The purpose of this study was to evaluate the rate of phrenic nerve palsy after interscalene brachial plexus block with anterior approach for arthroscopic shoulder surgery. A hundred twenty-five patients were enrolled in this study. We used 10 ml of 1％ mepivacaine and 10 ml of 0.75％ ropivacaine for all cases. Postoperative chest X-ray was taken at maximal expiration and maximal inspiration. Phrenic nerve palsy was defined as expiratory and inspiratory diaphragm height less than one vertebral body. The patients were divided into two groups, positive phrenic nerve palsy positive (PNP) group and negative phrenic nerve palsy (nPNP) group. The rate of phrenic nerve palsy was 33.6％ postoperatively. No patient complained of dyspnea during and after the operation. Median age was significantly high in PNP group. Body mass index, induction time for anesthesia, operation time, effectiveness and success rate of nerve block were not significantly difference in both groups.

This multicenter, post-marketing surveillance study (August 2019–November 2021) investigated the risk of dizziness-/somnolence-related events in patients receiving mirogabalin for peripheral neuropathic pain for ≤14 weeks. By renal impairment group, 57.3％–86.2％ and 37.2％–58.5％ of patients received the initial (2.5–10 mg) and effective (7.5–30 mg) mirogabalin doses recommended in the package insert, respectively. Dizziness-/somnolence-related event incidences were 6.29％/6.55％, and 7.46％/7.33％ in patients with normal renal function/mild impairment (n＝1,160) and moderate/severe impairment (n＝764). Median risk ratios of moderate/severe impairment vs normal/mild impairment for dizziness- (1.188; posterior probability ≥1.2 and ≥2.0, 47.67％ and 0.09％, respectively) and somnolence-related events (1.121; posterior probability ≥1.2 and ≥2.0, 34.20％ and 0.03％, respectively) did not reach the predefined increased risk criteria (posterior probabilities of risk ratios ≥1.2 [probability ≥90％] and ≥2.0 [probability ≥10％]). Similar results were obtained after adjusting for confounding factors. In clinical practice, dizziness-/somnolence-related event risk did not increase with renal impairment severity except for patients with end-stage renal failure/requiring hemodialysis.

Spinal cord stimulation (SCS) is considered to be an effective therapy for neuropathic pain that does not respond to conservative treatment. We report a case in which SCS effectively improved the chronic intractable lower leg pain due to nutritional and alcoholic neuropathy. A 40-year-old woman, with a history of alcoholism and anorexia. About two-years ago, she presented with lower leg pain. She was diagnosed with nutritional and alcoholic neuropathy by a neurologist and treated with vitamin supplementation. However, she was suffering from severe pain, and she was referred to our department. We treated with conservative treatments but they were not effective. Therefore, SCS was performed, and her symptoms improved after surgery. Metabolic neuropathy due to vitamin deficiency and alcoholism is occasionally accompanied by a form of intractable pain despite treatment of the primary disease. SCS treatment should be considered as an effective treatment for non-responders to conservative treatments.