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.

Intravenous Infusion of Lidocaine in the Management of Chronic Pain States / 대한마취과학회지

Recently, intravenous lidocaine has been reported to relieve chronic pain and to suppress the spontaneous abnormal ectopic discharge in injured nerve. Interest in the use of these modalities has been stimulated by animal researches of neuropathic pain syndromes. We performed this study to evaluate the analgesic responses and the side effects of intravenous(IV) irifusion of lidocaine used in chronic pain patients. Patients received 5 mg/kg of lidocaine, mixed in 150 mL over 40 minutes. The analgesic efficacy was evaluated in 20, 40, 60 minutes after the start of the initial IV lidocaine infusion, by a numeric rating scales (NRS) scores. The responders were received the repeated infusions at one week interval. The results were as follows; 1. Mean NRS scores was 6.7+/-1.9 before the infusion, and changed to 4.2, 2.7, 2.6, in 20,40,60 minutes after the start of the initial IV lidocaine infusion. 2. Eight of ten patients were responders during initial IV lidocaine infusion, and two patients were nonresponders. During the series of repeated lidocaine infusions to eight responders, six were partial relief, and two were complete relief of their pain without any medication. The diagnoses in responders were diabetic neuropathy, ischemic neuropathy, traumatic neuropathy, causalgia, reflex sympathetic dystrophy, erythromelalgia, and spinal stenosis. 3. The side effects, including sedation, dizziness, slurred speech, circumoral numbness, and lightheadedness, were not serious during the period of infusion. The conclusion is that repeated intravenous lidocaine infusions would be effective in the management of chronic pain states. But it needs more studies on the method of infusion and the safety of these modalities.