The effect of continuous iv fentanyl infusion (1μg·kg^-1·h^-1) on postoperative pain was compared with that of buprenorphine suppository (0.2mg) in patients undergoing abdominal simple total hysterectomy. The assessments of pain and side effects were made for 16h after the operation. Postoperative pain was scored as 1=none, 2=mild, 3=moderate or 4=severe. The patients who were receiving fentanyl had significantly lower pain scores after 4h postoperative period, and asked for less supplemental analgesia. No respiratory depression was observed in both groups. There was no significant difference in the incidence of nausea that was a major side effect. We conclude that continuous iv infusion of fentanyl, compared with buprenorphine suppository, provides clinical advantages for the management of postoperative pain after hysterectomy.

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The Minnesota Multiphasic Personality Inventory (MMPI) is widely used in the psychological assessment of patients with chronic pain. Patients' profiles have been used in a number of ways: in attempts to discriminate between cases; as predictors of both medical treatment and pain management outcomes; and in attempt to assess degree of disability. This study examines the relationship between the MMPI scales and the pain intensity of patients with chronic pain evaluated by the Visual Analogue Scale, the Verbal Rating Scale, the Numerical Rating Scale, and the McGill Pain Questionnaire (MPQ). In this study we selected newcomers as subjects to minimize the influence of other factors, to catch whether personality profiles affect the intensity of pain more accurately. Several kinds of analysis demonstrate that personality profiles derived from the MMPI itself is not useful for the prediction of the quantitative aspects of pain. But it is noteworthy that there is significant relationship between the personality profiles and the qualitative aspects of pain when we take it into consideration using the MPQ.

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Aim of the investigation: We conducted endoscopic electrocautery of the thoracic sympathetic chain in 38 cases of hyperhidrosis from January 1994 to October 1995.
Methods: The surgical technique devised by Claes was performed using a resectscope. The sympathetic nerve trunk and ganglia from the second to fourth vertebrae were cauterized.
Results: The results immediately after surgery indicated that perspiration were either stopped or markelly decreased in 74 (97.4%) of the 76 voler surfaces (38 cases).
A survey by questionnaire and interview through telephone was conducted at the end of October 1995, and responses from 34 of the 38 patients were obtained. The duration of observation ranged from 0.5 month to 22 months (mean 8 months). Of these 34 patients (68 palms), perspiration either stopped or decreased in 64 palms (93.4%).
Conclusions: Compared with the efficacy of thoracic sympathetic alcohol block in our department which was successful in 75.7% of patients with the efficacy duration of 8 months on average, the endoscopic electrocautery showed a higher success rate with a longer duration of efficacy we presume this technique will be expected to become an effective treatment for hyperhidrosis.

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Two adult patients had lower limb pain and it was difficult to insert a catheter into the epidural space because of their deformities of the spine. An epidural catheter was inserted into the psoas compartment and a local anesthetic was administered via the catheter in each patient.
The injection of 10-20ml of the anesthetic solution produced pain reduction in both of them. No complications were obserbed.
This block could be easily performed by using a nerve stimulator and was advantageous to the patients with pain of a lower extremity.

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As osteoarthropathy (OA) of the knee occurs in the elderly and it needs a long term treatment, we are concerned of side effects of NSAIDs, steroid arthropathy and suppurative arthritis, caused by their frequent injection into knee joints. We have been using Chinese medicines as the drug therapy for OA of the knee because of its low incidence of side effects. In this study we compared analgesic effect of NSAIDs with that of Chinese medicines for OA of the knee.
Method: Sixty-seven OA patients suffering from knee pain were divided into 3 groups; Group A (n=10): NSAIDs group, Group B (n=29): Chinese medicines group, Group C (n=28): NSAIDs+Chinese medicines group. We prescribed 5 kinds of NSAIDs, mainly propionic acids, and 12 kinds of Chinese medicines in accordance with Zheng (Kampo diagnosis), and evaluated the improvement of the pain by pain scores (mean±SD).
Result: Pain scores in Group A, Group B and Group C were 5.5±2.8, 2.0±2.2 and 3.0±2.5, respectively. Either Group B (p<0.01) or Group C (p<0.05) showed significant improvement compared with Group A. No difference was seen between the groups B and C.
Conclusion: This study indicates the usefulness of Chinese medicines in the treatment of OA patient with knee pain.

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Here I report a case with rare complication associated with stellate ganglion block (SGB). A 32-yr-old woman was scheduled to undergo the SGB in the left-right alternation for nasal allergy. She developed significantly reproducible hypertension after the left SGB. Systolic blood pressure increased to more than 160mmHg in 8 of the 16 left SGB trials (more than 200mmHg in 3) versus in none of the 13 right SGB trials. Laboratory data showed an increase in plasma noradrenalin concentration corresponding to the hypertension after the left SGB. Ultrasonography, MRI and laboratory data did not show existence of ectopic pheochromocytoma. I speculate that mechanical stimulation of the left sympathetic nerve followed by the left vagus nerve block due to infiltration of local anesthetics caused the hypertension. As the conclusion, it should be recognized that such a complication, although rare, can occur in the left SGB.

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Thirty-three patients who had cervical radiculopathy were treated by epidural steroid injection, epidural block, and/or stellate ganglion block, and several additional blocks, i.e. intradiscal steroid injection, facet block and nerve root block the patients were followed up during 6-months eriod. Seventy-three percents of these patients had good pain relief. Seven patients (21% of 33 cases) showed recurrence of radicular pain, whereas the pain was mild. The results suggest that as conservative therapy for cervical radiculopathy, the procedure of appropriate nerve blocks might be effective in patients with radicular pain at neck, shoulder, interscapula and/or arm regions.

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In the area of pain clinic, routine statistical tests have been performed to compare effective rates between two kinds of treatments. In most of the statistical analyses, only significance levels are evaluated, without referring to statistical power and required sample sizes. Such approaches are inappropriate and may reach misleading conclusions. This paper presented a method to estimate statistical power and required sample sizes in comparing effective rates between two kinds of treatments. Applications were given to clinical reports in which effective rates of two kinds of treatments were compared with routine statistical tests without considering statistical power and required sample sizes. The results of the applications showed that in cases where sample sizes were smaller than required ones, differences of effective rates could not be detected due to the lack of statistical power, and that in cases where sample sizes were larger than required ones, statistical power became large enough to detect almost the same magnitude of differences of effective rates. The present study indicates the necessity of evaluating statistical power and required sample sizes for appropriate comparisons of effective rates.

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