The Comparison of Epidural Morphine and Epidural Morphine-Ketamine for Postoperative Pain Relief after Subtotal Gastrectomy / 대한마취과학회지

BACKGROUND: Epidural narcotics are now widely used for postoperative pain relief, but their side effects are problematic. Thus, this study was undertaken to evaluate the analgesic effects and to minimize the side effects of the combination of epidural morphine and ketamine versus epidural morphine alone in pateints with postoperative pain. METHODS: The value of using a combined infusion of morphine with a variable dose of ketamine for postoperative analgesia following subtotal gastrectomy was assessed in a double-blind randomised study of 30 patients. Three groups of 10 patients received an infusion of morphine at 2 mg/day, either alone, or combined with ketamine at a rate of 0.4 or 0.6 mg/kg/day. RESULTS: Postoperative anlagesia, sedation, and side effects were not statistically significantly different between groups I and II. Postoperative sedation, and side effects were not statistically significantly different between groups I and III. VAS of group III at 1-2 h was lower than in group I. CONCLUSION: The addition of ketamine to a continuous infusion of morphine dose not significantly improve postoperative analgesia. In addition, increasing the dose of ketamine does not significantly improve postoperative analgesia, Nor does it increase sedation, or side effects.

Paraplegia Caused by Caudal Analgesia / 대한마취과학회지

Caudal analgesia is a widely accepted technique for providing pain relief. However, both permanent and transient neurologic complications, including paraplegia, have been reported. We report on a patient who developed paraplegia following a caudal block for an epidural mass. The cause of the paraplegia was unknown, but possibly spinal angioma may have taken part in the onset and progression of the paralysis. A mechanism is proposed by which the caudal injection may have caused a change in blood flow through the spinal angioma resulting in cord ischemia.