Preemptive Effect of Preoperative Intravenous Ketamine / 대한마취과학회지

BACKGROUND: Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with analgesic properties that may be important in the modulation of central sensitization to nociceptive stimulation. The aim of the present study was to determine if preemptive administration of systemic ketamine decreases postoperative pain when compared with postwound closure administration of ketamine. METHODS: Forty-five patients scheduled for total abdominal hysterectomy were divided into three groups. Before surgical incision, 0.5 mg/kg ketamine was administered alone (group 1, n=15) or followed by ketamine infusion of 10 microgram/kg/min until abdominal closure (group 2, n=15). The other patients were given 0.5 mg/kg of ketamine immediately after abdominal closure (group 3, n=15). Patient-controlled analgesia (PCA) using butorphanol and ketorolac was started after the awakening of patients. Postoperative pain and total infusion doses of the PCA drug were assessed during the 48 hr. period after awakening. RESULTS: The total infusion dose of the PCA drug was significantly lower in group 1 and 2. No significant intergroup differences were seen in the pain score, sedation score and incidences of side effects. CONCLUSIONS: Preoperative and intraoperative administration of ketamine is more effective in reducing postoperative analgesic requirements than it is when given after operation.

A Comparison of the Effects of Ondansetron and Granisetron on the Prevention of Postoperative Nausea and Vomiting after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effects of ondansetron and granisetron on the prevention of postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: In a randomized placebo-controlled study, 200 gynecologic patients were divided into 5 groups. Each patient received one of 5 medications: placebo (saline 3 ml), ondansetron 4 mg (O4), ondansetron 8 mg (O8), granisetron 1.5 mg (G1.5) and granisetron 3 mg (G3). They were administered intravenously immediately before the induction of anesthesia. A standardized inhalation anesthesia and a postoperative intravenous patient-controlled analgesia were applied. Twenty four hours after anesthesia, the incidence and severity of PONV and other adverse effects were assessed. RESULTS: The incidence of PONV was 88%, 83%, 75%, 70% and 60% in the placebo, O4, O8, G1.5 and G3 groups, respectively, which showed significantly lower value in the G3 group than in the placebo and O4 groups (P< 0.05). The severity of PONV was also significantly lower in the G3 group than in the placebo group (P < 0.05). CONCLUSIONS: In this study, granisetron 3 mg showed a better prophylactic effect in the mitigation of PONV in gynecologic patients then a placebo or ondansetron 4 mg.

Comparison of Analgesic Effect of Fentanyl and Butorphanol during Patient-Controlled Epidural Analgesia for Labor Pain Control / 대한마취과학회지

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of fentanyl and butorphanol mixed with bupivacaine. METHODS: After establishing effective epidural analgesia with 10 ml of 0.125% bupivacaine mixed with fentanyl 5 microgram/ml or butorphanol 1 mg/ml, 60 parturients in active labor were randomly assigned to one of two groups: PCEA using 0.0625% bupivacaine with fentanyl 2 microgram/ml (fentanyl group); PCEA using 0.0625% bupivacaine with butorphanol 20 microgram/ml (butorphanol group). PCEA pumps were programmed to deliver a 4 ml/hr basal infusion, 4 ml on-demand bolus, 10-min lockout intervals between doses, and a 20 ml hourly limit. Visual analogue pain scores, side effects, parturients' satisfaction scores, duration of labor and Apgar scores were recorded during and after labor. RESULTS: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores didn't differ between the two groups. Average hourly infusion rates were 11.8 0.3 ml/hr (fentanyl group) and 13.9 0.4 ml/hr (butorphanol group). CONCLUSIONS: PCEA is a safe and effective method for labor analgesia and both solutions, the 0.0625% bupivacaine plus fentanyl 2 microgram/ml and the 0.0625% bupivacaine plus butorphanol 20 microgram/ml, appear suitable for PCEA use for labor pain. There is no difference in effectiveness between fentanyl and butorphanol.

Comparison of Analgesic Effect of Fentanyl and Butorphanol during Patient-Controlled Epidural Analgesia for Labor Pain Control / 대한마취과학회지

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of fentanyl and butorphanol mixed with bupivacaine. METHODS: After establishing effective epidural analgesia with 10 ml of 0.125% bupivacaine mixed with fentanyl 5 microgram/ml or butorphanol 1 mg/ml, 60 parturients in active labor were randomly assigned to one of two groups: PCEA using 0.0625% bupivacaine with fentanyl 2 microgram/ml (fentanyl group); PCEA using 0.0625% bupivacaine with butorphanol 20 microgram/ml (butorphanol group). PCEA pumps were programmed to deliver a 4 ml/hr basal infusion, 4 ml on-demand bolus, 10-min lockout intervals between doses, and a 20 ml hourly limit. Visual analogue pain scores, side effects, parturients' satisfaction scores, duration of labor and Apgar scores were recorded during and after labor. RESULTS: The quality of analgesia, side effects, duration of labor, overall satisfaction and Apgar scores didn't differ between the two groups. Average hourly infusion rates were 11.8 0.3 ml/hr (fentanyl group) and 13.9 0.4 ml/hr (butorphanol group). CONCLUSIONS: PCEA is a safe and effective method for labor analgesia and both solutions, the 0.0625% bupivacaine plus fentanyl 2 microgram/ml and the 0.0625% bupivacaine plus butorphanol 20 microgram/ml, appear suitable for PCEA use for labor pain. There is no difference in effectiveness between fentanyl and butorphanol.

The Effect of Dexamethasone Combined with Ondansetron on Antiemesis and Analgesia during Postoperative Patient Controlled Analgesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effectiveness of ondansetron plus dexamethasone versus ondansetron alone in the prevention of postoperative nausea and vomiting for the patient using a patient controlled analgesia (PCA). METHODS: Of sixty women having general anesthesia for total abdominal hysterectomy (TAH), thirty received intravenous ondansetron 4 mg plus 150 microgram/kg of dexamethasone (Group 1) and thirty received intravenous ondansetron 4 mg plus saline 2 ml (Group 2) after awakening. Butorphanol 10 mg, ketorolac 180 mg and ondansetron 4 mg were connected to PCA pump for postoperative pain control. The severity of nausea, vomiting and pain were assessed at 0, 1, 2, 6, 12, 24, 36 and 48 hr after awakening. RESULTS: Nausea and vomiting occurred in 5 patients in Group 1 and in 4 patients in Group 2. There were no significant differences between groups in nausea, vomiting and pain scores. CONCLUSIONS: The combination of ondansetron and dexamethasone is not more effective than ondansetron alone in prevention of postoperative nausea, vomiting and pain for women having PCA following TAH.

The Comparison of Effectiveness of Ondansetron and Droperidol on Antiemesis / 대한마취과학회지

BACKGROUND: This study was designed to compare the efficacy and safety of ondansetron with droperidol in the prevention of postoperative nausea and vomiting (PONV) using intravenous patient-controlled analgesia (IV-PCA). METHODS: Sixty women were randomly allocated to one of four groups after total abdominal hysterectomy under general anesthesia, droperidol 1 mg (Group 1), 2 mg (Group 2), ondansetron 2 mg (Group 3), 4 mg (Group 4) bolus injection with butorphanol 1 mg and added the same drug to PCA drug (butorphanol 10 mg). The severity of pain, nausea, vomiting and sedation were assessed at 0, 1, 2, 6, 12, 24, 36 and 48hr postoperatively. RESULTS: The occurrence of nausea and vomiting was significantly higher in Group 1, 2 than Group 4. The sedation score and incidence of dizziness were significantly higher in Group 1, 2 than Group 3, 4. CONCLUSIONS: The addition of ondansetron to PCA drug is more effective and safe in the prevention of postoperative nausea and vomiting and has less sedation and dizziness effect than droperidol. But, droperidol has a cost-saving effect.

Comparison of Ondansetron and Droperidol in Reducing Postoperative Nausea and Sedation Associated with Patient-Controlled Analgesia / 대한마취과학회지

BACKGROUND: To know the effect of droperidol and ondansetron on nausea and sedation in postoperative patients, we studied 120 gynecological patients receiving patient-controlled analgesia (PCA) with morphine and droperidol or ondansetron. METHODS: Subjects were randomly allocated to one of four groups according to PCA regimen, morphine 0.5 mg/cc alone (group M); morphine plus droperidol 0.034 mg/morphine 1 mg (group D); morphine plus ondansetron 0.132 mg/morphine 1 mg (group O1); morphine plus ondansetron 0.066 mg/morphine 1 mg (group O2). The PCA device, WalkMed was set at basal rate 2 ml/hr (1 mg/hr), bolus dose 1 ml (0.5 mg), lockout time 10min, 1 hour maximum dose 4 mg. The severity of nausea, sedation and pain were assessed at 1h, 4h, 8h, 12h, 24h, and 48h postoperatively. RESULTS: The occurrence of nausea was not different among groups. But there were statistical differences in the nausea severity (p<0.05). The group D and group O1 had lower nausea scores, and between them there was no difference. The scores for sedation were significantly lower in the group O1 compared with group M and group D (p<0.05). Overall pain scores were not different among groups. CONCLUSIONS: Ondansetron and droperidol are effective in reducing nausea. Ondansetron is superior to droperidol in avoiding excessive sedation.

The Effects of Intravenous Patient-Controlled Analgesia using Morphine or Nalbuphine to Postoperative Respiratory Depression / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate the effects of respiratory depression of IV-PCA using morphine which has potent respiratory depression or nalbuphine which has less potent respiratory depression among opioids. METHODS: Forty patients were divided into two groups; Group M was used morphine, and Group N was used nalbuphine as a drug for IV-PCA. When patient emerges from general anesthesia, Group M was given initial bolus of 0.1 ml/kg of 0.1% morphine solution and connected Basal Bolus PCA infusor R containing morphine 50 mg per 40 ml in normal saline. Group N, similarly Group M, was given initial bolus of 0.1 ml/kg of 0.1% nalbuphine solution, and connected PCA infusor containing nalbuphine 50 mg per 40 ml in normal saline. To compare respiratory depression, arterial blood gas analyses were done preoperatively and at 1, 6 and 12 hour after IV-PCA. Simultaneously, analgesic and side effects were evaluated. RESULTS: There were no remarkable respiratory depression such as hypercarbia(PaCO2 > 50 mmHg), hypoxemia(PaO2 < 60 mmHg) and slow respiratory rate in both groups. Analgesic and side effects were similar in both groups. CONCLUSIONS: We conclude that IV-PCA using morphine or nalbuphine is relatively effective and safe method for the postoperative pain control. Ordinarily, IV-PCA dose not induce respiratory depression unless overdose in careless or mistaken mishaps are developed.