Introduction: Myelograghy is a process of instilling contrast medium to the subarachnoid space for evaluating the spinal column by radiography. There are various contrast solutions for different radiographic studies but not all of them are suitable for spinal column evaluation.Case Presentation: Our patient was a 60-year-old man who developed severe pain, tonic clonic convulsions and cardiopulmonary arrest after INTRATHECAL INJECTION of 14 mL of meglumine diatrizoate during an elective myelography procedure. Many of these cases would die or suffer from permanent sequelae if appropriate treatment is not received.Conclusions: Our subject recovered completely without any sequelae after receiving appropriate treatment in a multidisciplinary intensive care unit.

INTRATHECAL Fluorescein has been used widely for detection of cerebrospinal fluid (CSF) leakage. After administration of fluorescein many serious complications may happen. Pulmonary edema is one of the most serious complications that require emergency responses. In this study, we report a complicated case of pulmonary edema following INTRATHECAL fluorescein INJECTION.

Etomidate is an ultra-short-acting anesthetic agent derived from imidazole that can only be administered intravenously. Etomidate has excellent hemodynamic properties in inducing anesthesia, making it an ideal choice for patients with shock, hypovolemia, or significant cardiovascular disease, with minimal reduction in blood pressure. We report a case of a female patient who was given accidental etomidate INTRATHECALly instead of ropivacaine because of its similar appearance, which led to a slight decrease in blood pressure and no change in the pulse rate. The patient had stable vital signs and no neurological complications.

Tranexamic acid is generally used in the treatment of disorders that predispose one to bleeding. It is a synthetic lysine analog that has strong antifibrinolytic activity. Plasminogen binds to fibrin to form plasmin, which in turn degrades fibrin into fibrin degradation products. Tranexamic acid blocks the lysine binding site on plasminogen and prevents interaction with fibrin. Tranexamic acid reduces blood loss in open heart surgery, hip replacement, and gynecology procedures. In this first case of inadvertent INTRATHECAL INJECTION of Tranexamic acid in a pregnant woman, we found that a massive INTRATHECAL INJECTION of Tranexamic acid triggered refractory ventricular fibrillation and cardiovascular collapse, which did not respond to full resuscitation.

Background: High dose intravenous (i. t. ) INJECTION of methylprednisolone (MPSS) for spinal cord injury (SCI) is clinically controversial. Objectives: This study aimed to investigate whether i. t. MPSS would have a beneficial effect on SCI and whether or not it is a safe operation for SCI patients. Methods: An animal experiment was conducted to explore the safety and feasibility of i. t. Administration of MPSS. Male Sprague-Dawley rats were randomly divided into four groups: (1) sham group, i. t. INJECTION of normal saline (NS) (n = 25); (2) control group, SCI surgery (created using the Infinite Horizon IH-400 impactor) with i. t. INJECTION of NS (n = 25); (3) i. t. MPSS1 group, SCI with i. t. INJECTION of MPSS by a pulse therapy (n = 25); (4) i. t. MPSS2 group, SCI with i. t. INJECTION of MPSS intermittently (n = 25). Malondialdehyde (MDA), superoxide dismutase (SOD), and inflammatory cytokines in serum were measured at 6h, 24h, 48h, 7d, and 14d after surgery with commercial assay kits. Glial fibrillary acidic protein (GFAP) level was observed at 14 days after surgery by immunohistochemistry. Motor evoked potentials (MEP) and somatosensory evoked potential (SEP) were monitored and recorded separately before surgery and 1, 7, and 14 days after surgery. Also, locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale. Results: The results showed that the levels of MDA and SOD, and three inflammatory cytokines, including IL-1b, IL-6, and TNF- were reduced in i. t. MPSS groups than that of the control group (all P < 0. 05). The expression of GFAP was inhibited after i. t. MPSS treatment. The amplitude was reduced, and the latency period of SEP and MEP recovery was prolonged (all P < 0. 05) after MPSS administration. In addition, the recovery of limb function (BBB score) was significantly ameliorated (P < 0. 05) in SCI rats treated with MPSS compared with the control group. Conclusions: Our results demonstrated that i. t. MPSS was a potential strategy for reducing the secondary damage after SCI, especially the MPSS pulse therapy.

Background: This study compares patients’ satisfaction with patient-controlled analgesia versus INTRATHECAL opioid INJECTION after cesarean section in Shariati and Khalij Fars hospitals in Bandar Abbas City, Iran, from 2016 to 2017. Methods: This double-blind, randomized clinical trial included 60 women with term pregnancies scheduled for elective cesarean section in Shariati and Khalij Fars hospitals in Bandar Abbas City, Iran, from 2017 to 2018. The patients were randomized into two groups: One group received patient-controlled analgesia (PCA), and the other group received INTRATHECAL opioid INJECTION. A numerical rating scale was used to assess pain and patient satisfaction. The patients also reported nausea, vomiting, and pruritus. The data were analyzed using the SPSS software, version 25. Results: Nausea and or vomiting did not differ significantly between the groups (P=0. 46). The highest frequency of pruritus was observed in the PCA group at 1 (P=0. 44), 4 (P=1. 00), and 24 (P=0. 24) h after surgery. Patient satisfaction was higher in the INTRATHECAL opioid group (9. 23±1. 22) compared to the PCA group (8. 84±1. 22),however, the difference between groups was not statistically significant (P=0. 08). Discussion: The results of the current study showed that despite the novelty of PCA, this method is not superior to conventional methods such as INTRATHECAL opioid INJECTION for pain relief. Also, patient satisfaction was lower with PCA compared to INTRATHECAL opioids.

Background: Peripheral glucocorticoid receptors (GRs) are altered by peripheral nerve injury and may modulate the development of neuropathic pain. Two central pathogenic mechanisms underlying neuropathic pain are neuroinfl ammation and N-methyl-Daspartate receptor (NMDAR)-dependent neural plasticity in the spinal cord. Objectives: This study examined the eff ect of the non-competitive NMDAR antagonist dextromethorphan on partial sciatic nerve ligation (PSL)-induced neuropathic pain and the spinal expression of the glucocorticoid receptor (GR). Methods: Male mice were randomly assigned into a sham group and two groups receiving PSL followed by INTRATHECAL saline vehicle or dextromethorphan (iDMP). Vehicle or iDMP was administered 8-14 days after PSL. The hotplate paw-withdrawal latency was considered to measure thermal pain sensitivity. The spinal cord was then sectioned and immunostained for GR. Results: Thermal hyperalgesia developed similarly in the vehicle and iDMP groups prior to the INJECTIONs (P = 0. 828 and 0. 643); however, it was completely mitigated during the iDMP treatment (P < 0. 001). GR expression was signifi cantly higher in the vehicle group (55. 64  4. 50) than in the other groups (P < 0. 001). The iDMP group (9. 99  0. 66) showed signifi cantly higher GR expression than the sham group (6. 30  1. 96) (P = 0. 043). Conclusions: The suppression of PLS-induced thermal hyperalgesia by iDMP is associated with the downregulation of GR in the spinal cord, suggesting that this analgesic eff ect is mediated by inhibiting GR-regulated neuroinfl ammation.

I read with a great interest the recent article by Alebouyeh et al. about INTRATHECAL administration of amitriptyline and doxepin to induce spinal blockade and comparison of their effects with those of bupivacaine.

Background and objectives: In chronopharmacology the biological rhythm variations caused by drug administration is assessed. Evaluation of the time of drug administration and the qualitative and quantitative effects of reactions to drugs is called chronopharmacodynamics. In this study, we assessed the chronopharmacodynamics of INTRATHECAL co-administration of sufentanyl and bupivacaine in surgical operations of lower extremities.Methods: In 2006, patients aged 20-50 with ASA physical status of I and II, who underwent surgical operation of lower extremities were entered into this prospective study. The patients received a slow INTRATHECAL INJECTION of 10mg sufentanyl and 15 mg bupivacaine into subarachnoid of third and fourth lumbar spaces in 30 seconds. After the operation, the time of first pain sensation and the visual analogue scale (VAS) score, as the measure of severity of pain, were recorded.Results: 115 patients were studied in this project. The pain-free interval was considered as the time between INJECTION and patient’s demand for pain relief. This interval was 746 (± 322) minutes. The average score of pain severity on VAS at the time of demand for pain relief was 24.7 (± 9.3). The average pain-free duration in patients injected about noon or at midnight was significantly longer than the pain-free interval of other patients.Conclusion: The results show that INTRATHECAL co-administration of sufentanyl and bupivacaine at noon or midnight (conforming to the circadian rhythm) causes better pain-relief with longer duration in comparison with other times of the day or night.