Continuous wound infiltration of ropivacaine for reducing of postoperative pain after anterior lumbar fusion surgery:a clinical retrospective comparative study

Background@#Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. @*Methods@#Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients’ sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. @*Results@#The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; Background: Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. @*Methods@#Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients’ sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. @*Results@#The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; P = 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38;P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. @*Conclusions@#Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery. 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38; P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. @*Conclusions@#Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery.

Continuous wound infiltration of ropivacaine for reducing of postoperative pain after anterior lumbar fusion surgery:a clinical retrospective comparative study

Background@#Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. @*Methods@#Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients’ sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. @*Results@#The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; Background: Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. @*Methods@#Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients’ sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. @*Results@#The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; P = 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38;P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. @*Conclusions@#Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery. 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38; P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. @*Conclusions@#Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery.

Cement Augmented Anterior Reconstruction and Decompression without Posterior Instrumentation:A Less Invasive Surgical Option for Osteoporotic Thoracolumbar Fracture with Cord Compression / 대한신경손상학회지

Objective@#We investigated the clinical and radiological outcomes of a cement augmented anterior reconstruction and decompression without pedicle screw fixation in patients with osteoporotic thoracolumbar vertebral fracture with myelopathy. @*Methods@#There were 2 male and 6 female patients with thoracolumbar fracture and myelopathy included in the study. The mean follow-up period was more than 1 years.The anterolateral decompression and cement augmented anterior reconstruction with poly(methyl methacrylate) (PMMA) was performed. Demographic data, clinical outcomes, perioperative parameters and radiologic parameter were retrospectively evaluated. @*Results@#The symptoms due to myelopathy were improved in all patients. The preoperative median visual analog scale score for lower back and leg were 8.5 that improved 4.25 and 3 at last follow up. The preoperative function state showed a median Oswestry Disability Index score 61.5 that improved 33. After surgery, preoperative encroachment of the spinal canal (5.12 mm, 37%) was disappeared. The median height of fractured vertebral body significantly increased from 7.83 to 12.63 mm. At the last follow-up point, the median height was 9.91 mm. The median kyphotic deformity was improved from 22.12° to 14.31°. At the final followup, the improvement was preserved (median value: 15.03). The acute complication according to PMMA such as leakage and embolization was none, but adjacent compression fracture as late complication according to cement augmentation was. One patient developed surgical site infection. @*Conclusion@#On the basis of the preliminary results, we considered that anterolateral decompression and PMMA augmentation might be an optimal method for treating osteoporotic fracture with myelopathy in elderly patients or those with multiple medical comorbidities.

Comparison of the Hemodynamic Changes following Intraaortic and Intravenous Administration of Protamine after Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Reversal of heparin anticoagulation by protamine often produces hemodynamic changes such as hypotension, bradycardia, decreased cardiac output and various complications as anaphylactic reaction. Some studies have reported that intraaortic administration of protamine prevent profound hypotension and provide stable hemodynamics. The purpose of this study is to compare the hemodynamic changes following intraaortic and intravenous administration of protamine after cardiopulmonary bypass. METHODS: In a prospective double-blind trial, 30 patients undergoing cardiac valve replacement surgery were randomly assigned to receive intravenous protamine (n = 15) or intraaortic protamine (n = 15). Arterial pressure (AP), pulmonary arterial pressure (PAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were measured. RESULTS: The changes of HR, AP, PAP, CI, SVRI, PVRI were not significantly different between both groups. Both groups maintained hemodynamic stability afer protamine administration. CONCLUSIONS: There were no significant difference in the hemodynamic changes following intraaortic and intravenous administration of protamine after cardiopulmonary bypass. And there were no hemodynamic benefits of intraaortic versus intravenous administration of protamine.

Comparison of Total Intravenous Anesthesia between Two Dosing Regimens of Remifentanil and Propofol

BACKGROUND: More remifentanil and less propofol may speed up the early recovery from anesthesia. This study evaluated the hemodynamic response and recovery profile of high-dose remifentanil/lowdose propofol anesthesia, compared with low-dose remifentanil/highdose propofol anesthesia for lower abdominal surgery. METHODS: Sixty women undergoing lower abdominal surgery were randomly assigned to either groups H or L. Anesthesia was maintained with remifentanil 0.5 micro/kg/min and propofol 4 mg/kg/h in group H, or with remifentanil 0.25 micro/kg/min and propofol 8 mg/kg/h in group L. The heart rate, blood pressure, and EEG bispectral index (BIS) score were recorded. At the end of surgery, the anesthetic agents were discontinued, and the early emergence, recovery, and side effects were assessed. RESULTS: In both groups, the heart rate and systolic blood pressure were decreased over time compared with the preanesthetic baseline values (P < 0.05) but there were no differences between the two groups. The frequency of hemodynamic events (hypertension, hypotension, and bradycardia) and their rescue drugs were similar in the two groups. The BIS scores were lower during anesthesia in group L than in group H (P < 0.05). The time to spontaneous ventilation, eye opening on verbal command, extubation, orientation, and full recovery were faster in group H than in group L (P < 0.05). The incidences of side effects were similar in both groups. CONCLUSIONS: In lower abdominal surgery, high-dose remifentanil/ low-dose propofol anesthesia offers faster recovery than low-dose remifentanil/high-dose propofol anesthesia. However, there were no differences in the hemodynamic changes and side effects between the groups.

The Expression of alpha2-Adrenergic Receptor Subtypes in the Central Nervous System of Peripheral Nerve Injured Rats / 대한마취과학회지

BACKGROUND: The change of expression of the alpha2-adrenergic receptor (alpha(2)-AR) subtypes in the thalamus and hypothalamus were investigated in a neuropathic pain rat model. METHODS: The left sciatic nerve was clamped for creating a neuropathic pain model in five rats. A sham operation was done in three rats as control group. Behavioral tests for pain were conducted by using mechanical stimuli applied to the hind paws. After 7 days, the expression of alpha(2)-AR subtype mRNA in the rat thalamus and hypothalamus was measured using real time polymerase chain reaction. RESULTS: Mechanical allodynia were developed on postoperative 1, 3, and 7 days in the neuropathic pain model. The expression of alpha(2A)-AR, alpha(2B)-AR, and alpha(2C)-AR was significantly higher in the thalamus and hypothalamus in the neuropathic pain model (P > 0.05). CONCLUSIONS: These results would suggest that the subtypes of alpha(2)-AR in thalamus and hypothalamus may contribute to produce neuropathic pain.

Hemodynamic Response and Recovery Profile of Remifentanil Anesthesia in Pediatric Strabismus Surgery / 대한마취과학회지

BACKGROUND: This study evaluated the hemodynamic response and recovery profile of remifentanil-N2O anesthesia, compared with sevoflurane-N2O anesthesia in pediatric strabismus surgery. METHODS: Fifty-seven healthy children aged 1-9 years undergoing strabismus surgery were randomly assigned to two groups, group R or group S. None of the children was premedicated with an anticholinergic agent. Anesthesia was induced with intravenous ketamine 1.0 mg/kg. A laryngeal mask airway (LMA) was placed with rocuronium 0.4 mg/kg. Anesthesia was maintained with sevoflurane 2.0-3.0 vol% and N2O 66% in group S, and with remifentanil 0.75 microgram/kg over 1 min followed by remifentanil 0.5 microgram/kg/min and N2O 66% in group R. At the end of surgery, the anesthetic agents were discontinued, and the early emergence, recovery, and side effects were assessed. RESULTS: During anesthesia, the heart rate and blood pressure were lower in group R (P < 0.05). The incidence of an oculocardiac reflex was similar in both groups. The times to spontaneous ventilation and the removal of LMA were similar in the two groups. The times from eye opening to command, orientation and full recovery were faster in group R (P < 0.05). The incidence of postoperative nausea and vomiting was similar in both groups. The incidence of coughing was lower in group R (P < 0.05). Mild pruritus developed in 17.2% of patients in group R. CONCLUSIONS: In pediatric strabismus surgery, remifentanil provided similar hemodynamic stability, and an earlier and smoother recovery, compared with sevoflurane anesthesia.

Experience of Reoperation after Valve Replacement Using Mechanical Heart Valve: 8 cases / 대한흉부외과학회지

Eight patients underwvnt reoperation after valve replacement surgery with a mechanical valve from January, 1992 to December, 2003. Among the various indications for reoperation, there were 4 patients with paravalvular leakage; 3 patients underwent resuturing of the area of leakage and one patient underwent redo valve replacement. Among the three patients with stenosis due to thrombosis of the valve, 2 patients underwent redo valve replacement and one patient underwent thrombectomy. In one patient, the valve functioned normally, but stenosis was caused by overgrowth of the patient and redo valve replacement was done 123 months later. There was no postoperative mortality or morbidity. After an average of 51 months (2~134 months) of postoperative follow up, the patients were in good condition and were able to maintain a NYHA functional class of I or II. The operative method used, whether it be a redo valve replacement or valve sparing method, depends upon the type of lesion and the anatomic structure.

Colchicine Derivatives Allows Prolonged Survival of Cardiac Allograft in the Rat / 대한흉부외과학회지

BACKGROUND: Colchicine with its immunosupressive properties has been used with beneficial effects in autoimmune disease, such as Gout, etc. Whether colchicine, by virtue of the above property, could attenuate the process of cardiac allograft rejection in the rats is investigated in this report. MATERIAL AND METHOD: We compared the untreated group (Control, n=6), Cyclosporin A group (10 mg/kg, daily, n=20), and Colchicine derivative group (Colchicine 40 microgram/kg, n=20) of cardiac allografts in the rats. RESULT: In the untreated control group (n=6), all of 6 rats showed rejection within 3 weeks after cardiac allograft. In the cyclosporin A group (n=20), cyclosporin A (10 mg daily oral dose) was administered at a 10 mg daily oral dose and promoted long-term survival (over 100 days). The cyclosporin A group had one mortality at the 18th post-operative day due to infection. Furthermore, in the Colchicine derivatives group (n=20) with a daily IP (Intra Peritoneum) dose (40 ug/kg/day), we observed long-term survival.(>100 days), except for one rat that died of an anesthetic problem (respiratory failure) at the 9th post-operative day. CONCLUSION: Experiments have also been performed to evaluate whether the effect of colchicine derivatives allowed prolonged survival of cardiac allografts compared with the cyclosporin A administration group in the rats.

Repair of Aortic Periprosthetic Leakage with Pseudoaneurysm: A case report / 대한흉부외과학회지

There are several methods of repairing in aortic periprosthetic leakage after aortic valve replacement. We present a case in which the aortic periprosthetic leakage with pseudoaneurysm was repaired with dacron patch.

Repair of Postinfarction Ventricular Septal Defect on a Beating Heart: One case report / 대한흉부외과학회지

Postinfarction ventricular septal defect often induces cardiogenic shock and requires operative treatment early after myocardial infarction. Although the operative mortality of this disease has decreased during the past 3 decades, it is still relatively high. In this case, to prevent global myocardial ischemia, we used the technique of repair of postinfarction ventricular septal defect on a beating heart. This approach does not require aortic cross-clamping and provides superior myocardial protection.