Comparison between Bolus Injection and Continuous Infusion of Ondansetron on Nausea and Vomiting in Intravenous, Patient-controlled Analgesia after Laparoscopic-assisted Vaginal Hysterectomy using Propofol and Remifentanil Anesthesia / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate the effect of continuous infusion of ondansetron compared with bolus injection on the incidence of postoperative nausea and vomiting (PONV) in intravenous, patient-controlled analgesia (PCA). METHODS: Sixty three women undergoing laparoscopic-assisted vaginal hysterectomy were randomly allocated according to the method of ondansetron administration: bolus injection of ondansetron (8 mg) after the operation (Bolus group, n = 21); continuous infusion after ondansetron (8 mg) mixed to PCA (PCA 8 mix group, n = 22); and continuous infusion after ondansetron (16 mg) mixed to PCA (PCA 16 mix group, n = 20). The PONV were measured at 1 hr, 6 hr, 24 hr and 48 hr after operation and pain scores (visual analog scale, VAS) were checked. RESULTS: The incidence of PONV during 48 hr in the Bolus group (23.8%) and PCA 16 mix group (20.0%) were significantly lower than PCA 8 mix group (54.5%) (P < 0.05). The three groups showed similar VAS pain scores. CONCLUSIONS: Our results suggest that continuous infusion of ondansetron 16 mg is as effective as a bolus injection of ondansetron (8 mg) at preventing PONV in high-risk patients.

Detection of Substance P, Calcitonin Gene-Related Peptide and Prostaglandin E2 in Human Epidural Space / 대한통증학회지

BACKGROUND: Several biochemical mediators, such as substance P, calcitonin gene-related peptide (CGRP) and prostaglandin E2, have been demonstrated to be involved in herniated or degenerated disc-induced radiculopathy. The authors tested the hypothesis that these mediators would existed in the epidural space of humans. METHODS: Thirty nine patients were divided into two groups; 27 patients, who were diagnosed with spinal stenosis (stenosis group), and 12 scheduled for epidural anesthesia, without a history of back pain (control group). Under fluoroscopic guidance, an epidural catheter was introduced through the caudal space and placed into the anterior and posterior spaces, up to and around the epidural adhesive area, in the stenosis group. In the control group, the catheter was placed into the posterior epidural space through the L3 4 or L4 5 intervertebral space. Epidural irrigation was performed with 10 ml of saline, via an epidural catheter. Aspirated lavage fluid was collected, and the concentrations of biochemical mediators (substance P, CGRP and prostaglandin E2) measured using an enzyme immunoassay kit. RESULTS: Substance P, CGRP and prostaglandin E2 were detected in all the epidural lavage fluids from both groups. The concentrations of substance P and prostaglandin E2 in the stenosis group were higher than those of the control (P < 0.05). However, there was no difference in the CGRP levels between the two groups. In the stenosis group, the concentrations of these three mediators in the anterior epidural space were no different to those in the posterior space. CONCLUSIONS: These results suggest that biochemical mediators, such as substance P and prostaglandin E2, in the epidural space might be partly involved in pain mechanism associated with spinal stenosis.