Saori Hashiguchi

Long-Term Outcomes of Percutaneous Radiofrequency Thermocoagulation of Gasserian Ganglion for 2nd- and Multiple-Division Trigeminal Neuralgia

The objective of this study was to examine the long‐term outcome of percutaneous radiofrequency thermocoagulation (PRT) of the Gasserian ganglion for the 2nd division and multiple division trigeminal neuralgia (TN), compared to the isolated 3rd division TN.

Continuous spinal anesthesia and postoperative analgesia for elective cesarean section in a parturient with Eisenmenger's syndrome

We describe the use of continuous spinal anesthesia (CSA) for an elective cesarean section in a 29-year-old parturient with Eisenmenger’s syndrome at 30 weeks of gestation. It is essential in patients with Eisenmenger’s syndrome to prevent significant increases in right-to-left shunt following the reduction in systemic vascular resistance. In this case, the patient hoped to be awake during the operation because of her fear of death. We therefore applied CSA to this patient because single-shot spinal anesthesia and epidural anesthesia might cause sudden cardiovascular depression. In fact, sudden cardiovascular changes were avoided by the titration of local anesthetics and the operation was uneventful, although prompt treatment of hypotension was essential and adjustment of the anesthetic levels was difficult. Postoperative patient-controlled spinal analgesia provided satisfactory pain relief with hemodynamic stability and no significant side effects. However, thorough experience with the requisite techniques is critical in CSA because of the technical difficulty of the procedure, and anesthesiologists must gain such experience in less-demanding cases before attempting to administer it in patients presenting extreme challenges as described in this case report.

Pain management and related factors in advanced cancer patients who initiated opioid therapy in an outpatient setting.

OBJECTIVE The aim of this study was to clarify the state of pain management in Japanese patients with advanced cancer who initiated opioid therapy in an outpatient setting. METHODS Interview surveys using questionnaires were conducted and medical records were reviewed. Pain relief was defined as >33% decrease in worst pain intensity score, and significance of early pain relief was investigated in terms of changing self-efficacy for activities of daily living (ADL). Factors related to early pain relief were also investigated. RESULTS The study was conducted between June and December 2003, on 20 patients (13 women, 7 men; mean age, 59 years). Compared to score at initiation of opioid administration (Numerical Rating Scale, 8.3 +/- 1.3), pain relief was generally insufficient at 2 weeks (early pain relief ratio was only 42%). Patients with sufficient pain relief at 2 weeks displayed significant improvements in numerous ADL functions and symptom-coping efficacy (p = 0.037), confirming the importance of early pain relief. Early pain relief was associated with high frequency of hospital visits before opioid administration and absence of sudden excavation within the first 2 weeks. SIGNIFICANCE OF RESULTS Result of this study indicated insufficient pain relief at an outpatients setting with advanced cancer patients. In the meantime, patients had who their pain decrease after 2 weeks also had improved ADL and self-efficacy at the same time. These findings suggest that to achieve early pain relief in an outpatient setting, clinical staff must assess pain earlier and inform patients of possible breakthrough pain following opioid administration and available treatments for such occurrences.

Neutrophil gelatinase-associated lipocalin regulates gut microbiota of mice.

Because neutrophil gelatinase‐associated lipocalin (NGAL) is known to provide significant bacteriostatic effects during infectious conditions, we tested the hypothesis that this protein is up‐regulated and secreted into the intraluminal cavity of the gut under critically ill conditions and is thus responsible for the regulation of bacterial overgrowth.

Intra- and postoperative low-dose ketamine for adolescent idiopathic scoliosis surgery: a randomized controlled trial.

In this randomized controlled trial, we examined whether intra‐ and postoperative infusion of low‐dose ketamine decreased postoperative morphine requirement and morphine‐related adverse effects as nausea and vomiting after scoliosis surgery.

Psychological and endocrine factors and pain after mastectomy

This prospective study was designed to examine the associations of demographic, clinical, psychological and neuroendocrine factors with acute and chronic post‐operative pain following partial mastectomy.

Neurolysis Targeting Both the Aorticorenal Ganglia and Lumbar Sympathetic Plexus for Kidney Tumor–Related Pain

Dear Editor, Neurolysis of the celiac plexus and/or the retrocrural splanchnic nerves is a valuable approach to treat upper abdominal organ-related pain, particularly pancreatic cancer pain [1]. Few reports, however, have demonstrated celiac plexus block for kidney-related pain. The kidney is governed by a diverse nerve supply, such as sympathetic, parasympathetic, and sensory afferent fibers [2], and its related pain radiates from the flank and back to the hypogastric area, rather than from the upper abdominal region. Although sensory and autonomic nerve supply is relayed via the celiac plexus, it is questionable whether patients with kidney-related pain can benefit from celiac plexus neurolysis. We report a case of neurolytic block targeting both the aorticorenal ganglia and the upper lumbar sympathetic plexus for metastatic kidney tumor-related pain. A 41-year-old man, diagnosed with spindle cell sarcoma in the right lower leg 6 months previously, was admitted to our hospital because of uncontrolled right-side umbilical pain. For the 2 weeks prior to admission, the patient experienced abdominal discomfort that gradually worsened. Subsequently, a tumor in the lower part of the right renal medulla associated with lymph node swelling around the right renal and superior mesenteric artery …

Symptoms overlooked in hospitalized cancer patients: Impact of concurrent symptoms on overlooked by nurses

OBJECTIVE Physical and psychological symptoms in cancer patients are frequently overlooked by medical staff. However, little is known regarding the potential impacts of concurrent physical and psychological symptoms on the overlooking of other symptoms. The aim of this study was to examine the impact of concurrent symptoms on the overlooking of other symptoms in cancer inpatients. METHOD A total of 255 cancer inpatients in the general wards of one university hospital, who were referred to the palliative care team, were included. On the day of referral, nurses and patients were independently assessed for the presence of the following eight symptoms: pain, fatigue, nausea and vomiting, shortness of breath, lack of appetite, dry mouth, sleep problems, and distressed feelings. The presence of delirium was also separately assessed by nurses and psychiatrists on the team. A total of nine symptoms detected by nurses and those reported by patients or psychiatrists were compared, and logistic regression analysis was performed to identify the variables associated with the overlooking of these symptoms. RESULTS The most frequently reported symptom was pain (76.5%), followed by distressed feelings (49.8%), sleep problems (34.1%), and delirium (25.1%). The proportion of those overlooked was more than one quarter (25.0-63.6%) for all symptoms except pain (12.8%). Significant associations were found between the overlooking of shortness of breath and concurrent delirium (odds ratio [OR] = 110.9); the overlooking of sleep problems and concurrent lack of appetite (OR = 9.1); and the overlooking of distressed feelings and concurrent dry mouth (OR = 27.7). No patient demographic characteristic was associated with the overlooking of any other symptoms. SIGNIFICANCE OF RESULTS The presence of some specific concurrent symptoms is likely to lead to the overlooking of other symptoms in cancer inpatients by nurses. Comprehensive assessments of physical and psychological symptoms in daily clinical practice are needed.

Perioperative Factors Associated with Chronic Central Pain after the Resection of Intramedullary Spinal Cord Tumor

Objective: Some patients experience severe chronic pain after intramedullary spinal cord tumor (IMSCT) resection, but the underlying mechanisms have yet to be fully elucidated. We aimed to investigate perioperative factors associated with chronic pain after IMSCT resection. Materials and Methods: We analyzed data from a postal survey and the medical records of patients who had undergone IMSCT resection in our institution between 2000 and 2008. Chronic pain was assessed using the Neuropathic Pain Symptom Inventory score, and its associations with factors related to tumor pathology, patient demographics, neurological findings, surgery, anesthesia, and perioperative management were determined. Results: Seventy-eight consecutive patients (55 men and 23 women; age 17 to 79 y) were included in the statistical analysis of the present study. In univariate analyses, sex, body mass index, preoperative tumor-related pain, preoperative nonsteroidal anti-inflammatory drugs, intraoperative hypotension, postoperative corticosteroids, and decrease in Japanese Orthopaedic Association (JOA) scores were found to be associated with postsurgical chronic central pain. Logistic regression analysis identified 3 significant factors: a decline in JOA scores compared with preoperative values (odds ratio [OR], 3.33; 95% confidence interval [CI], 1.18-9.42; P=0.023), intraoperative hypotension (OR, 3.01; 95% CI, 1.02-8.97; P=0.047), and postoperative corticosteroids (OR, 3.21; 95% CI, 1.02-10.09; P=0.046). Discussion: Decline in JOA score, intraoperative hypotension, and postoperative corticosteroids are independently associated with postsurgical chronic central pain. Intraoperative hypotension and the use of postoperative corticosteroids can be avoided or modified during perioperative management. As results from animal studies have indicated that the administration of corticosteroids may intensify chronic pain, further studies in larger cohorts are required to definitively determine the effect of corticosteroids on postsurgical central pain.

Assessing Patient Satisfaction with Anesthesia: Attempting to be Painless and Safe

医療者主導で行われていた医療体制が患者主導に変わりつつあるなか, 麻酔においても, 患者が納得したうえで施行されることが以前にも増して求められるようになってきた. 患者が麻酔に期待することは ｢痛みがないこと, 安全であること｣ である. 当院では1999年より, APS (acute pain service) を導入し, 多職種のチームによる術後痛の緩和を行っている. 術後痛緩和は主に電動式のPCA (patient-controlled analgesia) ポンプを使用しており, これまで4,000例以上の管理を行ってきた. 多くのポンプを稼動させ安全に管理するためにはシステム作りが重要であり, コメディカルの協力が不可欠である.