Masui. The Japanese journal of anesthesiology
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Pain is a private internal event, the degree of which can not be evaluated directly by others. The measurement of the nociceptive pain threshold may apply to the evaluation of the degree of the pain. The instruments using mechanical and electrical stimulation are available for the clinical application. ⋯ The method seems to be well suited for the evaluation of pain in musculoskeletal disorders. The electrical stimulation test provides a quantitative measure of pain tolerance to a transcutaneous stimulation, neuroselective for large and small myelinated and unmyelinated nerve fibers. There are characteristics including advantages and faults in each method, and the method of measurement corresponding to the purpose and application is important.
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Equipments for epiduroscopy consist of an epidural endoscope, video camera system, video screen, recording system and C arm X-ray system. Epidural endoscope with a diameter of 0.9 mm is inserted from the hiatus sacralis, and has been used clinically for the observation of epidural space of a lumbar vertebrae level since 1996. There are still some problems to be solved in the epiduroscope development, but its dramatic pain reduction effect has been recognized and it has been held as an attractive diagnostic tool.
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Electrical infusion pumps (pump) were featured with the focus on patient-controlled analgesia (PCA). The specification and functional aspects of four types of PCA pumps were briefly summarized and listed in two tables. The clinical application of these PCA pumps should benefit both patients and medical staffs. For the successful introduction of PCA pumps into clinical practice, a medical team must be organized, where not only anesthesiologists but also nurses, pharmacists, medical electronic engineers and surgeons are expected to participate.
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Most of the patients who undergo radical or subradical hysterectomy with paraaortic lymphadenectomy suffer from postoperative pain for upper abdominal incision. They also complain of postoperative nausea and vomiting (PONV) frequently, which are increased by opioids. ⋯ We conclude that ropivacaine-fentanyl PCEA is effective after upper abdominal gynecological surgery, and we can decrease the dose of fentanyl by explaining PCEA system more effectively to the patients for suppressing the pain on moving and PONV.
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Case Reports
[Labor management using epidural anesthesia in a gravida patient with high spinal injury].
Since autonomic hyperreflexia (AH) is a serious complication during labor in a gravida with spinal cord injury, anesthetic measures should be taken for the suppression of AH even in a sensory-loss condition. Several reports have described various methods for the suppression of AH, in which epidural anesthesia has been advocated as a useful means for the prevention or amelioration of AH. However, it is difficult to evaluate the efficacy of epidural anesthesia due to the lack of sensory and motor functions. ⋯ Tubal-ligation was also performed under epidural anesthesia after the second delivery. No major obstetric complication including AH occurred in either of delivery. The woman with high spinal injury could have two healthy children without major complications during labor by the cooperation of gynecologists and anesthesiologists.