Percutaneous fully endoscopic surgical management of the ruptured epidural catheter: Rescue of the novice anesthesiologist from his dilemma.

Background: Epidural nerve block and analgesia are basic anesthetic techniques for anesthesia. Epidural catheter rupture and partial retention are adverse events and rare complications of epidural catheterization technique. The probability of occurrence when applied by novice doctors is high. Removal of the residual catheter by conventional surgery causes more trauma and bleeding, slows recovery, and may causes medical disputes. We hypothesized that percutaneous spinal endoscopy a safe and effective remediation technique. This study was to analyze the efficacy and safety of removing the residual dural catheter by a percutaneous full-endoscopic technique(PFET) and discuss the clinical technique and precautions. Methods: This was a retrospective analysis of 7 patients with ruptured epidural catheters treated in our department from October 2015 to October 2019 using the PFET to remove the remaining epidural catheter. The operation time, intraoperative bleeding volume, surgical complications, and neurological symptoms before and after surgery were recorded. The Self-Rating Anxiety Scale (SAS) was used to assess the anxiety level of the anesthesiologist and the patient before and after the catheter removal operation, and the postoperative low back pain VAS score was recorded. Results: The remaining epidural catheter was successfully removed from all 7 patients. The operation time was 54.14 ± 14.45 (32-78) minutes, and the intraoperative blood loss was 9.134 ± 3.078 (5-15) ml. There were no cases of dural damage, cerebrospinal fluid leakage, sensorimotor dysfunction of the lower limbs, or bowel dysfunction. The anxiety symptoms of the patient and the anesthesiologist disappeared after removal of the residual epidural catheter. The patients' postoperative back pain VAS score was 0 to 2 points. Conclusion: PFET is a safe and effective minimally invasive technique for removing residual epidural catheters. It causes less trauma and less bleeding, allows a faster recovery. It does not affect the recovery of patients from other surgical operations and reduces both medical risks and medical costs. At the same time, it avoids or reduces the occurrence of medical disputes and eliminates the pressure on novice anesthesiologists regarding similar adverse events.

Resolution of herpes zoster-induced small bowel pseudo-obstruction by epidural nerve block: A case report.

BACKGROUND: When herpes zoster is complicated with paralytic ileus, this mostly involves acute intestinal pseudo-obstruction of Ogilvie's syndrome manifesting as obvious dilatation of the cecum and right colon; small intestinal obstruction is rare. Here, we present a patient with a very rare case of small bowel pseudo-obstruction. CASE SUMMARY: A 76-year-old female patient complained of right upper quadrant pain. Two days later, a blistering, right-sided rash of the thoracoabdominal dermatome (T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate. Computed tomography of the abdomen confirmed small bowel pseudo-obstruction. Antiviral therapy, gastrointestinal decompression, and enemas proved unproductive. After 4 d of stagnation, an epidural block was performed for pain relief and prompted the passage of gas and stool, resolving the obstructive problem. Three days later, the rash appeared dry and crusted, and the pain diminished. After 5 d, no abnormality was visible by gastroenteroscopy, and the patient was discharged on day 7. CONCLUSION: This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction. Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.

[Comparative study between electroacupuncture at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery].

OBJECTIVE: To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery. METHODS: Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T0), skin incision (T1), extubation (T2) and 2 h after operation (T3); the dosage of anesthetics and extubation time were recorded; the plasma levels of ß-endorphin (ß-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2) were measured at the following time points: T0, T3, 12 h after operation (T4), 24 h after operation (T5) and 48 h after operation (T6). Visual analogue scale (VAS) was used to evaluate the analgesic effect. RESULTS: The MAP at T1 and T2 in the group A was lower than that in group B and control group (P<0.05), and HR at T1 and T2 was lower than that in control group (P<0.05). The MAP and HR at T1 and T2 in the group B were lower than those in the control group (P<0.05). The dosage of remifentanil in the group A and group B was lower than that in the control group (P<0.05), and extubation time was earlier than that in the control group (P<0.05). The content of ß-EP at T4, T5 and T6 in the group B was higher than that in the group A and control group (P<0.05); the contents of 5-HT and PGE2 at T3, T4 and T5 in the group A and group B were lower than those in the control group (P<0.05). The VAS scores at T3, T4 and T5 in the group A and group were lower than those in the control group (P<0.05). CONCLUSION: The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.

Comparative study between electroacupuncture at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery / 中国针灸

OBJECTIVE@#To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery.@*METHODS@#Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T@*RESULTS@#The MAP at T@*CONCLUSION@#The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.

Effect of Ultrasound-Guided Intercostal Nerve Block Versus Fluoroscopy-Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study.

OBJECTIVES: To compare the efficacy of a conventional fluoroscopy-guided epidural nerve block and an ultrasound (US)-guided intercostal nerve block in patients with thoracic herpes zoster (HZ). METHODS: This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1-month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US-guided intercostal nerve block or the fluoroscopy-guided epidural nerve block approach with the addition of a 5-mL mix of 2.5 mg of dexamethasone plus 0.5% lidocaine. The primary outcome measure was the NRS score reduction for the pain. Secondary outcomes included the duration of treatment, number of repeated injections until the final visit, and proportion of patients with pain relief after the first and final visits. RESULTS: All patients within both intervention groups showed significant pain relief on the NRS at the final follow-up point (P < .05). There was no significant difference in the mean value of NRS improvement based on the intervention type. There was also no statistically significant difference in the duration of treatment and the frequency of injection for pain relief. CONCLUSIONS: These findings showed that both the US-guided intercostal nerve block and the fluoroscopy-guided epidural nerve block were effective in patients with thoracic HZ. Compared data showed no significant differences in the pain reduction, duration of treatment, and frequency of injection. The US-guided intercostal nerve block, which is more accessible than the fluoroscopy-guided epidural nerve block, might be an alternative option for thoracic HZ.

Analgesia of Femoral Nerve Block on Knee Stiffness in Rehabilitation Training after Surgery / 中国康复理论与实践

@#ObjectiveTo compare the effect of rehabilitation training after surgical intervention of knee stiffness (SIKS) between femoral nerve block (FNB) and epidural nerve block (ENB).Methods60 patients undergoing SIKS at one knee joint were randomly assigned to two groups: 40 patients accepting a catheter for FNB in group A and 20 patients accepting a catheter for ENB in group B. All patients participated in passive rehabilitation therapy (PRT) and active rehabilitation therapy (ART) at 12 hours, 24 hours, 36 hours, and 48 hours after operation. 10 ml of lidocaine were applied via these catheters before rehabilitation therapy. The visual analogue score (VAS) for pain in PRT, the time needed from the end of PRT to the start of ART, and the incidence of side effects such as hypotension or nausea were recorded.ResultsThere was no significant difference in VAS between groups A and B. The time needed from the end of PRT to the start of ART in group A was significantly less than that of group B. The incidence of hypotension or nausea in group A was significantly less than those of group B.ConclusionFNB provides the same analgesic effect as ENB, has less time needed from the end of PRT to the start of ART, and lowers incidence of hypotension or nausea.

A Case of Intractable Chest Pain of Unknown Origin which was Suspicious of Complex Regional Pain Syndrome Type I: A case report / 대한마취과학회지

Complex regional pain syndrome (CRPS) type I is an intractable pain syndrome accompanied with autonomic nerve symptoms, but without certain evidence of nerve injury. It is mainly caused by trauma, such as, fracture, sprain, contusion, etc., and is characterized by, pain (either by contact or spontaneously), allodynia, hyperalgia, vasomotor, and autonomic changes (including variable skin color changes), temperature change, swelling, edema, sweating, trophic change, and motor disturbance. We report the case of a 60-year-old woman who had suffered from severe pain on the right chest for several years. She was satisfactorily treated by pharmacologic therapy and continuous epidural nerve block.