Airway Obstruction and Flattening of Arterial Pressure Wave during Whole Lung Lavage: A Case Report / 대한구급학회지

Whole lung lavage (WLL) is a challenging procedure; because lavage fluid may perturb the respiratory and hemodynamic systems. We observed severe airway obstruction and flattening arterial pressure wave during WLL for treatment of pulmonary alveolar proteinosis. The aim of this case report is to discuss the anesthetic requirement in order to prevent bronchospasm during WLL. Furthermore, we discuss the potential of lavage fluid to cause airway obstruction and decrease cardiac outflow through the mass effect.

Airway obstruction due to post intubation circumferential tracheal web formation: A case report

Tracheal stenosis is well known complication of endotracheal intubation. However, severe post intubation tracheal stenosis that requires interventional bronchoscopy or tracheal surgery is un-common. Necrosis induced by cuff pressure-related loss of regional blood flow is the central injury leading to postinubation tracheal stenosis. The large volume, low pressure cuff of endo-tracheal tubes have markedly reduced the occurrence cuff-induced injury. However, in any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, possibility of tracheal stenosis should be considered. We report a case of severe tracheal stenosis by tracheal web formation a 52-year-old following ventilator therapy for ARDS.

Hyperkalemia from preoperative non-steroidal anti-inflammatory drugs and angiotensin II receptor blockers in patients with nephropathy / 대한마취과학회지

No abstract available.

A case involing anesthesia for middle cerebral artery-distal internal carotid artery bypass surgery for a ruptured cerebral aneurysm in a patient with a descending aortic dissection and who had previously undergone a bentall operation: A case report

We experienced a case of middle cerebral artery-distal internal carotid artery bypass surgery for treating a ruptured cerebral aneurysm in a 50-year-old female who also had a descending aortic dissection and a past history of receiving a Bentall operation for an ascending aortic dissection 7 years previously. The patient successfully underwent surgery and we report on this experience along with a brief review of the relevant literature.

Effects of fentanyl and midazolam on emergence agitation following ketamine anesthesia in children

BACKGROUND: Recently, a high incidence of emergence agitation (EA) has been reported in children after sevoflurane or desflurane anesthesia. However, in case of ketamine, there are few up-to-date studies about EA in children. This study observed effects of fentanyl and midazolam on emergence agitation and the recovery profile following ketamine anesthesia for outpatient surgery in preschool children. METHODS: Seventy-five children, aged 1-7 years, undergoing brief procedure under intravenous ketamine anesthesia were randomly allocated one of three groups; saline-ketamine, fentanyl-ketamine, midazolam-ketamine. Patients were premedicated with normal saline or fentanyl 0.5microg/kg or midazolam 0.05 mg/kg 5 min before administration of ketamine. Ketamine was given in an initial dose of 1.5 mg/kg and additional dose of 0.5 mg/kg ketamine was given as needed during operative procedure. The incidence of EA and other adverse effects and stay time at recovery room and day surgery center (DSC) were noted. RESULTS: The incidence of emergence agitation was 20 % in control group, 12 % in fentanyl group, and 16 % in midazolam group. Most common adverse effects during recovery was vomiting. There were no significant differences in incidence of emergence agitation, adverse effects and stay time at recovery room and DSC among the three groups. CONCLUSIONS: In children undergoing brief outpatient surgery with ketamine anesthesia, emergence agitation was not significantly reduced by addition of fentanyl 0.5microg/kg or midazolam 0.05 mg/kg. No significant differences were observed among the three groups with respect to adverse effects and recovery profile.

The Inhibitory Effect of Propofol on Splenocytes Proliferations to Lipopolysaccharide in BALB/c Mice: Based on the Measurement of BrdU Incorporation in vitro / 대한마취과학회지

BACKGROUND: Anesthetics have been suspected of impairing various aspects of the immune function either directly by affecting the function of immunocompetent cells or indirectly by modulating the stress response. Splenocytes play important roles in the cellular host defense against infection. In order to assess the immune modulatory effects of propofol, this study examined the cytotoxic and proliferative effects of propofol on splenocytes. METHODS: Splenocytes, as responders, were isolated from BALB/c mice (n = 10). The cells were pretreated with different propofol concentrations (0micrometer, 30micrometer, 100micrometer, 300micrometer) for 24 hours. The cytotoxic effect was assayed by the NADH dehydrogenase activity and the proliferation was evaluated by the level of 5-bromo-2'-deoxyunridine (BrdU) incorporation during DNA synthesis in the presence or absence of propofol, in addition to lipopolysaccharide (LPS, 1 microgram/ml) for mitogenic stimulation. A cell proliferation enzyme-linked immuno-sorbent assay (ELISA) system was used, and the stimulation index was calculated in the presence or absence of propofol. RESULTS: The percentage of the NADH dehydrogenase activity was changed by the propofol pretreatment (P < 0.001). LPS stimulation significantly decreased the NADH dehydrogenase activity at 100micrometer and 300micrometer compared with the propofol-added or pretreated cells (P < 0.05). The stimulation index to LPS was lower at concentrations of 100micrometer and 300micrometer than at 30micrometer, and proliferative response of splenocytes were completely abrogated by adding toxic concentrations (100micrometer) of propofol (P < 0.05). CONCLUSIONS: Neither cytotoxicity, as defined by the NADH dehydrogenase activity, nor a proliferative effect, as measured by the level of (BrdU) incorporation in the splenocytes, were affected by the clinical concentration of propofol.

The effects of propofol and enflurane anesthesia on the proliferative responsiveness of peripheral blood mononuclear cells in culture as determined by the level of bromodeoxyuridine incorporation / 대한마취과학회지

BACKGROUND: Various aspects of immunological homeostasis are affected by anesthesia and surgery, including the function of immunocompetent cells and the modulation of stress responses. To evaluate immunologic changes that occurred following propofol and enflurane anesthesia, we evaluated the proliferative responsiveness of peripheral blood mononuclear cells (PBMC) in patients undergoing laparoscopic gynecologic surgery. METHODS: PBMC were isolated from patients prior to anesthesia and on the first postoperative day (n = 10). The proliferative response was then evaluated based on the level of 5-bromo-2-deoxyunridine (BrdU) incorporation that occurred during DNA synthesisafter the induction of mitogenic stimulation by treatment with 1 microgram/ml lipopolysaccharides (LPS). To accomplish this, cell proliferation was assayed by enzyme-linked immuno-sorbent assay (ELISA), after which a stimulation index was calculated. RESULTS: Although the calculated stimulation index decreased in response to both propofol and enflurane anesthesia, the stimulation index did not differ significantly between groups. However, following stimulation with LPS, the stimulation index was significantly higher in the enflurane group than in the propofol group (P < 0.05). CONCLUSIONS: Propofol and enflurane anesthesia inhibit the PBMC proliferation. However, the decrease in proliferation that occurred in response to enflurane was attenuated by LPS.

Management of Pulmonary Thromboembolism with Inferior Vena Cava Filter: A Case Report / 대한구급학회지

We managed a case in which an inferior vena cava filter was inserted for a pulmonary thromboembolism that occurred during general anesthesia. A 71-year-old woman was prepped for reduction of a distal femur fracture and arthroplastic surgery. Her initial vital signs were stable, but the end-tidal CO2 and SaO2 were decreased gradually after application of the tourniquet for surgery. Because of impaired ventricular wall motion and a dilated inferior vena cava on echocardiogram, we suspected a pulmonary thromboembolism. Thus, we inserted an inferior vena cava filter percutaneously under propofol sedation in the Radiology Department. In addition to ventilatory support and hemodynamic management, heparin was administered as anticoagulant therapy postoperatively in the intensive care unit. Multiple thrombi in the pulmonary artery were confirmed on chest CT. On the 4th postoperative day, she was transferred to the general ward without any complications.

Normal Lymphocyte Subpopulation of the Spleen is Altered after Peripheral Nerve Injury in Mice / 대한마취과학회지

BACKGROUND: Chronic neuropathic pain is often associated with altered immune function and the modulated immune cell response play a role in neuropathic pain by experimental nerve injury. In order to assess the possible changes in lymphocytes function following peripheral mononeuropathy, this study examined the lymphocyte subpopulation of the spleen using the monoclonal antibodies against the membrane surface markers in neuropathic BALB/c mice by a partial transection of sciatic nerve (PST). METHODS: After confirming tactile allodynia by paw withdrawal threshold, the splenic lymphocytes were stained with fluorescein isothiocyanate (FITC)-conjugated anti-mouse CD45R/B220 (B cell) and CD4 (helper/inducer T cell) or with phycoerythrin (PE)-conjugated anti-mouse CD90.2 (total T cell) and CD8 (suppressor/cytotoxic T cell). The proportions of subsets were analyzed using a FACScan laser flow cytometry system on postoperative day 5 and day 18 respectively. RESULTS: PST induced a mechanical allodynia as verified by the von Frey test at both 5 and 8 days postoperatively compared to pre-surgery (P < 0.05). Lymphocyte subpopulation was affected by PST. The proportion of CD4+ subset was significantly larger in the PST group than in the sham operated group on day 5, while the proportion of CD8+ subset was larger on day 18. In the PST group, there were significantchanges in the proportion of CD4+ on day 5 and in the proportion of CD8+ on day 18 (P < 0.05) compared to pre-surgery. There were no significant fluctuations in the proportion of total splenic T cell and B cell subsets of PST group compared to sham operated group. CONCLUSIONS: These results suggest that development of mononeuropathy is responsible for the proportional changes in splenic lymphocyte subsets in mice.

Alterations in NK Cell Cytotoxicity Induced by Peripheral Nerve Injury in Mice / 대한마취과학회지

BACKGROUND: Chronic pain is often associated with changes in the immune responses, which highlights the need for the aggressive pain control to obtain a better prognosis. This study examined splenic NK cell cytotoxicity in an attempt to assess the possible changes in the immune function under chronic neuropathic pain after a partial transsection of the sciatic nerve. METHODS: After confirming tactile allodynia in response to the von Frey filament, a modified lactate dehydrogenase (LDH) release assay was used to determine the cytotoxic activity of splenic NK cells on the YAC-1 cell line in C3H/HeN (H-2k) mice (n = 6). NK cells as effector cells were mixed with YAC-1 cells as target cells (1 x 10(4)/100microliter), resulting in an effector-target ratio of 1 : 25, 1 : 50, 1 : 100 in the culture medium. RESULTS: At 1 and 2 weeks after the nerve injury, all the subjects showed significant mechanical sensitivity compared with those observed before surgery. The percentage of NK cell cytotoxicity of the neuropathic mice increased significantly 1 week after the nerve injury but decreased within 2 weeks compared with the normal mice. CONCLUSIONS: In terms of the altered NK cell cytotoxicity, neuropathic pain can cause changes in the normal performance of the immune function.

Effect of Propofol Exposure on Hematopoiesis in Mouse Bone Marrow / 대한마취과학회지

BACKGROUND: It is evident that inhalational anesthetics, such as nitrous oxide, possess a certain degree of myelodepressive effect in humans. However, unlike nitrous oxide, propofol is frequently recommended for the anesthesia of oncologic patients or for harvesting bone marrow from donors. To evaluate the possible toxicity of propofol on hematopoietic stem cells, the in vitro sensitivity of colony growth to propofol was assessed using murine clonogenic hematopoietic progenitor cells. METHODS: Femoral and tibial marrow cells were obtained from 4- to 6-week-old male BALB/c mice. Propofol was diluted in culture medium (30microM, 300microM and 1 mM) and added into methylcellulose semi-solid culture media. After 14 days of culturing, the numbers of colony-forming unit granulocyte/monocyte (CFU-GM) colonies were counted. An advance liquid culture (RPMI 1640) of 5 hours duration was also applied prior to culturing in semisolid media to assess the short term exposure toxicity. RESULTS: The colony counts were significantly decreased compared to the control at higher concentrations than 1 mM (P<0.05). The pre-exposure to propofol did not affect the number CFU-GM colony count at the concentrations of 30microM and 300microM or under conditions of co-culture. CONCLUSIONS: No myelodepressive effect was observed in mouse bone marrow cells with exposure of propofol at concentrations under 300microM.

The Effect of Propofol on Cytotoxicity of Lipopolysaccharide Treated Mononuclear Cells / 대한마취과학회지

BACKGORUND: Trauma, surgical stress, and anesthesia are often associated with postoperative immune suppression and an increased susceptibility to infection. The role of propofol in a patient who may be at the risk of impaired immune function is contradictory. To access the possible role of propofol on human immune function, we investigated the cytotoxic activity of mononuclear cells from peripheral blood. METHODS: Healthy human mononuclear cells (MNCs) were isolated and stimulated with lipopolysaccharide (LPS) for 5 hrs. Activated MNCs were cultured in the presence of varying concentrations of propofol for 20 hrs and lactate dehydrogenase (LDH) release was measured to evaluate NMC cytotoxicity against K-562 cell target cells (cell to target 40:1). RESULTS: Propofol exposure at concentrations of 1, 5 and 10mug/ml did not significantly affect LDH release from K-562 cells, but the cytotoxic activity of MNCs was significantly suppressed at a concentration of 50mug/ml. (P<0.01) CONCLUSiONS: Since the concentrations of 1, 5 and 10mug/ml of propofol are in the clinically acceptable range for sedation and anesthesia, this result suggest that propofol does not significantly alter the cytotoxicity of NMCs in septic conditions.

Effect of Propofol on the Apoptosis of Lipopolysaccharide-Treated Mononuclear Cells and Lymphocytes / 대한마취과학회지

BACKGROUND: Sepsis, surgical stress, and anesthesia are often associated with postoperative immune suppression and an increased susceptibility to infection. Apoptosis is an important mechanism of cell death in sepsis and Endotoxemia, and the apoptosis-induced loss of lymphocytes may be responsible for immune depression. To access the possible role of propofol on human immune function in sepsis, we investigated the apoptosis of mononuclear cells (MNCs) and lymphocyte from peripheral blood. METHODS: Healthy human mononuclear cells were isolated and stimulated with lipopolysaccharide (LPS) for 5 hrs. And, activated MNCs were cultured in the presence of varying concentrations of propofol (1 microgram/ml, 5 microgram/ml, 10 microgram/ml and 50 microgram/ml) for 20 hrs. The apoptotic indices of LPS-treated MNCs, monocytes and lymphocytes were calculated by flow cytometry using an Annexin-V-FLUOS staining kit. RESULTS: Propofol exposure at 1, 5 and 10 microgram/ml did not significantly affect apoptosis of the LPS-treated MNCs, monocytes or lymphocytes, but a concentration of 50 microgram/ml increased the apoptosis of MNCs and lymphocytes significantly (P < 0.01). CONCLUSIONS: Since the concentrations of propofol used were in the clinically acceptable range for sedation and anesthesia, this result suggests that propofol does not significantly alter the apoptosis of NMCs, monocytes or lymphocytes in septic conditions for up to 20 hrs.

Early Effect of Endotoxin on Cerebral Autoregulation / 대한마취과학회지

BACKGROUND: Under normal conditions, cerebral blood flow is regulated as cerebral perfusion pressure changes (autoregulation). Inflammatory conditions like bacterial meiningitis result in a loss of cerebral autoregulation several hours after exposure to bacterial endotoxin. Endotoxin appears to produce effects via the production of reactive oxygen species, such as the superoxide anion. METHODS: Cerebral blood flow (CBF) was measured by hydrogen clearance in anesthetized rats 30 minutes after intravenous endotoxin 5 mg/kg or normal saline (control). Mean arterial pressure was reduced from 100 mmHg to 80 mmHg and 60 mmHg by hemorragic hypotension, and cerebral blood flow was measured at each pressure. RESULTS: In the control group, CBF did not change when arterial pressure was reduced to 80 mmHg (113.9 ml vs 111.9 ml), but declined significantly at 60 mmHg (113.9 ml vs 88.4 ml). In the group treated with endotoxin, both a reduction of mean arterial pressure to 80 mmHg (129.8 ml vs 101.8 ml) and 60 mmHg (129.8 ml vs 78.4 ml) caused a significant reduction in CBF, indicating that autoregualtion had been abolished. CONCLUSIONS: The results of this study indicate that within minutes of endotoxin exposure, CBF markedly increased, and that the autoregualtion of CBF was inhibited.

Propofol-N2O versus Seveflurane-N2O during Outpatient Knee Arthroscopic Surgery Using the Laryngeal Mask Airway: Hemodynamic Responses and Recovery Profiles / 대한마취과학회지

BACKGROUND: The increasing number of outpatient surgery which requiring the rapid, smooth induction of anesthesia with rapid recovery may lead to the use propofol or sevoflurane. Our objective was to compare the hemodynamic responses and recovery profiles obtained by sevoflurane inhalation with propofol infusion using a laryngeal mask airway (LMA) in an ambulatory setting. METHODS: Forty patients undergoing knee arthroscopic surgery were randomized into two groups. The laryngeal mask airway insertion was accomplished by using the voluntary maximal vital capacity breathing method (VCB) with sevoflurane 7% in nitrous oxide 50% (sevoflurane group) or by the infusion of propofol (target: 7microgram/ml) (propofol group). Under BIS monitoring (40-60), anesthesia was maintained by sevoflurane (2-3%) or propofol (range of 3.7-4.2microgram/ml) with spontaneous respiration. Time to loss of consciousness (LOC) and LMA insertion from induction of anesthesia, hemodynamic responses, end tidal CO2, and recovery profiles were evaluated. RESULTS: The mean time to LOC and to successful LMA insertion were similar in the groups. Hemodynamic responses in the sevoflurane group were not significantly different from those of the propofol group. However, in both groups, systolic and diastolic blood pressure were lower at the time of loss of consciousness and 5 min of after LMA insertion versus preinduction and LMA insertion values (P<0.05). Heart rate was significantly lower in the propofol group (P<0.05). After cessation of anesthesia, hemodynamic responses and to the time for LMA removal or to the time for responding to a verbal command were similar in both groups. CONCLUSIONS: Sevoflurane inhalation and propofol infusion anesthesia with spontaneous respiration provided comparable conditions for outpatient surgery.

The Effect of Intravenous Regional Block with Ropivacaine, Ketamine and Clonidine on Complex Reginal Pain Syndrome Type I: A case report / 대한마취과학회지

There is no treatment either to prevent the development of complex regional pain syndromes (CRPS), or to adequately and specifically control established pain. Symptom-based analysis of pain is important for disease progress assessments and treatment outcomes. An intravenous regional block (IVRB) with local anesthetics can contribute to the management of CRPS. We observed that by the IVRB using ropivacaine, ketamine and clonidine, the patient with CRPS type I who was resistant to sympathetic ganglion block and medical treatment with gabapentin, carbamazepine and antidepressant, was relieved of neuropathic pain.

Unilateral Cervical Sympathectomy Attenuates Hypertensive Responses Induced by Intracerebroventricular Administration of Choline in Rats / 대한마취과학회지

BACKGROUND: Brain acetylcholine is an important neurotransmitter in the control of blood pressure. Pharmacological activation of central cholinergic receptors by intracerebroventricular (ICV) administration of choline resulted in a marked pressure response in hypotensive experimental models, and the pressure response was associated with an increase in plasma vasopressin levels. The aim of this study was to determine whether a unilateral cervical sympathectomy affects the pressure response induced by ICV choline. METHODS: Rats were prepared with a cervical sympathectomy or with a sham operation and a 23 G cannula was implanted into the lateral cerebral ventricle. They were divided into three groups according to the pre-treated condition and the solution injected into the lateral cerebral ventricle; group 1 (ICV saline after sham operation), group 2 (ICV choline after sham operation), group 3 (ICV choline after cervical sympathectomy). Following the recovery period, pressure response was monitored for 50 min after injecting ICV choline or saline and plasma vasopressin levels were also assessed with an EIA kit at preinjection time, 10 min, and 50 min after ICV injection. RESULTS: The baseline systolic blood pressure was 120.6 +/- 3.9 mmHg in group 3 and 121.7 +/- 9.0 mmHg in group 2 and there was no significant difference. The pressure response to ICV choline became evident within 1 min and reached a maximum magnitude in 10 min in both groups. Compared to the sham operated rats (group 2), the pressure response to ICV choline was significantly attenuated in sympathectomized rats (p < 0.05). However, the plasma vasopressin levels were not significantly affected by ICV choline or a cervical sympathectomy. CONCLUSIONS: While the unilateral cervical sympathectomy itself did not have any effect on bloodpressure, it attenuated the pressure response to ICV choline. A unilateral cervical sympathectomy may attenuate the hypertensive response which is caused by an increased central cholinergic neurotransmission.

Arthroscopic Surgery of the Knee Through Ambulatory Care Unit Under General Anesthesia

PURPOSE: Though many patients who visit ambulatory care unit are performed arthroscopic surgery under local anesthesia, it is difficult to do it in some patients. By selecting the anesthetic agents, educating the patients preoperatively and controlling the pain carefully, we gained the good results in arthroscopic surgery of knee through ambulatory care unit under general anesthesia without complications. MATERIALS AND METHODS: From May 1998 to December 1999, arthroscapic surgery of the knee(menis-cectomy, synovectomy, debridement, loose body removal, bursa excision) was carried out under general anesthesia in 91 patients through ambulatory care unit. The anesthetic agents used in operation were propofol(52 cases) and ethrane(39 cases), 10cc of 0,25% bupivacaine with 1% lidocaine was injected in1o knee joint after arthroscopic surgery for pain control. RESULTS: The pain scores were improved from 12.5 points to 14.7 points at rest, from 9.5 points to 13 point at walking. Postoperatively, there were nausea(2 cases), chest pain(1 case), elevated blood pressure(2 case), redness(3 cases), pain(18 cases), effusion(27 cases). But these symptoms were improved without other complications. CONCLUSION: It is considered one of the comfortable, safe end reliable methods to perform arthroscopic surgery of knee through ambulatory care unit under general anesthesia.

Effects of Postoperative Patient-Controlled Ketorolac Analgesia on Recovery of Gastro-intestinal Motility after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: Postoperative ileus remains a common condition that prolongs hospitalization and increases the cost of surgical therapy. Ketorolac, a potent nonsteriodal antiinflammatory drug, has been known to prevent small bowel ileus in a rodent model. Therefore, we compared the effect of intravenous patient-controlled analgesia (iv PCA) with or without ketorolac. METHODS: Fifty-four patients undergoing gynecologic surgery were assigned in a double-blind manner into one of three groups (n = 18). Pain control was achieved using meperidine 600 mg only (group M), meperidine 300 mg-ketorolac 150 mg (group MK) or butorphanol 10 mg-ketorolac 150 mg (group BK) during the 48 hours following surgery. It was designed as loading (30 mg), continuous infusion (9.6 mg/hr), PCA dose (9.6 mg) and lockout interval (15 min) for group M and as loading (30 mg of ketorolac), continuous infusion (2 ml/hr), PCA dose (2 ml), and lockout interval (15 min) for groups MK and BK. We measured the interval to the first flatus during the 72 hours following surgery and recorded the numerical rating score (NRS) of pain with side effects at 1, 6, 12, 24 and 48 hrs postoperatively. RESULTS: Ketorolac expedited the return of bowel function significantly (P < 0.05). Analgesic efficacy and side effect were not significantly different in all three groups. CONCLUSIONS: IV PCA with meperidine-ketorolac and butorphanol-ketorolac afforded equal analgesia compared to the meperidine only. It also allowed earlier recovery of bowel function in patients undergoing gynecologic surgery.

The Analgesic Effect of Intrathecal Gabapentin in a Rat Model of Incisional Pain / 대한마취과학회지

BACKGROUND: Gabapentin, an anticonvulsant structurally related to gamma-aminobutyric acid (GABA), was recently reported to be effective in pain associated with reflex sympathetic dystrophy and neuropathy. However, the effects of intrathecal (IT) gabapentin in postoperative pain are unclear. This study was designed to evaluate the analgesic action of IT gabapentin in a rat model of postoperative pain which was similar to human postoperative pain states. METHODS: Rats were prepared with chronic intrathecal catheter. Under halothane anesthesia, a 1 cm incision was made in the plantar aspect of the hind paw and closed. Rats were divided into 7 groups, a control group (saline 20 microliter intrathecally n = 6); a GP 30 group (gabapentin 30 microgram intrathecally, n = 6); a GP 100 group (gabapentin 100 microgram intrathecally, n = 6); a GP 300 group (gabapentin 300 microgram intrathecally, n = 6); a GP 1000 group (gabapentin 1,000 microgram intrathecally, n = 6); a NS-GP group (saline 10 microliter and gabapentin 300 microgram intrathecally, n = 6) and DS-GP group (D-serine 100 microgram and gabapentin 300 microgram intrathecally, n = 6). The rats were placed on an elevated plastic mesh floor, and withdrawal threshold was determined using calibrated von Frey filaments applied from beneath the test cage to an area adjacent to the wound. A cumulative pain score based on the weight bearing behavior of the rats, and motor deficit score, were also assessed. RESULTS: In all group, the median withdrawal threshold for punctate hyperalgesia decreased from 148.4 mN before surgery to 1.5 mN-14.5 mN 2 hours after surgery-inducing hyperalgesia and remained unchanged during the 2hr testing period. The IT administration of gabapentin (30 300 microgram) increased the median withdrawal threshold toward preincision values dose-dependently and the nonevoked pain scores were also decreased. But the effects of intrathecal gabapentin were reversed by IT D-serine. The Analgegic effects of gabapentin were observed at doses that had no significant effect on motor function or spontaneous activity. CONCLUSIONS: These observations suggest that intrathecal gabapentin can modulate the facilitation of spinal nociceptive processing by tissue injury and may offer a therapeutic agent for the treatment of postoperative pain.