Endoscopic and Non-endoscopic Epidural Adhesiolysis in FBSS Patient / 대한마취과학회지

BACKGROUND: The pathophysiologies of Failed Back Surgery Syndrome (FBSS) are epidural adhesion& fibrosis; arachnoiditis, neural encroachment, mechanical instability. Epidural adhesiolysis alleviate back pain through blocking the neural activity of scar area and decreasing the inflammation & edema. There are two methods of adhesiolysis, endoscopic & non-endoscopic adhesiolysis. Present study was aimed to compare the pain relief & side effects between two methods. METHODS: We investigated 86 post-laminectomy patients with low back pain and radiculopathy, who do not relieved with any kinds of conservative treatment. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. Group I was consisted with non-endoscopic 41 patients, and Group II was endoscopic 45 patients. Evaluation included assessment of pain relief (visual analogue scale, VAS), rate of reprocedures and duration of pain relief (VAS < 5) at post-epidural adhesiolysis 2 week, and 1, 2, 6 months. We also looked for complication of adhesiolysis. RESULTS: Statistical analysis (t-test, chisquared test) demonstrated VAS & reprocedure rate was significantly low (P < 0.05) in group II at 6 month and duration of pain relief (VAS < 5) was more prolonged in group II. One patient in each groups complained skin eruption and pruritus, and one patient of group II was proved epidural abscess and one patient of group I complained headache. CONCLUSIONS: Endoscopic and non-endoscopic epidural adhesiolysis are effective and safe in patients, who was not relieved the symptoms with conservative treatment, but endoscopic epidural adhesiolysis is more recommendable because its more prolonged effect.

Intralesional Injection of Ketamine in Postburn Neuropathic Pain: Two cases report / 대한마취과학회지

The scarring process of burns can be accompanied by pain and/or paresthetic sensation which may persist after completion of scar formation. Once the wound is healed, it is possible that paresthetic and/or painful sensations persist as a result of abnormalities in the newly regenerated nerve endings or because of deficient reinnervation of the scarred tissue, that may give rise to abnormal inputs. Existence of glutamate receptors in peripheral nerves innervating normal and inflamed skin has been well addressed. Therefore we tried ketamine in postburn neuropathic pain expecting the antagonistic effect as a NMDA antagonist. We experienced two postburn pain patients who were successfully managed without any significant sign of side effects by an intralesional injection of ketamine and bupivacaine.

Percutaneous Vertebroplasty in a Patient with an Osteolytic Spinal Metastatic Tumor: A case report / 대한마취과학회지

Percutaneous vertebroplasty was first introduced in 1984. It allows reduction in pain and strengthening of bone. Main indications for this procedure are an osteoporotic compression fracture, hemangioma or a malignant spine tumor. Metastases to the vertebrae are not rare and often painful. Radiation therapy results in delayed (10 14 days) pain relief and minimal bone strengthening. Surgical procedures require significant postoperative recovery and have associated morbidity and mortality. However, a percutaneous vertebroplasty in patients with an osteolytic spinal metastatic tumor results in quick (1 3 days) disappearance of pain, vertebral consolidation, and spinal stability. We encontered a patient with severe back pain due to an osteolytic spinal metastatic tumor that had not responded to radiation therapy but which responded successfully to pain relief by a percutaneous vertebroplasty.

Comparison of Butorphanol with Morphine in Intravenous Patient Controlled Analgesia (PCA) for Postoperative Pain Relief / 대한마취과학회지

BACKGROUND: Morphine for the intravenous patient controlled analgesia (IV-PCA) provides effective postoperative pain control, but it has side effects such as itching, nausea and vomiting. Meanwhile, butorphanol, a synthetic potent agonist-antagonist narcotic with low incidence of adverse side effects and minimal addiction, produce adequate analgesia for postoperative pain. The purpose of this study was to compare the suitability of butorphanol combining with or without morphine with that of morphine in terms of relieving postoperative pain and incidence of side effects. METHODS: Sixty ASA physical status I or II female patients undergoing total abdominal hysterectomy were randomly allocated into one of three groups according to type of drug used (n=20 for each group). The groups were divided to group M (morphine 100 mg), group M B (morphine 50 mg+butorphanol 10 mg) and group B (butorphanol 20 mg). Drugs for each group mixed with 90 ml of normal saline (total amount: 100 ml) for infusion. Loading dose, PCA dose, lockout interval, mode of infusion was 0.05 ml/kg, 0.02 ml/kg, 8 minute, and PCA only, respectively. In each group, visual analog scale (VAS), pain score, sedation score, degree of satisfaction, total amount of drug used, history of attempt/injetion and incidence of side effects were checked. RESULTS: There were no significant differences in analgesic effects and degree of satisfaction among three groups, but incidence of side effects (especially pruritis) were less in group M+B and B compared with group M (p<0.05). CONCLUSIONS: Butorphanol showed comparable postoperative pain relief and marked less side effects compared with morphine. Butorphanol was considered as a useful drug for postoperative pain relief using IV-PCA.

The Effectiveness of Basal Infusion on Intravenous Patient-Controlled Analgesia(PCA) after Cesarean Section / 대한마취과학회지

BACKGROUND: Theoretical advantages in maintaining an effective blood concentration of the analgesic medication using basal infusions with or without standard intermittent PCA dosing regimens is controversial. The purpose of this study was to compare the effectiveness and incidence of side effects among three modes which include PCA only(group 1), PCA+ basal infusion(group 2), and basal infusion only(group 3). METHODS: Sixty ASA physical status 1 or 2 female patients who scheduled elective cesarean section were randomly allocated into one of three modes. Loading/PCA/basal infusion dose and lockout interval was 0.05 mg/kg, 0.02 mg/kg, 0.015 mg/kg/hr, and Smin, respectively. In each group, visual analog scale(VAS), pain score, sedation score, degree of satisfaction, total amount of morphine used, history of attempt or injection and incidence of side effects were checked. RESULTS: Group 2 did not show any improvement of VAS, and group 3 showed significantly higher VAS from 2 hours after initiation of morphine infusion compared to group 1(P<0.05). Degree of satisfaction was lower in group 3 compared to group 1 and 2(P<0.05). Total amount of morphine was increased in group 2(P<0.05) and reduced significantly in group 3 compared to group 1(P<0.01). There was no evidence of respiratory depression. Incidence of nausea and pruritus did not show any difference among groups. CONCLUSIONS: Addition of basal infusion did not show any improvement of postoperative pain control compared to conventional PCA method.