Comparison of Peri-operative Risks between General Anesthesia and Thoracic Epidural Blockade Combined with General Anesthesia for on Hepatectomy / 대한마취과학회지

BACKGROUND: This study was conducted to investigate risk factors for perioperative periods between general anesthesia (GA group) and thoracic epidural blockade combined with general anesthesia (CEA group) for consecutive hepatic resections. METHODS: A retrospective chart review was carried out regarding 85 patients who had undergone hepatic resections. We compared the effects of postoperative pain control in the two groups, including pulmonary complications and durations of hospital stay. RESULTS: There was no significant difference in demographic data between the two groups. The perioperative fluid requirement and transfusions were lower in the CEA group. Supplemental analgesics requirement was significantly lower in the CEA group than the GA group in the 3 days postoperatively. There were no statistical difference between the two groups in nausea, vomiting, urticaria, constipation or urinary retention, but hypotension was more pronounced in the CEA group than the GA group. Postoperative pulmonary and surgical complications were similar between the two groups, but the duration of hospital stay was longer in the GA group than the CEA group. CONCLUSIONS: We conclude that the thoracic epidural blockade combined with general anesthesia provided lower surgical blood loss and better postoperative analgesia and hospital stay than general anesthesia for hepatic resections.

A Comparison of the Analgesic and Side Effects of Continuous Epidural Morphine and Nalbuphine after a Cesarean Section / 대한마취과학회지

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as pruritus, nausea, vomiting, and respiratory depression. The purpose of this study was to evaluate the analgesic efficacy and side effects of epidural morphine compared with epidural nalbuphine. METHODS: Fifty nine patients were randomly divided into 2 groups. For group M (n = 30), a bolus of 7 ml of saline and 2 mg of morphine were administered and for group N (n = 29), a bolus of 7 ml of saline and 4 mg of nalbuphine were administered. Continuous epidural analgesia was induced with morphine 4 mg, 0.5% bupivacaine 20 ml, 2% lidocaine 20 ml and normal saline 60 ml by a 2day infuser in group M, and with nalbuphine 20 mg, 0.5% bupivacaine 20 ml, 2% lidocaine 20 ml and normal saline 58 ml by a 2day infuser in group N. We compared the analgesic effect and side effects of the two groups for 48 hours. RESULTS: No significant hemodynamic changes were seen in any of the groups. The analgesic effects were good in the two groups (mean VAS < 3.0). The patients of group M had lower pain scores continually compared with group N and pain scores were statistically significant at 6, 12 and 24 hours. However, side effects occurred more frequently in group M. CONCLUSIONS: These results suggest that an adequate dosage of epidural morphine provides good analgesic effects and reduces the occurrence of side effects.