Background and Objectives. Effectiveness and incidence of side effects for epidural butorphanol-bupivacaine combination for postoperative analgesia were examined.
Methods. One hundred and six patients undergoing elective surgery received epidural of 1% lidocaine 3ml and butorphanol 1mg just prior to surgery. Continuous epidural administration of butorphanol-bupivacaine solution was initiated at one hour after skin incision. The solution consisted of 3 or 4mg butorphanol and 60ml of 0.25% bupivacaine, and the infusion rate was 2ml/hour. Patients were allocated to 4 groups accoding to type of surgery received: group U, upper abdominal surgery (n=43); group L, lower abdominal surgery (n=21); group G, gynecological surgery (n=25); and group C, laparoscopic cholecystectomy (n=17). The authors recorded patient's rated pain, nausea, vertigo, pruritis, hypotension, respiratory state, somnolence, and psychic state at 0, 3, 6, 12, 24, and 48 hours after surgery.
Results. Additional analgesics were administered in 12%/5% (at 0/48 hours after surgery) patients in group U, 10%/10% in group L, 24%/36% in group G, and 12%/0% in group C. Sixty-eight percent of the patients in group G and 47% of the patients in group C complained of nausea. Pruritis was reported in only one patient. Somnolence was revealed in about 20% patients.
Conclusions. Epidural butorphanol-bupivacaine provides adequate postoperative analgesia after upper and lower abdominal surgery, but is inadequate after gynecological surgery and laparoscopic cholecystectomy.

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To assess the applicability of the stellate ganglion block (SGB) to asthmatic patients, ventilatory response to step-wise changes in end-tidal carbon dioxide concentration was analyzed with FIO₂ levels lower than 20% and higher than 60% in 10 stable bronchial asthmatics (5 men and 5 women, aged between 26-65, mean 49.4); and under low FIO₂ conditions in 5 volunteer controls (4 men and 1 woman, aged 26-50, mean 35.8).
After SGB, ventilatory response to carbon dioxide under conditions of higher than 60% inspired oxygen concentration and lower than 20% inspired oxygen concentration was not impaired. The ventilatory response to carbon dioxide in bronchial asthmatics under mild hypoxia was not different from that in controls.
We may conclude that SGB can be safely done in bronchial asthmatic patients while they are mildly hypoxic.

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We evaluated analgesic effects of oral prednisolone for cancer pain in 33 patients who had been treated with ordinary analgesics according to the WHO method for relief of cancer pain. The patients were divided into two groups, those with dull pain caused from bone metastasis and others with neuropathic pain caused from nerve compression by tumors. We administered prednisolone orally for nine days with the stepwise decrements; 30mg for the first three days, 20mg for the second three days and 10mg for the last three days. This treatment decreased pain scores by VAS from 7.0 to 2.0 without any side effects. Good results were observed most frequently in those who had been treated with codeine phosphate together with acetaminophen. It is concluded that the oral use of prednisolone in addition to oral analgesics is effective for cancer pain from bone metastasis or nerve compression, and that the administration of cortico-steroids should be started at earliest possible stages in the clinical course of cancer pain for improvement of QOL of patients.

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The treatment of pain occurring after lumbar operation is often difficult. Such pain is often referred to as ‘failed back syndrome’, it is also a significant problem in the field of orthopedic surgery. We treated 4 patients who experienced persistent pain following operations.
Case 1 and Case 2 were following lumbar spinal stenosis, while Case 3 and Case 4 were following lumbar disc herniation. All patients showed improvement after operations, but the symptoms returned within one year. We treated them with lumbar sympathetic ganglion block (LSGB), which caused a significant reduction in their symptoms. LSGB is thought to be a useful therapy for prolonged pain occurring after lumbar operations.

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A 32-year-old female with numbness in her right infraorbital region was diagnosed of a trigeminal nerve dysfunction because of hypesthesia in the right half of her face and loss of her right corneal reflex. Following a stellate ganglion block, the numbness became worse and more widespread the right hemifacial members. Computed tomographic scan and magnetic resonance image showed a large tumor in the left posterior fossa. After the total tumor resection, it was diagnosed as meningioma. The contralateral trigeminal nerve dysfunction may be due to a shift of the brain stem by the tumor. Neurological disorders disappeared after the surgery. When neurological dysfunction of the trigeminal nerve is found in a young patient and the effect of stellate ganglion block is unexpected, an intracranial tumor should be ruled out.

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Four patients with intractable cancer pain were treated with continuous intrathecal administration of lidocaine and morphine (continuous subarachnoid analgesia: CSA) using an implanted drug delivery system (Hickman subcutaneous port). Excellent pain relief was obtained in all patients. These patients became able to walk and increased their daily activities immediately after the commencement of the therapy. The consciousness of the patients was kept clear.
Temporary gait impairment was observed in one patient. Small amount of cerebrospinal fluid leakage, decubitus on port site and infection at the access port were observed in another patient. These complications treated properly did not impair the CSA treatment. Seizures, cerebrospinal clonus, respiratory depression and neurologic deficits were not observed in any patients.
This technique is effective and recommended as one of the treatments for the intractable cancer pain.

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Arm pain in a 60-year-old male patient, strunk by lightning 6 years ago, underwent sympathetic nerve block without effect, but was successfully treated with prostaglandin E₁ i. v. injection. The patient's sympathetic nerve system may be demaged by lightning as nerve block therapy does not effect a cure.

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