The Analgesic Effect of Postoperative Combined Epidural, Soft Tissue, and Intra-articular Injection of Morphine and Bupivacaine in Patients undergoing Total Knee Arthroplasty / 대한마취과학회지

BACKGROUND: Epidural opioids and local anesthetics provide excellent postoperative analgesia. In addition, soft tissue and intra-articular injection of bupivacaine and morphine may have a beneficial analgesic effects after total knee arthroplasty (TKA). This study was designed to assess the additional analgesic effect of combined soft tissue, and intra-articular injection of morphine and bupivacaine in patients undergoing TKA under spinal anesthesia with continuous epidural morphine and bupivacaine injection. METHODS: Forty patients aged 55 to 75 years for a TKA under spinal anesthesia were randomly divided into 2 groups. The both group of patients received a continuous epidural infusion using a two-day infusor containing morphine 5 mg in 100 ml of 0.125% bupivacaine. The experimental group of patients (n = 20) received soft tissue, and intra-articular injection containing 10 mg morphine in 100 ml bupivacaine 0.125%. The control group of patients (n = 20) received soft tissue, and intra-articular injection of 100 ml normal saline. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 8, 12, 24, and 48 h postoperatively and side effects, such as hypotension, nausea, vomiting, pruritus, and respiratory distress were recorded. Whenever patients demanded supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for additional analgesic requirement was recorded. RESULTS: The experimental group of patients had significantly lower pain score and analgesic requirements than the control group for 2 days. There was no difference in the incidence of side effects between groups. CONCLUSIONS: Combined soft tissue, and intra-articular injection of morphine and bupivacaine with continuous epidural morphine and bupivacaine infusion reduces postoperative pain and supplementary analgesic requirements than continuous epidural morphine and bupivacaine infusion only in patients undergoing TKA.

Effects of Low Dose Propofol on Core and Peripheral Temperatures during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Core hypothermia during the first hour after induction of anesthesia results primarily from a redistribution of body heat. Propofol in low doses provides reliable sedation and is associated with fast recovery. However, propofol-induced peripheral vasodilation is likely to facilitate core-to-peripheral heat redistribution. This study was designed to evaluate the effects of low dose propofol on core and peripheral temperatures during spinal anesthesia. METHODS: Fifty patients of ASA status I or II, aged 20 to 60, undergoing lower extremity surgery under spinal anesthesia were studied. Spinal anesthesia was administered to all patients, who were assigned sedation as follows: 1) control (n = 25), 2) propofol (n = 25); propofol infusion rates were, 8 mg/kg/h for the first 3 min, 4 mg/kg/h for the next 10 min, and 2 mg/kg/h for the next 15 min. Temperatures were recorded after beginning surgery at 5-min intervals for 30 min. RESULTS: Core temperature was significantly decreased after 15, 20, 30 min of surgery in the propofol group, and this result was statistically different between the two groups. Forearm skin temperature decreased in the control group and increased in the propofol group, without significance. Fingertip skin temperature did not changed significantly in the control group, but increased significantly after 15 min in the propofol group and continued to increasing to 30 min. Forearm minus finger skin temperature gradients were not changed significantly in control group, but decreased between 5 and 30 min in the propofol group, which was statistically significant. CONCLUSIONS: Low dose propofol may induce a degree of hypothermia during spinal anesthesia. Close monitoring is needed to prevent core hypothermia, if sedation is induced using propofol during spinal anesthesia.