The effects of intrathecal fentanyl for spinal anesthesia in lower extremity surgery / 대한마취과학회지

BACKGROUND: Intrathecal opioids in combination with bupivacaine has been shown to provide adequate sensory blockade and early recovery from spinal anesthesia. This study was investigated the added effects of intrathecal fentanyl 10 microgram to bupivacaine for spinal anesthesia. METHODS: Sixty patients undergoing lower extremity surgery were into three groups. Group I received bupivacaine 10 mg (0.5%), gruop II received bupivacaine 5 mg with normal saline 1 ml, and group III received bupivacaine 5 mg with fentanyl 10 microg and normal saline 0.8 ml. RESULTS: There was no significant difference between group I and group III in the peak level and duration of sensory block. But the intensity of motor blockade was decreased in group III compared with group I and side effects of spinal anesthesia with local anesthetics was decreased in group III compared with group I. In Group II, 7 patients were complained the pain during surgery. CONCLUSIONS: Intrathecal fentanyl 10 microgram with bupivacaine 5 mg on spinal blockade provide reliable anesthesia for lower extremity surgery.

Effect of tramadol on bispectral index during anesthesia with desflurane / 대한마취과학회지

BACKGROUND: This study is aimed to investigate the effect of tramadol on the bispectral index (BIS) during anesthesia with desflurane. METHODS: One hundred fifty adults, ASA class 1 and 2 patients, scheduled for general anesthesia for elective surgical procedures were included in this study. None of the patients were premedicated and anesthesia was induced with propofol 2 mg/kg and maintained with air-oxygen (FiO2 0.5) and desflurane, adjusted to keep the BIS between from 50 and 60. Forty minutes before completing surgery, the subjects were randomly allocated into 3 groups to receive saline (control group), tramadol 1.5 mg/kg (T1 group) or 3.0 mg/kg (T2 group) intravenously. Hemodynamics and BIS values were then recorded every 5 minutes until completion of the operation, during which time the concentrations of desflurane were not modified. RESULTS: The mean BIS values after tramadol administration weren't significantly different from the control group throughout the period of observation. No significant changes in the hemodynamics were noted, except systolic and diastolic arterial blood pressure in the T1 and T2 groups significantly increased in the first 5 minutes after the tramadol injection. CONCLUSIONS: The results indicate that the administration of tramadol while maintaining anesthesia with desflurane, adjusted to keep the BIS between 50 and 60, does not modified BIS values. So, we propose that tramadol can be safely administered as an immediate postoperative analgesia without concern about intra-operative awareness.

The Dose-Dependent Analgesic Effect of Lidocaine for Pain on Injecting Rocuronium / 대한마취과학회지

BACKGROUND: Rocuronium produce intense discomfort on IV injection in conscious patients. The purpose of this study was to evaluate the incidence and severity of pain associated with IV injection of rocuronium in conscious patients and to determine the efficacy of different doses of IV lidocaine at minimizing injection pain. METHODS: The author evaluated 120 in-patients undergoing various elective surgeries. Patients were randomized into four groups of 30 patients for this blind, prospective study. After tourniquet application on the forearm, the patients were given saline (3 ml) (Group I, n = 30), lidocaine 20 mg (Group II, n = 30), lidocaine 40 mg (Group III, n = 30), or lidocaine 60 mg (Group IV, n = 30) diluted in a 3 ml solution. The occlusion was released after 20 seconds and rocuronium 0.6 mg/kg was injected over 10 seconds. The patients were observed and asked immediately if they had pain in the arm; responses were assessed. Five mg/kg of thiopental sodium was injected intravenously, 30 seconds after the administration of rocuronium. RESULTS: The incidence of pain was 86.7% in group I and was significantly lower group II (60.0%), group III (36.3%), and in IV (P <0.05). In addition, patients pretreated with lidocaine were less likely to suffer moderate to severe pain. But, pain incidences and severities were similar in those that received 40 mg or 60 mg of lidocaine. CONCLUSIONS: Lidocaine was effective at relieving rocuronium-induced and doses of 40 mg and 60 mg of lidocaine were most effective.

The Effect of the Thoracic Epidural Analgesia on Postoperative Pain and Pulmonary Function Recovery after Thoracoscopic Surgery / 대한마취과학회지

BACKGROUND: The study was performed to evaluate the effect of the thoracic epidural analgesia on the postoperative pain and pulmonary function after thoracoscopic surgery. METHODS: Postoperative pain control consisted of continuous thoracic epidural infusion of normal saline in group 1 (Control group) and 0.125% bupivacaine mixed with fentanyl 5microgram/ml in group 2 (TEA group) added in single intercostal nerve block patient in sixty patients who had undergone elective thoracoscopic surgery. The visual analogue scale (VAS), Prince-Henry score (PHS) and pulmonary function (FVC and FEV1) were measured preoperatively and postoperatively at 4, 8, 12, 24, 48 hours. RESULTS: There were significant improvement of the degree of pain in both groups but TEA group was lower than control group during 48 hours except at postoperative 4 hours. Pulmonary function was decreased less and recovered faster in TEA group than control group during 48 hours (P < 0.05). CONCLUSIONS: Thoracic epidural analgesia added in single intercostal nerve block has a benefit on the recovery of the postoperative pulmonary function and also provide superior analgesia after thoracoscopic surgery when compared to single intercostal nerve block alone. The authors recommend thoracic epidural analgesia for patient undergoing thoracoscopic surgery who receive single intercostal nerve block.