessed. After onset of allodynia, we examined the actions of intraperitoneal gabapentin (100 mg/kg), etanercept (20 and 40 mg/kg), ketorolac (15 mg/kg), and morphine (1, 3, and 10 mg/kg). Additionally, using the conditioned place preference (CPP) paradigm, we examined the effects of gabapentin and ketorolac on the presumed pain state initiated by cisplatin. Additionally, we examined the spinal cord and dorsal root ganglia (DRG) of cisplatin-treated mice. RESULTS: Cisplatin, but not saline treatment, produced persistent hindpaw tactile allodynia, which persisted 46 days with no effect on thermal escape. Gabapentin and morphine, but neither etanercept nor ketorolac, produced a complete but transient (2-hour) reversal of the allodynia. Etanercept (40 mg/kg) pretreatment resulted in a delay in onset of mechanical allodynia. Using CPP, gabapentin, but not ketorolac, in cisplatin animals resulted in a significant preference for the drug-associated treatment compartment. There was no place preference in non-cisplatin-treated (nonallodynic) mice after gabapentin injection. Immunohistochemistry in cisplatin-treated mice showed no change in glial fibrillary acidic protein (astrocyte) or Iba1 (ionized calcium binding adaptor molecule 1) (microglia) activation states, but a significant increase in activated transcription factor 3 was observed in the DRG. CONCLUSIONS: Cisplatintreated mice display allodynia and an activation of DRG activated transcription factor 3, which is paralleled by its effects on behavior in the CPP system, wherein gabapentin, but not ketorolac, in the presence of the cisplatin polyneuropathy, is positively rewarding, confirming that this neuropathy is an aversive (painful) state that is ameliorated by gabapentin.

Blood Biomarkers in Patients with Parkinson's Disease: A Review in Context of Anesthetic Care.

Parkinson's disease (PD) is the second most common inflammatory neurodegenerative disorder after dementia. Preclinical and epidemiological data strongly suggest that chronic neuroinflammation slowly induces neuronal dysfunction. Activated microglia secrete several neurotoxic substances, such as chemokines and proinflammatory cytokines, which may promote blood-brain barrier (BBB) permeabilization. CD4+ T cells comprise proinflammatory cells such as T helper (Th) 1 and Th17 cells, as well as anti-inflammatory cells such as Th2 and T regulatory cells (Tregs). Th1 and Th17 cells can be detrimental to dopamine neurons, whereas Th2 and Tregs are neuroprotective. The results of studies on the serum levels of cytokines such as IFN-γ and TNF-α secreted by Th1 T cells, IL-8 and IL-10 secreted by Th2 T cells, and IL-17 secreted by Th17 cells in PD patients are not uniform. In addition, the relationships between serum cytokine levels and motor and non-motor symptoms of PD are controversial. Surgical stress and anesthesia induce inflammatory responses by disturbing the balance between pro- and anti-inflammatory cytokines, which may exacerbate the neuroinflammatory response in PD patients. Here we review studies on blood inflammatory biomarkers in PD patients and discuss the roles of surgery and anesthesia in PD progression.