Comparison of 0.075% Bupivacaine/Fentanyl and 0.125% Ropivacaine/Fentanyl Infusion for Postoperative Epidural Analgesia / 대한마취과학회지

BACKGROUND: The new, long-acting local anesthetic ropivacaine is structurally very similar to bupivacaine, but the motor block is less profound and of shorter duration. The aim of this study was to compare analgesic effectiveness and side effects during postoperative pain control after a Caesarean section with either a bupivacaine/fentanyl or ropivacaine/fentanyl mixture. METHODS: Thirty-nine patients undergoing a Caesarean section were randomized in a double-blinded manner to receive bupivacaine or ropivacaine. Postoperative epidural analgesia was provided using a PCA pump with either bupivacaine/fentanyl 0.075%/3.4 microgram/ml after 10 ml of 0.125% bupivacaine with morphine (n = 18) or ropivacaine/fentanyl 0.125%/3.4 microgram/ml after 10 ml of 0.2% ropivacaine with morphine (n = 21). Verbal rating pain scores (rest and cough), side effects (nausea, vomiting, pruritus, sedation, motor block and hypotention) and time to ambulation were measured for 48 hr after surgery. RESULTS: There were no significant differences between the groups in verbal pain scores, sensory level, motor blockade and other side effects, but time to ambulation was earlier in the ropivacaine group. CONCLUSIONS: 0.125% ropivacaine with 3.4 microgram/ml fentanyl provided similar successful pain relief as 0.075% bupivacaine/fentanyl. However, earlier recovery of ambulation in patients receiving ropivacaine/ fentanyl will improve outcome after surgery.

Extension of Sensory Blockade after Thoracic and Lumbar Epidural Administration of a Test dose of Lidocaine / 대한마취과학회지

BACKGROUND: The distribution of solutions injected into the epidural space has not been well determined. The aim of this study was to compare the difference in extension of sensory blockade between the thoracic and lumbar regions in epidural analgesia. METHODS: Forty-five female patients scheduled for postoperative pain control were enrolled. In group 1 (n = 22), the Tuohy needle was inserted at T6 10 levels and in group 2 (n = 23), it was inserted at T12 L2 levels. The catheter was introduced 3 4 cm into the epidural space and 3 ml of 1.5% lidocaine with epinephrine (1:200,000) was injected. The extension of sensory anesthesia to loss of cold sensation and pinprick test was measured every 5 minute for 15 minutes. RESULTS: Fifteen minutes after epidural injection, the mean sensory block extension in group 1 (7.8 +/- 2.0 dermatomes) was significantly wider than in group 2 (4.7 +/- 2.2 dermatomes) but cranial and caudad spread of sensory blockade in relation to the puncture level was the same in both groups. CONCLUSION: The mean dose of local anesthetic required for analgesia was smaller in the thoracic region than in the lumbar region.

Effect of Mixed Administration of Thiopental Sodium on Vascular Pain Associated with Intravenous Propofol Injection / 대한마취과학회지

BACKGROUND: Propofol is a rapidly acting intravenous anesthetic agent used for the induction of anesthesia with a low incidence of side effects. But propofol has a high incidence of pain during intravenous injection, and many methods have been used to minimize the incidence and severity of this pain. The aim of this study was to compare the use of thiopental and lidocaine mixed with propofol for the reduction of pain during the injection of propofol. METHODS: Sixty healthy ASA physical status I or II patients scheduled for general anesthesia were randomly divided into three groups. Each patient received mixed propofol solution (normal saline 1 cc, thiopental 0.5 mg/kg, lidocaine 0.5 mg/kg) via 20 G angiocatheter inserted at the antecubital fossa. The assessment of pain was done at the induction of anesthesia and at the recovery room. The severity of pain was classified as none, mild, moderate, and severe. RESULTS: The severity and incidence of pain diminished significantly in the thiopental group and the lidocaine group compared with control group at the induction of anesthesia (p<0.05), and there was no significant difference between the thiopental and the lidocaine group. Recall of pain during intravenous injection at the recovery room has no significant difference among three groups. CONCLUSIONS: Mixd administration of thiopental or lidocaine could significantly reduce the severity and incidence of pain for intravenous injection of propofol.