Bilateral Ilioinguinal and Iliohypogastric Nerve Blockade for Analgesia after Surgery through a Pfannenstiel Incision / 대한마취과학회지

BACKGROUND: Epidural administration of morphine is a common method for postoperative analgesia in the lower abdominal surgery, but many complications can be produced. Since the pfannenstial incision lies within L1 dermatome, bilateral ilioinguinal and iliohypogastric nerve blocks(IINB) should provide analgesia after surgery through that incision. METHODS: Forty patients undergoing cesarean delivery or total abdominal hysterectomy(TAH) through a pfannenstiel incision were randomly assigned to one of two groups: epidural morphine group(n=20) received 3 mg of morphine epidurally after surgery with epidural anesthesia; IINB group(n=20) performed IINB with 0.5% bupivacaine, 10 ml to each side after surgery with general anesthesia. Visual analogue scale(VAS) scores at resting and moving state, and complications were checked at 0, 2, 4, 8, 12, 24 hours after surgery. RESULTS: Postoperative VAS scores did not show significant differences between the two groups at rest after 0, 2, 4, 8, 12, 24 hours and at moving state after 0, 2, 4 hours, but IINB group had less pain with movement than epidural morphine group at 8, 12, 24 hours after surgery(p<0.05). The incidence of pruritus was rare in IINB group(P<.05), but incidences of other complications were not significantly different between the two groups. CONCLUSIONS: IINB is effective for analgesia after surgery through a pfannenstiel incision because of a lower incidence of complications and less postoperative pain with movement than epidural morphine, and can be performed to patients who have contraindications and difficulty for epidural analgesia.

The Combined Spinal Epidural Anesthesia in Total Knee Arthroplasty / 대한마취과학회지

Spinal anesthesia has a rapid onset and requires small doses of local anesthenc to provide reliable surgical anesthesia and good muscular reiaxation but the disadvantages are the unpredictability of upper level of block, precipitous hypotension, inability to extend the block, and the risk of postdural puncture headache. A combined spinalepidural (CSE) technique can be used to reduce or eliminate some of the disadvantages of spinal and epidural anesthesia while preserving their activity. A combined spinalepidural block may combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks. CSE anesthesia was performed in the 19 patients scheduled for elective total knee arthroplasty. At first 17 G Tuohy needle was inserted L2-3 interspace, the epidual space would be identified, and then a long 22 G spinal needle was introduced through the Tuohy needle until the tip of the spinal needle would penetrate the dura. The correct placement of the spinal needle was confirmed by the appearence of cerebrospinal fluid at the head of needle, then 0.5% hyperbaric tetracaine 1.6-2 ml was injected into subarachnoid space. The spinal needle was withdrawn and a 18 G epidural catheter was introduced into the epidural space. If the patients complained pain during operation, 5 ml of 2% lidocaine was injected through epidural catheter, 2.5 mg Morphine was injected into epidural space for postoperative pain control after operation. Operations were well performed under CSE anesthesia and postoperative pain controls were well managed, too. The responses of the patients who has experienced CSE anesthesia were mostly good.

The Study of Continuous Infusion Rates of Sodium Nitropusside in Deliberate Hypotensive Anesthesia / 대한마취과학회지

Sodium nitroprusside(SNP) is used to induce hypotension for a wide variety of indica- tions. Ordinarily, blood pressure responds sensitively to infusion of SNP in low doses, but occasioally resistance is seen, and actual tachyphylaxis during SNP infusion has been reported. To investigste the continuous infusion rates of SNP, we retrospectively reviewed 144 cases of spinal fusion operations which had been performed under deliberate hypotensive anesthesia (mean arterial pressure at 50-60 mmHg). To produce deliberate hypotension, The mean dose of SNP was 17.16 mg, the mean infusion time 283.85 minutes, and the average infusion rates 1.05 ug/kg/min. Patients who received csptopril required less SNP than untreated patients(0.95 vs 1.23 ug /kg/min., p<0.05). Isovolemic hemodilution also reduced aversge infusion rates of SNP (0. 87 vs 1.22ug/kg/min., p<0.05). There were, however, no significant differences in preoperative hypertention vs normotension, mild hypothermia vs. normothermia during the operation, and male vs. female. In addition, the average infusion rates of SNP were significantly correlated with body mass index(r=0.3329, p<0.01). But those were not correlated with age, infusion time of SNP, weight, volume of transfusion, height/age, and height.

The Priming Principle with Anticholinesterases for the Recovery of Profound Muscle Relaxation / 대한마취과학회지

The success of accelerating the onset of neuromvacular blocking drugs by giving them in divided doses encouraged others to attempt the same "priming principle" using reversal agents. Naguib et al and Abdulatif et al demonstrated that the reversal time(time to reach a TOF of 0.75) was reduced when the reversal agent was administered in divided doses at T, 10% of control. But Donati et al and Szalados et al either could not detect any differences in the rate of reversal when anticholinestereses were administered in divided doses. This study hes been conducted to evaluate the reversal effects of neostigmine or pyridostigmine with priming principle in the rabbit after pancuronium injection when pro- found relaxation(PTC=0) was confirmed. Rabbits(n=60) were randomly allocated to 4 groups. After pancuranium 0.2mg/kg IV, the onset and recovery times were evalusted. When the profound relaxation(PTC=0) was confirmed at Smin. after pancuronium injection, neostigmine 50 ug/kg and atropine sulfate (atropine) 20 ug/kg were injected in group 1. At thst time, neostigmine 10/kg and atropine 4 ug/kg were injected and after 3min. neostigmine 40/kg and atropine 16 ug/kg were injected in group 2. At that time, pyridostigmine 250 ug/kg and atropine 20 ug/kg were injected in group 3. At that time, pyridostigmine 50 ug/kg and atropine 4 ug/kg were injected and after 3min. pyridostigmine 200 ug/kg and atropine 16 ug/kg were injected in group 4. The results were as follows :. 1) The time until 75% recovery of twitch amplitude was 53.1+/-12.4min. in group 1, 44.9+/-212.1min. in group 2, 54.9+/-9.7min. in group 3 and 48.2+/-7.1min. in group 4. The reversal times were tended to reduce when the reversal agents were administered with "priming principle" at the profound relaxation. 2) At the profound relaxation the reversal effects of neostigmine were greater than that of pyridostigmine.