Young Joo, Eun-Kyung Kim, Hyun-Gul Song, Haesun Jung, Hanssl Park, and Jee Youn Moon. Korean J Pain 2021;34:304-14. https://doi.org/10.3344/kjp.2021.34.3.304

Young Joo, Hyung Rae Cho, and Young Uk Kim. Korean J Pain 2020;33:60-5. https://doi.org/10.3344/kjp.2020.33.1.60

Objective. Thickened inferior glenohumeral ligament (IGHL) is considered as one of the major morphological parameters of adhesive capsulitis (AC). Previous studies reported that the anterior band of inferior glenohumeral ligament thickness (aIGHLT) is correlated with shoulder capsular contracture, luxatio erecta humeri, and AC. However, the thickness varies from the measured angle. To reduce this measurement error, we devised a new morphological parameter, called the anterior band of inferior glenohumeral ligament area (aIGHLA). Methods. The aIGHL samples were collected from 54 patients with AC and from 50 control subjects who underwent shoulder magnetic resonance imaging (MRI) without any evidence of AC. Coronal T2-weighted MRI images were obtained at the shoulder level from each patient. We measured the aIGHLA and aIGHLT at the maximal view of the IGHL in the coronal plane using our picture archiving and communication system. The aIGHLA was measured at the whole cross-sectional area of the IGHL in the most hypertrophied segment of the coronal MR images. The aIGHLT was measured at the thickest point of the IGHL. Results. The average aIGHLA was 55.58 ± 14.16 mm² in the control group and 83.71 ± 28.45 mm² in the AC group. The average aIGHLT was 3.47 ± 0.99 mm in the control group and 4.52 ± 1.02 mm in the AC group. AC patients showed significantly greater aIGHLA (p<0.001) and aIGHLT (p<0.001) than control subjects. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score of the aIGHLA was 63.37 mm², with 79.6% sensitivity, 80.0% specificity, and AUC of 0.84 (95% CI, 0.76–0.92). The optimal cut-off point of the IGHLT was 3.81 mm, with 74.1% sensitivity, 74.0% specificity, and AUC of 0.77 (95% CI, 0.68–0.86). Conclusions. Although the aIGHLA and aIGHLT were both significantly associated with AC, the aIGHLA was a more sensitive diagnostic parameter.

Carpal tunnel syndrome (CTS) is correlated with increased intracarpal canal pressure (ICP). The effect of palmaris longus tendon (PLT) loading on ICP is documented in previous researches. PLT loading induces the greatest absolute increase in ICP. Therefore, to analyze the connection between the PLT and CTS, we newly made the measurement of the PLT cross-sectional area (PLTCSA). We assumed that PLTCSA is a reliable diagnostic parameter in the CTS. PLTCSA measurement data were acquired from 21 patients with CTS, and from 21 normal subjects who underwent wrist magnetic resonance imaging (W-MRI). We measured the PLTCSA at the level of pisiform on W-MRI. The PLTCSA was measured on the outlining of PLT. The two different cutoff values in the analysis were determined using receiver operating characteristic (ROC) analysis. The mean PLTCSA was 2.34 ± 0.82 mm² in the normal group and 3.97 ± 1.18 mm² in the CTS group. ROC curve analysis concluded that the best cutoff point for the PLTCSA was 2.81 mm², with 76.2% sensitivity, 71.4% specificity, and area under the curve of 0.88 (95% CI, 0.78‐0.98). PLTCSA is a sensitive, new, objective morphological parameter for evaluating CTS.

Background and Objectives: Remimazolam is a recently introduced benzodiazepine that has been increasingly adopted as an alternative to propofol. Although several trials have compared remimazolam with propofol, these studies have primarily focused on induction-related hypotension in non-gynecologic settings. To the best of our knowledge, both intraoperative hypertension and hypotension have not been systematically evaluated throughout the full anesthetic course in the specific physiologic context of robot-assisted laparoscopic gynecologic surgery performed in the steep Trendelenburg position with pneumoperitoneum. Materials and Methods: In this retrospective study, propensity score matching was performed to minimize selection bias. The demographic data of 694 patients, along with the incidence of intraoperative hypertension and hypotension, were collected through a review of medical records. Results: A total of 694 patients met the selection criteria, all of whom underwent total intravenous anesthesia (TIVA) using either remimazolam (n = 321) or propofol (n = 373). After propensity score matching, 317 pairs were analyzed. The incidence of intraoperative hypertension was higher in the remimazolam group (66.2% vs. 52.1%; p < 0.001), whereas hypotension was more frequent in the propofol group (12.0% vs. 5.4%; p = 0.003). Conclusions: TIVA with remimazolam was associated with a higher incidence of intraoperative hypertension compared to propofol, whereas propofol was more likely to cause hypotension in patients undergoing laparoscopic gynecologic surgery.

Background and Objectives: The Analgesia Nociception Index (ANI), a surrogate marker derived from heart rate variability (HRV) analysis, has been validated for assessing the balance between antinociception and nociception during propofol anesthesia. The ANI continuously monitors this balance, with values above 50 indicating optimal analgesia. By adjusting analgesic administration based on ANI values, anesthesiologists can provide more personalized intraoperative pain control. Remimazolam, a novel benzodiazepine anesthetic lacking intrinsic analgesic properties, exhibits distinct HRV patterns compared to propofol. Considering these differences, the validity of the ANI during remimazolam anesthesia remains uncertain. We evaluated the validity of the ANI by assessing its ability to detect nociceptive stimuli during remimazolam anesthesia. Materials and Methods: In total, 28 patients were administered general anesthesia using remimazolam and remifentanil. We evaluated changes in the ANI before and after tetanic stimulation. In addition, we investigated the association between hemodynamic responses during surgical incisions and changes in the ANI. Results: Tetanic stimulation resulted in a significant (p < 0.001) reduction in the ANI, from 62.0 (interquartile range [IQR] 50.5–76.0) to 44.0 (IQR 37.0–55.5). Of the 13 patients who experienced hemodynamic responses during surgical incision, the ANI significantly decreased from 63.2 ± 13.6 to 36.9 ± 13.8 following noxious surgical stimulation (p < 0.001). Conclusions: The ANI reflects the dynamic equilibrium between antinociception and nociception during remimazolam-based general anesthesia.