The Use of a Continuous Interscalene Brachial Plexus Block for Pain Control following Shoulder Surgery / 대한마취과학회지

BACKGROUND: Pain following shoulder surgery is usually severe and difficult to control using conventional postoperative pain control maneuvers. Therefore, we investigated the pain control efficacy, PONV (postoperative nausea vomiting) and complications by the use of a continuous brachial plexus block in patients who had undergone shoulder surgery. METHODS: Thirty three shoulder surgery patients were enrolled in this study. According to the Borgeat's modified lateral technique, 30 ml of 0.37% ropivacaine were injected into the patients, which was followed by insertion of a continuous brachial plexus catheter into the plexus sheath. The operation was then conducted under general anesthesia, and postoperative pain was evaluated in the recovery room 12, 24, 36, and 48 hr after surgery. In addition, nausea and vomiting was calculated using the visual analogue scale (VAS) and sedation was evaluated using the modified Ramsay score. A total of 400 ml of 0.2% Ropivacaine was administered at a rate of 8 ml/hr to control the postoperative pain for 2 days. In addition, other neurological complications were investigated, and the catheter tips were cultured after they were removed to determine if any infection had occurred. RESULTS: The postoperative pain scores were below 2 on the 10 cm VAS, and the level of nausea and vomiting was also satisfactorily (< 2/10 cm VAS). In addition, the mean sedation score of the patients in the recovery room was 2. There were complications including motor weakness (24%), dyspnea (15%), Hornor's syndrome (9%), postauricular numbness (9%) and metallic taste (3%), however, there were no patients who complained of neurological symptoms after one month of follow-up, and no signs of infection were found when the results of catheter tip cultures were evaluated. CONCLUSIONS: The use of a continuous interscalene brachial plexus block is a feasible method of postoperative pain control for patients who undergo major shoulder surgery.

The Effect of Butorphanol on the Bispectral Index during Intravenous Anesthesia with Propofol and Remifentanil

BACKGROUND: The aim of this study was to investigate the effect of butorphanol on the Bispectral Index (BIS) during the administration of intravenous anesthesia with propofol and remifentanil. METHODS: Forty adult patients, ASA I-II, scheduled for an emergency laparoscopic appendectomy were studied. The doses for the anesthetics were adjusted to keep the BIS value between 40 and 50. After 20 minutes of stable anesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or 0.02 mg/kg butorphanol (butorphanol group). The BIS values, mean arterial pressure, and heart ratewere recorded every five minutes for a period of 20 minutes. RESULTS: The mean BIS values after butorphanol administration were not significantly different from the values following the administration of saline, throughout the observation period. No patients were able to recall explicitly any events under anesthesia. No significant changes in mean arterial pressure and heart rate were noted after butorphanol administration. CONCLUSIONS: Butorphanol given to prevent postoperative pain does not modify the BIS value during anesthesia maintained with remifentanil and propofol.

Motor Paresis Caused by Herpes Zoster in Patients with Rotator Cuff Tear: A report cases / 대한통증학회지

Segmental zoster paresis is characterized by focal, asymmetric motor weakness in the myotome corresponding to the dermatome of the rash. A 73-year-old man, who presented with severe right shoulder pain and shoulder girdle muscle weakness, was diagnosed with segmental zoster paresis involvement of the C5 C6 motor roots as a complication of herpes zoster. Girdle muscles (supraspinatus, deltoid and infraspinatus) atrophy had developed in his right shoulder. An MRI showed rotator cuff tearing in his right shoulder; therefore, an arthroscopic rotator cuff repair was performed. Herein, this case is presented to emphasize the importance of considering post-herpetic segmental motor paresis in the differential diagnosis of acute painful motor weakness of the upper extremities.