According to Journal of Anesthesia (1994, 1995, 1996), Journal of Japan Society for Clinical anesthesia (1993, 1994, 1995) and Journal of Japan Society of Pain Clinicians (1994, 1995, 1996), there were 125 postoperative pain control reports following thoracotomy and intraabdominal surgery. Epidural analgesia was applied to 115 reports (92%) of 125 reports. Continuous epidural infusion of local anesthetics and opioids by balloon type infuser were commonly used. Bupivacaine 0.25-0.5% solution was a main local anesthetics for postoperative use. Common continuous epidural infusion rates were 1-2ml/h. Morphine (4.7±0.5mg/day), fentanyl (0.45±0.15mg/day) and buprenorphine (0.35±0.15mg/day) were 3 main opioids administered epidurally. There was few reports associated with respiratory depression in these reports.
However, respiratory depression following epidural opioids is unpredictable and may be associated with any opioid. It is clear that there is no opioid that is unequivocally safer than morphine for epidural use. Slow infusion should be safer than large intermittent epidural injections. Monitoring of the level of consciousness and counting of the respiratory rate are important. Other complications from administration of epidural opioid include pruritus, nausea, and urinary retention. Because of slow onset of epidural morphine analgesia, it is recommended that primary dose of epidural morphine is administered before surgery and then start continuous epidural infusion during surgery. That is useful to shorten the time of respiratory monitoring.

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The aim of this study is to evaluate the necessity of pain clinic therapy techniques in the emergency room.
Methods: Among the patients who visited Saga Medical School Emergehcy Department after the business hour, 30% of them presented pain as a chief complaints. A total of 2030 pain cases (974 male, and 1056 female) in emergency room were analyzed with respect to age, sex, time of visit, pain site and the disease causing the pain.
Results: 60% of all patients who visited the emergency room during the night was complaint of pain. Most of these patients were under 15 years old. On the other hand, over 16 years old with pain mostly visited in the day time. The most common site of pain was the abdomen. The complaints of upper abdominal pain were presented by male patient, while the most of those with lower abdominal pain were female patients. Earache, headache, eye pain, pain in the extremity were the next common types. Among others, 170 patients visited to control pain derived from urethral pain.
Conclusion: Despite pain is not a fatal disease, many patients visit the emergency room at night. An analysis of patients with pain revealed specificity to age, gender, and the time of the visit. There were pain cases which were misdiagnosed as a mental case or a drug addiction. Although pain itself does not lead a patient to death, patients with pain visit emergency room regardless of time. As presented above, we conclude needs for pain management exist as a part of emergency room function.

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The prognosis of sudden deafness depends on the time duration from the onset to the treatment. Otolaryngologists suggest that the prognosis is poorer if the treatment is started 9 days after the onset. We examined the effectiveness of stellate ganglion block (SGB) for sudden deafness according to the time differences of a start of SGB. Ninety-one patients scheduled to undergo SGB were divided into two groups: those who were receiving SGB within 8 days of onset, and those who were receiving SGB 9 days after the onset. Treatment was effective in 65.8% of the 16 patients who underwent SGB within 8 days of the onset, and in 69.3% of the 75 patients who underwent SGB 9 days after the onset. There was no statistically significant difference between them. Furthermore, we divided the latter 75 patients into two groups: those who were receiving SGB within three weeks of the onset and three weeks after the onset. Treatment was effective in 76.9% of the patients who underwent SGB within 3 weeks of onset, and in 52.2% of the 23 patients who underwent SGB 3 weeks after onset. A statistically significant difference between them was found. We conclude that SGB should be performed within three weeks of the onset of sudden deafness.

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Objectives: RSD is associated with intractable pain, hyperalgesia and decreases in bone mass. In the present study, we measured bone mass in 19 upper limb RSD patients and compared obtained values on both the affected and normal side. Left and right differences in the patients were also compared to those observed in healthy volunteers. The correlation between the time from RSD onset and decreases in bone mass was also evaluated.
Methods: Bone mass was measured in the second metacarpus by microdensitometry (MD). The following 4 parameters were used for comparison: MCI, ΣGS/D, GSmax and GSmin.
Results: Left and right differences were 3% to 9% for all parameters in the control group, while in the RSD group, decreases in bone mass of 14% (MCI) and 12% to 25% (ΣGS/D, GSmax and GSmin) were observed on the affected side. ΣGS/D and GSmin data showed significant correlation between the time from RSD onset and decreases in bone mass.
Conclusion: Findings obtained in the present study suggested that decreases in bone mass are due to decreases in bone density, rather than thinning of cortical bones, a pattern different from that observed at the degenerative stage of osteoporosis. It was also found that bone density decreases with time after onset and that decreases in bone mass occur already at an acute stage.

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The Neurometer is a variable constant current sine wave stimulator, and has recently been proposed as a simple non-invasive, quantitative and selective measure of peripheral nerve function. In order to assess its potential and significance in the quantification of peripheral nerve function of Aβ, Aδ, and C fibers in patients with chronic pain, perception thresholds and amount of current required to elicit moderate pain at 5, 250, and 2, 000Hz stimulation were measured in different sites before and after intravenous regional sympathetic block in three patients with sympathetically maintained pain and compared with the pain complaint. There was a good correlation between the quantitative results and patients' qualitative complaints; when the above two values increased after the block, the degree of subjective pain perception decreased. It is concluded that the supplementary use of the device may be a simple and comprehensive way of assessing peripheral nerve function in patients with chronic pain.

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To study whether an implanted epidural catheter and drug infusion system improve patients' QOL, we used this device for 18 patients. An implanted epidural catheter inserted by paramedian approach through the subcutaneous tunnel was connected to the external ambulatory infusion pump system. Epidural morphine, 4mg/day, through this delivery system provided excellent pain relief in patients suffering intractable pain and not responding to oral analgesic.
A technique for the insertion of an implanted drug system is easy, a less invasive procedure, and this system is much less expensive in comparison with the system, formerly used.
This method of delivery systems can be used in home health care programs as well as in outpatient clinic.

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We report two patients whose unilateral edema in the lower limb disappeared after lumbar sympathetic ganglion block. Neither patient had clinically apparent cardiovascular disorders. Case 1: An 85-year-old woman had edema in the left lower limb. The edema improved markedly one week after lumbar sympathetic ganglion block with alcohol. Case 2: A 76-year-old man having edema and pain in the left lower limb received lumbar sympathetic ganglion block with bupivacaine. Three days after the start of the procedure, edema in the limb disappeared. We conclude that lumbar sympathetic ganglion block may be effective in some patients with unilateral edema in the lower limb.

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We used lidocaine tape which contained 60% lidocaine (Penles^®) as ancillary therapy in patients with trigeminal neuralgia (TN). Five patients with TN were treated with the tape, which was applied to the skin surface on the infraorbital foramen or trigger point. After 30 minutes of application, pain decreased significantly, and no skin damage was found. It was concluded that the lidocaine tape is useful in the treatment of TN because of reduction of pain at the site of application.

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