The Analgesic Efficacy of a 5% Eutectic Mixture of Lidocaine and Prilocaine Prior to Insertion of Spinal and Epidural Block / 대한마취과학회지

BACKGROUND: We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLA(R)) topically applied before performing skin puncture for spinal or epidural anesthesia. METHODS: The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLA(R) cream 120 min before spinal block; group B - subcutaneous infiltrationof 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLA(R) cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediatelybefore epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale. RESULTS: Patients in group A experienced less pain compared with those in groups B and C (2.0 +/- 1.9 cm vs 4.1 +/- 1.9 cm and 3.9 +/- 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 +/- 2.4 cm vs 4.1 +/- 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05). CONCLUSIONS: EMLA(R) cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia.

A case of spinal myoclonus with radiculopathy following spine surgery: A case report / 대한마취과학회지

Despite adequate surgery, a number of patients have a return of back pain and radiculopathy of the legs following their operation. We present here a case of spinal myoclonus with radiculopathy after spine surgery. A 51 year old woman with bilateral radiculopathy and urinary incontinence was diagnosed with a cauda equina syndrome along with spinal stenosis. The patient underwent emergency operation for posterior decompression and internal fixation from the L2 to S1 levels. Immediately after surgery, the patient continued to experience intermittent myoclonic movement with severe shooting pain in her legs despite being given pharmacological treatments such as benzodiazepines, opioids, NSAIDs and gabapentin. The patient was found to have sudden, brief, bilateral involuntary muscle contraction on the lower extremities. The patient was referred to our pain clinic. She underwent a caudal block 2 times in 4 days. However, she reported only limited pain relief for 3 to 4 hours. She was then prescribed phenytoin 300 mg intravenously in a day; her myoclonic movement gradually subsided after 1 week of receiving phenytoin. Sixty days later, she was discharged without any long term sequelae.

Anesthetic Management in a Patient with Latex Anaphylaxis after Tourniquet Release: A case report / 대한마취과학회지

Latex is the second most common cause of anaphylaxis during anesthesia. The increasing number of reports of latex-induced anaphylaxis are a major concern for anesthesiologists. We encountered a 56-year-old male patient who developed severe anaphylactic shock whilst under anesthesia when the tourniquet was deflated during elbow arthrolysis. A subsequent allergy workup revealed an IgE mediated hypersensitivity to latex. This case highlights the need for anesthesiologists to be able to diagnose the signs and symptoms of allergic reactions in patients under anesthesia.

Neuromuscular Pharmacodynamics of Mivacurium in Patients with Major Burns / 대한마취과학회지

BACKGROUND: Burned patients sometimes require rapid onset of neuromuscular paralysis to secure the airway in full stomach patients or to treat laryngospasm. Because of poor lung function and hypermetabolic state, they desaturate quite rapidly. Burned patients are usually resistant to the effects of nondepolarizing relaxants. Mivacurium can be potentially a good alternative for rapid onset of paralysis, since it is metabolized by plasma cholinesterase, an enzyme often decreased in subject with major burns. This prospective study was conducted to define the neuromuscular pharmacodynamic profile of a single bolus dose of mivacurium in adult patients with major burns. METHODS: Adults (M/F = 22/8), aged 44.0 +/- 10.2 years, with total body surface area (TBSA) burn of 35.0 +/- 12.5% were studied at 39.8 +/- 28.9 post burn days. Age and sex matched 30 non-burned patients served as controls. Anesthesia was consisted of propofol and fentanyl infusion with nitrous oxide and oxygen. Mivacurium 0.2 mg/kg was administered as a bolus. Using TOF Watch, neuromuscular block was monitored with T1 response after the initial tetanic stimulation to recruit all muscle fibers. Onset time was defined as the interval from the beginning of drug administration to maximal twitch suppression. Intubation was attempted at 1 minute after the drug administration to simulate the rapid sequence induction with recording of either failure or success of intubation. By allowing spontaneous recovery without reversal drug, recovery profiles of neuromuscular paralysis were also measured. RESULTS: Patients demographics were similar in both groups except for the burn. Onset times and all recovery profiles were significantly prolonged in the burned versus non-burned groups. Attempts at intubation at 1 minute after the drug administration were successful with difficulty in approximately 70% of patients in both groups. CONCLUSIONS: Mivacurium 0.2 mg/kg demonstrated the conflicting dual responses in the burned patients. The prolonged onset time suggests resistance to neuromuscular effects. The prolonged recovery suggests increased sensitivity. This can be partially explained by the acetylcholine receptor proliferation and decreased level of plasma pseudocholinesterase. In view of the prolonged onset time of almost two minutes for maximal paralysis, mivacurium does not appear to be a good drug for rapid onset of paralysis in burns.

Enhanced Clearance of Propofol in Patients with Major Burns / 대한마취과학회지

BACKGROUND: Major burns can alter the pharmacokinetics of the commonly used drugs during the perioperative period. This study was carried out to define the pharmacokinetics of propofol in the burned patients during the subacute hyperdynamic phase of the injury. METHODS: Twenty adults, aged 43.7+/-2.3 years, with total body surface area burn of 44.0+/-22.2%, were examined at 14.1+/-2 days after the injury (mean+/-SD). Age and sex gender matched unburned patients were used as controls. Propofol 2 mg/kg was given intravenously over 10 seconds as a single bolus in both groups. Blood samples (n = 20) were collectedat predetermined intervals. A noncompartmental approach was used for the pharmacokinetic analyses of the propofol concentrations, which were determined by HPLC. The cardiac index was measured by esophageal echocardiography. RESULTS: The burns patients had a significantly higher cardiac index (CI). The clearance (Cl) and total volume of distribution (Vd) of propofol were higher in the burns patients, compared with the controls, yielding a smaller area under the curve. The total half-life (t1/2) was similar in both groups. CONCLUSIONS: There is a large increase in Vd and Cl in the burns patients compared to with the controls. The increased Cl in the burns patients is most likely to be related to the increased CI. Therefore, the initial bolus dose and maintenance infusion may have to be increased in the burns patients, provided the pharmacodynamic sensitivity is unaltered.

Enhanced Clearance of Propofol in Patients with Major Burns / 대한마취과학회지

BACKGROUND: Major burns can alter the pharmacokinetics of the commonly used drugs during the perioperative period. This study was carried out to define the pharmacokinetics of propofol in the burned patients during the subacute hyperdynamic phase of the injury. METHODS: Twenty adults, aged 43.7+/-2.3 years, with total body surface area burn of 44.0+/-22.2%, were examined at 14.1+/-2 days after the injury (mean+/-SD). Age and sex gender matched unburned patients were used as controls. Propofol 2 mg/kg was given intravenously over 10 seconds as a single bolus in both groups. Blood samples (n = 20) were collectedat predetermined intervals. A noncompartmental approach was used for the pharmacokinetic analyses of the propofol concentrations, which were determined by HPLC. The cardiac index was measured by esophageal echocardiography. RESULTS: The burns patients had a significantly higher cardiac index (CI). The clearance (Cl) and total volume of distribution (Vd) of propofol were higher in the burns patients, compared with the controls, yielding a smaller area under the curve. The total half-life (t1/2) was similar in both groups. CONCLUSIONS: There is a large increase in Vd and Cl in the burns patients compared to with the controls. The increased Cl in the burns patients is most likely to be related to the increased CI. Therefore, the initial bolus dose and maintenance infusion may have to be increased in the burns patients, provided the pharmacodynamic sensitivity is unaltered.

Performance Characteristics of High Efficiency Fluid and Blood Warmer using Print Circuit Board Heater at Various Flow Rates / 대한마취과학회지

BACKGROUND: Currently available warming devices are often heavy and cumbersome, requiring development of more portable, user friendly, high efficiency fluid and blood warmer. The intravenous fluid heating capabilities of a new, heat-plate print circuit board (PCB) based warmer at various low flow rates were tested. METHODS: Model Joyother BM-1(R) was investigated for normal saline (0.9% NaCl) and colloid at various infusion rates (60-6000 ml/hr). Final temperatures were measured by electronic thermometer after passing through the warmer. Effective warming was defined as a fluid temperature > or = 32degrees C. Ambient temperature was maintained at 22-25degrees C. Degree of heating capability and temperature decrease were compared and correlated between different flow rates. RESULTS: The device warmed the room temperature crystalloid and colloid efficiently. Its warming capability was continuously improved as the flow rates increased in all tested flow rates, reaching maximum 41degrees C. After the warming, the temperature decrease showed high negative correlation with the flow rates. The extent of cooling was less in colloid. No overheating was noted at sudden brake. CONCLUSIONS: Joyother BM-1(R) heated crystalloid and colloid sufficiently and safely enough for clinical application (exit temperature > or = 35degrees C) at various flow rates. The warming capacity and the length of the intravenous tube infusion system determined the efficiency of the warmer. Further study is warranted for the efficiency of warming for the blood and its element changes.

Anesthetic Management of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and a ST segment elevation in the right precordial leads), but without structural heart disease. It is a rare genetic disorder, with an autosomal dominant inheritance pattern. Many factors during general anesthesia (medication, bradycardia, temperature changes) can precipitate malignant dysrhythmia in this patient, so careful choice of anesthetics is required. We experienced the anesthetic management of a 50-year-old male patient with Brugada syndrome, who underwent an emergency operation, under general anesthesia for acute appendicitis. Surgery was performed uneventfully, and the patient was discharged without complication.

Anesthetic Management of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and a ST segment elevation in the right precordial leads), but without structural heart disease. It is a rare genetic disorder, with an autosomal dominant inheritance pattern. Many factors during general anesthesia (medication, bradycardia, temperature changes) can precipitate malignant dysrhythmia in this patient, so careful choice of anesthetics is required. We experienced the anesthetic management of a 50-year-old male patient with Brugada syndrome, who underwent an emergency operation, under general anesthesia for acute appendicitis. Surgery was performed uneventfully, and the patient was discharged without complication.

Acute Pulmonary Edema following Failed Intubation: A Case Report / 대한구급학회지

Pulmonary edema that follows upper airway obstruction may occur in a variety of clinical situations. Post anesthetic laryngospasm has been implicated as the most frequent cause of this syndrome. Risk factors for development of post laryngospasm pulmonary edema include difficult intubation; nasal, oral, or pharyngeal surgical site; and obesity with obstructive apnea. We report a case that developed acute bilateral pulmonary edema after laryngospasm induced by failed intubation.

A Study on the Effect of Dosage Increase and Methods of Ondansetron Administration on the Prevention of Postoperative Nausea and Vomiting of Vaginal Total Hysterectomy Patients during IV Patient-Controlled Analgesia / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting are a 'Big Little Problem' during IV-PCA after vaginal total hysterectomy. This study was designed to determine the effect of dosage and the method of ondansetron administration on the incidence of postoperative nausea and vomiting in patients that received intravenous patient-controlled analgesia (IV-PCA). METHODS: Sixty ASA I-II patients that underwent elective total vaginal hysterectomy and received postoperative IV-PCA were randomly divided into three groups according to dosage and the timing of ondansetron administration. These patients were given ondansetron; twice, (4 mg each) after induction and 5 minutes before the end of the operation (group 1); 8 mg 5 minutes before the end of the operation (group 2); and twice, (8 mg each) after induction and 5 minutes before the end of the operation (group 3). The incidences of nausea and vomiting and pain scores by visual analogue scale (VAS) were checked and recorded in recovery rooms and wards at 1, 6, 24, and 48 hours after operation, respectively. RESULTS: The three groups showed no significant differences in terms of the incidences of nausea and vomiting and had similar VAS pain scores. CONCLUSIONS: Our findings suggest that ondansetron dosage and methods of its administration are not effective at reducing the incidence of postoperative nausea and vomiting.

A Case of Acute Fatty Liver of Pregnancy / 대한주산의학회잡지

Acute fatty liver of pregnancy(AFLP) is rare, potentially fatal disorder developing in the third trimester of pregnancy. It is characterized by nausea, vomiting, jaundice and malaise. Initially the disease is often mistaken for preeclampsia, HELLP(hemolysis, elevated liver enzymes, low blood platelet count)syndrome, fulminant hepatitis and cholestasis of pregnancy. But acute fatty liver of pregnancy has clinical manifestations, biochemical findings and complications clearly distinguished of HELLP syndrome, fulminant hepatitis and cholestasis of pregnancy. We report a case of pregnancy complicated with fatty liver with brief review of the common causes of acute hepatic failure associated with pregnancy.

Experimental Radiofrequency Lesion Size Utilizing Different Parameters and Neuropathologic Correlation on the Peripheral Nerve / 대한마취과학회지

BACKGROUND: Radiofrequency (RF) lesioning is one of the most frequently used neurolytic techniques for the relief of pain. Technical advances enables one to make a more reliable and reproducible lesion production. If the size at different parameters is known, the maximal effects and reduction of the side effects could be achieved. However, its size can not be measured systematically using thermocouple (TC) electrodes. 'Differential selection of pain fibers' was proposed but there was not any neuropathologic evidence. We studied pathologic changes produced with various sizes and shapes of electrodes using different parameters. METHODS: Using fresh egg white, RF lesions were produced by four different electrodes at 65, 70, 75, 80 and 90degreesC. At each temperature, Photographs were taken at 10, 20, 30, 40, 50, 60, 90 and 120 seconds. Using the sciatic nerve of the rats, we performed RF lesioning utilizing two different electrodes at 70, 80 and 90degreesC and dissected them 1, 7, and 30 days after treatment. The pathologic changes of lesions were studied and analyzed by applying a quantitative experimental scoring system on the light and electron microscopy (LM and EM). RESULTS: The lesion size increased with a higher temperature and larger electrode. Among the electrodes with the same thickness, the lesion size with the longer electrode was larger than the shorter one. In a histopathologic study, there were significant changes with time, but no significant changes with different electrode and temperature. On electron microscope (EM), large myelinated fibers were relatively intact on RF lesion of 80degreesC after 1 day. 7 days after treatment, there were significant inflammatory cell infiltration and axonal regeneration. At 30 days after the same treatment, there were relatively large amount of small myelinated fibers and unmyelinated fibers. CONCLUSIONS: We measured the lesions systematically with different parameters expecting the result can be used as the reference for the RF lesion. There were no histopathologic differences on LM at different electrodes and temperatures. But we found the evidence of 'differential selection of pain fibers' with 22 gauge electrode at 80degreesC. And also we found the axonal regeneration as early as 1 week later. We learned the neuropathic pain can be induced by pathologic changes, such as bleb formation, inflammatory cell infiltration and predominance of small myelinated and unmyelinated fibers.

Three Cases of Lung Volume Reduction Surgery in Patients with Severe Emphysema / 대한마취과학회지

We have recently experienced with 3 cases of bilateral lung volume reduction surgery (LVRS) in patients with severe emphysematous disease in an effort to improve pulmonary mechanics. We compared intraoperative total dynamic lung compliance (CT) and % of breath exhaled in one second (V1.0%) obtained immediately pre-lung reduction and immediate post-lung reduction. In addition we also compared preoperative pulmonary function test (PFT) [FEV1, TLC, TG (trapped gas) and FRC] with 3 month postoperative values. Two of the three patients demonstrated post-reduction improvement in dynamic CT while only one patient demonstrated post-reduction improvement in V1.0%. All three patients demonstrated an increase in FEV1 and a decrease in TLC, TG and FRC with the greatest change in one patient who also had a significant reduction in CT and an improvement in V1.0% intraoperatively, and post-lung reduction. Although our results of the 3 cases are preliminary, it appears that side stream spirometry with immediate intraoperative measurement of dynamic CT and V1.0% could play a role in predicting expected follow-up objective pulmonary function tests; improvement in both CT and V1.0% may predict significant improvements in PFT.

Undesirable Symptoms of Patients in the Postanesthesia Recovery Situation / 대한마취과학회지

BACKGROUND: Healthcare quality can be improved by avoiding patient discomforts and customizing care to meet the needs of the patient. Therefore, the goal of this study was to quantify patients' discomfort for postoperative anesthesia outcomes for healthcare quality improvement. METHODS: One hundred orthopedic surgical patients were asked to tell possible undesirable postoperative outcomes preoperatively. In addition, they were also asked to tell undesirable postoperative outcomes from their most undesirable to least undesirable outcomes that they have experienced postoperatively. RESULTS: Patients expressed the following undesirable outcomes from most frequent to least frequent (in order); incisional pain, nausea/vomiting, shivering, headache, dizziness, sore throat, residual weakness, generalized myalgia, and somnolence. However, the severity of the symptoms were in the following order; nausea/vomiting, incisional pain, headache, dizziness, shivering, generalized myalgia residual weakness, sore throat, and somnolence. CONCLUSIONS: Although there is variability in how patients expressed postoperative outcomes, anesthesiologists can improve the quality of anesthesia by designing anesthesia regimens and methods that most closely meet each individual patient's preferences.

Comparison of the Effects of Induction before and after Surgical Preparation on Neonatal Well-being in General Anesthesia for Elective Cesarean Section / 대한마취과학회지

BACKGROUND: Generally, in order to decrease the fetal exposure time from anesthetic drugs, anesthetic induction is conducted after the completion of surgical preparation in general anesthesia for cesarean section. However, this method, in decreasing the fetal exposure time from anesthetic drugs, has been regarded as also aggravating the feeling of anxiety and fear of the patients. The purpose of this research is to compare the result of anesthetic induction conducted before and after surgical preparation in relation to the well-being of the newborn. METHODS: Fifty healthy women scheduled for elective cesarean section, not in labor, with no signs of fetal distress were randomly divided into 2 groups. Group A (n = 25) started anesthetic induction after surgical preparation and group B (n = 25) started before surgical preparation. Induction to delivery (I-D) interval and uterine incision to delivery (U-D) interval were measured and for the evaluation of the neonatal outcome, blood gas analysis at umbilical vein and artery, 1 and 5 min Apgar scores, and neurobehavioral test at 15 min, 2 hr and 24 hr of age, respectively, were performed. RESULTS: There was a significant difference in the I-D interval (P < 0.05) but no significant difference in the U-D interval between the two groups. Blood gas analysis, acid-base status, Apgar score and neurologic and adaptive capacity score (NACS) all did not differ significantly between the two groups. CONCLUSIONS: From our results, the induction before surgical preparation did not seem to affect neonatal well-being significantly. Therefore, when patients without fetal distress are very anxious, anesthetic induction before surgical preparation would reduce the patient's anxiety and fear without neonatal depression in general anesthesia for cesarean section.

Effect of Continuous Infusion of Low Concentrations of Ketamine on the Bispectral Index and Recovery from Propofol-N2O-O2 Anesthesia / 대한마취과학회지

BACKGROUND: Ketamine as an analgesic adjunct in propofol-based anesthesia has the benefit of potent analgesic action and more stable vital signs due to sympathetic stimulation. However, its impact on the bispectral index and speed of recovery is still controvertial. The aim of this study was to evaluate the effects of continuous infusion of low concentrations of ketamine (0.1 microgram/ml) on the bispectral index and speed of recovery from propofol-N2O-O2 anesthesia. METHODS: Forty ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to one of two groups according to intraoperative ketamine use. In group P, anesthesia was induced and maintained with propofol (Ct: 3 - 6 microgram/ml), 67% nitrous oxide and 33% oxygen and the target concentration of propofol was kept at 4 microgram/ml at least 20 min before the end of propofol infusion. In group P + K, the method of anesthesia was same as in group P, but the low concentration (0.1 microgram/ml) of ketamine was continuously infused until discontinuation of propofol using computer-assisted continuous infusion. Bispectral index, recovery time from anesthesia, current/effect concentration of drugs, vital signs before and at induction, end of drug infusion, eye opening time on verbal command, and orientation time were checked. RESULTS: Changes in vital signs showed no differences between the groups. For bispectral index, there was no difference between groups initially, but it was higher (4 - 8) after the end of drug infusion in group P K than in group P. Also, recovery from anesthesia was delayed significantly in group P + K (P < 0.05). CONCLUSIONS: From these observations, we concluded that the use of low concentrations of ketamine during propofol-N2O-O2 anesthesia increased BIS, delayed eye opening and recovery from anesthesia without any benefit to vital sign stability.

A Case Report of Epidural Anesthesia for Cesarean Section in a Patient with Takayasu's Arteritis / 대한마취과학회지

Takayasu's arteritis is a chronic, idiopathic occlusive inflammation of the aorta and its major branches, affecting females in over 85% of the cases. The major clinical finding is loss of palpable pulses in the upper limbs and neck. Several authors have cautioned against the use of regional anesthesia in Takayasu's arteritis, because of the dangers of hypotension and subsequent vasopressor use. However, regional anesthesia, with an awake patient, is the easiest way to monitor cerebral function and is the preferred technique in the parturient. We report on a case of Takayasu's arteritis associating renovascular hypertension during pregnancy with successful cesarean delivery under epidural anesthesia.

A Study of Epidural Droperidol Dosage for Reducing Nausea, Vomiting and Pruritus Due to Epidural Morphine and Fentanyl in Epidural Pain Management of Patients Undergoing Vaginal Total Hysterectomy / 대한마취과학회지

BACKGROUND: Epidural pain control has been used extensively for postoperative pain management, but nausea, vomiting and pruritus associated with morphine and fentanyl administration remain intractable problems. The aim of this study is to find the optimal epidural droperidol dosage for reducing the side effects of epidural morphine and fentanyl. METHODS: 140 patients randomly sampled and undergoing vaginal total hysterectomy were divided into 7 groups. Groups I and IV, and groups II and V, and groups III and VI, received 5 mg, 3.75 mg, 2.5 mg of droperidol by 2-day infusion pump through the indwelling epidural catheter, respectively. Group IV, V, VI patients received 1.25 mg of bolus droperidol through the indwelling epidural catheter at the time of peritoneal closure. As group VII was the control group, these patients received only epidural analgesics (morphine 10 mg, fentanyl citrate 300 microgram and 0.05% bupivacaine 100 ml) by 2-day infusion pump. RESULTS: Droperidol significantly reduced the incidence and severity of postoperative nausea, vomiting and itching sensation compared with the control group but verbal rating scale (VRS) of sedation was increased with the dosage of droperidol. There was no significant difference in the intensity of analgesia between the there groups. CONCLUSIONS: An effective epidural droperidol dosage for reducing postoperative nausea, vomiting and pruritus due to epidural pain control is 2.5 mg by 2-day infusion pump.

A Study of Epidural Droperidol Dosage for Reducing Nausea, Vomiting and Pruritus Due to Epidural Morphine and Fentanyl in Epidural Pain Management of Patients Undergoing Vaginal Total Hysterectomy / 대한마취과학회지

BACKGROUND: Epidural pain control has been used extensively for postoperative pain management, but nausea, vomiting and pruritus associated with morphine and fentanyl administration remain intractable problems. The aim of this study is to find the optimal epidural droperidol dosage for reducing the side effects of epidural morphine and fentanyl. METHODS: 140 patients randomly sampled and undergoing vaginal total hysterectomy were divided into 7 groups. Groups I and IV, and groups II and V, and groups III and VI, received 5 mg, 3.75 mg, 2.5 mg of droperidol by 2-day infusion pump through the indwelling epidural catheter, respectively. Group IV, V, VI patients received 1.25 mg of bolus droperidol through the indwelling epidural catheter at the time of peritoneal closure. As group VII was the control group, these patients received only epidural analgesics (morphine 10 mg, fentanyl citrate 300 microgram and 0.05% bupivacaine 100 ml) by 2-day infusion pump. RESULTS: Droperidol significantly reduced the incidence and severity of postoperative nausea, vomiting and itching sensation compared with the control group but verbal rating scale (VRS) of sedation was increased with the dosage of droperidol. There was no significant difference in the intensity of analgesia between the there groups. CONCLUSIONS: An effective epidural droperidol dosage for reducing postoperative nausea, vomiting and pruritus due to epidural pain control is 2.5 mg by 2-day infusion pump.