Effect of Peritonsillar Lidocaine Infiltration on Posttonsillectomy Pain in Children / 대한마취과학회지

BACKGROUND: Recent studies suggest the hypothesis that blockade of nociceptive input with local anesthetics before surgery can decrease pain beyond the immediate postoperative period. The purpose of this study was to determine if the preincisional infiltration with local anesthetics affected postoperative pain relief. METHOD: Among 30 patients having tonsillectomy, 15 patients(group 1) given peritonsillar infiltration using lidocaine with epinephrine(1 : 200,000) were compared with 15 patients(group 2)given peritonsillar infiltration using saline with epinephrine(1 : 200,000). Following general anesthesia with a mixture of O2-N2O(50%) and enflurane(1-2vol.%), peritonsillar infiltration were performed 5 minutes before surgery. Constant incisional pain and pain on swallowing were assessed using a visual analogue scale at 4 hour, 1, 2, 3 and 4 days postoperatively. The time to emergence and behaviour of patient at 0.5, 1 and 4 hour were recorded postoperatively. RESULT: Preincisional infiltration with lidocaine resulted in a significant decrease in postoperative pain during 4 days after surgery and smoother emergence. CONCLUSION: There were significant difference in pain scores between lidocaine group and saline group during 4 days after surgery. Preincisional lidocaine infiltration seemed to have analgesic activity beyond the residual anesthetic period. The results of this study support the theory of pre-emptive analgesia.

Prolongation of Tetracaine - Spinal Anesthesia by Intrathecal Morphine / 대한마취과학회지

Narcotic analgesics may be added to spinal anesthetics solution to improve the quality of sensorimotor blockade and to produce postoperative pain relief. The opioid-related side effects of respiratory depression, pruritus, nausea, and urinary retension also occur with intrathecal administration and the effects are dose-related. It is difficult to select morphine with spinal anesthetic solution due to fatal side-effect, respiratory depression. Intrathecal morphine dose used for our study was less than 1mg, thereby the risk of respiratory depression was decreased. There was no report that the addition of morphine affected the motor block produced by the local anesthetics in spinal anesthesia. But in our study, we found that 0.9 mg of intrathecal morphine produced prolongation of optimal condition for operation(more than 3 hours duration), and sufficient postoperative pain relief(for about 20 hours) without respiratory depression in 28 out of 30 spinal anesthesia cases. On the other hand, 0.5 mg or 0.7 mg of intrathecal morphine produced sufficient postoperative pain relief without respiratory depression(for about 20 hours), but insufficient prolongation of optimal condition for operation in each 30 cases of spinal anesthesia.

CT Guided Celiac Plexus Block / 대한마취과학회지

Neurolysis of the celiac plexus has been performed to relieve intractable pain cauaed by carcinoma of the pancreas, liver, gall bladder or atomach. It is also occasionally effective in controlling the pain of chronic pancreatitis. In practice, hoarever celiac plexus 71oct ig not a simple procedure to the beginner. The results and 77mplications are variable, In order to correctly inject neurolytic agents into or near the celiac plexus and to reduce the time consumed to perform celiac plexus block, we used CT scanner for 7 cases of alcohol celiac plexus b1ock. The effects will be described. The purpose Of 7hia article is to improve the technical aspect of Celiac Plexus block to the beginner.

Acute Pulmonary Edema during Anesthesia and Operation - A case report / 대한마취과학회지

Acute pulmonary edema during anesthesia and operation is not common. We have recently experienced a case of acute pulmonary edema in a 13 year old girl which developed during anesthesia and operation for her fractured radial head. No specific cause could be found. She didn't have any known cardiopulmonary disease, and responded well to vigorous therapy, but hypoxic brain damage resulted. Her semicomatose state lasted about 40days, and she then recovered slowly and completely in several months.