Toracostomía cerrada bajo sedación en el servicio de urgencias / Thoracostomy under sedation in the emergency service

El trauma es uno de los principales retos en cuanto a salud pública mundial se trata. Según la OMS, causa alrededor de cinco millones de muertes al año, siendo el trauma de tórax uno de los más frecuentes, reportándose hasta 90-96% de lesiones penetrantes con una mortalidad cercana al 30%. La toracotomía es un procedimiento frecuentemente realizado en el servicio de urgencias, pero es una técnica dolorosa e incómoda que puede generar dificultades a la hora de su realización. Se requiere encontrar la información disponible acerca de la seguridad en la intervención bajo sedación y determinar su utilidad en el servicio de urgencias, así como conocer los niveles de sedación para poder realizar las diferentes técnicas y evaluar según el procedimiento a realizar a qué nivel se debe llevar el paciente. La utilización de fármacos para analgesia y sedación en este servicio tiene por objetivo el control efectivo y seguro del dolor, control de la ansiedad, para evitar movimientos del paciente, buscando disminuir las posibles complicaciones. En esta revisión se estudian medicamentos como ketamina, propofol, morfina, hidromorfona, fentanilo, etomidato y midazolam, así como sus posibles combinaciones para implementarlos en el proceso de sedación en la toracostomía de urgencia. No hay una estrategia terapéutica aplicable a todos los pacientes por lo que cada una de ellas debe individualizarse..Au

Trauma constitutes one of the main challenges in terms of public health in the world. According to the WHO, it causes about five million deaths per year, chest trauma is one of the most frequently occurring injuries, reporting up to 90-96% of penetrating injuries with mortality close to 30%. Thoracostomy is a procedure frequently performed in the emergency department, however, it is a painful and uncomfortable procedure, and there could be difficulties while it is done. It is required to find the available information about how safe a thoracostomy is under sedation is and determine its usefulness in the emergency department; learning the levels of sedation, and depending of the procedure the patient needs, determine the level of sedation the patient has to induced into. The use of medications for analgesia and sedation in the emergency room is aimed to the effective and safe control of pain and anxiety as well as to avoid movements of the patient to reduce complications. This review considers medications such as ketamine, propofol, morphine, hydromorphone, fentanyl, etomidate, midazolam and the best combinations of these medications to carry out sedation for emergency thoracostomy. However, there is not a therapeutic strategy applicable to all patients, therefore each patient has to be analyzed individually..Au

Comparison of Adductor Canal Block Versus Local Infiltration Analgesia on Postoperative Pain andF unctional Outcome after Total Knee Arthroplasty: A Randomized Controlled Trial

@#Introduction:Total knee arthroplasty (TKA) is associated with intense postoperative pain for which effective analgesia is essential to facilitate early postoperative recovery. Adductor canal block (ACB) and local infiltration analgesia (LIA) have become increasingly involved in postoperative pain management after TKA. We aimed to compare their efficacy and outcomes in patients undergoing TKA. Materials and Methods: Sixty patients undergoing unilateral TKA were randomized to receive either postoperative single-injection ACB (Group A) or LIA (Group L) during the operation. All patients received spinal anaesthesia. Primary outcome was total morphine consumption over postoperative 24 hours. Visual analog pain scale, time to first and total dosage of rescue analgesia, performance-based evaluations [timed-up and go (TUG) test, quadriceps strength], side-effects, length of hospital stay and patient satisfaction were measured. Results: Fifty-seven patients were available for analysis. Median total morphine consumption over 24 and 48 postoperative hours of Group A were significantly less than Group L (6/10 mg vs 13/25 mg, p, 0.008 and 0.001, respectively). Similarly, Group A had significantly lower VAS at postoperative 6, 12 and 18 hours, VAS at ambulation on postoperative (POD) 1-3, better TUG tests on POD 2 and during POD 3 than those of Group L. However, quadriceps strength and patient satisfaction were not different between both groups. Conclusion:Patients undergoing TKA with single-injection ACB required less postoperative opioids than those with LIA. Furthermore, multimodal analgesia using ACB provided better postoperative analgesia, as well as performance-based activities, than those with LIA.

Relation of pain threshold with anxiety affecting labor analgesia in nulliparous / 第二军医大学学报

Objective: To explore relation of pain threshold and effect of labor analgesia with Anxiety in Nulliparous. Methods: The psychosis according to Hamilton Anxiety Scale(HAS) and Hamihon Depression Scale(HDS) were evaluated in 50 primiparae requiring epidural labor analgesia. The cases were divided into two groups the experiment group subdivided into exp I(24 cases with mild anxiety) and exp H(9 cases with moderate to severe anxiety) and the control group(19 cases without anxiety) There was no Nulliparous with depression(HDS, scores<8) The effect of analgesia the labor course the mod e of delivery the plasma concentrations of epinephrine (E), norepinephrine(NE) and β-EP in the two groups were observed Results: The rate of anxiety in 50 nulliparous was 66 In the experimental group the epidural labor analgesia was weak the degree of nulliparous anxiety was less the latent time prolonged the E level elevated and NE levels lowered as compared with the control(P<0 01), the changes of PPT was significantly negatively correlated to the HAS score(P<0 005) Conclusion: The degree of nulliparous anxiety descrease the pain threshold and influences the effect of the epidural labor analgesia Therefore it is necessary to estimate fully the degree of nulliparous anxiety before delivery and to take individual and to improve the obstetrics quality.

Efficacy of Basal Infusion in Intravenous Patient-Controlled Analgesia after Mastectomy / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) is widely used for postoperative pain control. Theoretical advantages in maintaining an effective blood concentration of the analgesic medication using a basal infusion regimen is controversal. Therefore in this study, we compared the analgesic effect between PCA and PCA with a basal infusion and assessed whether the use of a basal infusion improves the analgesic effect in intravenous PCA or not. METHODS: Twenty six ASA physical status 1 or 2 female patients undergoing mastectomy were assigned randomly to the PCA group (group 1) or the PCA with basal infusion group (group 2). Group 1 was programmed to deliver 0.02 ml/Kg of bolus infusion with a 5 minute locKout interval. In group 2, 0.02 ml/Kg of basal infusion was added to the PCA regimen. The PCA analgesic solution contained 50 mg of nalbuphine and 150 mg of Ketorolac in a total volume of 200 ml. At sKin closure, 0.2 ml/Kg of a loading dose was given to all patients and a PCA was started according to the experimental group. A visual analogue scale (VAS) for pain, analgesic consumption, side effects and degree of satisfaction was assessed at postoperative 1 hour, 2 hours, 4 hours, 8 hours, 24 hours and 48 hours. RESULTS: Group 2 did not show any improvement in the VAS compared with group 1. Degree of satisfaction and incidence of complications were not different between two groups. Total infused amount of analgesics increased in group 2 (P < 0.05). CONCLUSIONS: The addition of basal infusion in a PCA after mastectomy did not show any improvement of postoperative pain control compared to the regimen of a PCA with only bolus infusion.

Differential Analgesic and Adverse Effects of 0.125% Bupivacaine vs. Ropivacaine Coadministered Epidurally with Morphine / 대한마취과학회지

BACKGROUND: This study aimed to compare analgesic efficacy and occurance of motor block and other side effects of a 48 hr postoperative continuous epidural infusion of 0.125% bupivacaine or ropivacaine with morphine. METHODS: Forty patients undergoing a Cesarean section were allocated randomly into two groups. Both groups received an epidural injection of 2.0% lidocaine 18 20 ml and 0.5% bupivacaine 2 5 ml with fentanyl 50microgram 20 minutes before surgical incision and received 2 mg of epidural morphine by bolus 40 minutes after surgical incision. For post-operative pain control, a continuous epidural infusion was started using a two day infusor containing 6 mg of morphine in 100 ml of 0.125% bupivacaine (Group 1, n = 20) or 100 ml of 0.125% ropivacaine (Group 2, n = 20). Visual analog scale (VAS) for pain during rest and movement, sensory change and motor blockade were assessed for 48 hrs. after surgery. RESULTS: There were no significant differences in VAS for pain during rest and movement. The incidences of side effect were similar in both groups. CONCLUSIONS: Using 0.125% bupivacaine with morphine via the epidural route provided similar pain relief and side effects as 0.125% ropivacaine with morphine.

Effects of Intravenous and Epidural Patient-Controlled Analgesia on Postoperative Pain and Knee Rehabilitation after a Unilateral Total Knee Replacement / 대한마취과학회지

BACKGROUND: Postoperative pain is a major concern after a total knee replacement (TKR). It hinders early intense physical therapy, the most influential factor for good postoperative knee rehabilitation. The purpose of this study was to compare intravenous patient-controlled analgesia (IV-PCA) using morphine and continuous ketorolac IV infusion with patient-controlled epidural analgesia (PCEA) using morphine and continuous bupivacaine infusion in terms of analgesic efficacy and postoperative knee rehabilitation after a unilateral TKR. METHODS: Eighteen patients undergoing a unilateral total knee replacement were randomly allocated to one of the two groups. In group IV-PCA (n = 9), 30 min before the end of surgery, patients received ketorolac 30 mg IV bolus followed by continuous infusion with ketorolac (5 mg/h) and IV-PCA with morphine (20microgram/kg, lockout 10 min). In group PCEA (n = 9), 30 min before the end of surgery, patients received 2 mg morphine bolus followed by continuous infusion with 0.1% bupivacaine (2 ml/h) and PCEA with morphine (1 mg, lockout 15 min). RESULTS: There were significant differences in visual analogue scale scores at the first 2-hours after the unilateral TKR, cumulative morphine consumption and number of postoperative days required to obtain 90o knee flexion. CONCLUSIONS: PCEA using a morphine-bupivacaine combination provided better pain relief and faci litated the continuous passive motion more than IV-PCA using a morphine-ketorolac combination. This results in possible faster postoperative knee rehabilitation.

Patient Controlled Analgesia Using Surgical Wound Infusion / 대한마취과학회지

BACKGROUND: This study was undertaken to evaluate the analgesic effect of a self administered surgical wound infusion of local anesthetic alone compared to combination of local anesthetic and morphine or ketorolac. METHOD: Forty eight patients undergoing minor surgery were randomly classified into four groups: Group 1 (saline, n = 10), Group 2 (bupivacaine only, n = 11), Group 3 (bupivacaine with morphine, n = 14), and Group 4 (bupivacaine with ketorolac, n = 13). A two-hole 19 G epidural catheter was tunneled subcutaneously into the surgical wound and was connected to 100 ml elastometric balloon pump filled with either 0.5% bupivacaine only, 0.5% bupivacaine and morphine 40 mg, or 0.5% bupivacaine and ketorolac 80 mg. We assessed the postoperative visual analogue scale (VAS) pain scores at postoperative 0.5, 1, 2, 6, 12, 24, 36, and 48 hours, and the side effects, sedation score and total amount of infused bupivacaine were recorded. RESULTS: VAS pain score were significantly decreased until 36 hours in groups 2, 3, and 4 compared to group 1, and significantly lower at 1, 2, 12, and 24 hrs in groups 3, 4 than in group 2 (P < 0.05). The total requirement of infused bupivacaine in groups 3, 4 is significantly decreased compared to that of group 2. Side effects like nausea, vomiting, urinary retension, pruiritis, respiratory difficulty, sedation, and dizziness did not occur in the four groups but seroma did in one case. CONCLUSION: Patient-controlled surgical wound infusion of bupivacaine reduced postoperative pain after minor surgery without any side effects. The combination of bupivacaine with morphine or ketorolac gave rise to a significant additive effect to local analgesia.

The Comparison of Cryoanalgesia and Epidural Analgesia in Thoracotomy / 대한마취과학회지

BACKGROUND: Cryoanalgesia provides postoperative analgesia following thoracotomy without serious complications compared with epidural analgesia, but little data indicates which one is better in terms of postoperative analgesia, side effects or associated complications. METHODS: Forty patients undergoing lateral thoracotomy, were randomized to receive a mixture of fentanyl and 0.15% bupivacaine at 0.5 microgram/kg/h of fentanyl via thoracic epidural catheter (Group E) or cryotherapy on the 4th, 5th, 6th, or 7th intercostal nerves using Frigitronics (Group C). Postoperative pain was assessed everyday for 7 days after the thoracotomy by a visual analog scale (VAS). The side effects and patient satisfaction of analgesia were assessed by a system of 4 grades. RESULTS: The VAS scores at rest in group C were significantly higher than those in group E. There was no side effect except numbness in group C, which continued for 3 months on the average. The incidences of side effects (nausea, vomiting, pruritus, sedation, urinary retention) were 15-35% in group E. The 35% of patients in group C were satisfied with postoperative analgesia compared with 95% in group E (P < 0.05). CONCLUSIONS: Epidural fentanyl provided a better analgesic effect than cryoanalgesia for thoracotomy, but there is a clinical advantage in cryoanalgesia over epidural fentanyl with respect to incidences of serious side effects not including. (Korean J Anesthesiol 2000; 39: 83-90)

Electronmicroscopic Changes of Rat's Sciatic Nerve after Phenol Injection or Drip / 대한마취과학회지

BACKGROUND: Phenol is the most commonly used neurolytic agent for the management of intractable somatic pain, but side effects such as motor dysfunction and potential loss of bladder or rectal sphincter function develop following their application. This study observed functional changes of hind limb and neuropathologic changes in the sciatic nerve after phenol application, highlighting the time of nerve regeneration. METHODS: Functional changes in hind limbs were observed for 6 weeks and the distal part of the phenol-injected or dripped sciatic nerve was severed in 3 rats of each group respectively at 10 minutes, 1 hour, 24 hours, 3 days, 1 week, 2 weeks, 4 weeks and 6 weeks. The pathologic changes in the severed nerves were observed under the electron microscope. RESULTS: The phenol-injected or-dripped hind limbs showed more pronounced motor weakness and more obvious gait changes. About 2 weeks after the phenol application, gradual improvement of gait changes began, and after 6 weeks, motor weakness and gait changes were no longer perceptible. In the group with phenol injection, at 10 minutes after injection, destructive lesions were confined to unmyelinated fibers and the myelin sheath of small myelinated fibers. On the 3rd day and at 1 week, pathologic changes on axonal fibers and Schwann cells were in progress with phagocytosis in spite of myelin restitution. From 2 to 4 weeks, axonal regeneration and remyelination appeared concurrent with myelin disintegration and axonolysis, and histologic findings at 6 weeks were similar to those of the control group. In the group with phenol drip, the histologic changes in the sciatic nerve were very similar to the injection group. CONCLUSIONS: These results suggest that histopathologic lesions after a phenol application on the peripheral nerves are not influenced by application methods. The progress of histopathologic changes is obvious according to the time interval following the phenol application. Accordingly, side effectsthat developed following the use of phenol may be improved around the time when the nerve regeneration occurs, between the second and fourth weeks after the injection. The course of histopathologic changes and clinical findings following the application of phenol is very similar to the previous experiment using alcohol.

Effect of Continuous Epidural Analgesia on the Progress of Labor / 대한마취과학회지

BACKGROUND: The effect of epidural analgesia on the progress of labor is controversial. The objective of this study is to determine the effect of analgesia on the outcomes of labor, especially the cesarean delivery rate in the epidural and non-epidural (intramuscular nalbuphine) groups, prospectively. METHODS: All the nulliparous women were divided into two groups, group 1 (epidural group, n = 35) and group 2 (non-epidural group, intramuscular nalbuphine, n = 43) randomly. Epidural analgesia was maintained with a continuous epidural injection of 0.0625% bupivacaine with 0.2 microgram/ml fentanyl in group 1 and nalbuphine 10 mg was intramuscularly injected in group 2 when the cervix was dilated to at least 3-5 cm. The duration of the first and second stages of labor, cesarean delivery rate, Apgar score and body weight of infant were recorded and the pain score of parturient was recorded by 0-100 mm visual analogue scale. RESULTS: The duration of first and second stage were prolonged in the group 1 (epidural group). But there were no significant differences in the duration of first and second stage, Apgar score and body weight of infant between the two groups. Cesarean delivery rate was 16% (n = 7/35) in group 1 and 17% (n = 6/43) in group 2, so there was no significant difference between the two groups. Pain score was significantly lower in group 1 than in group 2. CONCLUSIONS: Epidural analgesia was not associated with increased cesarean delivery rate and provided safe and effective intrapartum pain control. Maternal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate.

The Effect of Analgesic Technique on Recovery of Patients after Colon Surgery / 대한마취과학회지

BACKGROUND: Different types of analgesia may affect the rate of recovery of gastrointestinal function after colon surgery. METHODS: Sixty-six patients undergoing colon surgery which including right and left hemicolectomy, anterior resection and Miles` operation were categorized into four groups. All groups received a general anesthesia. Control group, in surgical ward the patients received adjuvant analgesics on request postoperatively. Group M received a intraoperative bolus epidural morphine followed by an infusion of morphine. Group MB received a intraoperative bolus of epidural morphine followed by an infusion of bupivacaine and morphine. Group PCA received a intraoperative bolus of intravenous morphine followed by patient- controlled morphine postoperatively. RESULTS: Ambulation, oral feeding and duration of hospitalization were not differed among groups. Group MB, recovered gastrointestinal function approximately 30 hours earlier than Group PCA (p<0.05). CONCLUSION: Epidural analgesia with bupivacaine and morphine accelerated postoperative recovery of gastrointestinal function.

Postoperative Pain Control in Low Abdominal Surgery; Comparison of Subarachnoid Block with Morphine or Morphine and Clonidine and Continuous Epidural Block with Morphine and Bupivacaine / 대한마취과학회지

BACKGROUND: Although epidural block has been widely used to control post operative pain, still there are many problems to be solved such as inadequate pain control and difficulty in its techniques. Subarachnoid morphine and clonidine injection also has been used to control postoperative pain and as adjuvant to spinal anesthesia. We compared subarachnoid morphine or morphine and clonidine injection with epidural morphine and bupivacaine injection for postoperative pain control. METHOD: The effect of the different types of postoperative pain control method in low abdominal surgery were investigated. 30 patients were randomly divided into one of three groups; single intrathecal morphine injection (group M), single intrathecal morphine and clonidine injection (group M/C) and continuous epidural morphine and bupivacaine injection (group M/B) prior to induction of general anesthesia. Visual analogue scale (VAS), Prince-Henry Hospital score (PHS), patient satisfaction score and the side effects were investigated at emergence, 1, 2, 4, 8, 12, 24 and 48 hours after emergence of anesthesia. The blood pressure and heart rate were monitored 0, 5, 10 and 30 min, 1, 2, 24 and 48 hours after block for monitor the hemodynamic changes. RESULT: In group M/C, the VAS showed statistically significant decrease till first 24 hours after block and in group M/B after then (p<0.05). PHS and patient satisfaction scores were similar in all groups. The side effects, pruritis and nausea, by the opioids were more frequent in subarachnoid groups versus epidural group but that were tolerable without medication in most cases. In spite that systolic and diastolic blood pressures and heart rate were significantly low (p<0.05) in group M/C, there were no severe hypotension or bradycardia that need treatment. CONCLUSION: From these results, it seems that intrathecal morphine and clonidine combination therapy can be used as an another choice for postoperative pain control in low abdominal surgery.

The Effects of Epidural Droperidol on the Analgegic and Side Effects of Epidural Morphine / 대한마취과학회지

BACKGROUND: Epidural morphine is effective in the treatment of postoperative pain, but the incidence of associated side effects is high. To evaluate the reduction of opioid sideeffects by epidural use of droperidol mixture, this study was performed. METHODS: Randomly sampled sixty patients undergoing upper abdominal surgery were divided into two groups. To assess a reduction of opioid side effects by droperidol, group I (n=30) were received 3mg morphine and 0.15% bupivacaine 10ml through the indwelling epidural catheter before the conclusion of operation, followed by an infusion of 6 mg morphine plus 0.15% bupivacaine 100ml with the two day infusor. Group II (n=30) were treated with the same protocol as group I but 1.5 mg of droperidol was added to initial bolus and 5mg of droperidol to the two day infusor. Analgesic effect and side effect were 48 hours after operation. RESULTS: No significant differences in intensity of analgesiaand sedation were seen. The intensity of nausea and vomiting in the group II was significantly less than in the group I at 8, 12 hours after operation (p<0.05). The intensity of pruritus in group II was significantly less than in group I at 4, 8 hours of postoperative period (p<0.05). The frequency of nausea, vomiting, pruritus and urinary retention in group II were less than in group I. respiratory depression. Epidural injection of droperidol did not result in any local or systemic side effects. CONCLUSION: The addition of epidural droperidol significantly reduced the side effects of epidural morphine without altering the effect on analgesia.

Comparison of Postoperative Analgesia and Side Effects of Continuous Epidural Morphine Infusion and Continuous Intravenous Morphine Infusion following Cesarean Section / 대한마취과학회지

BACKGROUND: Continuous epidural morphine infusion is a good and popular method to control postoperative pain. But intravenous morphine infusion after general anesthesia can avoid anxiety during operation and also control postoperative pain. We compared analgesia and side effects between continuous epidural infusion and continuous intravenous infusion of morphine sulfate to control of postoperative pain after cesarean section. METHODS: Forty women who received cesarean section were randomly divided into epidural and IV groups. Morphine 0.08 mg/kg was administered intravenously as an initial loading dosage for both groups. Morphine 0.08 mg/kg for epidural group or morphine 0.8 mg/kg for IV group was diluted into 96ml of normal saline. A mixture was injected into Two-day Infusor which is continuously infused 2 ml/hr. The patients received morphine solution into epidural or intravenous route with Two-day Infusor according to their allocated group. The assessments for pain score with VAS, VRS, patient's satisfaction score and side effects were made at recovery room, 0.5, 3, 12, 24, 36, 48 and 60 hours after operation. RESULTS: The VAS in IV group was significantly higher than that in epidural group at 3, 12, 24 and 36 hours after the operation (P<0.05). The VRS in IV group was significantly higher than in epidural group at recovery room and 3 hours of postoperative period (p<0.05). The frequency of pruritus, nausea, vomiting, back pain and urinary retention were less in IV group than in epidural group. The patient's satisfaction scores were similar in both groups. CONCLUSIONS: The management of postoperative pain in epidural group was more effective than the continuous intravenous morphine infusion. But the incidence of complications was more frequent in the epidural group while patient's satisfaction scores were similar in both groups. Therefore, the continuous intravenous morphine infusion can be used effectively as a postoperative pain management.

The Effect of Acetaminophen Rectally Administered before Operation on Postoperative Pain and Behavior after Tonsillectomy in Small Children / 대한마취과학회지

BACKGROUND: Prostaglandin inhibitors have been successfully used to inhibit some types of postoperative pain and reduce opioids requirements in others. Antiprostaglandin activity may be ineffective unless the preparations are given at the appropriate time before surgery. This study aimed to determine if the intrarectal administration of acetaminophen immediately before surgery would markedly reduce pain in the postoperative period. METHODS: The children were divided to two groups. Each group was consisted of 15 children. The children in control group were administered intramuscularly glycopyrrolate(0.004 mg/kg) 20 minute. The children in experimental group were administered glycopyrrolate(0.004 mg/kg) intramuscularly and were administered acetaminophen(250 mg) rectally 20 minute before the children were taken to the operating theatre. RESULTS: In the recovery room, the children who had recived acetaminophen were signifcantlly quieter (p<0.01), agitated less(p<0.01) and cried less(p<0.01) painless(p<0.01) than those nonadministered group. There were no obvious differnces between the groups in intra-operative bleeding (as estimated by the surgeon), or in measured blood loss. No postopertive complications become evident. CONCLUSIONS: The preoperative rectal administration of acetaminophen for pain relief after tonsillectomy is safe and effective.

A Comparative Study on Epidural Fentanyl, Bupivacaine, Lidocaine, and Intravenous Fentanyl in Patients Undergoing Gastrectomy under General Anesthesia / 대한마취과학회지

Backgronud : Postoperative pain control became anesthesiologist's familiar yield, so many anesthesiologists are very interested in opioid and local anesthetic's characterestics and there cardiovascular effects. It's important which anesthetic has the best pain killing and the least cardiovascular effect. We used epidural opioid and local anesthetics and intravenous opioid to investigate their pain killing and cardiovascular effects. METHODS: We studied 50 patients undergoing gastrectomy. An epidural catheter was placed via the T8-9 or L1-2 interspace. Epidural fentanyl group (Ep-F) received fentanyl 2 microgram/kg in 10ml saline, epidural bupivacaine group (Ep-B), 10 ml 0.25% bupivacaine, and epidural lidocaine group (Ep-L), 10 ml 1.5% lidocaine, epidurally; intravenous fentanyl group (IV-F) received fentanyl, 2 microgram/kg. 50% of the original dose was repeated every hour until the operation ended. Control group was given nothing before general anesthesia. Cardiovascular data was compared between those before and those at 1hour after skin incision. The time interval between end of the operation and the time of first analgesic requirement and the total number of intramuscular analgesic requirements during the first 48hours postoperatively were compared. RESULTS: Urinary output during surgery was significantly larger in group Ep-F. Group Ep-L developed more frequent episodes of hypotension. Group Ep-F, group IV-F and control group required higher enflurane concentrations. CONCLUSIONS: Group Ep-F was accompanied less hypotension and postoperative analgesic requirements were reduced.

Clinical Experience of Postoperative Pain Control / 대한마취과학회지

BACKGROUND: We prospectively studied 615 patients who received postoperative pain control (epidural analgesia or intravenous patient controlled analgesia) to evaluate pain relief, side effects and complications. METHODS: All study patients receiving postoperative pain control were assessed three times a day by the pain control resident for pain relief, using a visual analogue scale. The presence of side effects and complications was assessed. RESULTS: Over 1year, 615 patients (65.9% women, aged 46.9+/-16.4yr) were studied. General surgery, gynecology and obstetrics in the department; and lower abdomen, upper abdomen and perineum in the operation site were order of decreasing frequency. The most common site of epidural puncture level was T12-L1 in the epidural analgesia. The average pain score using VAS in all groups was less than 3.0 and the degree of satisfaction in postoperative pain control was rated as good on 88% of the patients. Nausea occurred in 9.1% of all patients, vomiting in 6.3%, pruritis in 0.9%, urinary retention in 2.6%, hypotension in 3.2%, but there was no case of respiratory depression. Dislodgement of the epidural catheter occurred in 0.5% of all patients. CONCLUSIONS: Postoperative epidural fentanyl/bupivacaine infusions and IV PCA are an effective method of postoperative pain control with a low incidence of side effects. We believe that, with appropriate patient observations and careful drug selection and with the use of epidural catheters placed appropriately for the proposed surgery, that high quality postoperative pain control can be offered.

Effect of Preoperative Infiltration on Postoperative Analgesic Requirements in Total Abdominal Hysterectomy Patients / 대한마취과학회지

BACKGROUND: The concept of preemptive analgesia has been suggested recently as another technique in the treatment of postoperative pain. This study was undertaken to determine whether preoperative blockade of nociceptive input with operative bupivacaine would exert a preemptive effect on postoperative analgesia. METHODS: 40 patients undergoing hysterectomy with general anesthesia were allocated randomly to receive either 0.25% bupivacaine 40ml infiltrated into the proposed wound line 10min before incision or no infiltration. Patient-controlled analgesia fentanyl and ketorolac were administered to both groups during first 48 postoperative hours. RESULTS: Pain scores and cumulative fentanyl and ketorolac consumption dosage at 12, 24, 36, 48 hours after surgery was similar in both groups. CONCLUSIONS: We concluded that preincisional infiltration with bupivacaine had no advantage in reducing postoperative analgesic requirements or pain scores after hysterectomy.

Comparison of bupivaeaine or fentanyl for caudal postoperative analgesia in children / 中华麻醉学杂志

To compare the efficacy and side effects of bupivaeaine(Bup)at two concentrations and fentanyl for caudal analgesia in children. Method:One hundred-fifty children undergoing hernia repair procedures under caudal anesthesia, were randomly assigned to five groups. Group A: 1% lidocaine (Lid), group B: 10% Lid+0.1% Bup, group C: 1% Lid+0.25% Baeup, group D: 1%Lid+0.15%Bup with 2?g?kg~(-1) fentanyl, group E: 1%Lid+0. 25%Bup with 2?g?kg~(-1) fentanyl for caudal analgesia, The degree of pain(LPS), nausea and vomiting (NV) were as sessed at 4, 8, 12 and 24 h after operation. Result: The numbers of LPS