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Addition of Capsaicin to Local Anesthetics for spinal Anesthesia in Rats Shortens Motor Deficits and Prolongs Anti-Nociception

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Open Journal of Anesthesiology 2014年第6期4卷 123-130页

作者： Charles H. Wang Jeffrey C. Wang Mieke A. Soens Peter Gerner Gary Strichartz California Institute of Technology Pasadena USA Department of Anesthesiology Critical Care and Pain Medicine General Hospital Salzburg Paracelsus Medical University Salzburg Austria Pain Research Center Department of Anesthesiology Perioperative and Pain Medicine Brigham & Women’s Hospital Harvard Medical School Boston USA

Background and Objectives: Sensory-selective anesthesia, greater or longer-lasting anti-nociception than motor or autonomic deficits, is often clinically desirable but traditional local anesthetics rarely have such selective actions. Addition of capsaicin to tertiary amine local anesthetics has recently been reported to affect a preferential prolongation of nociceptive over motor block in rat sciatic nerve. We hypothesized that this combination when used intrathecally will also prolong nociceptive block. Methods: Under sevoflurane inhalation anesthesia, rats were injected intrathecally either with local anesthetics (bupivacaine, lidocaine, and articaine) alone or simultaneously with capsaicin. Motor block was evaluated by the contractile function of foot muscles, from proximal to distal. Anti-nociception was assessed by reductions in nocifensive withdrawal and vocalization induced by pinching the skin fold over the lateral metatarsus. Durations and degrees of deficits were assessed, along with complete recovery times and compared between local anesthetics alone and in combination with capsaicin. Results: Addition of capsaicin to any of the local anesthetics shortened motor deficits. Bupivacaine, lidocaine and articaine motor blocks were reduced upon combination with capsaicin to 0.32, 0.32 ans 0.43 of the duration from the respective local anesthetic alone. Duration of anti-nociceptive action was increased by capsaicin only for articaine. The ratios of block nociceptive to sensory block durations were 3.5, 5.1 and 3.3 for the respective local anesthetics. Conclusions: Intrathecal injection of capsaicin combined with local anesthetics produced a preferentially longer anti-nociceptive deficit. These combinations have potential clinical applications, including peri-operative spinal anesthesia and pain management.

关键词： spinal Anesthesia Differential Blockade Analgesia TRPV-1

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Traumatic spinal Cord Injuries in Gold Miners in Mali: Preliminary Study on 76 Cases

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World Journal of Neuroscience 2019年第3期9卷 208-215页

作者： Oumar Coulibaly Mahamadou Dama Oumar Diallo Daouda Sissoko Boubacar Sogoba Singuepiré Alpha Youssouf Sogoba Drissa Kanikomo Hô pital du Mali Bamako Mali Hô pital Gabriel Touré University of Sciences Technics and Technologies of Bamako (USTTB) Bamako Mali

Introduction: Gold panning is the research and artisanal exploitation of gold in the auriferous areas (rivers or others). Traumatisms arising from these activities are due to severe spinal cord injury and generally affect young people in full activity. They constitute a real social handicap in Mali and even in Africa. The aim of our study is to share our expertise in the management of these vertebro-medullary traumasin these miners who currently escape to all controls in Mali. Material and Methods: From 2013 to 2016, 76 Traumatic Spine Cord Injuries (TSCI) were treated in the department of Neurosurgery of “Hôpital du Mali”. There were 73 males (96.05%) versus 03 Females (3.95%), aged between 21 - 43 years old. Results: All of our patients were admitted with deficit differing from paraparesis to tetraplegia. According to Frankel scale, we found 59 patients with complete deficits (A grade, 77.63%), and incomplete deficits in 17 cases (12 grade B, 04 grade C, 01 grade D). The X-ray standard radiographies were done in 24 cases (31.58%) from which 02 patients had been operated with these data. CT scan centered on the injured spinal segment was performed in 74 cases (97.37%). The lumbar spine was affected in 39 cases, followed by thoracolumbar junction in 19 cases and thoracic spine in 16 cases. The cervical spine was only interested in two cases. Fractures dislocations are the most frequently lesions encountered in our series. The surgical approach was performed in 74 patients and 02 patients received conservative treatment. Conclusion: Traumatic spinal Cord Injuries (TSCI) among miners are a real disaster in Mali and continue to plague thousands of families or increase the number of disabled people in our society. It is the only work, where the person concerned is making of his own grave. And according to witnesses, several miners remained at the bottom of the wells. Their prevention must first involve users by raising the awareness of local residents and traditio

关键词： spinal Cord Injury Gold Mali

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Challenges faced for undertaking a stem cell based clinical trial in spinal cord injury in emerging countries

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Journal of Translational Neuroscience 2018年第3期3卷 1-8页

作者： Harvinder Singh Chhabra Kanchan Sarda Spine Service Indian Spinal Injuries CenterSector-CVasant KunjNew Delhi 110070India

Repair and regeneration after spinal cord injury(SCI)is an unmet need and research into finding new avenues to achieve this are ongoing *** cells with their immense potential to proliferate and differentiate have been identified as prime candidates for spinal cord ***-clinical data on their efficacy has been very encouraging,especially in case of adult stem *** clinical translation of these findings has not been so successful,due to the ease of obtaining autologous adult bone marrow stem cells and their perceived therapeutic potential,these cells have been offered as a“therapy”in many countries without any scientific evidence generated though a valid clinical *** this review,we attempt to highlight the need for conducting clinical trials and the challenges faced in case of emerging *** current scenario of regulations governing the use of stem cells in emerging countries is also discussed.

关键词： stem cells emerging countries spinal cord injury(SCI) regulations clinical trial

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The Effect of Different Regional Blocks: Combined Femoral-Sciatic, spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries —A Randomized Controlled Trail

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Open Journal of Anesthesiology 2017年第4期7卷 88-97页

作者： Heba Omar Bassant Abd Elhamid Ashraf Rady Shaymaa Khaled Faculty of Medicine Cairo University Cairo Egypt

Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleterious effects including hemodynamic changes, serum lactate and potassium level changes and tourniquet-induced pain which sometimes can be severe and intolerable. Aim of the study: To evaluate the effect of different regional blocks: femoral-sciatic, spinal and epidural blocks on serum lactate and potassium levels and the degree of arterial tourniquet-induced pain in patients undergoing lower limb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic surgery with application of tourniquet for duration not more than 90 minutes. Patients were assigned randomly to one of three groups (20 each) Group I had sciatic-femoral block, Group II: patients had spinal anesthesia and Group III: patients had epidural anesthesia. Intraoperative hemodynamics, changes in serum potassium and lactate levels and tourniquet pain after tourniquet inflation & deflation, were recorded. Results: There was no statistically significant difference among the three groups regarding tourniquet pain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding serum levels changes of potassium (p = 0.067) and lactate (p = 0.051). However, each group showed statistically significant increase in post deflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively) and serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively) and lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively) when compared to the pre-deflation values, and the increase was directly proportional to the duration of tourniquet. Conclusion: the three different types of anesthesia (femoral-sciatic, spinal and epidural block) have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were relat

关键词： Tourniquet Pain Potassium Lactate Femoral-Sciatic spinal Epidural

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Serotonin Influences the Endogenous Opiate Peptides in the Rat spinal Cord to Participates in Pain Modulation

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Open Journal of Anesthesiology 2012年第2期2卷 29-35页

作者： Yan-Juan Pan Zhi-Kui Yin Jun Yang Ying Zhao Da-Xin Wang College of Pharmacy Xinxiang Medical University Henan China College of Pharmacy Xinxiang Medical University Henan China 2Subei People’s Hospital of Jiangsu Province Yangzhou University Jiangsu China Subei People’s Hospital of Jiangsu Province Yangzhou University Jiangsu China.

spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain. Endogenous opiate peptides have been proven to participate in the nociceptive process at spinal level. It has reported that serotonin (5-HT, 5-hydroxytryptamine) in spinal cord plays a role in pan modulation, which can be blocked by opiate receptor antagonists. The present study was designed to investigate the interaction between 5-HT and endogenous opiate peptides at rat spinal level effecting on pain modulation. The results showed that 1) pain stimulation increased not only leucine-enkephalin (L-Ek), β-endorphin (β-Ep) and dynorphin A1-13 (DynA1-13) concentrations but also 5-HT and 5-hydorxyindoleace acid (5-HIAA, the 5-HT main metabolic product) concentrations in spinal cord significantly;2) 5-HT could increase L-Ek, β-Ep and DynA1-13 concentrations in spinal cord in a dose-dependent manner, whereas cypotolamine (a 5-HT receptor antagonist) decreased L-Ek, β-Ep and DynA1-13 concentrations in spinal cord. The data suggested that 5-HT antinociceptive role might be involved in the endogenous opiate peptide system through 5-HT receptors at spinal level.

关键词： Serotonin Endogenous Opiate Peptide spinal Cord Antinociception

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Sexuality of People with spinal Cord Injury: Knowledge, Difficulties and Adaptation

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Journal of Biomedical Science and Engineering 2014年第6期7卷 380-386页

作者： Simone Beatriz Torriani Flavia Costa Britto Gelson Aguiar da Silva Deyse Cardoso de Oliveira Zuila Maria de Figueiredo Carvalho Federal University of Border South UFFS Santa Catarina Brazil Federal University of Ceará Fortaleza Ceará Brazil University of Southern Santa Catarina Santa Catarina Brazil University of the West Regional Hospital Santa Catarina Brazil

Expressing sexuality is an important part of life, whether the person has a spinal cord injury (SCI) or not. This study investigated the sexual activity before and after SCI, the difficulties, and adjustments made by these people in relation to their sexuality. This is a qualitative study conducted with 14 people with SCI through semi-structured interviews, which we analyzed in light of pertinent literature and organized into three themes: sexual activity before and after SCI;difficulties in performing sexual activities;and adjustments in sexual activity after SCI. We conclude that, although there may be many difficulties, with the partner’s support they can get sexual satisfaction and adapt to the new reality. Nonetheless, it is necessary and essential that the patient receive guidance about the possible changes and adaptive methods, and nurses can play a critical role in this process.

关键词： spinal Cord Injuries Sexuality Adaptation

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Ultrasound Imaging of spinal Vertebrae to Study Scoliosis

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Open Journal of Acoustics 2012年第3期2卷 95-103页

作者： Wei Chen Lawrence H. Le Edmond H.M. Lou Department of Radiology and Diagnostic Imaging University of Alberta Edmonton Canada Department of Surgery University of Alberta Edmonton Canada Departmentof Biomedical Engineering University of Alberta Edmonton Canada

Scoliosis is a musculoskeletal disorder manifested as a three-dimensional spinal deformity. It affects 2% - 3% of the adolescent population. The conventional method to diagnose scoliosis is to measure the Cobb angle from posteroante-rior radiograph. Since radiation exposure is not desirable for patients, other non-ionizing methods have been explored. Among all the non-ionization methods, ultrasound (US) is a potential cost-effective method. However, our understand-ing of US interaction with the vertebrae or the spine is limited. The purpose of this study was to demonstrate the ability of US to identify bony landmarks for measuring spinal deformity. This study used a phased array US system with a 5 MHz transducer and a position encoder. In-vitro experiment on a cadaver vertebra and a pilot clinical study were carried out. The in-vitro experimental results showed that the lamina and spinous process were strong reflectors from the single vertebra. Less than 4% of error occurred on the dimension measurements. The pilot study was performed on a healthy subject and a scoliotic patient. The results indicated the lamina and spinous process could be identified and the curvature of the spine could be estimated using the reflectors. The difference of the curvature angle of the spine measured from the radiograph and the US images was 2?. These results have illustrated that US is a promising tool to measure curvature of spinal deformity and study scoliosis.

关键词： Ultrasound Cobb Angle Phased Array Scoliosis spinal Deformity Ultrasonic Imaging

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Evolution and Role of Intraoperative Neurophysiological Monitoring in Intramedullary spinal Cord Surgery: A 2-Year Series from Saudi Arabia

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World Journal of Neuroscience 2014年第4期4卷 326-333页

作者： Saleh Baeesa Emmanuel Labram Mohammed Bin Mahfoodh Mohammed Khalid Youssef Al-Said Division of Neurosurgery Department of Neurosciences King Faisal Specialist Hospital and Research Center Jeddah KSA Division of Neurosurgery Faculty of Medicine King Abdulaziz University Jeddah KSA

Introduction: Despite recent advances in neuroimaging and microsurgical techniques, surgical resection of spinal cord tumours remains a challenge. However, the evolution with advances and refinement of neurophysiological equipment and methodologies, intra-operative neurophysiolo- gical monitoring (IONM) is now regarded as an essential adjunct to the surgical management of intramedullary spinal cord tumours. This study aims to report our preliminary experience with IONM and emphasise its effective role of achieving maximum tumour resection and minimising neurological injury. Methods: This is a retrospective study performed at our institution between July 2012 and August 2013. It included a cohort of 6 consecutive patients presented with intramedullary spinal cord tumours. Their mean age was 26 years (range, 4 months - 37 years), all were males, and the mean follow up was 11.6 months. Results: We combined the use of somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in spinal cord surgery. SSEPs are monitored during the incision of the dorsal midline of the spinal cord and this was used in two of our patients and MEPs were used as an essential monitoring during the tumour resection. In addition, we used free-running electromyography (EMG) and muscle MEPs (mMEPs) during tumour resection. Four of our patients (two with ependymoma, one with ganglioglioma, and one with pilocytic astrocytoma) had complete tumour resection and two patients (pilocytic and diffuse astrocytoma) had IONM changes during surgery and had partial tumour resection. At 6-month follow up all our patients had made a good recovery with no new neurological sequelae. Conclusion: This small series and literature review is presented to add and improve the understanding of IONM in intramedullary spinal cord procedures and to reinforce the importance of IONM in optimising tumour resection and neurological outcome. Our series confirm that without D-wave monitoring, free-running EMG and

关键词： Neurophysiological Monitoring Intramedullary spinal Cord Surgery

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Thoracic Unilateral spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

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Open Journal of Anesthesiology 2019年第11期9卷 197-202页

作者： Nahir Chalup Torija Á lvaro Ramiro Ruiz Rubén Rodriguez Salas Beatriz Fuentes Benito Marina Nevado Villafruela Manuel Cortés Guerrero Anaesthesia Critical Care Department and Pain Medicine Hospital Universitario 12 de Octubre Madrid Spain Hospital Universitario Fundación Alcorcón Alcorcón Spain Centro de Salud de Torrelodones Áreanoroeste Torrelodones Spain

Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.

关键词： Neuraxial Anaesthesia Regional Anaesthesia Neurologic Complications spinal Cord Injury

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Is There a Relationship between Endotheline-1, Vascular Cell Adhesion Molecule-1 and the Arterial Hypotension Observed during spinal Anesthesia?

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Journal of Biosciences and Medicines 2021年第1期9卷 64-85页

作者： J. F. Nnang Essone K. Nzé Pascal G. Edjo Nkhilli N. Ekegue Diaw Mor C. P. Akagha Kondé P. Nzoghe Nguéma E. Anyunzok E. R. Obame C. Allognon B. Nguéma Asseko F. Ovono Abessolo E. Ngou Milama Department of Physiology Faculty of Medicine and Health Sciences of Libreville (USS) Libreville Gabon Department of Anesthesia and Emergency Resuscitation The University Hospital of Owendo Libreville Gabon Department of Anesthesia and Emergency Resuscitation The Mother Child University Hospital Center Libreville Gabon Department of Anesthesia and Resuscitation The Army Instruction Hospital Libreville Gabon Laboratory of Biology and Physiological Functional Explorations UCAD Dakar Senegal Department of Medicine The University Hospital of Libreville Libreville Gabon Department of Epidemiology Biostatistics and Medical Mathematics USS Libreville Gabon Department of Surgery The University Hospital of Libreville Libreville Gabon Department of Chemistry-Biochemistry Faculty of Medicine and Health Sciences USS Libreville Gabon

Introduction: The involvement of the endothelial dysfunction (ED) in arterial hypotension (AHPT) post of spinal anesthesia (SA) has not been established. Objective: To determine if there is a relationship between ED and AHPT observed during the 1st 15 minutes after SA. Population and Methods: The study concerned 40 people who were to benefit from a programmed herniorrhaphy under SA and 40 controls (SA-). The correlations between mean plasma concentrations of endothelin-1 (CmET-1, pg/ml) and Vascular Cell Adhesion Molecule-1 (CmVCAM-1, pg/ml) taken from SA+ one hour before (H0), then 15 minutes after the SA (H15) and the mean arterial pression (AMP, mmHg) with heart rate (bpm) were analyzed (p Results: CmET-1 and CmVCAM-1 of SA- were 1.07 and 3.34, respectively, compared to 1.12 (p = 0.735) and 3.57 (p = 0.862) in SA+ at H0 and H15. In SA+, at H15, CmET-1 was 1.13 (p = 0.823) and CmVCAM-1 was 3.57 (p = 0.257). In SA-, a negative correlation existed between CmET-1 and CmVCAM-1 (r = -0.438;p = 0.005). Conversely, in SA+, whether at H0 (r = -0.31;p = 0.051) or at H15 (r = 0.024;p = 0.883), no correlation existed between CmET-1 and CmVCAM-1, nor between MAP and ED markers (r = 0.111;p = 0.325). Conclusion: These results show that there is no relationship between the AHPT which occurs during the first fifteen minutes post SA, CmVCAM-1 and CmET-1. Moreover, these data suggest that ED is not involved in AHPT post SA.

关键词： Endothelin-1 VCAM-1 Hypotension Endothelial Dysfunction spinal Anesthesia

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