Tratamiento multimodal del dolor agudo postoperatorio agregando paracetamol IV a protocolo ya establecido / Multimodal treatment of acute postoperative pain adding IV paracetamol to an established protocol

Introducción: El paracetamol intravenoso fue autorizado en el año 2001 para Europa, en el 2016 se autoriza en Guatemala. Esta presentación ha generado diferentes expectativas alrededor del mundo, por lo que se evaluó su administración al agregarse al tratamiento de analgesia postoperatoria multimodal. Objetivo: Evaluar el efecto analgésico en el tratamiento multimodal de dolor agudo postoperatorio con paracetamol IV en la población guatemalteca. Métodos: Estudio retrospectivo caso-control para la evaluación del dolor postoperatorio inmediato (24 horas) al agregar paracetamol IV al protocolo de analgesia estándar. En pacientes de ambos géneros, entre 18 y 70 años de edad, con peso mayor o igual a 50 Kg. con una cirugía electiva abierta o por vía laparoscópica, en una muestra de 110 pacientes dividida en dos grupos. Se comparó el número de pacientes que necesitaron dosis de rescate y el nivel de dolor según la Escala Visual Análoga (EVA) durante 4 evaluaciones en el postoperatorio agudo. Para determinar la correlación entre las variables se utilizó la prueba de independencia de Ji cuadrado. Resultados: Se demostró que agregar paracetamol IV al tratamiento estándar disminuye la cantidad de pacientes que requieren dosis de rescate y mejoran su analgesia durante el postoperatorio agudo. Conclusiones: El paracetamol IV es de beneficio al ser agregado al tratamiento de analgesia multimodal convencional de un hospital privado de Z.10. Palabras clave: Analgesia, anestesia, Escala Visual Análoga, multimodal, paracetamol, control post operativo del dolor

Background: In 2001 was authorized IV paracetamol for its use in Europe. In Guatemala it was used for the first time until 2016. This formulation has awakened different expectations around the world, for this reason its administration was evaluated when added to the multimodal postoperative analgesia treatment to demonstrate its efficiency. Objective: The aim of this study is to evaluate the analgesic effect in the multimodal treatment for acute postoperative pain with IV paracetamol in a group of Guatemalans patients. Methods: Retrospective case-control study for the evaluation of acute postoperative pain (24 hours) by adding IV paracetamol to the standard analgesic protocol. Patients of both sexes, between 18 and 70 years old, with a weight greater than or equal to 50 kg with open or laparoscopically elective surgery, in a sample of 110 patients divided into two groups. The number of patients needing rescue dose and the level of pain according to the Visual Analogue Scale (VAS) were compared during 4 evaluations in the acute postoperative period. To determine the correlation between the variables, the chi square independence test was used. Results: Adding IV paracetamol to standard treatment decreases the number of patients who require rescue doses with opioids and improves their analgesia during the acute postoperative period. Conclusions: IV paracetamol is of benefit when added to the conventional multimodal postoperative analgesia treatment of a private hospital. Keywords: Analgesia, anesthesia, Visual Analogue Scale, multimodal, paracetamol, postoperative pain control

Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

STUDY DESIGN: Prospective study. OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.

Efficacy and Safety of Combined Subacromial and Intravenous Patient-controlled Analgesia after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.

Efficacy and Safety of Combined Subacromial and Intravenous Patient-controlled Analgesia after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.

Probable tramadol-induced atypical serotonin syndrome in a patient receiving selective serotonin reuptake inhibitor and stopped at 10 days before surgery: A case report

Tramadol can increase the serum level of serotonin, causing serotonin syndrome, which is a potentially life-threatening condition. Serotonin syndrome occurs when tramadol is used in combination with other drugs that affect serotonin. A patient who had been taking selective serotonin reuptake inhibitor and stopped at 10 days before surgery experienced intermittent heart rate elevation, tremor of the upper extremities and mental change after receiving an infusion of tramadol for postoperative pain control. Although he did not show the typical triad of serotonin syndrome (systemic autonomic dysfunction, neuromuscular impairment and mental status change), the patient was suspected to have serotonin syndrome caused by tramadol.

A Preliminary Study for Randomized, Controlled Trial of On-Q® PainBuster® Pain Pump vs. Intravenous Patient-controlled Analgesia after Gasless Transaxillary Endoscopic Thyroidectomy / 대한내분비외과학회지

PURPOSE: Gasless transaxillary approach to endoscopic thyroidectomy is a widely performed procedure for benign or malignant thyroid neoplasms. However, it requires wide dissection for approaching the target area. The intravenous patient-controlled analgesia (IV PCA) is an effective method for postoperative pain control and patients can use it according to their requirement. However, patients suffer from nausea, vomiting, sleep disturbance, etc. due to opioids. Pain pump ON-Q® PainBuster® (pain buster) has been used widely in various surgeries for control of postoperative localizing and wide area pain without side effects of opioid analgesia because it consists of Ropivacaine. METHODS: From Aug. 2008 to Jan. 2013, Gasless transaxillary endoscopic thyroidectomy was performed in 90 patients in a single institution, who were divided into three groups, including the IV PCA, pain buster, and null groups. We compared postoperative outcomes, pain severity between groups. We recorded scores immediately, 6, 12, 24, and 48 hours after surgery following visual analog pain score (VAS), and investigated hospital stay and occurrence of events of nausea, vomiting, and complications. RESULTS: In the IV PCA group, it was discontinued due to nausea in 36.7% of patients. No significant difference in pain severity following VAS score was observed among the three groups. However, smaller numbers of analgesia injections were required in the Pain buster group than in the other groups, and fewer patients suffered from constipation, compared with the PCA group. CONCLUSION: Pain buster showed even effects compared to IV PCA, with few side effects and less discomfort of patients, compared with the other groups. Therefore, pain buster was thought to be the proper method for pain control after dissection of the anterior chest wall, cervical area in order to secure an operative view for transaxillary endoscopic thyroidectomy.

Postoperative Pain Control by Ultrasound-Guided Sciatic Nerve Catheterization: A Technical Note / 대한족부족관절학회지

Intravenous Patient Controlled Analgesia (IV PCA) after general or spinal anesthesia may be a method of postoperative pain control, but side effects such as nausea, vomiting, and sedation occurs in most patients. The following research is based on the ultrasound guided femorosciatic nerve block held on parts below the knee joint operation. Because this anesthesia is held locally on the sciatic nerve with continuous anesthesia performed through perineural catheterization, the complications of nausea, vomiting, and sedation may be reduced while postoperative pain caused by the sciatic nerve is controlled. The following report is held on this experience.

Gender-related Difference in Intravenous Patient-controlled Analgesia for Postoperative Pain Control in Rotator Cuff Repair / 대한정형외과학회잡지

PURPOSE: This study examined the efficacy and gender-related difference of intravenous patient-controlled anesthesia (IV PCA) for postoperative pain control in patients undergoing rotator cuff repair. MATERIALS AND METHODS: Forty-five patients undergoing rotator cuff repair had their postoperative pain controlled using IV-PCA. There are 21 males and 24 females. The results of the two groups were compared prospectively using a visual analogue scale score (VAS score) measured before and until 5 days after surgery, hospital stay, postoperative rehabilitation, additional analgesics consumption and medication-related adverse effects. RESULTS: There was no difference in age, body mass index, tear size and operative time between the groups. The mean VAS scores measured before and until the 5th postoperative day were 7.6, 8.0, 5.2, 4.0, 4.0, 3.6 and 3.0. There was no statistically significant difference in VAS score on preoperative, immediate postoperative day and until 4th postoperative day. Significant pain relief was noted in the male group on the 5th postoperative day. In medication-related adverse effects encountered were constipation (35.6%), nausea (28.9%), dizziness (22.2%) and vomiting (15.6%). The consumption of additional analgesics was 1.7 and 3.6 times in the male and female group, respectively. Three (14.3%) and 5 (20.0%) patients in the male and female group, respectively, had their IV PCA stopped because of medication-related adverse effects. Although lower in the male group, there were no statistically significant differences in the medication-related adverse effects, additional analgesics consumption and stop IV PCA. CONCLUSION: There were gender-related differences in IV PCA for postoperative pain control in rotator cuff repair, such as a significant decrease in the VAS score on the 5th postoperative day and a shorter hospital stay in the male group.

Severe muscular rigidity following the usual analgesic dose of meperidine in the child at postanesthetic recovery room: A case report

Severe muscular rigidity is a rare but potentially serious side effect from the use of opioid, usually in high dose. However it has also been reported with the use of low to moderate dose of opioids in a few occasions. The age of the patients varied from newborn to old. These diverse and unpredictable natures of clinical manifestations seem to be related to the unknown mechanisms in the subcortical areas which are difficult to study. Now the author reports the case of severe muscular rigidity which occurred in the 5 year old child who received the usual analgesic dose of meperidine, notably in rapid injection. And after reviewing the related literatures,the author puts some emphasis regarding management of this problem.

The effect of sono-guided brachial plexus block on postoperative pain control for arthroscopic shoulder surgery: comparison with general anesthesia

BACKGROUND: Interscalene brachial plexus block (IS-BPB) offers many advantages over general anesthesia for both arthroscopic and open surgeries of the shoulder, including shorter hospital stay, reduced postoperative analgesia requirements, and avoidance of the risks and side effects of general anesthesia. The purpose of this study was to compare the effectiveness of postoperative pain control by IS-BPB to general anesthesia for performing arthroscopic shoulder surgery. METHODS: Sixty patients were divided into three groups: general anesthesia (group A, n=20), general anesthesia and suprascapular nerve block (SSNB) (group B, n=20), and only IS-BPB(group C, n=20). All patients received patient-controlled analgesia (PCA), and were instructed to rate their pain using a visual analogue scale (VAS) ranging from 0 to 10. VAS was measured at 1, 4, 8, 12, and 24 hours after surgery. Hospital stays were recorded. RESULTS: VAS decreased significantly with time in group A and B (P < 0.05) (Fig. 1), but not in group C. Group C had less pain at 1, 4, 8, 12, 24, hours postoperatively than the other groups (P < 0.05) (Fig. 1). Group C had shorter hospital stays than the other groups (P < 0.05) (Fig. 2). CONCLUSIONS: IS-BPB results in less postoperative pain and a shorter hospital stay than general anesthesia for arthroscopic shoulder surgery (P < 0.05).

Comparison of Analgesic Efficacy between Single Interscalene Block Combined with a Continuous Intra-bursal Infusion of Ropivacaine and Continuous Interscalene Block after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study evaluated the effectiveness of a continuous interscalene block (CISB) by comparing it with that of a single interscalene block combined with a continuous intra-bursal infusion of ropivacaine (ISB-IB) after arthroscopic rotator cuff repair. METHODS: Patients who had undergone CISB (CISB group; n = 25) were compared with those who had undergone ISB-IB (ISB-IB group; n = 25) for more than 48 hours after surgery. The visual analog scale (VAS) for pain, motor and/or sensory deficit, supplementary analgesics and adverse effects were recorded. RESULTS: There were no significant differences between the postoperative VAS of the CISB and ISB-IB groups, except at 1 hour after surgery. Their supplementary analgesics of the two groups were similar. Transient motor weakness (52%) and sensory disturbance (40%) of the affected arm were observed in patients in the CISB group. The catheters came out accidentally in 22% of the CISB group but in only 4% of the ISB-IB group. CONCLUSIONS: ISB-IB provides similar analgesia to CISB. However, the ISB-IB group had a lower incidence of neurological deficits and better catheter retention.

Comparison of Remifentanil and Fentanyl for Postoperative Pain Control after Abdominal Hysterectomy

PURPOSE: In this randomized, double-blind study, we investigated the analgesic efficacy and side effects of continuous constant-dose infusions of remifentanil after total abdominal hysterectomy and compared it to fentanyl. MATERIALS AND METHODS: Fifty-six adult female patients scheduled for elective total abdominal hysterectomy were enrolled in this study. Patients were randomly assigned to two groups according to fentanyl (group F, n=28) or remifentanil (group R, n=28) for postoperative analgesia. Patients in group F were given fentanyl intravenously with an infusion rate of fentanyl 0.5 microgram/kg/hr; group R was given remifentanil with an infusion rate of remifentanil 0.05 microgram/kg/min for 2 days. Pain intensity at rest, occurrence of postoperative nausea and vomiting (PONV), dizziness, pruritus, and respiratory depression were assessed 1 hr after arrival at the post-anesthesia care unit, at 6; 12; 24; and 48 hr post-operation and 6 hr post-infusion of the study drug. Pain was evaluated by using visual analogue scale (VAS; 0-10). The time that patients first requested analgesics was recorded as well as additional analgesics and antiemetics. RESULTS: There were no significant differences in VAS, time to first postoperative analgesics, and additional analgesics between the 2 groups. The incidences and severities of PONV and opioid related side effects were not different between the groups; however, there were 3 episodes (10.7%) of serious respiratory depression in group R. CONCLUSION: Continuous infusion technique of remifentanil did not reveal any benefits compared to fentanyl. Furthermore, it is not safe for postoperative analgesia in the general ward.

Intravenous Patient-controlled Analgesia using Remifentanil after Cardiac Surgery / 대한마취과학회지

BACKGOUND: For rapid onset and predictable elimination half life, remifentanil may be suitable for patients undergoing cardiac surgery with unstable vital sign and decreased metabolism. We evaluated the efficacy, safety and proper dosage of intravenous patient-controlled analgesia (IV PCA) using remifentanil in patients undergoing cardiac surgery. METHODS: Forty-nine patients scheduled for cardiac surgery with sternotomy were randomly allocated to three groups. Group F had IV PCA using fentanyl with basal rate of 0.3microgram/kg/h, bolus of 0.5microgram/kg and lockout time of 15 min. Group L had remifentanil IV PCA with basal rate of 4microgram/kg/h, and group S with basal rate of 1microgram/kg/h. Both of group L and group S had setting of bolus of 0.5microgram/kg and lockout time of 5 min. In 12, 24 and 36 hours after surgery, vital sign, arterial blood gas analysis, visual analog pain scale (VAS), sedation score, and incidences of side effects were evaluated. RESULTS: The VAS score of group L was significantly low until 24 hours after surgery compared with other groups (P < 0.001). In group L, sedation score and PaCO2 in 12 hours after surgery were significantly high compared with other groups (P < 0.05), but no treatments were needed. CONCLUSIONS: Remifentanil IV PCA with basal rate of 4microgram/kg/h showed lower VAS score compared with small dosage of remifentanil and fentanyl with basal rate of 0.3microgram/kg/h. In the safety and proper dosage, further evaluations were needed.

Postoperative Pain Control using Intravenous Patient Controlled Analgesia in Cesarean Section and Hysterectomy / 대한마취과학회지

BACKGROUND: Postoperative pain degree is variable according to the site, type, and method of operation. This study compared the pain degree and amount of analgesics required among 3 types of operation. METHODS: Ninety patients were selected that cesarean section (Group I, n = 30), open total hysterectomy (Group II, n = 30), laparoscopic total hysterectomy (Group III, n = 30) were scheduled. Patients received PCA with basal rate 2 ml/h, bolus 1 ml, lockout interval 5 min using fentanyl and ketorolac. We evaluated VAS at 30 min, 2, 6, 12, 18, 24, 36, 48 h postoperatively, demand of button and attempt of button, 6 hourly used amount of analgesics; side effects and degree of satisfaction after 24, 48 h postoperatively. RESULTS: The rest VAS decreased below 30 at 6 hr in group I & II and at 2 hr in group III. More analgesics were needed for the first 6 hr compared with remained time in 3 groups (group I vs. group II vs. group III, P < 0.05). Total amount of analgesics including loading dose were fentanyl 1,536 +/- 342microgram, ketorolac 167 +/- 34 mg for group I; 1,212 +/- 215microgram, 132 +/- 30 mg for group II; 866 +/- 125microgram, 97 +/- 27 mg for group III (group I vs. group II vs. group III, P < 0.05). CONCLUSIONS: The postoperative pain was painful as order of cesarean section, open total hysterectomy, and laparoscopic total hysterectomy. The pain was reduced 6 hr in laparotomy and 2 h in laparoscopy.

Epidural Hematoma after Epidural Catheterization without Coagulopathy: A case report / 대한마취과학회지

Epidural hematoma after epidural catheterization is very rare but one of serious complications. Although true incidence and origin is unknown yet, coagulopathies and anticoagulant therapy are predominant risk factors. Other risk factors are NSAIDs treatment and ankylosing spondylitis. We experienced a case of epidural hematoma without any risk factors after epidural catheterization for postoperative pain control. We performed epidural catheterization before operation and postoperatively the patient received continuous epidural infusion for postoperative pain control. On the first operative day, the patient was noted to have developed complete paraplegia and hypoesthesia below L1 and anesthesia below L2 level. Immediately after noting we performed TL-spine MRI and epidural hematoma at T10 level was diagnosed and treated by decompressive laminectomy. But she has not fully recovered yet.

Influence of Ketamine and Midazolam on the Analgesic Effect of Epidural Bupivacaine and Fentanyl after Low Abdominal Surgery / 대한통증학회지

BACKGROUND: There are many ways to provide superior analgesia for postoperative pain after abdominal surgery of which epidural analgesics with opioids and local analgesics are the most useful. In an effort to maximize the level of analgesia and to minimize the side effects, ketamine, midazolam, clonidine, and adrenalin can be co-administrated as an adjuvant. This study examined the analgesic effect and side effects of midazolam compared with those given an epidural injection of bupivacaine, fentanyl and ketamine. METHODS: In a double blind randomized controlled trial, 50 patients received either fentanyl 0.3 microgram/kg/h and ketamine 0.1 mg/kg/h (Group FK) or fentanyl 0.3 microgram/kg/h, ketamine 0.1 mg/kg/h and midazolam 0.4 mg/h (Group FKM), added to 0.125% of bupivacaine at a rate of as much as 2 ml/h, for patient controlled epidural analgesia (PCEA) after low abdominal surgery. Ten minutes before surgery, the patients received either 10 ml of 0.125% bupivacaine with 0.5 mg/kg of ketamine or 10 ml of 0.125% bupivacaine with the same amount of normal saline, added to fentanyl 50microgram. The pain score and the side effects were recorded at 1, 3, 6, and 24 hours after surgery. RESULTS: There was no difference in the pain score except for the VAS on coughing 1 hour after surgery. FKM group had fewer side effects. CONCLUSIONS: There was a better analgesic effect and fewer side effects with the addition of epidural midazolam to bupivacaine and fentanyl with ketamine formula. However, more study on the dose and route of administration will be needed.

The Optimal Dose Range of Epidural Naloxone to Minimize Nausea during Continuous Epidural Infusion of Morphine / 대한마취과학회지

BACKGROUND: This study was designed to determine the optimal dose range of epidural naloxone that can preserve analgesia while minimizing nausea, one of the most common side effects caused by epidural morphine. METHODS: Seventy-four patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of three groups. All received 2 mg epidural morphine bolus just before closing abdominal cavity and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n = 24), 0.167 mg/kg/hr of naloxone (Group 2, n = 19) or 0.412 mg/kg/hr of naloxone (Group 3, n = 31) for postoperative pain control. Analgesia and nausea were evaluated by blinded observers. RESULTS: The combination of epidural morphine and bupivacaine provided good analgesia. Pain scores in group 3 were lower than in group 1 after surgery, but there were no significant statistical differences except at 16 hr. Group 2 showed the lowest pain scores at 8, 16 and 24 hr (P < 0.05). Nausea scores were lower in group 2 and 3 than in group 1 at 16 and 24 hr (P < 0.05). CONCLUSIONS: Epidural administration of naloxone below 0.412 mg/kg/hr was optimal and safe dose range that maintained the analgesic effects of morphine while minimizing nausea.

Influence of Ketamine on the Analgesic Effect of Epidural Bupivacaine and Fentanyl after a Transabdominal Hysterectomy / 대한통증학회지

BACKGROUND: There have been many attempts to alleviate pain after surgery, but there is no common approach to the control of postoperative pain. The use of epidural opioids, with local anesthetics, has been a widely employed formula to date. Ketamine, an N-methyl-d-aspartate receptor antagonist, has an excellent analgesic effect. Although there have been many reports on the dose and route of administrating analgesics, there have been few concerning the continuous epidural infusion of ketamine with fentanyl. We designed this study to find the effects of ketamine compared to those of epidurally injected bupivacaine and fentanyl, and used this trial to study any potential side effects. METHODS: In a double blind trial, 55 patients received either fentanyl, 0.3microgram/kg/h (Group F), or fentanyl, 0.3microgram/kg/h, and ketamine, 0.1 mg/kg/h (Group FK), added to 0.125% bupivacaine, at rates as high as 2 ml/h, for patient controlled epidural analgesia (PCEA) following a transabdominal hysterectomy. Ten minutes before the operation, patients received 10 ml of 0.125% bupivacaine, with either 0.5 mg/kg ketamine or the same amount of normal saline with 50microgram fentanyl added. The pain scores and the side effects were recorded at 1, 3, 6 and 24 hour post operation. RESULTS: There were no differences in the pain scores or side effects between the two groups. CONCLUSIONS: We failed to find any effect of the addition of epidural ketamine compared to the that of the bupivacaine and fentanyl formula. However, it is suggested that further investigations will be required on the dose and route of administration.

Clinical Observations of the Analgesic Effect of Epidural Resiting Following Accidental Dural Puncture / 中国医师杂志

Objective To evaluate the safety of epidural resiting and the incidence of postdural puncture headache following accidental dural puncture. HZ Methods Among 63 patients of ASA I-II undergoing lower abdominal or lower extremity surgery, forty-two with postdural puncture who had received epidural resiting were randomly assigned to patient controlled epidural analgesia (PCEA) ( n =21) or control treatment ( n =21). The remaining 21 patients who had successful epidural insertion received the routine PCEA. All patients after operation received 48-hours monitoring of BP, HR, RR and SpO_2. The analgesic effect of each treatment and the occurrence of headache were also assessed. Results All operations were uneventful under epidural anesthesia. A satisfactory level of analgesia was observed in patients who received PCEA. There was no statistically significant difference in pain control between patients who had had epidural resiting and who received PCEA and those who received routine PCEA. No respiratory inhibition was observed. The occurrence of headache in the epidural resiting group was 19% (4/21), compared to 57% (12/21) in the control group ( P

Pain Control Effects of Myprodol(R) after Periodontal Surgery and Dental Implant Surgery / 대한치주과학회지

Although various analgesics have been administrated for postoperative pain control, postoperative pain has not been adequately controlled . The purpose of this study was to evaluate the effects and patient's satisfaction of Myprodol(R)(combination analgesics with codeine, ibuprofen, paracetamol) compared to Acetamionphen and placebo drug after periodontal surgery and dental implant surgery. We studied 98 cases of outpatients which were composed of 67 cases of flap operation(which separated to 3 groups: Placebo group(n=25), Myprodol(R) group(n=22), Acetaminophen group(n=20)) and 21 cases of dental implant surgery(which separated to 3 groups : Placebo group(n=10), Myprodol(R) group(n=12), Acetaminophen group(n=9)). We evaluated the postoperative pain(Pain 1), Pain after first drug administraion(Pain 2), the degrees of pain reduction(pain 3), patient's satisfaction for drug, and side-effects. We obtained following results; 1. In Pain 1, making a comparison among groups, there was no significant difference in both cases of flap operation-group and dental implant surgery-group 2. In Pain 2, establishing a comparison among groups, there was no significant difference in flap operationgroup, but significant difference was seen between placebo group and Myprodol(R) group in cases of dental implant surgery group(P<0.05). 3. In Pain 3, making a comparison among groups, Myprodol(R) group showed significant differences compared to placebo group and Acetaminophen group in both cases of flap operation group and dental implant surgery group(P<0.05). 4. In patient's satisfactory score, making a comparison among groups, there were significant differences between placebo group and Myprodol(R) group in cases of flap operation group and between Myprodol(R) group and Acetaminophen group in cases of dental implant surgery group(P<0.05). 5. Making a comparison in side-dffect, no significant differrence was seen. Our conclusion is that Myprodol(R) is a effective oral analgesics to the patients who underwent periodontal surgery or implant surgery for it's synergism among three dugs.