BackgroundPostherpetic neuralgia (PHN) is usually managed pharmacologically. It is not uncommon for patients with chronic kidney disease (CKD) to suffer from PHN. It is difficult to prescribe a sufficient dose of anticonvulsants for intractable pain because of the decreased glomerular filtration rate. If the neural blockade and pulsed radiofrequency ablation provide only short-term amelioration of pain, spinal cord stimulation (SCS) with a low level of evidence may be used only as a last resort. This study was done to evaluate the efficacy of spinal cord stimulation in the treatment of PHN in patients with CKD.MethodsPHN patients with CKD who needed hemo-dialysis who received insufficient relief of pain over a VAS of 8 regardless of the neuropathic medications were eligible for SCS trial. The follow-up period was at least 2 years after permanent implantation.ResultsEleven patients received percutaneous SCS test trial from Jan 2003 to Dec 2007. Four patients had successfully received a permanent SCS implant with their pain being tolerable at a VAS score of less than 3 along with small doses of neuropathic medications.ConclusionsSCS was helpful in managing tolerable pain levels in some PHN patients with CKD along with tolerable neuropathic medications for over 2 years.

Certain oral procedures require a sedated patient who is responsive to allow for the mouth opening and position change. Dexmedetomidine is a relatively selective alpha2-adrenoceptor agonist with sedative, analgesic, amnestic, and anesthetic-sparing effects. Large dose dexmedetomidine is suitable as a single agent for sedation and anxiolysis for plate removal in a patient with bilateral sagittal split osteotomy and Lefort 1 osteotomy with genioplasty.Key Words: Dexmedetomidine, Sedation, Oral procedure A 25-year-old, 50 kg, 160 cm woman with surgical history of bilateral sagittal split osteotomy (BSSO) and Lefort 1 osteotomy with genioplasty, was scheduled for plate and screw removal. In the operating room, standard ASA monitors were applied with a MAC-safe nasal cannula to monitor end-tidal CO 2 concentration (Fig. 1). Dexmedetomidine was initiated with an intravenous (IV) loading dose of 1 mcg/kg delivered over 10 minutes, followed by an infusion rate of 1 mcg/kg/hr. Subsequently, the dexmedetomidine infusion was titrated to effect and stoped when the main part ofthe procedure was completed.The patient was then prepped and draped in a standard fashion for an orthognathic surgical procedure. The patient's oropharynx was thoroughly irrigated and suctioned free of debris. 10 ml of 2%