The Effect of Lidocaine and Ketorolac Combined to Fentanyl IV PCA on Postoperative Bowel Function / 대한마취과학회지

BACKGROUND: A postoperative ileus after anesthesia and surgery may be bothersome to recovery and prolong hospitalization periods. The object of this study was to investigate the effect of lidocaine and ketorolac combined to fentanyl IV PCA on the recovery of bowel function after surgery. METHODS: Forty-nine patients undergoing a total abdominal hysterectomy were divided into three groups (F, FT, LFT). All patients received IV PCA for postoperative pain control. PCA contents were fentanyl 1,000 microgram only in saline 100 ml in group F (n = 16) and fentanyl 500 microgram-ketorolac 150 mg in saline 100 ml in group FT (n = 17) and LFT (n = 16). Group LFT received a lidocaine bolus (1.5 mg/kg) before induction and a continuous infusion of lidocaine (2 mg/min) until one hour after surgery. We measured postoperative pain scores (at postoperative 1 hour, 6 hours, 24 hours, and 48 hours) and checked the first flatus time, the first defecation time, and the side effects. RESULTS: The intravenous lidocaine infusion group showed better pain scores at postoperative 1 hour only. The FT and LFT groups provided a more rapid return of bowel function than group F. A combined infusion of lidocaine and ketorolac had no difference in the return of bowel function. There were no significantly different incidences of nausea, vomiting and other side effects. CONCLUSIONS: Ketorolac allowed an earlier recovery of bowel function after surgery. However, an additional infusion of lidocaine was not helpful in the return of bowel function.

Acute Dystonia by Droperidol during Intravenous Patient-Controlled Analgesia in Children / 대한마취과학회지

Patient-controlled analgesia (PCA) is an important means for postoperative analgesia with parenteral opioids. However, postoperative nausea and vomiting (PONV) remains a major complication with a PCA system. Droperidol is used in PCA to prevent PONV. Extrapyramidal reactions by droperidol are, however, occasionally induced. We describe two cases of severe extrapyramidal hypertonic syndrome with an IV administration of droperidol in PCA in two children, following orthopedic surgery. One patient showed a hypertonic syndrome 20 minutes after receiving droperidol 1.0 mg IV and the symptoms persisted for nearly 12 h without prescription. Another patient revealed an acute rigidity 19 h after the beginning of PCA and was treated with an IM administration of midazolam 2 mg successfully.

Combination of Small Doses of Subarachnoid Bupivacaine/Fentanyl and Epidural Bupivacaine in Combined Spinal-Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: An intrathecal injection of a small-dose local anesthetic and an opioid using combined spinal-epidural anesthesia (CSEA) technique is a new trend in regional anesthesia for cesarean section. Prophylactic epidural injection may be useful to complete the new regimen. METHODS: Spinal anesthesia via the CSEA technique was performed with 6 mg 0.5% hyperbaric bupivacaine plus 20ng fentanyl in 75 parturients undergoing cesarean section. group S (study, n = 38) received an epidural injection of 10 ml of 0.25% bupivacaine 5 min after intrathecal injection, and was compared with group C (control, n = 37) in sensory levels and Bromage scores, incidences of side effects such as hypotentsion, pain and discomfort, nausea and vomiting, dizziness, pruritus and shivering. Recovery times from sensory and motor block and the duration of postoperative analgesia were assessed between the groups. RESULTS: Sensory block levels were higher (but remained

Comparison between Epidural Analgesia and Combined Spinal-Epidural Analgesia for Labor and Delivery / 대한마취과학회지

BACKGROUND: This study was designed to compare analgesic efficacy and side effects of intrathecal morphine and fentanyl with epidural bupivacaine. METHODS: Twenty nine healthy women, ASA physical status 1 or 2 with an uncomplicated pregnancy and single fetus in vertex position were given lumbar epidural or combined spinal-epidural analgesia. In the epidural analgesia group (n = 18), 0.25% bupivacaine 8 - 10 ml and fentanyl 50 - 75ng was injected into the epidural space. In the CSE group (n = 11), analgesia performed dural puncture with a 27 gauge spinal needle and fentanyl 15ng and morphine 0.2 mg in 2 ml normal saline solution was injected. In both groups, whenever the patient requests further analgesia, we injected 0.125% bupivacaine 10 ml and fentanyl 50 - 75ng into the epidural space. RESULTS: There was no significant difference between the two groups in duration of analgesia, the second stage of labor and pushing. The CSE group offers rapid onset time. The total dose of bupivacaine and fentanyl administered during analgesia was significantly more in the epidural group than the CSE group. After intrathecal fentanyl 15ng and morphine 0.2 mg, the duration of analgesia was 162 +/- 122 min. After the first 0.25% bupivacaine 10 ml and fentanyl 50 - 75ng, it was 92.5 +/- 5 min in the epidural group and 190 +/- 101 min in the CSE group (P < 0.05). CONCLUSIONS: Compared with epidural analgesia, Intrathecal fentanyl 15ng and morphine 0.2 mg as part of CSE analgesia provide rapid onset time and prolonged analgesia, and a lower total dose of local anesthetics for labor and delivery. However women who received CSE analgesia were more likely to itch (64%) than solely epidural analgesia.

Effect of Intravenous Clonidine-Fentanyl on Prevention of Postepidural Shivering / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the efficacy of intravenous clonidine-fentanyl to prevent postepidural shivering in patients undergoing an elective orthopedic surgery. METHODS: Forty ASA class 1 or 2 patients who received epidural anesthesia for an orthopedic surgery were allocated randomly to two groups. 10 min before epidural anesthesia group 1 received intravenous clonidine 2.0ng/kg and group 2 received clonidine 1.0ng/kg and fentanyl 1.0ng/kg shivering was determined objectively by observing involuntary muscle activity. Mean arterial pressure, heart rate and sedation score were measured at 5 minute intervals during the first 30 minutes following epidural anesthesia. RESULTS: There were no significant differences between the two groups in the occurrence of shivering, hemodynamic changes and sedation score. CONCLUSIONS: Intravenous clonidine 2.0ng/kg and the combination of clonidine 1.0ng/kg and fentanyl 1.0ng/kg were not significantly different in occurrence of postepidural shivering. Therefore, a combination of small doses of intravenous clonidine and fentanyl may be safe and useful to reduce postepidural shivering.

The Effects of Intravenous Piroxicam on Pruritus and Pain in Patients Receiving Epidural Fentanyl / 대한마취과학회지

BACKGROUND: This study was designed to evaluate the effect of intravenous piroxicam on pruritus and pain in patients undergoing abdominal surgery after epidural fentanyl was administered. METHODS: Ninety nine patients, ASA physical status 1 - 2, were randomly allocated to receive either piroxicam 20 mg (n = 50) or saline 2 ml (n = 49) intravenously before surgical incision. An epidural catheter was inserted in all patients before induction of anesthesia. All patients received 5 mg/kg of thiopental sodium and 1.5 mg/kg of vecuronium. Anesthesia was maintained by 50% O2 in N2O with 2 vol% enflurane. Epidural fentanyl 50 microgram was administered intraoperatively and 9.5 12.5 microgram/ml of fentanyl mixed in 100 ml of 0.15% bupivacaine was infused continuously by the Baxter two day infusor for 50 hours postoperatively. Postoperative pruritus and pain were measured by a numeric rating scale (0 - 10) in the piroxicam group and control group. RESULTS: Pruritus and pain scores at 1, 4, 8 and 24 hours in the piroxicam group were significantly lower than those in the control group (P < 0.05). The incidence of pruritus after epidural fentanyl varied from 2 to 6% in the piroxicam group and from 57 to 67% in the control group. Mean scores of pruritus were 0.6, 0.3, 0.2 and 0.1 in the piroxicam group and 5.1, 3.5, 2.8 and 1.8 in the control group. Mean scores of pain were 1.7, 1.2, 0.9 and 0.6 in the piroxicam group and 3.2, 2.4, 1.9 and 1.1 in the control group. CONCLUSIONS: This study demonstrates that intravenous piroxicam 20 mg significantly reduces the incidence and severity of postoperative pruritus and pain in patients who received perioperative epidural fentanyl.

Patient-controlled Sedation and Analgesia in Patients Undergoing Cataract Surgery / 대한마취과학회지

BACKGROUND: Patient-controlled sedation with propofol has been shown to provide safe and effective sedation for patients undergoing surgery under local anesthesia. The purpose of this study was to evaluate the efficacy of patient-controlled sedation and analgesia with propofol and fentanyl in 17 patients undergoing cataract surgery. METHODS: An admixture of 400 mg of propofol with 100microgram of fentanyl (42 ml) was loaded into a patient-controlled analgesia pump and administered at a rate of 10 ml/hr. The lock-out time was 1 minute and the bolus dose was 1 ml. At the end of surgery, pain relief, anxiety relief and the satisfaction score were recorded on a patient questionnaire with a 1 to 10 scale. RESULTS: The sedation level varied from patient to patient and there was no incidence of oversedation. Most patients were satisfied with this anxiety and pain relieving technique (more than a score of 8). Blood pressure and arterial oxygen saturation showed minimal changes and remained within normal ranges. There were no complications except complaints of pain at infusion sites from 3 patients. CONCLUSIONS: Patient-controlled sedation and analgesia is a safe and satisfactory method for most patients undergoing cataract surgery for relieving pain and anxiety.

Is a Basal Infusion Required in Patient-controlled Analgesia Using Fentanyl after Orthopedic Surgery? / 대한마취과학회지

BACKGROUND: It has been suggested that addition of a basal infusion (BI) to patient-controlled analgesia (PCA) improves the continuity of analgesia for post-operative pain, by maintaining a minimum effective blood concentration of opioids between PCA demands. The aim of this study was to determine whether the addition of a BI to PCA using fentanyl would lead to improved pain control and patient satisfaction without increasing the side effects. METHODS: Seventy three patients, ASA class I or II, aged 22 - 72 years, following an orthopedic surgery under general anesthesia were studied. Patients were randomly allocated into two groups as follows: PCA group (n = 37), fentanyl 20 microgram demand dose with a lockout time of 6 min; PCA + BI group (n = 36), addition of fentanyl 20 microgram/h as a BI in the same regimen as the PCA group. RESULTS: Pain scores, patient satisfaction, sedation, and incidence of side effects were similar between the two groups. However, total consumption of fentanyl during the first 24 h after surgery was significantly increased in the PCA + BI group compared with those in the PCA group (1114 +/- 334 microgram vs. 841 +/- 409 microgram, P < 0.05). CONCLUSIONS: Despite the increased fentanyl consumption, the pain scores and patient satisfaction were not improved in the PCA + BI group. Addition of a BI at 20 microgram /h of fentanyl did not confer any advantage over a PCA alone and is not recommended when fentanyl PCA is used after orthopedic surgery.

The Efficacy of Patient-Controlled Sedation and Analgesia in Patients Undergoing Endoscopic Sinus Surgery / 대한마취과학회지

BACKGROUND: Patients receiving surgery under local anesthesia might feel anxiety during surgery and suffer pain due to the insufficiency of local anesthesia. The purpose of this study was to evaluate the efficacy and side effects of patient-controlled sedation and analgesia in patients undergoing endoscopic sinus surgery (ESS). METHODS: We studied 63 adult patients. A mixture of 400 mg of propofol and 200microgram of fentanyl (total 44 ml) was infused to the patient at a rate of 10 ml/hr using a PCA device. The lock-out time was 1 minute and the bolus dose was 1 ml. During surgery, we monitored vital signs and sedation state. At the end of surgery, we assessed the degree of satisfaction about pain and anxiety relieving effects by using a questionnaire with a 1 to 10 scale. RESULTS: About 90% of patients were wide awake during surgery, others were drowsy or intermittently sleeping. About 95% of the patients were satisfied with anxiety relief (more than a score of 8) and 84% were satisfied with pain relief in painful episodes (more than a score of 8). Vital signs were within normal limits. The oxygen saturation was maintained above 94% during surgery, except three patients whose oxygen saturation was 92% for short while. Twenty-two percent of the patients complained of pain at their drug infusion sites. CONCLUSIONS: We concluded that patient-controlled sedation and analgesia using the mixture of fentanyl and propofol might be a good way to relieve patient's anxiety and pain without respiratory depression and excessive sedation for those undergoing ESS under local anesthesia.

The Incidence of Hypoxia Following the Use of Hypnotics and Analgesics during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.

Comparision of Intrathecal 0.5% Hyperbaric and Isobaric Bupivacaine for Cesarean Section / 대한마취과학회지

BACKGROUND: Baricity differences between spinal anesthetic solutions are thought to produce differences in distribution of anesthetics within the subarachnoid space. We evaluated the influence of baricity of bupivacaine on the quality of the block and the incidence of side effects obtained following intrathecal injection of bupivacaine 8 mg with fentanyl 20 microgram. METHODS: Thirty healthy term parturients scheduled for a cesarean section under combined spinalepidural procedures were randomly allocated into Group I, hyperbaric bupivacaine (n = 15); or Group II, isobaric bupivacaine (n = 15). The dose of both groups was bupivacaine 8 mg combined with fentanyl 20 microgram. The maximum level of sensory blockade, time to reach T4 level and maximum level, time to get complete motor recovery and perioperative complications were assessed. RESULTS: Time to sensory block T4, motor block Bromage scale 3, complete resolution of motor block and sensory regression time to T10 was significantly delayed in Group II compared to Group I. Maximal block height, and time to maximal block had no significant differences between the two groups. There were no significant clinical advantages of one preparation over the other. CONCLUSIONS: The data from this study suggests that intrathecal injection of either hyperic or isobaric bupivacaine produces satisfactory anesthesia with similar side effects.

A Comparison of Epidural 0.2% Ropivacaine Alone and in Combination with 4 microgram/ml Fentanyl for Postoperative Analgesia after Total Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Epidural infusions usually comprise a local anesthetic, an opioid, or more commonly, a combination of the two, to minimize individual doses and to reduce unwanted side effects. The aim of this study was to compare analgesic and side effects of epidural infusion with 0.2% ropivacaine alone and in combination with 4 microgram/ml fentanyl after total abdominal hysterectomy. METHODS: Forty healthy total abdominal hysterectomy patients under general anesthesia with postoperative analgesia by continuous epidural infusion were randomly allocated into Group I; 0.2% ropivacaine alone (n = 20) or Group II; 0.2% ropivacaine and 4 microgram/ml fentanyl (n = 20). We assessed the visual analogue scale (VAS, 0 = no pain, 10 = worst pain), frequency of supplemental analgesics, side effects and patients' satisfaction of the result. RESULTS: The VAS and the frequency of supplemental analgesics were significantly lower and fewer in Group II compared to Group I. The incidence and severity of side effects were no differences between two groups. The satisfactions of patients were significantly higher in Group II. CONCLUSIONS: For postoperative analgesia, the epidural infusion of 0.2% ropivacaine with 4 microgram/ml fentanyl provided better analgesia than 0.2% ropivacaine alone.

Effects of Local Anesthetics and Opioids on Human Isolated Umbilical Arteries / 대한마취과학회지

BACKGROUND: An adequate uteroplacental and fetal blood flow during labor and cesarean delivery is of prime importance for fetal well-being and neonatal outcome. METHODS: Using the vascular smooth muscle of the human isolated umbilical arteries, this study was performed to see whether commonly used local anesthetics (bupivacaine, lidocaine and 2-chloroprocaine) and opioids (morphine,fentanyl and meperidine) could induce contracion or relaxation of these resting and precontracted vessels. Rings from human umbilical arteries were prepared by microdissection. The vessel rings were mounted in tissue baths for an isometric recording of the contractile activity. For resting muscles, the reactivity to drugs is expressed as a percentage of a maximal KCl-induced contraction, and for precontracted muscle, it is expressed as a percentage of a submaximal KCl-induced contraction. RESULTS: Bupivacaine, lidocaine and 2-chloroprocaine all induced contractions. Bupivacaine showed a maximal contraction (46.7 +/- 10.5%) at concentrations of 43 micrometer, lidocaine 19.7 +/- 4.8% at 0.11 mM. and 2-chloroprocaine showed 14.6 +/- 2.9% at 0.65 mM. Morphine, fentanyl and meperidine all induced contractions. Morphine showed a maximal contraction (19.6 +/- 7.1%) at a concentration of 10 4 M, meperidine at 17.2 +/- 8.4% at 3 x 10 5 M, and fentanyl at 1.7 +/- 2.0% at 3 x 10(-6)M. When umbilical arteries were induced to contract with a submaximal concentration of KCl, bupivacaine and lidocaine showed an ability to increase the magnitude of the sustained contraction, but 2-chloroprocaine showed a relaxation of the sustained contraction. Morphine, fentanyl and meperidine showed no change in the sustained contraction. CONCLUSIONS: This study demonstrates these local anesthetics and opioids as vasoactive on human umbilical arteries. If applicable in vivo, these drugs might have some influence on umbilical vessel tone and thus might reduce umbilical blood flow.

Comparisons of Two Solutions of Ropivacaine/Fentanyl with Different Volume for Postoperative Epidural Analgesia / 대한마취과학회지

BACKGROUND: Ropivacaine is a new local anesthetic approved for epidural analgesia. The addition of fentanyl improves analgesia from epidural ropivacaine. We studied the effects of two solutions of ropivacaine/fentanyl for postoperative pain after a total abdominal hysterectomy. METHODS: Twenty five female patients scheduled for an elective total abdominal hysterectomy were prospectively randomized to receive one of two solutions. Group 1 (n = 13) received 0.2% ropivacaine and 5 microgram/ml of fentanyl at a rate of 2 ml/hour (bolus: 10 ml). Group 2 (n = 12) received 0.08% ropivacaine and 2 microgram/ml fentanyl at a rate of 5 ml/h (bolus: 25 ml) postoperative for two days. After an epidural bolus injection, we assessed the blood pressure, pulse rate, respiratory rate, visual analog scale (VAS), level of sensory block, motor block and sedation score among the two groups. Additional analgesic requirements and side effects such as nausea, itching and urinary retention were assessed for 48 hours post operation. RESULTS: There were no significant differences in the blood pressure, pulse rate and respiratory rate between the two groups. The sum of VAS for 48 hours, the level of sensory block after an epidural bolus injection, additional analgesics, and the number of patients showing motor blockade were similar. Although statistically insignificant, the incidence of nausea, and urinary retention in group 2 was higher than group 1. CONCLSIONS: Both the continuous epidural infusion of 0.2% ropivacaine with fentanyl (2 ml/hour) and 0.08% ropivacaine with fentanyl (5 ml/h) showed similar quality of analgesia on postoperative pain. To reduce the side effect of fentanyl, the volume of ropivacaine/fentanyl solution is important.

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.

A Comparison of the Effect of Nalbuphine-Ketorolac and Morphine-Fentanyl-Ketorolac for Postoperative Analgesia with the Use of IV-PCA / 대한마취과학회지

BACKGROUND: Intravenous patient-controlled analgesia (IV-PCA) is a safe and effective method for post-operative pain control. But opioids used in IV-PCA result in some side effects such as respiratory depression, nausea, vomiting, itching and urinary retention. Nalbuphine, an agonist-antagonist, has a considerable analgesic effect without serious complications. This study was designed to evaluate the effectiveness of post-operative pain relief in PCA-administered nalbuphine-ketorolac and morphine-fentanyl-ketorolac. METHODS: Patients scheduled for total abdominal hysterectomy were randomly assigned in a double-blind manner into one of two groups. Group 1 (n=24) and Group 2 (n=28) received nalbuphine-ketorolac or morphine-fentanyl-ketorolac, respectively. All patients received same background infusion rate (2 ml/hr), PCA dose (0.5 ml) and lockout interval (15 min) just after peritoneum closure. And post-operative pain scores were recorded with numerical rating scale (NRS) at 1, 2, 6, 12, 24 and 48 hr after operation. RESULTS: The pain control effect in group 1 was more effective than in group 2. The patients' satisfaction was more superior in group 1. And the number of using PCA button was more frequent in group 2. CONCLUSION: This study suggests that intravenous nalbuphine is an excellent alternative to morphine and fentanyl for postopertive pain control.

A Comparison of Epidural Fentanyl-Bupivacaine and Intravenous Morphine Using Patient-Controlled Analgesia after Thoracic Surgery / 대한마취과학회지

BACKGROUND: Epidural and intravenous (IV) administration of opioids are commonly used for postoperative pain management. However, studies that compare the epidural and IV routes of opiate administration show conflicting results. The purpose of this study was to determine the superior route of analgesics by comparing the effect of epidural fentanyl-bupivacaine with IV morphine using patient-controlled analgesia (PCA) system in the management of posterior thoracic surgery pain. METHODS: Sixty patients undergoing elective thoracic surgery were randomly assigned to receive either Epiural-PCA (Epi-PCA, n=30) or IV-PCA (n=30) when postoperative pain first increased to 40/100 mm (by visual analogue scale; VAS). Epi-PCA group received epidural bolus of 0.1% bupivacaine 10 ml containing fentanyl 100 microgram and then followed by Epi-PCA with 0.1% bupivacaine 100 ml containing fentanyl 800 microgram (basal infusion 2 ml/hr, PCA dose 1 ml, lock-out interval 30 min), IV-PCA group received repeated IV boluses of 3 mg of morphine until postoperative pain decreased to 40/100 mm and then followed by a IV-PCA with morphine (basal infusion 0.005 mg/kg/hr, PCA dose 0.02 mg/kg, lock-out interval 8 min). Analgesic efficacy, degree of patient satisfaction and pain, analgesics consumptions, forced vital capacity (FVC), forced expired volume in one second (FEV1) and side effects were evaluated. RESULTS: There were no significant differences in analgesic efficacy and degree of patient satisfaction and pain in both group. But the PHS were significantly lower (p<.05), and FEV1 higher (p<.05) in Epi-PCA group, signifying better analgesia during movement (cough and deep breaths). CONCLUSIONS: We concluded that an epidural PCA with mixture of fentanyl and bupivacaine administration is superior to that of intravenous PCA with morphine in the management of pain after thoracic surgery.

The Preemptive Analgesic Effect of Ketamine Used with Fentanyl in Epidural Anesthesia / 대한마취과학회지

BACKGROUND: The present study was undertaken to determine whether ketamine, used with fentanyl in epidural anesthesia, can potentiate postoperative analgesia. METHODS: Fifty patients undergoing Cesarean section were allocated randomly into two groups. Group 1 received epidural injection of 2.0% lidocaine 18-20 ml and 0.5% bupivacaine 2-5 ml with fentanyl 50 ug on 20 minutes before surgical incision, and group 2 added epidural ketamine 30 mg to group 1 at the same time. Postoperative pain relief was provided with epidural morphine 3 mg and 0.25% bupivacaine 8 ml on 40 minutes after surgical incision in both groups. Numeric rating scales for pain and mood, Prince Henry Hospital scores for pain were assessed at 2, 6, 12, 24, 48 hours after anesthesia. We measured the first request time of analgesics for postoperative pain, the dose of analgesics within postoperative 48 hours and the incidence of side effects postoperatively. RESULTS: There were no significant difference in the first request time of analgesics and use of analgesics for postoperative pain control between two groups. Pain and mood scores, and PHS score for pain in group 2 were better than those of group 1. The incidence of side effects were similar in both groups. CONCLUSIONS: The combined use of fentanyl and ketamine in epidural anesthesia provided little effect in potentiation of postoperative pain control. Further studies are needed to provide more prominent analgesic effect.

Spinal Anesthesia for Cesarean Section: A comparison of three doses of hyperbaric bupivacaine and the effects of fentanyl / 대한마취과학회지

BACKGROUND: Spinal anesthesia has several advantages in cesarean section. Those are rapid induction, complete analgesia, profound muscle relaxation, low failure rate and systemic toxicity. But the determination of anesthetic level is more difficult in spinal anesthesia than in epidural anesthesia. So we would like to determine the appropriate dosage of 0.5% hyperbaric bupivacaine and the effects of addition of intrathecal fentanyl. METHODS: Sixty full term parturiants scheduled for cesarean section were randomly received 0.5% hyperbaric bupivacaine 8, 10, 12 mg intrathecally. Analgesia, sensory and motor blockade, muscle relaxation, hypotension and side effects were assessed. We compared these results with the previous study that was done with the same dosages mixed with 10 microgram fentanyl. RESULTS: The maximum level of block was higher in 12 mg group (T2) then 8 and 10 mg group (T3). 5 parturients showed more than T1 sensory block in 12 mg group (n=20). 4 parturients did not reach T4 in 8 mg group (n=20). 7, 4 and 0 parturients complained pain during operation in each 8, 10, 12 mg group (p=0.012 between 8 and 12 mg group, p=0.062 between 10 and 12 mg group). Addition of 10 microgram fentanyl showed better analgesia and less shivering. CONCLUSION: Intrathecal 0.5% hyperbaric bupivacaine 12 mg showed complete analgesia for all parturients but the tendency of high spinal anesthesia. Analgesia was inadequate in 8 mg group. Addition of 10 microgram fentanyl showed better analgesia and less shivering.

Nausea and Vomiting after Tympanomastoidectomy: Effect of Small Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.