Fidel Pagés, el auténtico descubridor de la anestesia epidural, en el centenario de su publicación Anestesia metamérica (1921-2021) / Fidel Pagés, the true discoverer of epidural anesthesia, on the centenary of his publication Anestesia metamérica (1921-2021)

Resumen: Pocas han sido las Figuras españolas que han aportado alguna interesante novedad al mundo de la anestesia, pero ninguna tan injustamente tratada y olvidada como la de Pagés, verdadero pionero de la anestesia epidural, que él denominaría «anestesia metamérica¼ en su artículo publicado en el mes de marzo de 1921 en la Revista Española de Cirugía, fundada por él mismo. Años después, en 1931, Dogliotti, profesor de Cirugía de Módena publicó sus experiencias sobre la anestesia epidural, a la que llamó «anestesia peridural segmentaria¼, ignorando el trabajo de Pagés publicado 10 años antes. El trabajo de Dogliotti fue rápidamente reconocido, asumiendo todos los méritos de la paternidad de la técnica epidural, quedando Pagés relegado a un olvido injusto que con este trabajo tratamos de reparar. La idea central de este texto versará sobre el reconocimiento de Pagés como verdadero promotor del abordaje epidural con fines quirúrgicos. Destacar sus ideas innovadoras sobre el bienestar del paciente y la minimización de los efectos adversos de las técnicas anestésicas y quirúrgicas, así como valorar una obra que, aunque corta, bien podría incluirse entre los mejores cirujanos españoles de principio del siglo XX, un cirujano con alma de anestesiólogo.

Abstract: Few Spanish Figures have contributed any interesting novelty to the world of anesthesia. But none so unjustly treated and forgotten such as Pagés, a true pioneer of epidural anesthesia, which he would call «metameric anesthesia¼ in his article published in March 1921 in the Spanish Journal of Surgery, founded by himself. Later, in 1931, Dogliotti, Modena Professor of Surgery published his experiences on epidural anesthesia, which he called «segmental peridural anesthesia¼, ignoring Pagés work published 10 years earlier. Dogliotti's work was quickly recognized, assuming all the merits of the paternity of the epidural technique, leaving Pagés relegated to an unjust oblivion that with this work we try to repair. The central idea of this text will focus on the recognition of Pagés as a true promoter of the epidural approach for surgical purposes. Highlight his innovative ideas about patient well-being and minimizing the adverse effects of anesthetic and surgical techniques. As well as assessing a work that, although short, could well be included among the best Spanish surgeons of the early twentieth century, a surgeon with the soul of an anesthesiologist.

Plasma rico en plaqueta en el tratamiento de la enfermedad degenerativa discal / Platelet-rich plasma in the treatment of degenerative disc disease

Introducción: La enfermedad degenerativa discal es una entidad frecuente y uno de los principales motivos de consulta. Genera altas tasas de discapacidad, años útiles perdidos, así como altos costos económicos por asistencia médica y grandes pérdidas monetarias. Su tratamiento es generalmente conservador, aunque en la actualidad se incluyen terapias biológicas novedosas. Objetivo: Describir las principales propiedades biológicas que hacen del plasma rico en plaquetas una terapéutica efectiva para la enfermedad degenerativa discal. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, LILACS; en idioma español, inglés y portugués, durante los últimos diez años. Desarrollo: Se expusieron características clínico epidemiológicas de la enfermedad degenerativa discal, así como las propiedades biológicas que le permiten al plasma rico en plaqueta tener una función activa en la regeneración del disco intervertebral o el retraso de la cascada de degradación de este. Se resaltan los principales estudios de acuerdo a la vía de administración del plasma rico en plaquetas y sus resultados. Conclusiones: De acuerdo con lo publicado por los autores, el plasma rico en plaquetas es una alternativa efectiva en el tratamiento de la enfermedad degenerativa discal por la producción de factores derivados de las plaquetas, que intervienen en la degeneración del disco intervertebral, siendo la vía intradiscal la que más se emplea(AU)

Introduction: Degenerative disc disease is a frequent condition and one of the main reasons to attend the consultation. It generates high rates of disability, useful years lost, as well as high economic costs for medical assistance and large monetary losses. Its treatment is generally conservative, although novel biological therapies are currently included. Objective: To describe the main biological properties that make platelet-rich plasma an effective therapy against degenerative disc disease. Methods: A nonsystematic review of the bibliography was carried out based on articles published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, and LILACS, in Spanish, English and Portuguese. Development: Clinical-epidemiological characteristics of degenerative disc disease were presented, as well as the biological properties that allow platelet-rich plasma to have an active function in the regeneration of the intervertebral disc or the delay of its degradation cascade. The main studies are highlighted, according to the route of administration of platelet-rich plasma and their results. Conclusions: According to what has been published by authors, platelet-rich plasma is an effective alternative in the treatment of degenerative disc disease, due to the production of factors derived from platelets, which intervene in the degeneration of the intervertebral disc, being the intradiscal pathway the most used(AU)

Concordance between the loss of resistance technique and ultrasound in measuring the distance from the skin to the epidural space in pediatric patients: Observational study / Concordancia entre la técnica de pérdida de resistencia y ecografia en la medición de la distancia entre la piel y el espacio epidural en pacientes pediátricos: Estudio observacional

Abstract Introduction: The use of ultrasound in regional anesthesia has become a standard technique to improve nerve block accuracy and reduce associated complications. The literature reports a good correlation between the distance from the skin to the dura mater or the ligamentum flavum measured on ultrasound and the conventional technique of "loss of resistance". Latin American populations have not been included in the studies conducted so far but, because of differences in physical build, it is important to determine whether this correlation is maintained in the various populations. This paper offers new information about the role of ultrasound in determining the distance to the ligamentum flavum and recognizing the proximity of the dura mater to avoid accidental puncture of this structure in Latin American populations. Objective: To determine correlation and concordance in estimating the distance from the skin to the epidural space between the loss of resistance technique and ultrasound measurement. Methodology: Observational study conducted in 52 pediatric patients who received general anesthesia plus epidural analgesia for acute perioperative pain management between July 2014 and November 2015 to assess correlation and concordance between loss of resistance and ultrasound measurement of distance to the epidural space. Results: There is a correlation between distances measured using the two techniques, which appears to be higher as patient age increases. As for concordance, the study found that 0.43 cm should be added to the ultrasound measurement to achieve agreement with the distance obtained using the loss of resistance technique; however, the interval between the two measurements is 1.15 cm. Conclusions: A correlation was found between the measurement taken from the skin to the epidural space using ultrasound and the measurement obtained with the traditional needle puncture and loss of resistance technique. Although concordance was not as expected and the distance measured with ultrasound may be smaller than the real measurement with the needle, ultrasound offers good guidance regarding proximity to the epidural space.

Resumen Introducción: El uso del ultrasonido en la anestesia regional se ha convertido en una técnica estándar para mejorar la precisión de los bloqueos nerviosos y disminuir las complicaciones relacionadas con dicha anestesia. La literatura informa que hay una buena correlación entre la distancia entre la duramadre o el ligamento amarillo y la piel según el ultrasonido y la técnica convencional de "pérdida de resistencia". Los estudios realizados hasta ahora no han incluido población latinoamericana y, debido a las diferencias en la contextura física, es importante determinar si esta correlación se mantiene en varias poblaciones. Con este trabajo se aporta nueva información sobre la utilidad del ultrasonido para determinar la distancia al ligamento amarillo y advertir la cercanía de la duramadre con el fin de evitar la punción accidental de esta estructura en población latina. Objetivo: Determinar la correlación y concordancia en la estimación de la distancia de la piel al espacio epidural entre la técnica de pérdida de resistencia y la medición por ultrasonido. Metodología: Se llevó a cabo un estudio observacional en 52 pacientes pediátricos, que recibieron anestesia general más analgesia epidural para manejo del dolor agudo perioperatorio entre julio de 2014 y noviembre de 2015. Se evaluó la correlación y la concordancia de la distancia medida al espacio epidural entre la técnica de pérdida de resistencia y la distancia por ultrasonido. Resultados: Existe una correlación entre la distancia obtenida mediante las dos técnicas de medición que parece aumentar a medida que aumenta la edad de los pacientes. En cuanto a la concordancia se encontró que a la medida tomada por ultrasonido se le debería sumar 0,43 cm para que concuerde con la distancia tomada por pérdida de resistencia; no obstante, el intervalo entre ambas medidas es de 1,15 cm. Conclusiones: Encontramos una correlación entre la medida tomada desde la piel hasta el espacio epidural por ultrasonido y la tomada por la técnica tradicional de punción con aguja y pérdida de resistencia. Aunque la concordancia que hallamos no fue la esperada, y la medición del ultrasonido puede ser menor a la medición real encontrada con la aguja, es una buena guía para advertir la cercanía del espacio epidural.

Cervical cancer with intraspinal epidural space metastasis: A case report and literature review / 肿瘤

Objective: To introduce the diagnosis and treatment of a patient suffering from cervical cancer with intraspinal epidural space metastasis, aiming to provide the further insight into the metastasis of advanced cervical cancer for clinicians. Methods: A middle-aged female patient with multiple metastasis of advanced cervical cancer was reported. The diagnosis and treatment process of this case was analyzed, and the related literatures were reviewed. Results: A 41 years old female was admitted to the hospital in July 2019 owing to the acratia and numbness of double lower limbs for 1 week. Moreover, the patient suffered from cervical cancer and had been operated for more than 4 years. According to her medical history and the test of contrast-enhanced MR of thoracolumbar segment, the lesion located in the intraspinal epidural space on the height of T5-7 vertebral body was considered to be metastatic cancer. To alleviate the symptom, the patient received the palliative operation. The mass obtained from the intraspinal epidural space by operation was pathologically confirmed as the cervical cancer metastasis. The myodynamia of double lower limbs increased 1 month after operation. However, the patient died from multiple organ failure due to advanced cancer in December 2019. Conclusion: The advanced cervical cancer generally invades the organs by hematogenous metastasis, but the intraspinal epidural metastasis is very rare and the prognosis is very poor. Therefore, it should be highly suspected that cervival cancer may be accompanied by brain or intraspinal epidural metastasis if the patient has cervical cancer history and the symptoms of nerve system.

Systemic effects of fluoroscopically guided epidural steroid injection with dexamethasone / 대한통증학회지

BACKGROUND: Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. METHODS: This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. RESULTS: Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). CONCLUSIONS: Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.

Skin-to-epidural distance in the Southeast Asian paediatric population: multiethnic morphometrics and international comparisons

INTRODUCTION@#Paediatric epidurals can present technical challenges due to wide variations in age and weight among children, ranging from neonates to teenagers. This study evaluated the skin-to-epidural distance in the thoracic and lumbar regions to determine the relationship between age, weight and ethnicity and depth to the epidural space in our Singapore paediatric population.@*METHODS@#Data from the Acute Pain Service was prospectively collected over 16 years. Details included patient demographics, level of epidural performed and distance from skin to epidural space. Multivariable regression analysis was performed to determine the association of weight, age, ethnicity and gender with the depths to the thoracic and lumbar epidural spaces. A simple linear regression was calculated to predict the depth to both thoracic and lumbar epidural spaces based on body weight. Equations were formulated to describe the relationship between weight and depth of epidural space.@*RESULTS@#A total of 616 midline epidurals were studied. Regression analysis was performed for 225 thoracic epidurals and 363 lumbar epidurals. Our study revealed a clear correlation between skin-to-lumbar epidural distance and weight in children. The best correlation was demonstrated between skin-to-lumbar epidural distance and body weight (R = 0.729). This relationship was described by the formula: depth (mm) = (0.63 × weight [kg]) + 9.2.@*CONCLUSION@#Skin-to-lumbar epidural distance correlated with weight in children. Our results highlighted the clinical significance of differences between Southeast Asian paediatric populations when compared to other populations.

Unusual Posterior Epidural Migration of Intervertebral Herniated Disc: A Report of Two Cases

@#Disc herniation is one of most common causes of spine surgery. Because of the presence of posterior longitudinal ligaments, disc fragments often migrate into the ventral epidural space. A posterior epidural herniation of a disc fragment is a rare occurrence. We report two cases of posterior migrated disc fragments, with, radiological and clinical findings. Because of the rarity of a posterior migration of the intervertebral disc fragments, a differential diagnosis can be challenging. This painful syndrome associated with neurological lower limb deficits can be confused initially, with other posterior epidural spaceoccupying lesions such as tumours, abscess or hematomas. A gadolinium-enhanced MRI scan is the gold standard for a correct diagnosis. Early surgical decompression of the spine with a posterior approach remains the optimal technique in ensuring the best possible outcome for the patient.

Transient paralysis by loculation of the injectant associated with epidural injection

@#Transient paralysis occasionally occurs after an epidural injection, but the reasons for this are still unknown. We present here a patient with transient paralysis following loculation of the injectant associated with the procedure. A 50-year-old woman with a history of two previous spinal operations complained of a burning sensation and radiating pain. A caudal block and right S1 transforaminal epidural block were performed. Loculation of the block injectant into the right L5 and S1 epidural space was confirmed through computed topographic imaging. She showed transient weakness of the right lower limb, which completely recovered after 1 day. This case shows that extra care should be taken when performing an epidural injection in a patient with adhesions around the injection site and appropriate adjustments should be made to the volume of the injectant.

Efficacy of ultrasound-guided lumbar epidural access using paramedian transverse scanning with the needle in-plane: a comparison with paramedian saggital scanning / 中华麻醉学杂志

Objective To compare the efficacy of ultrasound-guided lumbar epidural access using paramedian transverse scanning (PMTS) versus paramedian saggital scanning (PMSS) with the needle inplane.Methods Fifty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients,aged 50-75 yr,weighing 55-85 kg,undergoing lower extremity surgery under combined spinal-epidural anesthesia,were divided into PMSS group (n=25) and PMTS group (n=25) using a random number table.The realtime ultrasound-guided lumbar epidural access (L3,4) was performed using PMTS and PMSS in PMTS and PMSS groups,respectively.The visibility of ligamentum flavum,posterior and anterior dura maters,posterior epidural space on the prepuncture ultrasound images,imaging quality score,time for puncture and depth of puncture were recorded.The development of air ultrasonic contrast sign and backflow of cerebrospinal fluid from the spinal needle were recorded.The development of adverse reactions such as paresthesia and hypokinesia was also recorded on 2 days after operation.Results Compared with group PMSS,the time for puncture was significantly shortened,the depth of puncture was shallower (P＜0.05),and no significant change was found in the visibility of spinal structure,imaging quality score or air ultrasonic contrast sign and incidence of backflow of cerebrospinal fluid in group PMTS (P＞0.05).No significant change was found in adverse reactions such as paresthesia or hypokinesia between the two groups (P＞0.05).Conclusion PMTS provides clear imaging and simple and convenient operation in guiding lumbar epidural access with the needle in-plane when compared with PMSS,and it is worthy of clinical application.

Complication of epiduroscopy: a brief review and case report

Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.

Unintentional lumbar facet joint injection guided by fluoroscopy during interlaminar epidural steroid injection: a retrospective analysis

BACKGROUND: An epidural steroid injection (ESI) is a commonly administered procedure in pain clinics. An unintentional lumbar facet joint injection during interlaminar ESI was reported in a previous study, but there has not been much research on the characteristics of an unintentional lumbar facet joint injection. This study illustrated the imaging features of an unintentional lumbar facet joint injection during an interlaminar ESI and analyzed characteristics of patients who underwent this injection. METHODS: From December 2015 to May 2017, we performed 662 lumbar ESIs and we identified 24 cases (21 patients) that underwent a lumbar facet joint injection. We gathered data contrast pattern, needle approach levels and directions, injected facet joint levels and directions, presence of lumbar spine disease as seen on magnetic resonance images (MRI), and histories of lumbar spine surgeries. RESULTS: The contrast pattern in the facet joint has a sigmoid or ovoid contrast pattern confined to the vicinity of the facet joint. The incidence of unintentional lumbar facet joint injection was 3.6%. The mean age was 68.47 years. Among these 21 patients, 14 (66.7%) were injected in the facet joint ipsilaterally to the needle approach. Among the 20 patients who received MRI, all (100%) had central stenosis and 15 patients (75%) had severe stenosis. CONCLUSIONS: When the operator performs an interlaminar ESI on patients with central spinal stenosis, the contrast pattern on the fluoroscopy during interlaminar ESI should be carefully examined to distinguish between the epidural space and facet joint.

The outcome of epiduroscopy treatment in patients with chronic low back pain and radicular pain, operated or non-operated for lumbar disc herniation: a retrospective study in 88 patients

BACKGROUND: Patients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome. METHODS: A total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy. RESULTS: All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group. CONCLUSIONS: Epiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.

Catéter epidural retenido. Complicación poco frecuente. Reporte de dos casos / Retained epidural catheter: A rare complication. Report of two cases

Introduction: Inserting a catheter into the epidural space is an anesthetic technique, not exempt from complications. Catheter knotting and retention are rare complications. Clinical findings, diagnostic evaluation and interventions: Two cases of epidural catheter-associated complications are discussed. The first was due to the development of a spontaneous knot and the second due to retention and t hen rupture; both cases required surgical removal. Conclusion. To prevent these potential complications, refrain from passing excessive catheter length and do not leave more than 5 cm of catheter into the epidural space. If a catheter cannot be easily removed, try using several maneuvers and if these fail or there is any pain or paresthesia, diagnostic imaging is required to locate the catheter and request neurosurgery support.

Introducción: La inserción de un catéter en el espacio epidural es una técnica anestésica que no está exenta de complicaciones. El anudamiento y la retención de un catéter son complicaciones poco frecuentes. Hallazgos clínicos, evaluación diagnóstica e intervenciones: Presentamos dos casos de complicaciones asociadas al catéter epidural. El primero debido a la formación de un nudo espontaneo y el segundo por retención y posterior ruptura. Los dos casos requirieron extracción quirúrgica. Conclusión: Para evitar estas posibles complicaciones no pasar en exceso el catéter y no dejar más de 5 cm del catéter en el espacio epidural. Si un catéter no puede ser fácilmente retirado se pueden intentar extracción de este usando varias maniobras, si estas son infructuosas o si hay dolor o parestesias, se debe ubicar el catéter con imágenes diagnósticas y solicitar apoyo de neurocirugía.

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

BACKGROUND: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. METHODS: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. RESULTS: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. CONCLUSIONS: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.

Posterior Epidural Herniation of a Lumbar Disk Fragment at L2–3 That Mimicked an Epidural Hematoma

Lumbar disk herniation is common. Because of the posterior longitudinal ligament, migration usually occurs into the ventral epidural space. Rarely, fragments migrate into the dorsal epidural space. A 57-year-old man presented with lower back pain and weakness on right hip flexion and right knee flexion. He had lower back pain 1 day previously and received a transforaminal epidural block at a local hospital. The next day, he reported weakness of the right lower extremity. Lumbar spine magnetic resonance imaging revealed a dorsal epidural lesion with compression of the thecal sac at L2–3. Initial differential diagnoses included epidural hematoma after the block, neoplasm, and a sequestrated disk. Posterior lumbar decompression was performed. The lesion was identified intraoperatively as a large herniated disk fragment. Posterior epidural herniation of a lumbar disk fragment is rare and may be difficult to diagnose preoperatively. It may present as a variety of clinical scenarios and, as in this case, may mimic epidural hematoma.

Observation on curative effect of pulse-radiofrequency combined with epiduralspace block in cervicogenic headache / 重庆医学

Objective To observe the curative effect of cervicogenic headache(CEH)treatment through the combination of pulse radio frequency(PRF)on the C2 dorsal rootganglion and continuous epidural space block.Methods Sixty patients with CEH in our hospital were randomly divided into groups A and B,30 cases in each group.The group A was treated with combination of PRF on cervical dorsal root ganglion and continuous epidural space block.The group B was treated with PRF on cervical dorsal root ganglion method.The pain VAS scores before treatment and at 1 week,3,6 months after treatment were compared between the two groups.Results Compared with pretreatment,the VSA scores at 1 week,3,6 wonths after treatment in the two groups had statistical difference(P＜0.05),moreover,the VAS score decrease in the group A was better than the group B.All the patients had no nerve and artery injury or infection complications.Conclusion It is safe and effective to treat cervical CEH through the combination of ganglion PRF on the cervical 2 dorsal root and continuous epidural space block.

Effect of wire-reinforced polyurethane epidural catheters on success rate of epidural catheterization in patients undergoing caesarean section / 中华麻醉学杂志

Objective To evaluate the effect of wire-reinforced polyurethane epidural catheters on the success rate of epidural catheterization in the patients undergoing caesarean section.Methods A total of 182 pregnant patients,aged 25-43 yr,with body height of 145-178 cm,weighing 51-100 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were divided into 2 groups using a random number table:polyvinyl chloride epidural catheter group (group Ⅰ,n =94) and wire-reinfnrced polyurethane epidural catheter group (group 11,n=88).Spinal or epidural puncture was performed at L2,3 or L3,4 interspace,and the corresponding epidural catheter was inserted in each group aficr succcssful puncturc.Thc dcvclopment of difficult insertion,intravascular catheter insertion or paresthesia during puncture or insertion was defined as a failure of epidural catheterization.The occurrence of failed epidural catheterization was recorded.Results The failure rate of epidural catheterization was significantly lower in group 1Ⅱ than in gronp Ⅰ (P＜0.05).Conclusion Wire-reinforced polyurethane epidural catheters can raise the success rate of epidural catheterization in the patients undergoing caesarean section.

Postlaminectomy Bilateral Lumbar Intraspinal Synovial Cysts

Lumbar intraspinal synovial cysts are included in the difference diagnosis of lumbar radiculopathy. Developing imaging modalities has result in increased reporting about these lesions. However, the case of bilateral new lumbar intraspinal synovial cysts after laminectomy has been rarely reported. We report of a rare case with bilateral lumbar intraspinal synovial cysts after laminectomy, requiring surgical excision.

Efficacy of paravertebral block for postoperative rehabilitation pain after unilateral ureterolithotomy / 中国基层医药

Objective To compare the efficacy and safety in patients received paravertebral block and epi-dural block for postoperative rehabilitation pain after unilateral ureterolithotomy.Methods 120 ASA Ⅰor Ⅱ patients were randomly allocated into research group (n =60)and control group (n =60).After operation,the research group received paravertebral block performed with peripheral nerve stimulator,the control group received epidural block.All patients received patient -controlled intravenous analgesia (PCIA)in the same time.The operation time,amount of bleeding,postoperative hospitalization time,operation completion,number of press PCIA,occurrence rate of postopera-tive adverse reaction in 48 h,and visual analog scores (VAS)at 4,8,16 and 24 h after surgery were recorded. Results The patients of the two groups were completed the stone surgery,there was no cases of conversion to open surgery.There was no significant difference in operation time,bleeding volume,postoperative hospital stay between the two groups (all P >0.05).But the PCIA times of the research group was (2.14 ±0.45)times,which of the control group was (4.20 ±0.68)times,the difference was statistically significant (t =4.27,P =0.029).The postoperative VAS scores of the research group[4 h (2.68 ±0.480)points,8 h (2.68 ±0.48)points,16 h (2.81 ±0.43) points,24 h (2.88 ±0.49)points]were significantly lower than those of the control group[(3.12 ±0.53)points, (3.37 ±0.58)points,(3.42 ±0.52)points,(3.39 ±0.55)points],the differences were statistically significant (t =2.68,3.13,306,311,all P <0.05).Of the research group,the nausea and vomiting occurred rate (23.33%), hypotension rate (0.00%),skin itching (5.00%),the incidence of decreased muscle strength (0.00%)were significantly lower than the control group(43.3%,31.6%,28.33% and 8.33%),the differences were statistically significant(χ2 =5.40,22.57,11.76,522,all P <0.05 ).Conclusion Nerve stimulator guidance for thoracic paravertebral nerve block for upper ureter incision to take stone surgery patients can significantly reduce postoperative pain and the PCIA analgesia drug dosage and the incidence of adverse reactions.

A sheared Racz catheter in cervical epidural space for thirty months: a case report / 대한마취과학회지

Percutaneous epidural neuroplasty may lead to complications such as hematoma, infection, epidural abscess, meningitis, hypotension, respiratory depression, urinary and fecal dysfunction, sexual dysfunction and paresthesia. Other technical complications may include shearing or tearing, misplacement, blockage and migration of the catheter. We report a case of a 41-year-old female patient, who underwent surgical removal of a sheared catheter, which was retained for 30 months after cervical Racz neuroplasty.