The Hemodynamic Effect of Nerve Block by Cranial Pinning in Brain Surgery Patients / 대한마취과학회지

BACKGROUND: It is already known that the cranial pinning causes a sudden increment of blood pressure and heart rate which is harmful especially in brain surgery patient. These changes may be reduced by local infiltration at the sites of cranial pinning. This study was designed to investigate the hemodynamic effects of nerve block by cranial pinning and compare them with the effects of local infiltration at the pinning site. METHODS: Forty patients of brain surgery with cranial pinning were involved. After general anesthesia with isoflurane and 50% N2O, they were divided into 2 groups randomly: the control group (n = 20), had local infiltration at each pinning site with 1% lidocaine 2 ml, and the study group (n = 20), had nerve block of the supraorbital, and supratrochlear, and postauricular branches of the great auricular nerve with lidocaine 2 ml, the auriculotemporal nerve with lidocaine 2.5 ml, and the greater and lesser occipital nerves with lidocaine 2.5 ml. The hemodynamic variables(systolic, diastolic, mean blood pressure, and heart rate) were measured at the 3 different points just before cranial pinning, and 1 min and 5 min after cranial pinning. RESULTS: The values of hemodynamic variables at 1 min after cranial pinning increased in both groups when compared with just before cranial pinning, but there was no difference between the two groups. The increased values at 1 min were not high clinically, and returned to the levels recorded before cranial pinning by the 5 min recording time in both groups. CONCLUSION: From these results, we concluded that nerve block could also reduced the harmful hemodynamic effect of cranial pinning.

The Preemptive Analgesic Effect of Bupivacaine Infiltration on Postoperative Pain after Inguinal Herniorrhaphy / 대한마취과학회지

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of central sensitization, which amplifies the postoperative pain. In this study, we investigated the preemptive effect of local infiltration of bupivacaine on postoperative pain after inguinal herniorrhaphy. METHODS: Thirty adult patients scheduled for inguinal herniorrhaphy were randomly assigned to one of two groups. 0.25% bupivacaine 20 ml was infiltrated in the surgical wound site either 15 min before skin incision or immediately after skin closure. Postoperatively, visual analogue scale (VAS) at rest and movement were assessed. Also the time to the first request for postoperative analgesic and the total dose of postoperative analgesics were assessed. In addition, the number of patients who didn't require any analgesics during the postoperative period were assessed. RESULTS: The VAS at rest and movement was not significantly different between the two groups. The time to the first request for postoperative analgesic, the total dose of supplemental analgesics and the number of patients who didn't require any analgesics were not significantly different. CONCLUSIONS: In pain after inguinal herniorrhaphy, we could not demonstrate the pre-emptive analgesic effect of preincisional bupivacaine infiltration. Traction pain after inguinal herniorrhaphy was sustained during the study period and this kind of pain was not inhibited (or prevented) by local infiltration of bupivacaine.

Comparison of Intravenous Administration and Surgical Site Infiltration of Ketorolac Combined with Preincisional Infiltration of Bupivacaine / 대한마취과학회지

BACKGROUND: We postulated that ketorolac as a component of surgical site infiltration would result in better analgesia than intravenous ketorolac. METHODS: Sixty patients who scheduled for elective total abdominal hysterectomy received ketorolac 60 mg (2 ml) either via surgical site infiltration directly (n=30) or parenteral route (n=30) with surgical site infiltration of 0.25% bupivacaine 18 ml 20 min before skin incision. RESULTS: Postoperative analgesic requirement, 48 hour total infusion dose and first 12 hour infusion dose of PCA fentanyl, were significantly lower in surgical site group. There were no significant differences in VAS score and side effects between two groups. CONCLUSION: Ketorolac improves analgesia when it is administered in the surgical site.