The Comparison of Ropivacaine and Bupivacaine in Epidural Patient Controlled Analgesia (PCA) / 대한마취과학회지

BACKGROUND: Local anesthetics combined with an opiate are frequently used as a postoperative epidural PCA regimen. Ropivacaine is known to have a selective blockade of the sensory nerve without motor blockade. This study is designed to show advantages of ropivacaine over bupivacaine. METHODS: Patients undergoing elective abdominal and orthopedic surgeries were randomly selected and divided into two groups, B and R. The patients in group B and R received 0.2% bupivacaine and 0.2% ropivacaine respectively through an epidural catheter using a PCA pump. Both local anesthetic solutions were mixed with 4 microgram/ml of fentanyl. The PCA pumps of both groups were set in the same manner. A basal rate of 2 ml/hr was infused from 1hour after the onset of surgery. This basal rate was continued postoperatively. A bolus dose and lock out time were set at 2 ml and 20 minutes respectively. The Visual analogue pain scale (VAS), demand dose, complication and additional intramuscular analgesic requirements were checked up to 24 hours after surgery in 6-hour interval. RESULTS: The VAS was significantly lower in group R than in group B at 6, 12, 18 and 24 hours after the surgery (P < 0.05). Total additional bolus doses of the PCA pump were not significantly different in either group at 6, 12, 18 and 24 hours after surgery. The patients in group R showed more satisfaction and less additional intramuscular injections. CONCLUSIONS: 0.2% Ropivacaine, mixed with 4microgram/ml of fentanyl, was more effective than bupivacaine, mixed with the same concentration of fentanyl, in controlling postoperative pain using an epidural PCA pump.

The Effect of Ketorolac on Propofol Injection Pain / 대한마취과학회지

BACKGROUND: Many strategies to reduce pain during propofol injection have been investigated. Inhibitors of cyclooxygenase are frequently used to provide post operative pain relief in patients undergoing minor gynecologic surgery. Therefore, in this study, we have investigated whether ketorolac injected intravenously reduces pain during propofol injection. METHODS: Fifty healthy female patients scheduled for minor gynecological surgery were randomly allocated to one of four groups. All patients were inserted 20 G Angiocatheter into the veins on the dorsum of the hands. After applying an arm tourniquet at an inflation pressure of 40-45 mmHg, the control group received 2 ml of 0.9% saline, and those in groups I, II, and III received ketorolac 0.5, 0.75, and 1.0 mg/kg mixed with 2 ml of 0.9% saline respectively. The tourniquet was released 2 minutes later. 2 mg/kg of 1% propofol bolus was then injected with an infusion pump intravenously. After 50 mg of propofol were injected, patients were assessed for visual analogue scale (VAS) scores and pain grades. RESULTS: VAS scores during propofol injection diminished significantly in group II (0.75 mg/kg ketorolac) and group III (1 mg/kg ketorolac) compared with the control (saline) group. CONCLUSIONS: Pretreatment with intravenous ketorolac more than 0.75 mg/kg during the 2 minutes tourniquet time can reduce pain elicited by profofol injection.

The Relationship Between Central Venous Pressure and Pulmonary Capillary Wedge Pressure in Patients with Aortic Stenosis / 대한마취과학회지

BACKGROUND: Hemodynamic monitoring during aortic valve replacement in patients with aortic stenosis is controversial and there are little prospective data on which to base an enlightened clinical decision. The relationship between central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) was examined in patients with aortic stenosis. METHODS: 30 patients with aortic stenosis who underwent aortic valve replacement were examined. For each patient, simultaneous measurements of CVP, pulmonary artery diastolic pressure (PADP) and PCWP were made at pre-and post-cardiopulmonary bypass. After cardiopulmonary bypass, measurement of left atrial pressure(LAP) was made. RESULTS: The PCWP correlated well with PADP(r=0.86 p0.05, r=0.45 p>0.05), PCWP(r=0.39 p0.05, r=0.51 p<0.05). CONCLUSIONS: This study confirmed the disparities between CVP and PCWP which were anticipated in aortic stenosis. This disparity seems due to marked differences between either compliance or function of the two ventricles. Therefore, CVP monitoring in aortic stenosis is limited value and may mislead in management.