Objective: Obese patients demonstrate a variety of biochemical, metabolic, and pulmonary abnormalities. Inflammatory mediators such as tumor necrosis factor-␣ and interleukin-6 (IL-6) may have a direct effect on glucose and lipid metabolism. Hypoxemia in itself induces release of IL-6. The aim of this study was to examine the relationship between IL-6 levels in healthy volunteers (control group) and three different groups of obese patients: patients without obstructive sleep apnea syndrome (OSAS), patients with OSAS, and patients with obesity hypoventilation syndrome (OHS) (daytime baseline oxygen saturation of Ͻ93%). Research Methods and Procedures:We measured serum IL-6 levels in 25 obese patients (body mass index of Ͼ35 kg/m 2 ) and 12 healthy women. Results:The results demonstrate statistically significant differences in serum IL-6 levels between the control group (1.28 Ϯ 0.85 pg/mL) and obese patients without OSAS (7.69 Ϯ 5.06 pg/mL, p Ͻ 0.05) and with OSAS (5.58 Ϯ 0.37 pg/mL, p Ͻ 0.0005). In the patients with OHS, IL-6 concentrations were highest (43.13 Ϯ 24.27 pg/mL). Discussion: We conclude that serum IL-6 is increased in obese patients. The highest IL-6 levels were found in the patients with OHS.

A pilot study of continuous postoperative regional analgesia by nerve sheath block for lower limb amputation is presented. At the time of exposure of sciatic or posterior tibial nerve trunks during above- or below-knee amputations in 11 patients with ASA physical status III or IV, a catheter was introduced directly into the transected nerve sheath for continuous infusion of 0.25% bupivacaine at a rate of 10 mL/h for 72 h. Effective amputation stump analgesia was obtained, significantly reducing the need for on-demand narcotic analgesics during this time to a mean dose equivalent of 1.4 mg of morphine compared with a retrospective control group who received the equivalent of a mean dose of 18.4 mg of morphine (P less than 0.0001). No complications related to the technique were observed. A follow-up of the group receiving continuous postoperative regional analgesia for up to 12 mo showed a total absence of phantom pain despite the presence of preoperative limb pain.

The history of intrathecal and epidural anaesthesia is in parallel with the development of general anaesthesia. As ether anaesthesia (1846) is considered the first modern anaesthetic since its use by Morton 157 yr ago, so Bier made history by using cocaine for intrathecal anaesthesia in 1898. The first published report on opioids for intrathecal anaesthesia belongs to a Romanian surgeon, Racoviceanu-Pitesti, who presented his experience at Paris in 1901. It was almost a century before the opioids were used for epidural analgesia. Behar and his colleagues published the first report on the epidural use of morphine for the treatment of pain in The Lancet in 1979. Epidural and intrathecal opioids are today part of a routine regimen for intra- and postoperative analgesia. Over the last 30 yr, the use of epidural opioids has became a standard for analgesia in labour and delivery, and for the management of chronic pain. Finally, epidural opioids have been shown to have a pre-emptive effect, when used before major surgery. We present the evolution of neuraxial anaesthesia and the history of intrathecal and epidural administration of opioids.