Kwi Chu Seo

Factors contributing to episodes of bradycardia hypotension during shoulder arthroscopic surgery in the sitting position after interscalene block

Background Arthroscopic shoulder surgery has been performed in the sitting position under interscalene block (ISB). Bradycardia hypotension (BH) episodes have a reported incidence of 13-29% in this setting. We performed a retrospective study to investigate contributing factors to the occurrence of BH episodes. Methods According to BH episodes, we divided 63 patients into two groups: BH group (n = 13) and non-BH group (n = 50). Anesthetic records and block data sheets were reviewed for demographic data, intraoperative medications, sites of ISB, use of epinephrine in local anesthetics, degree of sensory blockade, and percent change of heart rate or systolic blood pressure (SBP). Statistical analysis was done using Chi square test and Students t-test. Results There were no significant differences in the use of epinephrine in local anesthetics between the two groups. The location of ISB site was different between the two groups in that there were relatively more right-sided ISBs in the BH group than in the non-BH group (P = 0.048). The degree of sensory blockade was lower, but not significantly, in the C8 and T1 dermatomes of the BH group than in the non-BH group (P = 0.060 and 0.077, respectively). There was a relatively higher incidence of fentanyl supplementation in the BH group than in the non-BH group (P = 0.000). Conclusions These results suggest that right ISB and perioperative supplementation of fentanyl due to incomplete block are possible contributing factors to the occurrence of BH episodes in the sitting position during shoulder surgery using ISB.

Injury to the spinal cord by a thoracic epidural catheter used to control postpneumonectomy pain - A case report -

A thoracotomy is one of the most severe painful operations. This severe pain can usually be controlled by thoracic epidural analgesia. Epidural catheterization for analgesia has several complications, e.g., epidural hematoma, abscess, spinal stenosis, spinal infarction, direct cord trauma, and neurotoxicity by chemical contamination. These complications can cause acute paraplegia, but permanent paraplegia is extremely rare. We report a case of paresthesia and temporary paralysis in a 54-year-old patient who suffered spinal cord injury after thoracic epidural catheterization for the control of postpneumonectomy pain under general anaesthesia.

Combined femoral and popliteal sciatic nerve blocks versus epidural anesthesia in great saphenous veins stripping surgery with multiple stab avulsion

BACKGROUND This study was designed to test the hypothesis that a combined femoral and politeal sciatic nerve blocks (FPSNB) would have excellent clinical properties and better patient satisfaction than epidural anesthesia for the great saphenous veins stripping (GSVS) surgery with multiple stab avulsion (MSA). METHODS Sixty patients were allocated into two groups. The epidural group received epidural anesthesia with 15 ml of 0.75% ropivacaine (n = 30), and the FPSNB group received a combined FPSNB with 25 ml of 1.5% mepivacaine with a nerve stimulator (n = 30). We assessed the anesthetic and postoperative records. A questionnaire-based study including patient satisfaction for anesthetic techniques (100 point scale) was conducted 3 days postoperatively by a blinded observer. RESULTS The time from initial injection to the start of surgery and the duration of sensory blockade were not different between groups (P > 0.05). The percentage of patients with anesthesia-related complications in epidural anesthesia was 33.3%, 46.6%, 23.3% and 20% for shivering, hypotension, bradycardia and postoperative voiding difficulty, respectively. FPSNB did not produce these complications. Additional analgesia with 50-100 microgram of fentanyl was more frequently used in FPSNB (60% vs 6.7%, FPSNB vs Epidural group, P < 0.01), but patient satisfaction of FPSNB was higher than epidural anesthesia (88.1 +/- 13.2 vs 76.5 +/- 15.8, FPSNB vs Epidural group, P < 0.01). CONCLUSIONS A combined FPSNB with a small amount of narcotics is an adequate anesthetic technique for unilateral GSVS surgery with MSA.