Spinal anaesthesia with plain articaine 50 mg resulted in a faster recovery of motor function and earlier spontaneous voiding compared with plain prilocaine 50 mg. Surgical anaesthesia was not different. The incidence of TNS was low.
Rationale:Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative lumbar disc disorder. Contralateral radiculopathy, as a complication of TLIF, has been recognized in this institution, but is rarely reported in the literature.Patient concerns:In this article, we report 2 cases of contralateral radiculopathy after TLIF in our institution and its associated complications.Diagnoses:In the 2 cases, the postoperative computed tomography (CT) and magnetic resonance image (MRI) showed obvious upward movement of the superior articular process, leading to contralateral foraminal stenosis.Interventions:Revision surgery was done at once to partially resect the opposite superior facet and to relieve nerve root compression.Outcomes:After revision surgery, the contralateral radiculopathy disappeared.Lessons:Contralateral radiculopathy is an avoidable potential complication. It is very important to create careful preoperative plans and to conscientiously plan the use of intraoperative techniques. In case of postoperative contralateral leg pain, the patients should be examined by CT and MRI. If CT and MRI show that the superior articular process significantly migrated upwards, which leads to contralateral foraminal stenosis, revision surgery should be done at once to partially resect the contralateral superior facet so as to relieve nerve root compression and avoid possible long-term impairment.
Rationale:Extremely sharp angular spinal deformity of healed tuberculosis can be corrected by vertebral column resection (VCR). However, the VCR techniques have many limitations including spinal column instability, greater blood loss, and greater risk of neurologic deficit.Patient concerns:We described a new spinal osteotomy technique to collect sharp angular spinal deformity in Pott disease. A 52-year-old woman presented with back pain and gait imbalance.Diagnosis:The kyphosis of healed tuberculosis was diagnosed based on history and imaging examinations.Intervention:A new posterior VCR was designed to treat this disease.Outcomes:The neurological function improved from Japanese Orthopedic Association scale 3 to 7. The back pain and neurological function were significantly improved. The Oswestry Disability Index decreased from 92 to 34. There was also a significant decrease in back pain visual analog scale from 9 to 2.Lessons:For cases with extremely severe Pott kyphotic deformity, the technology of modified VCR offers excellent clinical and radiographic results.
(Eur J Anaesthesiol. 2020;37:309–315) Phenylephrine is considered the first-line therapy for the prevention of hypotension in obstetric anesthesia. However, phenylephrine may cause bradycardia and decreased maternal cardiac output. Norepinephrine has been proposed as an alternative to phenylephrine for treating or preventing hypotension during cesarean delivery. The primary goal of this study was to determine the effective dose (ED) of norepinephrine to prevent spinal-induced hypotension during cesarean delivery. The secondary aim was to examine adverse events and neonatal outcomes seen with various infusion rates of norepinephrine.
BackgroundEpidural analgesia provided satisfactory analgesic effects of incision pain after cesarean section. However, uterine contraction pain is also a common complication that cannot be relieved despite adequate levels of sensory blockade by epidural analgesia. This study evaluates the effect of flurbiprofen axetil with patient-controlled epidural analgesia on incision pain and uterine contraction pain after cesarean section.MethodsA multi-center, prospective, randomized, blinded trial was performed. 1000 obstetric patients scheduled for cesarean delivery were randomized to receive epidural analgesia with intravenous flurbiprofen axetil (group EF) or placebo (group E) postoperatively. The primary outcomes were incision pain and uterine contraction pain score 48 hours after a cesarean section. Secondary outcomes were the PCEA attempts, the incidence of complication, satisfaction scores, and return of gastrointestinal (GI) function.ResultsBaseline characteristics were similar between groups. The VAS of uterine contraction pain was significantly lower in group EF than in group E from 12 hours to 48 hours after cesarean delivery (P < 0.01). The VAS of incision pain at rest and on movement was lower in group EF than in group E from 12 hours to 48 hours after cesarean delivery. While sitting or walking, the VAS of incision pain was lower in group EF compared with that in group E. GI function recovered faster in group EF than that in group E (15 ± 6 vs. 25 ± 12, 95%CI 5.7 to 8.7, P < 0.01). The satisfaction scores are higher in group EF than that in group E (3.2 ± 0.5 vs. 2.9 ± 0.5, 95%CI -0.36 to -0.11, P < 0.01).ConclusionCombination flurbiprofen axetil with PCEA provides more effective analgesia for uterine contraction pain and incision pain after cesarean section, with a higher quality of recovery and better satisfaction scores.Trials RegistrationThis study was approved by the Institutional Review Board of Guangzhou Women and Children’s Medical Center (IRB2017062201) and written informed consent was obtained from his or her parents or legal guardians for each pediatric patient in the trial. The trial was registered before patient enrollment at chictr.org.cn (ChiCTR-IOR-17011956, Principal investigator: Ying-Jun She, Date of registration: 2017.07.12). Written informed consent was obtained from patients in the study.
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