-Abstract-
For the relief of pain in : cases of whiplash syndromes (case Ⅰ, Ⅱ and Ⅳ) and in
one of reflex sympathetic dystrophy (case Ⅲ), we have carried out six intentional. total
spinal blocks (TSB) which attempted two times in case Ⅰ, three in case Ⅱ and one in
carte Ⅲ whoso various symptoms were chronically unresponsive to the usual
conservative treatments, and a time of cervical epidural and right suprascapular nerve
block in case W whose acute symptom lasted 4 drys following the cervical injury (see
fables from 1 to 9).
During the 753, we have observed clinically the sequential charges of respiration, lid
and pupil reflexes, body motion and consciousness. And checked the blood pressure,
pulse rate and arterial Pco2.
The effectiveness of those blocks has been assessed by using the Visual Analog Scale
which is designed to measure the patients subjective intensity of pain and also we have
found out the sequelae following those blocks.
The methods of the blocks were as the following:
1. Under the N.P.O. for 8∼10 hours, the preparations of immediate cardiopulmonary
resuscitation and premedication with atropine 0.5ng at thirty minutes before the TSB, it
was performed by injecting the mixture of 2% mepivacaine 10 or 15㎖ and normal saline
10 or 5㎖ through No.23 G. spinal needle into the subarachnoid space of
C7-T1 interspinous region with fully flexed neck on the
lateral posture.
Immediately after the injection of the local anesthetic in the lateral position, the
patients were hasten to change Trendelenburga position in order to act the drugs
cephalad and to make easy controlled respiration with oxygen.
2. The cervical epidural block was done by injecting the mixture of 0.5% bupivacaine
4㎖, normal saline 4㎖ and triamcinolone 15㎎ through No. 186. Tuohy needle into the
epidural space on the same region and posture as the above without premedication.7he
suprascapular nerve block was done by injecting of 0.5% bupivacaine 3㎖ only into the
right suprascapular fossa on the sitting posture.
The results were as the following:
1. The cessation of respiration was seen within 5 minutes following the
subarachnoidal injection of the above 20㎖ mixture in 2 to 3 minutes and then soon the
consciousness began to disappear. The loss of Lid and pupil reflexes noted between 5 to
10 minutes and the size of the dilated pupils was equal between 5 to 20 minutes, but
the pupil of the dependent side on tile lateral position was dilated 1 to 3 minutes earlier
than that of the independent. The patients had r=ever responded to any stimulations
during the TSB except their heart funtion.
2. The recovery of the TSB was as the following, firstly the ankle and lower limb of
the independent side began to move slightly with in 34 to 7i minutes after the injection
and then that of the dependent Secondly the neck and upper limb moved 6 to 15
minutes later than the lower limb. Thirdly the self respiration began to appear between
40 to 80 minutes from the block. The lid and pupil reacted to touch and light
respectively between 40 to 80 minutes but the pupil of the independent side responded
earlier than that of the depends. Lastly the consciousness recovered completely between
80 to 125 minutes from the block.
3. In the cardiopulmonary function during the TSB, the blood pressure were stable
except the 210/130 tory at the and block of case Ⅰ. There were bradycardias between
6i to 85 minutes in case Ⅰ and Ⅱ but no arrythmia on the EKG. The level of the
arterial Pco2 was maintained to 43∼45 torr during the TSB.
4. The effectiveness of the above blocks was no pain(0%) in case n , and light (10∼
20%) in case Ⅰ and Ⅱ but no improvement in case Ⅲ.
5. The right arm weakness has been complicated as to be Injected accidently the
"COLD" local anesthetic at the End block of case Ⅰ.
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