Spinal anesthesia-lidocaine and dextrose.
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Adult↗
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Results for “Injections, Spinal”
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Peridural effusion of drugs following sympathetic blockade.
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Aged↗
Percutaneous injection of metrizamide into spinal cord cysts for preoperative diagnosis of syringomyelia.
Five cases of syringomyelia are reported in which the spinal cysts were percutaneously punctured and filled with metrizamide for preoperative diagnosis. There were no side effects from the puncture or the contrast medium. In all cases the cyst was larger than had been demonstrated by previous myelography. A communication to the fourth ventricle was seen in two cases. Four patients had surgical treatment; the neurologic deficits improved in two patients, while the condition of the others has remained unchanged.
Humans↗
[Comparative study between continuous and bolus subarachnoid administration of 2% lidocaine].
OBJECTIVE: To compare anesthesia with lidocaine 2% by bolus or by continuous perfusion through a subarachnoid catheter. PATIENTS AND METHODS: Thirty-one patients undergoing surgery on a lower limb were studied prospectively. Patients were divided into two groups: 14 received subarachnoid anesthesia in continuous perfusion (group CP) while 17 were given subarachnoid anesthesia in bolus form (group B). An 18G Tuohy needle was used with a 20 G catheter. An initial bolus of 20 mg (1 ml) was administered in group CP and followed by continuous perfusion at a rate of 16 mg/h (0.8 ml/h). In group B an initial 20 mg bolus was followed by additional ones of 10 mg (0.5 ml). The optimum sensory level was T 10. RESULTS: The two groups were homogeneous with respect to age, weight, height and medical history. Fewer boluses were needed with continuous perfusion. Seven patients (50%) in group CP required additional boluses. The ratio of total drug dose administered in mg to time of surgery was significantly higher in group CP. The sensory and motor blockade levels obtained were similar in the two groups. One case of hypotension and one of bradycardia were recorded. Two cases of minor headache were recorded in group B. Sedation was used in 7 patients (50%) in group CP and in 13 (76%) in group B. CONCLUSION: Subarachnoid administration of lidocaine 2% in continuous perfusion affords the same sensory and motor blockade as administration in bolus form and does not reduce the overall amount of lidocaine used.
Aged↗
Epidural steroid injections in the treatment of symptomatic lumbar spinal stenosis associated with epidural lipomatosis.
Epidural lipomatosis has been implicated as a cause or contributor of symptomatic lumbar spinal stenosis. Although epidural steroid injections have been very successful for symptomatic treatment of spinal stenosis; their role in treatment of symptomatic stenosis secondary to epidural lipomatosis is unclear. A review literature (MEDLINE, PubMed) found no reports justifying the use of steroids. We present two patients with lumbar epidural lipomatosis causing or contributing to symptomatic spinal stenosis. Both patients presented with unilateral lower limb radicular symptoms unrelieved with conservative measures such as medications and physical therapy. They were treated with a single transforaminal epidural steroid injection at the symptomatic level. Both had 80-85% pain relief. These reports suggest a beneficial role of epidural steroid injections for patients with symptomatic lumbar spinal stenosis caused by or contributing to epidural lipomatosis.
Aged↗
Spinal cord blood flow after intrathecal injection of ropivacaine and bupivacaine with or without epinephrine in rats.
BACKGROUND: Ropivacaine is a new local anaesthetic available for spinal and epidural anaesthesia. When new drugs are being introduced for spinal application, their effect on spinal cord blood flow (SCBF) should be studied for safety and toxicological aspects. In the present study, SCBF was studied after intrathecal (i.t.) application of ropivacaine and bupivacaine with and without epinephrine. METHOD: SCBF was measured continuously in spontaneously breathing, enflurane/N2O anaesthetized rats, using laser-Doppler flowmetry technique. The spinal cord was exposed by laminectomy at the L1-L2 level, and a laser-Doppler probe was placed over the dorsal horn, allowing on-line registration of SCBF in a tissue hemisphere of 1-2 mm. Relative changes in SCBF were then measured on-line after i.t. administration of increasing doses of ropivacaine, bupivacaine or bupivacaine with epinephrine. RESULTS: Ropivacaine and bupivacaine decreased SCBF in a dose-dependent manner. In contrast, the reduction in SCBF produced by bupivacaine + epinephrine (Bupi + Epi) was equal for all doses of bupivacaine. The order of magnitude of SCBF decreases was Bupi + Epi > ropivacaine > bupivacaine. The maximal decrease in SCBF at the highest concentration given (10 mg/ml) was 37 +/- 6% for ropivacaine, 27 +/- 7% for bupivacaine and 40 +/- 6% for bupivacaine + epinephrine. CONCLUSION: Ropivacaine and bupivacaine produce a dose-related, transient decrease in SCBF following i.t. administration in anaesthetized rats. However, the decrease in SCBF produced by both ropivacaine, when epinephrine was added in a concentration of 5 micrograms/ml. These results suggest that ropivacaine, like bupivacaine, may be used for spinal anaesthesia without important effects on SCBF.
Amides↗
Spinal cord blood flow after intrathecal injection of a N-methyl-D-aspartate receptor antagonist or an adenosine receptor agonist in rats.
Evaluation of spinal cord blood flow (SCBF) is important as a preclinical screening for potential neurotoxicologic side effects before introducing new therapeutic drugs for intrathecal (IT) administration. This study was undertaken to determine whether two drugs with possible antinociceptive effects, the N-methyl-D-aspartate receptor antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) and the adenosine agonist R-phenylisopropyladenosine (R-PIA), would affect SCBF after IT administration in the rat. SCBF was measured 30 min after IT injection of either saline, 4 nmol of CPP or 10 nmol or R-PIA in anesthetized rats by quantitative autoradiography with [14C]iodantipyrine as a tracer. No differences in SCBF were found between groups treated with saline or CPP. In the group where R-PIA was administered IT, grey matter blood flow was 10% greater than in the group that received saline, whereas no differences were found in white matter blood flow or in the grey/white matter ratio between the groups. We concluded that neither CPP nor R-PIA, when administered IT to anesthetized rats in provocative doses within the upper pharmacologic dose range, reduces SCBF in rats 30 min after IT injection. This indicates that neither neurotoxicologic nor antinociceptive effects are likely to occur due to decrease in SCBF. Our results do not indicate that these drugs should be avoided for the treatment of pain.
Animals↗
[Influence of injection speed of the spread of 4.0 ml of 0.5% isobaric bupivacaine in spinal anesthesia].
Influence of injection speed on the spread of isobaric 0.5% bupivacaine 4.0 ml was studied in 100 patients to analyze the correlation between analgesia levels and patient's characteristics. All patients (ASA PS I.II) were scheduled for orthopedic or urological procedures, and received no premedication. They were randomly divided into two groups by injection speed; group 1 of 0.2 ml.sec-1 and group 2 of 0.03 ml.sec-1. Spinal tap was performed in lateral decubitus position at the L 3-4 intenspace with median approach, using a 25 G Quincke needle. Immediately after the injection, the patient was placed in supine position. The maximum sensory block was tested by pinprick method, and no significant difference in the height of sensory block was observed between the two groups. No significant correlation with patient's characteristics was observed except body weight in group 1. This study suggests that the speed of injection does not influence the spread of isobaric 0.5% bupivacaine 4.0 ml.
Anesthesia, Spinal↗
Anterior thoracic spinal fusion in dogs by injection of recombinant human bone morphogenetic protein-2 and a synthetic polymer.
The purpose of this study was to achieve spinal fusion in the absence of bone graft material using a new, injectable, and semi-liquid synthetic polymer (polylactic acid polyethylene glycol [PLA-PEG] block copolymer) containing recombinant human bone morphogenetic protein-2 (rhBMP-2). Twenty-seven skeletally mature beagles underwent anterior thoracic spinal fusion at T9-T10. Group I (n = 9) was injected with 1 mL of PLA-PEG block copolymer carrier alone into space under the vertebral pleura and the anterior longitudinal ligament. Group II (n = 9) was injected with 1 mL of PLA-PEG carrier containing 500 microgram of rhBMP-2. Group III (n = 9) was injected with 1 mL of PLA-PEG carrier containing 1000 microgram of rhBMP-2. In the Group I animals, no evidence of new bone formation was noted at the implanted sites both radiographically and histologically. In contrast, all of the nine animals in Group III showed new bone formation in 12 weeks, and four of the nine animals in Group II showed bony mass at the injected sites. However, vertebral bony fusion was incomplete despite the significant amount of new bone formation in both groups that showed new bone formation. In addition to resulting in improvements in the surgical procedure, injection of rhBMP-2 and a synthetic polymer is useful for bone formation for spinal fusion.
Animals↗
A study of overlap and collateralization of bulbar reticular and raphe neurons which project to the spinal cord and diencephalon of the North American opossum.
Labeled neurons were found in most reticular and raphe nuclei of the opossum's medulla after horseradish peroxidase (HRP) injections into either the spinal cord or diencephalon. The labeling produced by spinal injections differed somewhat from that produced by diencephalic ones, but HRP-positive neurons were found in what appeared to be comparable areas. In order to study the intermingling of bulbospinal and bulbodiencephalic neurons more directly, we used fluorescent markers (true blue, nuclear yellow and diamidino yellow dihydrochloride) in double-labeling experiments. When injections of one dye into the spinal cord were combined with injections of another into the diencephalon, neurons labeled by one or the other marker were found to be intermingled in most reticular and raphe nuclei. The double-labeling experiments also showed that some neurons of the bulbar reticular formation and raphe project to both the spinal cord and diencephalon, presumably by axonal collaterals. The number of such neurons represents a somewhat larger proportion of those projecting to the diencephalon than to the spinal cord. It appears, however, that most neurons project either to the spinal cord or to the diencephalon and do not provide collaterals to both areas.
Animals↗
Thrombosis of the posterior spinal arteries. A complication of an intrathecal injection of phenol.
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Anesthesia, Spinal↗
[Morphofunctional changes in the spinal cord and spinal ganglion tissues following epidural injection of clopheline].
Epidural injection of clophelin extends the possibilities and increases of the effectiveness of regional anesthesia in clinical treatment of pain syndromes. Morphological and histoenzymological changes in spinal cord and spinal ganglion neurons were analyzed in dogs after epidural injection of clophelin. The results indicate the absence of pathological structural and metabolic changes in nervous tissue following clophelin administration. Increase in neuronal RNA content and microvascular alkaline phosphatase activity in experimental group as compared to the control one indicates the activation of protein synthesis and the augmentation of active transport processes in the nervous tissue capillary endothelium, both of which may be interpreted as the favorable phenomena.
Analgesics↗
Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature.
BACKGROUND CONTEXT: The injection of various solutions aimed at producing a sclerosing effect has been used to treat soft tissues injuries (eg, inguinal hernia) for more than 100 years. In the 1930s, this treatment approach was applied to injured joints in an attempt to stimulate connective tissue repair. Although several studies have been published about this method of treatment for various orthopedic and spinal indications (termed prolotherapy), its use remains controversial. PURPOSE: To conduct a critical review of the literature on prolotherapy for spinal pain. STUDY DESIGN/SETTING: Critical review of the literature. METHODS: Computerized medical literature databases (Medline, CINAHL, Mantis, Cochrane Central Register of Controlled Trials) were searched to uncover all published information about the use of sclerosing injections in humans with spinal pain disorders. Search results were reviewed for relevance, and information was abstracted from full-text articles. RESULTS: Our search uncovered almost 200 reference materials in various media related to prolotherapy, including 31 clinical studies related to spinal pain. There were 26 observational cohorts and 5 randomized clinical trials (RCTs). Indications in these studies were low back pain (22), neck pain (3), cervical headaches (3) and dorsal or thoracic pain (3). A total of 20 sclerosing solutions were used in these studies; the most common was a mixture of dextrose 12.5%, glycerin 12.5%, phenol 1.25% and lidocaine 0.25%. Wide variations were found in treatment protocols, such as dose, number of treatments and use of adjunct therapies. Most cohort studies were only of moderate quality and varied greatly in the substances injected and the use of co-interventions. Most clinical studies reported positive results such as decreased pain or disability, although differences between treatment and control groups did not always reach statistical significance. Commonly reported adverse reactions to this treatment include temporary postinjection pain and stiffness. A handful of more serious adverse events were reported in the 1950s and 1960s with stronger or unknown solutions. CONCLUSION: Prolotherapy describes a variety of treatment approaches rather than a specific protocol. Results from clinical studies published to date indicate that it may be effective at reducing spinal pain. Great variation was found in the injection and treatment protocols used in these studies that preclude definite conclusions. Future research should focus on those solutions and protocols that are most commonly used in clinical practice and have been used in trials reporting effectiveness to help determine which patients, if any, are most likely to benefit from this treatment.
Clinical Trials as Topic↗
Monoclonal autoantibody SCH94.03, which promotes central nervous system remyelination, recognizes an antigen on the surface of oligodendrocytes.
A monoclonal antibody SCH94.03, made in syngeneic mice by injection of spinal cord homogenate, promotes central nervous system remyelination when injected into SJL/J mice chronically infected with Theiler's virus. To elucidate the mechanism of antibody-mediated remyelination, SCH94.03 was investigated by immunocytochemistry, flow cytometry, immunoelectron microscopy, Western blotting, and immuno-thin layer chromatography. All cell types investigated in vitro showed strong cytoplasmic staining with a pattern resembling a cytoskeletal protein. In contrast, among the primary cultured cells studied, only oligodendrocytes showed strong surface reactivity. Other cell types, including astrocytes, microglia, Schwann cells, myoblasts, and T and B lymphocytes, were negative. Mouse and rat oligodendrocytes which showed strong surface reactivity exhibited a well-differentiated morphology, and approximately 50% expressed myelin basic protein. Since oligodendrocyte progenitors were negative for surface staining, the expression of the antigens recognized by this monoclonal antibody appears to be developmentally regulated, i.e., transiently expressed on younger, terminally differentiating oligodendrocytes. Among the cell lines studied, only two rat oligodendrocyte lineage cell lines showed surface reactivity with SCH 94.03. Western blotting of secondary isolated oligodendrocytes lysates revealed reactivity with multiple protein bands of 27, 32, 50, 100, and 106 kDa, whereas there was no reactivity to lipid antigens by immuno-thin layer chromatography. These results raise the possibility that SCH94.03 recognizes a novel oligodendrocyte-specific surface antigen, and may act directly on oligodendrocytes to promote remyelination.
Animals↗
Effects of intramedullary injection of methiodal and lidocaine on spinal cords of dogs.
A solution of methiodal sodium (20%) and lidocaine HCl (0.20%) was given by intramedullary injection into the lumbar spinal cords of 12 anesthetized dogs (group I). Two control groups of 12 dogs each were subjected to needle placement only or were given 5% dextrose. The results showed that both solutions given by intramedullary injection caused severe spinal cord malacia and cavitation in 2 group I dogs and in 1 group III dog.
Animals↗
The effects of intrathecal administration of the dopamine agonist apomorphine on penile reflexes and copulation in the male rat.
Relatively high doses of systemically administered apomorphine inhibit penile reflexes. It is possible that these inhibitory effects are due, at least in part, to actions of apomorphine on the lumbosacral spinal cord. The present experiments examined this possibility by injecting apomorphine (10 and 50 micrograms/5.0 microliters vehicle) into the lumbosacral subarachnoid space through chronic, indwelling cannulae. Such injections impaired ex copula penile reflexes, slowed the rate of copulation, and decreased the number of intromissions preceding ejaculation. These results suggest that lumbosacral cord dopamine receptors may normally regulate male sexual performance.
Animals↗
[Effectiveness and safety of radium chloride in the treatment of ankylosing spondylitis. Results of an observational study].
After radium chloride was approved for the therapy of ankylosing spondylitis (AS) in Germany on October 23, 2000, an open, non-comparative prospective observational study was planed. The assessment involved 308 patients with the diagnosis of AS and radiological evidence of spinal involvement who were treated with at least one injection of radium chloride. 278 of these patients received the full cycle of 10 injections (a total of 10 MBq radium-224) one injection one per week for a period of 10 successive weeks. Validated outcomes were measured before therapy and six months after therapy according to the recommendations of the "assessment in ankylosing spondylitis working group"(ASAS). The primary endpoint was disease activity assessed using the BASDAI ("Bath Ankylosing Spondylitis Disease Activity Index"). Secondary endpoints included the BASFI ("Bath Ankylosing Spondylitis Functional Index"), as well as self-reported pain and global patient ratings. Patients showed significant improvement in all of the parameters assessed (BASDAI, BASFI, pain, global patient rating) at 6-months post-treatment. At this time, the mean BASDAI and BASFI scores improved from 5.5 to 3.5 and from 5.6 to 3.7, respectively. Pain decreased from a mean of 7.3 to 4.1, and disease activity (as rated by patients) also decreased from 7.2 to 4.1 (p < 0.001 for all of them). Drug tolerance was good. Six adverse events were documented, none of which was serious and none led to discontinuation of treatment. According to the data provided here medical treatment with radium chloride seems to be effective and safe during an observation period of 6 months. Nevertheless, a randomized placebo-controlled study should be performed in the near future in order to safeguard the level of evidence.
Adult↗