Electroneuronography (ENoG) of the orbicularis oris muscle can predict the prognosis of acute peripheral facial palsy. There have been few studies of ENoG of the orbicularis oculi muscle to predict the prognosis of acute peripheral facial palsy. We studied the relationships between ENoGs of the orbicularis oris and orbicularis oculi muscles and the outcome of acute peripheral facial palsy to clarify whether ENoG could predict the prognosis of acute facial palsy shortly after the onset. ENoG and facial palsy score were evaluated in 25 patients with acute facial palsy after initial treatment. They were followed until complete recovery. The ENoG value, defined as percentage of the amplitude of the affected side divided by that of the contralateral side of each muscle, decreased after the onset. It took the lowest value (min-ENoG value) was observed at a mean of 12 days after the onset. There were significant negative correlations between min-ENoG and the number of days until full recovery (orbicularis oris r=-0.67,P=0.0003;orbicularis oculi r=-0.50,P=0.009).Since the amplitude of the ENoG of the orbicularis oris muscle was larger than that of orbicularis oculi muscle, min-ENoG value of the orbicularis oris muscle was easier to calculate than that of the orbicularis oculi muscle. We conclude that the ENoG of the orbicularis oris muscle, rather than orbicularis oculi muscle, is useful to predict the prognosis of acute peripheral facial palsy.

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We report the results of treatment of breakthrough pain in patients with cancer, who were using transdermal fentanyl and could not take oral medications, using a disposable infuser for patient-controlled analgesia (PCA) with opioids. Intravenous or subcutaneous rescue dose of morphine or fentanyl with ketamine (1-3 mg) was initially begun with 5% of equipotent dose of daily fentanyl delivered through transdermal route. Optimal rescue dose of opioid was determined by pain reduction, sedation, and degree of satisfaction of the patients. We analyzed 16 cancer patients with breakthrough pain who had used transdermal fentanyl 2.5-60 mg/72 hours. The optimal equipotent rescue dose of opioids was 5.8±1.9% (mean±S.D.) of the basal daily fentanyl. We conclude that intravenous opioids with small dose of ketamine given by disposable PCA infuser is effective for the treatment of breakthrough pain in patients with cancer who cannot take medications orally. This modality of treatment improves patients' satisfaction and makes it easier to titrate the optimal rescue dose for breakthrough pain.

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We studied the effects of local anesthetic volume on diaphragmatic excursion after ultrasound-guided interscalene brachial plexus block (ISBPB). Twenty patients underwent ultrasound-guided ISBPB for pain in the upper extremity, shoulder, or neck with either 10 ml (n=10) or 20 ml (n=10) of 1% mepivacaine. Diaphragmatic excursion during quiet and deep inspiration was assessed by ultrasonography before and after ISBPB. All patients had hypoalgesia of at least C5-7. There was no significant change in diaphragmatic excursion in the 10 ml group, while a significant decrease was observed in the 20 ml group. We concluded that diaphragmatic excursion is preserved after ultrasound-guided ISBPB with 10 ml of 1% mepivacaine.

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BACKGROUND: We evaluated the sedative effects of epidural anesthesia on bispectral index (BIS) during awake phase and general anesthesia with propofol.
METHODS: Sixty patients aged 20-80years were randomly assigned into three groups in double-blinded fashion : epidural group that received 3 mg•kg^-1 of 1.5% lidocaine epidurally as a bolus and intravenous normal saline; continuous intravenous (CIV) group that received the same volume of epidural saline and an intravenous administration of 0.5 mg•kg^-1 of 2% lidocaine for 5 min followed by 1.8mg•kg^-1•hr^-1; control group that received the same volume of epidural and intravenous saline. During the awake phase, the BIS values were measured at 0, 5, 10, and 15 min after epidural injection, then cold test was performed. General anesthesia was thereafter induced with propofol; BIS values were recorded at 5, 10, and 15 min after the effect-site concentration aiming 3.2 μg•ml^-1 with target-controlled infusion technique. Plasma lidocaine concentrations were measured at 5, 10, and 20min after epidural injection. HR, MBP, SpO₂, PETCO₂, and BT were recorded at 0, 5, 10, and 15 min after each phase was started.
RESULTS: The BIS values during the awake phase were significantly lower in the epidural group than in the others (p<0.05). The average plasma lidocaine concentrations in the epidural group were comparable to those in the CIV group.
CONCLUSIONS: Epidural anesthesia decreased BIS values during awake phase. Epidural lidocaine brought about more sedative effect than intravenous lidocaine that achieved similar blood concentrations of lidocaine.

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We report a patient whose cancer pain in the upper limb was refractory to oral and transdermal opioids and was treated with continuous epidural and brachial plexus block by implanted port. A man aged in his 50s had pain in the upper limb due to pulmonary sulcus cancer. The pain was not relieved by oral or trandermal opioids. An epidural catheter was inserted via C6/7 intervertebral space and continuous infusion of 0.2% ropivacaine with morphine was begun. This strategy relieved the pain. Reinsertion of an epidural catheter was attempted 1 month after continuous epidural block. The catheter was embedded subcutaneously and a port was also fixed into left-sided anterior chest wall just beneath the breast. Continuous infusion of 0.2% ropivacaine with morphine gave almost the same pain relief as the epidural block. CT scan revealed that the catheter tip was located in the ipsilateral brachial plexus to the painful upper limb, instead of epidural space. The pain was controlled until his death 4 weeks after reinsertion of the catheter.

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We report a patient who developed drug-induced hypersensitivity syndrome while on oral carbamazepine and mexiletine therapy. A 56-year-old man with zoster-associated pain began taking mexiletine 12 days after administration of carbamazepine. Maculopapular skin lesions developed on the right thigh and the body temperature rose to around 38°C, 20 days after taking carbamazepine. He quit carbamazepin; however, the skin lesions worsened. He quit mexiletine 2 days after stopping carbamazepine. The white cell count in peripheral blood increased to 11,170/mm3; AST was 105 U/L, and ALT 280 U/L. There were atypical lymphocytes in the peripheral blood. The body temperature decreased after the patient received oral betamethasone 1 mg/day; however, the skin lesions further worsened and covered almost the whole body. He received pulsed intravenous methylprednisolone 1 g/day for 3 days. The body temperature, which once elevated > 39°C, rapidly decreased. The skin lesions gradually resolved. The presence of generalized skin lesions, fever, lymphadenopathy, leukocytosis, and elevated transaminases strongly suggested that the patient developed drug-induced hypersensitivity syndrome to carbamazepine or mexiletine.

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We report a patient whose phantom limb pain was controlled by mirror box therapy and continuous epidural block. A 37-year-old man developed phantom limb pain with stump pain after brachial plexus avulsion. Because the stump pain worsened shortly after mirror box therapy, it was difficult to continue mirror box therapy. The worsened stump pain was treated with continuous epidural block. Mirror box therapy was resumed after improvement of stump pain with continuous epidural block. The phantom pain gradually decreased with mirror box therapy. Thereafter, he received epidural electrical stimulation of the spinal cord. The pain was wellcontrolled.

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The committee on terminology of the Japanese Society of Pain Clinicians published the first edition of "glossary of pain-related medical terms" in 1999. We are revising it for the third edition. The booklet has collected pain-related medical terms used in the field of pain treatment, with official translations of English-to-Japanese and vice-versa. On the other hand, the committee on pain terminology of the International Association for the Study of Pain had launched basic pain terminology since 1979, and published a booklet on classification of chronic pain in 1994. With reviewing the history and recent topics on the publications about pain related-medical terms, we discuss the desirable revision for the third edition.

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[in Japanese]

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[in Japanese]

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