The author experienced the management of pain of the arrested-disease patients at the national leprous sanatorium during 2 years. Thirty patients complained the leprous neuralgia on the face, head, or the extremities. These pain could be classified into three types, chronic neuralgia, phantom limb-like neuralgia and acute neuralgia accompanied with ENL.
Stellate ganglion block or lumbar epidural blockade were effective for these neuralgias. Especially epidural blockade induced the perfect pain relief for phantom limb-like neuralgia inspite of that they had characteristics of deafferentation pain syndroms.

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We investigated the adequate repetition frequency of Stellate Ganglion Block (SGB) from the autonomic nerve function by heart rate variability analysis. A case of 61 years old female with postcerebro-meningitis, who suffered mainly with some numbness at face and extremity and with a weakness at underextremity was examined. She received 200 times of SGB during 2 years and the analysing results of autonomic nerve function in this case were as follows;
1) From a point of view concerning sympathetic and parasympathetic nerve function, the sympathetic side was more clearly blocked after left or right SGB each time. But when it evaluated by the parameters to show only para-sympathetic nerve function, those parameters were restraind especially after left SGB.
2) Until 50 times of SGB, above treatments displayed some balance regulating effect between sympathetic and parasympathetic nerve function, and restraining effect to the excessive excitement of sympathetic nerve function on all such occasions at least until 90 times. Those effects were not recognized even if more than 90 times.
3) When the autonomic nerve function after SGB showed countrary to mentioned above, it suggested that the condition of patient was abnormal in particular.

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An increasing number of patients with osteoporosis of the type that occurs chronicaly in the elderly, and particulaly in elderly women have recently realized in our pain clinic.
We feel that it is important not only to treat pain in these patients, but also to follow up bone mass and prevent the loss of bone mass. To measure bone mass in patients with osteoporosis, we emploied the Microdensitometry (MD) method, and we examined change of bone mass in patients on long-term therapy with Gui-zhi-jia-shu-fu-tang.
In 15 patients given Gui-zhi-jia-shu-fu-tang, the initial bone mass data were: metacarpal index (MCI), 0.39±0.99; bone density (ΣGS/D), 2.07±0.36. Measurements performed after three, six, and nine months of treatment showed no difference or an increase from the initial values. At nine months, the MCI was 0.41±0.09 and the ΣGS/D was 2.15±0.31, showing a 2.4% and 4.4% increase, respectively. In addition, the severity of pain was reduced by treatment with Gui-zhi-jia-shu-fu-tang.
As an untreated control group, we selected 10 osteoporotic patients who have discontinued the treatment. Bone mass was measured by the MD method and the follow-up period was six months to one year (mean: 9.9 months). The initial MCI and ΣGS/D value were 0.40±0.07 and 2.26±0.41, respectively, and they were 0.36±0.05 and 1.99±0.37 after 10 months, showing a significant decrease.
The control group revealed a 10% decrease of bone mass over 10 months, while the group given Gui-zhi-jia-shu-fu-tang showed suppression of bone loss demonstrating the effect of this agent in maintaining and improving bone mass.

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We investigated the mechanism of the hanging-drop sign used for identification of the epidural space in the lateral position. We found that the movement of a drop in the hub is momentory and not continuous.
Method: In 29 patiens, we advanced 17G Tuohy needle to the interspinous ligament in the second or third lumbar interspace in lateral position. Then we connected the electric pressure transducer to the needle, and measured the pressure changes through epidural puncture. We also measured pressure changes using an epidural space model made from two thin rubber sheets representing the ligamentum flavum and dura mater.
Results: There were three pressure patterns in clinical cases. In the first 19 cases, the pressure went down to the negative range momentary with the feeling of penetration of the ligamentum flavum and continued negative pressure. In the second 8 cases, at first the negative pressure was same to the first cases but there was no negative pressure after penetration of the ligamentum flavum. In the third 2 cases, there was no negative pressure. In epidural space model, there was the same pressure patterns to clinical investigations according to the distance between two rubber sheets. Momentaly negative pressure was recorded when the rubber sheet which was regarded as the ligamentum flavum was penetrated.
Discussion: We thought that the changes of epidural puncture pressure were synthesis of penetration of the ligamentum flavum and compression of the dura mater. The ligamentum flavum could be the cause of the hunging drop sign.

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This study was performed to investigate effectiveness of 0.25% or 0.5% bupivacaine HCl which was applied to forty postoperative patients who underwent the upper abdominal surgery with continuous epidural analgesia. Analgesic extent, pain score, blood gas, blood pressure and plasma concentration of bupivacaine were measured. Tip of epidural catheter was placed at the Th7 epidural space in all patients before operation. 0.25% or 0.5% bupivacaine was administered continuously for 48 hours in 20 postoperative patents of two groups. A single dose of 6-7ml with bupivacaine was injected one hour before continuous epidural analgesia started. Continuous epidural infusion was given at the rate of 3.3-4.3ml/hour for 48 hours. The group of 0.5 bupivacaine revealed improved pain score than in 0.25% group. The plasma concentration of 0.5 bupivacaine reached 3.07±0.61μg/ml after 48 hours. This concentration did not exceed toxic dose of 4μg/ml. In this study, we demonstrated that 3.3-4.3ml/hr of 0.5% bupivacaine provided satisfying analgesic effects with better pain score and notoxic plasma concentration and no severe hypotension.

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A 32-year-old man received mid-thoracic epidural analgesia for Herpes Zoster. On the fifteenth day after epidural catheter insertion, symptoms began with increased fever, pain during epidural injection and thoracic and back pain. A white-yellowed pus was sucked through the catheter. The catheter was immediately and removed, antibiotic treatment was started, Piperacillin and Ceftazidime. A neurological examination demonstrated neck rigidity and bilateral hypesthesia in the distribution of Th3-Th7. However, muscle strength was normal in all extremities with brisk and symmetrical reflexes. On the next day, signs of epidural infection appeared, the patient lost bladder and bowel control. A MRI revealed a mass located behind the vertebral bodies. Culture of the tip of the catheter grew Penicillin resistant Staphylococcus aureus. Treatment with Piperacillin and Ceftazidime was changed to Cefazolin and Vancomycin according to the result of culture. Antibiotic therapy was continued until clinical improvement and repeated MRI showed resolution of the abscess and cord compression.

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Stellate ganglion block has been successful in the treatment of patients suffering from a variety of acute and chronic syndrome related sympath nervous system. We present a patient with vasomotor rhinitis due to whiplash injury, who responded positively to a stellate ganglion block given once a week.

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In the pain clinic area, the effectiveness of an analgesic treatment is generally evaluated with “effective rate” which is defined as the proportion of patients respondent to the treatment. For the appropriate evaluation of effective rate, its point estimation should be accompanied by an interval estimation, that is, a confidence interval to show the variability of the point estimation. In most cases, however, clinical investigations are based on only the point estimation, not on the interval estimation. Such approaches are not only inappropriate but also misleading. The paper presented 2 representative statistical methods to estimate confidence intervals of effective rate. Applications were given to 8 clinical reports in which only the point estimation of effective rate was used. The estimated confidence intervals were so long, particularly in small sample cases, that only the point estimation could not give enough information for the appropriate evaluation of effective rate. The results of the present study indicate the necessity of the interval estimation for the appropriate evaluation of effective rate.

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