Pain Management for Low Bsck Pain and Lumbosacral Raliculopathy / 대한마취과학회지

Since the introduction of epidural corticoateroid injections for the management of sciaticall, luintosacral radiculopathy has become one of the most common pain problems enco-untered by anesthesiologists. In order to function effectively, anesthesiologiats should be able to: 1) recognize those syndromes which may respond to nerve block: 2) understand the pathophysiology of the conditions being treated and 3) be familiar with alternate ther-apeutic pathways for patientg not responding to merre b1ock. There are many etiologic factors of low back pain and lumbosacral radiculopathy. Particularly, Nerve root compression caused by a protruding disc, a osteophyte or tumors are usually responsible for pain. Neural inflammation, therefore, is considered to play a major role in pain production.The use of local anesthetics in mixture with steroids is believed to break down neural inflammation. Steroids and local anesthetics were injected lumbar or caudal epidmal to 106 patients for the purpose of relieving low back pain and lumbosacral radiculopathy. The resu1ts are as follows : Excellent Pain relieved group : 27 Patients (25.5%) Good Pain relieved group: 49 Patients(46.1%) Fair pain relieved group : IS patients(14.2%) Not effective group : 15 Patients (14.2%).

Analgesic Effects and Complications of Very Low Dose Intrathecal Morphine in Postoperative Patients / 대한마취과학회지

Intrathecal administration of morphine for pain relief became popular since Pert, et al (1973) reported the opioid receptors in spinal cord. It is obvious now morphine bas prolonged and profound analgesic effect with few compl-ications but the leant dose which produces sufficient analgsia with insignificant complication is still controversial. The dosage of intrathecal morphine used for postoperative analgesia has varied from 0.1 mg to 2 mg, but significantly low dosage was required br direct intrathecal route than by epidural one to reach the appropriate analgesic CSF concentration. We selected 60 Patients (50 for cesarean section, 10 for total hysterectomy) and divided into 3groups to compare the effects respectively. Group l : 20 patients receiving 0.05mg of intrathecal morphine, Group ll : 20 patients receiving 0.1 mg of intrathecal morphine, Group lll : 20 Patients receiving 0.2 mg of intrathecal morphine The results are as follows ; 1) The analgesic effects of group l and ll were good and similiar, but 2 of group l and 1 of group ll required a single supplementary intramuscular demerol 6 hours after intrathecal morphine injection. The quality of analgesia was judged to be better in group lll than in group I and ll. 2) The duration of analgesia of group lll was a little longer than group I and ll, which showed similar duration. 3) The side effects of group l, ll and lll were similar, but pruritus was noted twice as much in group in lll than in group l and ll.