Preemptive Effect of Epidural Fentanyl on Postoperative Pain / 대한마취과학회지

BACKGROUND: Preemptive analgesia may prevent nociceptive input generated during surgery from sensitizing central neurons and, therefore, may reduce postoperative pain. The purpose of this study is to examine the effect of epidural fentanyl between preincisional (preemptive) and postincisional groups on postoperative morphine requirements. METHODS: Sixty patients (ASA physical status 1 or 2) scheduled for elective total abdominal hysterectomy under general anesthesia were allocated randomly to one of two groups and prospectively studied in a double-blind manner. Group 1 received epidural fentanyl(2 g/kg in 15 ml normal saline) before surgical incision followed by epidural normal saline (15 ml) 15 minutes after skin incision. Group 2 received epidural normal saline(15 ml) before surgical incision followed by epidural fentanyl(2 g/kg in 15 ml normal saline) 15 minutes after skin incision. No additional analgesics were used before or during the operation. Postoperative visual analogue pain scores, PCA morphine requirements and side effects were assessed. RESULTS: Postoperative PCA morphine requirements in preincisional group were significantly less (p<0.05) than those in postincisional group between 6 and 24 hours postoperatively. VAPS was also significantly less (p<0.05) in preemptive group than in postincisional group 12 hours after surgery. CONCLUSIONS: Preemptive analgesia with epidural fentanyl is more effective in reducing the postoperative morphine requirements and VAPS than analgesia with postincisional epidural fentanyl in patients with total abdominal hysterectomy.

The Comparison of Central Approach and Nobukata`s Method for the Internal Jugular Vein Cannulation / 대한마취과학회지

Anesthesiologists prefer the intemal jugular vein (IJV) for central venous cannulation. Most approaches use the sternocleidomastoid muscle as a landmark but, a new approach for internal jugular venipuncture is using bony rather than soft tissue landmarks that was developed by Nobukata et al. in 1991. The landmarks of Nobukata's method consist of four bony landmarks the notch, which was located just above the medial end of the clavicle; the sternal end of clavicle; the mastoid process; and the cricoid cartilage. In order to compare Nobukata's method with Central approach, we evaluated 100 patients prospectively. We allocated randomly two hundreds ASA physical status 1, 2 and 3 patients to two groups. Central approach was employed for central venous cannulation in group 1 and Nobukata's method was done in group 2. In both group, two attempts were employed to right IJV and one attempt was done left IJV if right venipuncture was failed or hematoma formation occured. Successful cannulation rate on the 2nd attempt was 97% in group 1 and 96% in group 2, and overall success rate was 100% in both groups. Complications included arterial puncture in 3 cases (3%) and in 2 cases (2%) in group 1 and group 2 respectively, and hematoma formation in 2 cases (2%) in group 2. From the above results, in some cases of anesthetized patients, short neck, obese patients whose soft tissue landmarks are less t, and during cardiac arrest, Nobukata's method can be used alternatively to Central approach.