Comparison of the Analgesic Consumption in Patient-Controlled Analgesia (PCA) with and without a Basal Infusion after Caesarean Section / 대한마취과학회지

Bakground : Patient-Controlled Analgesia (PCA) has become popularized for postoperative pain control. Theoretically, addition of a basal infusion would ameliorate the pain control as related to less need for additional demands. Regardless of theoretical background, usefulness of a basal infusion in PCA is controversial. Therefore, in this study we compared the analgesic consumption between PCA only and PCA plus basal infusion and assessed if the use of a basal infusion improves the analgesic efficacy in intravenous PCA. METHODS: 40 patients undergoing caesarian section, were assigned randomly to PCA only group (group 1) and PCA plus basal infusion group (group 2). Group 1 was programmed to deliver 1.5 ml of bolus infusion with 10 minutes of lockout interval and four times per hour of the maximum usage of patient control module. In group 2, 0.5 ml of basal infusion was added to the same PCA. The analgesic solution contained 60 mg of morphine, 180 mg of ketorolac and 5 mg of droperidol in total volume of 60 ml. PCA was started at the time of the peritoneal closure with 2 ml of loading dose in all patients. Postoperative assessments were pain score, sedation score, side effect, total analgesic consumption and the degree of patients, satisfaction. RESULTS: Total analgesic consumption was significantly greater in group 2 than in group 1. Pain score, sedation score, complication and the degree of the satisfaction were almost the same at all time interval in each group. CONCLUSION: We concluded that there was no significant benefit of basal infusion in intravenous PCA after caesarean section.

The Effects of Epidural Morphine and Bupivacaine after Upper Abdominal Surgery / 대한마취과학회지

Among various mehtods for postoperative pain management, epidural narcotics is one of the most prevalent techniques used by anesthesiologists. Although it is a highly effective analgesia, epidural morhpine has disadvantages such as delayed onset, nausea, vomiting, pruritus, urinary retension and even life-threatening respiratory depression. To search for a more effective analgesic mehtod with minimum side effects, we studied the effects of morphine, bupivacaine and a combination of each durg with different dosages in patients undergoing upper abdominal surgery. Hemodynamic changes, duration of analgesia, and side effects were compared. The results suggested that the combination of 2 mg of morphine and 0.125% of bupivacaine is the most effective method with minimum side effects for postoperative pain.

The Influence of Fentanyl on the Action of Epidural Bupivacaine / 대한마취과학회지

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.

The Influence of Fentanyl on the Action of Epidural Bupivacaine / 대한마취과학회지

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.