The Effects of Intraarticular Bupivacaine and Morphine on Postoperative pain After Knee Arthroscopy / 대한마취과학회지

BACKGROUND: An effective control of postoperative pain may contribute to success of day-case surgery. After knee arthroscopy, local anesthetics was injected into the knee joint to reduce postoperative pain, but results were variable and the duration of action may be short. The recent reports have suggested that intraarticular morphine would provide more effective and longer acting analgesia than expected from the same dose given systemically. METHODS: A randomized, controlled study was conducted in patients undergoing elective knee arthroscopy under general anesthesia to assess the analgesic effect of intraarticular bupivacaine and morphine, either alone or in combination. Patients in group I(n=20) received 20 ml of normal saline as a control; patients in group II(n=20) received 20 ml of 0.25% bupivacaine; patients in group III(n=20) received 5 mg of morphine in 20ml of normal saline; patients in IV(n=20) received a combination of 5 mg of morphine and 50 mg of bupivacaine in 20 ml of normal saline. All the drugs were injected intraarticularly. Postoperative pain was assessed using the VAS at 1, 2, 4, 8, 12, and 24h after the intraarticular injection. Whenever patients want supplemental analgesia, 90 mg of diclofenac(dicknol ) was injected intramuscularly and then the need for supplemental analgesia was recorded. RESULTS: Patients in groups III and IV had significantly lower pain scores than those in groups I and II. There was no significant difference in the pain scores or analgesics requirements between groups III and IV. CONCLUSIONS: We conclude that intraarticular morphine(5 mg) significantly reduces postoperative pain following knee arthroscopy and there is no significant advantage of combining bupivacaine with morphine.

Cases Report of Classic Celiac Plexus Block and Transaortic Celiac Plexus Block / 대한마취과학회지

To relieve intractable upper abdominal cancer pain using 75% alcohol, Celiac Plexus Blocks (C.P.B.) were performed by means of the classic two needle technique in 7 cases and by single needle transaortic method in 3 cases under fluroscopic guidance. Both methods relieved the pain effectively and there was no significant hemorragic, neurologic and other complications. The degree of pain relief estimated by Graphic Rating Scale (GRS) and the incidence of complication were similar between two methods but the single needle transaortic method was more simple, easier and effective with just one third of alcohol used in the classic method.

Effect of Intravenous Anesthetics on Systemic Vascular Resistance during Cardiopulmanary Bypass / 대한마취과학회지

We have studied the effect of thiopental sodium, propofol, midazolam and ketamine on systemic vascular resistance(SVR) during cardiopulmonary bypass with constant pump flow in 20 patients undergoing elective open heart surgery. SVR decreased about 13(+/-3.42)% of control values after thiopental sodium 4 mg/kg, about 10 (+/-5.30)% of control after propofol 2 mg/kg and about 8(+/-3.72)% of control after midazolam 0.2 mg/kg; it returned to control values about 2 min 30 sec(+/-1 min 20 sec) after administration of thiopental sodium and about 4 min 30 sec(+/-2 min 15 sec) after administration of propofol. It remained under control values after 10 min after administration of midazolam. Ketamine showed no significant changes on SVR. Analysis of variance showed that there were no significant differences in the changes in SVR between the groups. Change of SVR after administration of thiopental sodium did not have statistical significance(P< 0.05).

AnaIysis of Anesthesia for Total Correction of TOF / 대한마취과학회지

TOF is a congenital cyanotic heart disease which has severe physiodynamic changes in the cardiovascular system. The anesthesiologist should be able to manage the anesthesia for open heart surgery, be aware of the operation procedure, and have knowledge and experience to cope with the unpredictable changes of the patient's condition during operation. One hundred open heart anesthesias have been performed in BNUH from July 1981 to August 1983, of which 17 cases of anesthesia for total correction of TOF were analyzed and the following results were obtained. 1) It was difficult to predict the prognosis for the patient after open heart anesthesia by the chest X-ray, echocardiogram or electrocardiogram. 2) Anesthesia were performed by the combination of halothane-N2O0morphine as the main anesthetic agents. 3) Postoperative complication were wound infection(4 cases, 14.3%), arrhythmia(3 cases, 10.7%), low cardiac output syndrome(3 cases, 10.7%) and cardiac arrest (3 cases, 10.7%). 4) In 7 cases of death, the causes of death were low cardiac output syndrome(3 cases, 43.9%), heart failure (2 cases, 28.5%), renal failure (1 case, 14.3%) and aneurysmal rupture (1case, 14.3%).