The analgesic effect of nefopam combined with low dose remifentanil in patients undergoing middle ear surgery under desflurane anesthesia: a randomized controlled trial / 대한마취과학회지

BACKGROUND: We investigated the effects of the combined administration of nefopam, a N-methyl-D-aspartate receptor antagonist and low dose remifentanil, on early postoperative pain and analgesic requirement. METHODS: Fifty patients scheduled to undergo mastoidectomy and tympanoplasty were randomized to be given either nefopam 40 mg mixed with normal saline 100 ml (Group N) or an equal amount of normal saline (Group C) before anesthesia induction. Anesthesia was maintained with 5-6 vol% desflurane and remifentanil 0.05-0.15 microg/kg/min during the surgery. Postoperative pain was controlled by titration of ketorolac in the postanesthesia care unit (PACU) and ward. We evaluated the intraoperative remifentanil dose, recovery profiles, ketorolac demand in the PACU and ward, numeric rating scale (NRS) for pain at time intervals of every 10 min for 1 h in the PACU, 6, 12, 18 and 24 h in a ward, as well as the time to first analgesic requirement in the PACU and ward. RESULTS: Ketorolac demand and NRS in the PACU were significantly lower in Group N than Group C (P = 0.002, P = 0.005, respectively). The time to first analgesic requirement in the PACU in Group N were significantly longer than Group C (P = 0.046). There were no significant differences in intraoperative remifentanil dose, ketorolac demand, NRS, and the time to first analgesic requirement in the ward between the groups. CONCLUSIONS: Nefopam administration combined with low dose remifentanil infusion reduces pain and analgesic consumption during the immediate postoperative period in patients undergoing middle ear surgery under desflurane anesthesia.

Monitored anesthesia care using dexmedetomidine and remifentanil for the hip surgery in a high risk patient with brain metastasis of lung cancer, cerebral infarction, seizure and quadriplegia: A case report

To perform the major operation for high risk patients with both serious systemic diseases and major organ complications, the monitored anesthesia care could be available as a reasonable alternative for both general and regional anesthesia when it is impossible to administer; however, the choice of analgesics and sedatives is still an important and difficult task. We present a high risk patient who suffers from neurologic complications including decreased consciousness caused by brain metastasis of lung cancer, cerebral infarction, quadriplegia and seizure as well as decreased respiratory function and bleeding tendency. When performing the operation on hip joints, we administered both dexmedetomidine as a major sedative, and remifentanil as an adjunct analgesic; as a result, we could successfully perform the monitored anesthesia care without any complications including cardiovascular instability, respiratory depression, and seizure.

Paroxysmal atrial fibrillation developed during perioperative periods in an adolescent without any underlying disease: A case report

Although the development of arrhythmias including atrial fibrillation (AF) is common under general anesthesia during surgery, the first episode of AF to occur during this period is rather uncommon. Moreover, most instances of AF are associated with old age, cardiopulmonary diseases as well as metabolic, endocrine, or genetic abnormalities. The occurrence of paroxysmal AF in the perioperative period in an adolescent without any underlying diseases or organic abnormalities has never been reported. Herein, we report a case of a 16-year-old adolescent whose paroxysmal AF was suspected before the anesthesia induction for strabismus surgery and diagnosed after anesthetic induction. Nevertheless, he was managed successfully with esmolol infusions during and after the surgery and thus recovered spontaneously.

Sufentanil infusion before extubation suppresses coughing on emergence without delaying extubation time and reduces postoperative analgesic requirement without increasing nausea and vomiting after desflurane anesthesia / 대한마취과학회지

BACKGROUND: Coughing, hypertension, tachycardia, and even laryngospasm can occur due to airway irritation during emergence from anesthesia. We investigated the effect of maintaining a sufentanil infusion during emergence from anesthesia by evaluating the incidence of cough and recovery profiles at extubation. METHODS: In total, eighty-four patients undergoing an elective laparoscopic hysterectomy were randomly divided into two sufentanil groups and a control group. During emergence, sufentanil was administered in the sufentanil groups at a rate of 0.2 microg/kg/hr (Group S1) or 0.3 microg/kg/hr (Group S2), and saline was administered to the control group. Cough score, hemodynamic changes, and recovery profiles, such as duration from skin closure to a bispectral index of 80, to eye opening at verbal command, to tracheal extubation and the total duration of study solution infusion, were recorded. The pain score, the total volume of administered patient-controlled analgesia (PCA), and the postoperative nausea and vomiting (PONV) score were evaluated 1, 6, and 24 hours after surgery. RESULTS: Groups S1 and S2 showed significantly lower cough scores and smaller hemodynamic changes on extubation compared to Group C. Recovery profiles showed no significant differences among the three groups. Pain score, PONV at 1 hour postoperatively, and the total volume of PCA administered at all evaluation times were significantly lower in Groups S1 and S2 than in the control group. However, pain score, and PONV at 6 hours and 24 hours postoperatively showed no significant differences. CONCLUSIONS: A sufentanil infusion (0.2-0.3 microg/kg/hr) during emergence from desflurane anesthesia may suppress coughing on extubation in patients with body mass indexes (BMI) of 21-26 without delaying extubation time. It may also reduce the postoperative analgesic requirement without increasing PONV.

Sufentanil infusion before extubation suppresses coughing on emergence without delaying extubation time and reduces postoperative analgesic requirement without increasing nausea and vomiting after desflurane anesthesia / 대한마취과학회지

BACKGROUND: Coughing, hypertension, tachycardia, and even laryngospasm can occur due to airway irritation during emergence from anesthesia. We investigated the effect of maintaining a sufentanil infusion during emergence from anesthesia by evaluating the incidence of cough and recovery profiles at extubation. METHODS: In total, eighty-four patients undergoing an elective laparoscopic hysterectomy were randomly divided into two sufentanil groups and a control group. During emergence, sufentanil was administered in the sufentanil groups at a rate of 0.2 microg/kg/hr (Group S1) or 0.3 microg/kg/hr (Group S2), and saline was administered to the control group. Cough score, hemodynamic changes, and recovery profiles, such as duration from skin closure to a bispectral index of 80, to eye opening at verbal command, to tracheal extubation and the total duration of study solution infusion, were recorded. The pain score, the total volume of administered patient-controlled analgesia (PCA), and the postoperative nausea and vomiting (PONV) score were evaluated 1, 6, and 24 hours after surgery. RESULTS: Groups S1 and S2 showed significantly lower cough scores and smaller hemodynamic changes on extubation compared to Group C. Recovery profiles showed no significant differences among the three groups. Pain score, PONV at 1 hour postoperatively, and the total volume of PCA administered at all evaluation times were significantly lower in Groups S1 and S2 than in the control group. However, pain score, and PONV at 6 hours and 24 hours postoperatively showed no significant differences. CONCLUSIONS: A sufentanil infusion (0.2-0.3 microg/kg/hr) during emergence from desflurane anesthesia may suppress coughing on extubation in patients with body mass indexes (BMI) of 21-26 without delaying extubation time. It may also reduce the postoperative analgesic requirement without increasing PONV.

Tension pneumothorax after ultrasound guided internal jugular venous catheterization in an inadvertently endobronchially intubated patient with kyphosis / 대한마취과학회지

No abstract available.

The effect and optimal dose of sufentanil in reducing injection pain of microemulsion propofol / 대한마취과학회지

BACKGROUND: Propofol is used as an induction and maintenance agent for general anesthesia but it can cause adverse reactions like hyperlipidemia, growth of microorganisms, and pulmonary embolisms. Microemulsion propofol was developed to avoid these side effects but incidence and severity of pain on injection is higher than with lipid emulsion propofol. We aimed to compare the effects of sufentanil in analgesic doses for reducing the injection pain of microemulsion propofol. METHODS: The candidates included eighty patients, 19-60 years old and ASA I-II. They were randomly classified into four groups and pretreated with normal saline, sufentanil 0.1 microg/kg, 0.2 microg/kg or 0.3 microg/kg before injection of microemulsion propofol. Five minutes after receiving pretreatment drug, 2 mg/kg of microemulsion propofol was injected and VAS was recorded. RESULTS: There were no significant differences in the incidence of injection pain among the groups. Severity of injection pain was significantly lower in the sufentanil 0.3 microg/kg group than normal saline and sufentanil 0.1 microg/kg group. Significant differences in blood pressure and heart rate were observed in sufentanil groups only after endotracheal intubation. One patient each in sufentanil 0.1 microg/kg and 0.3 microg/kg group experienced mild cough, one from sufentanil 0.3 microg/kg group experienced dizziness and another showed signs of hypoxia. One patient each in normal saline and sufentanil 0.1 microg/kg group showed clinical symptoms of phlebitis in the injection area. CONCLUSIONS: Pretreatment with sufentanil 0.3 microg/kg reduced the severity of microemulsion propofol injection pain without increasing arterial blood pressure and heart rate after endotracheal intubation.

Multiple Psoas Abscess Formation after Pharmacopuncture: A Case Report

Acupuncture has been widely used in alternative medicine for pain relief but may have many complications due to lack of appropriate cares. Pharmacopuncture is a sort of acupuncture that injects a herbal ingredient through a thin tube for the purpose of combining the effects of the herb and acupuncture and it has many pitfalls. The agents used in pharmacopuncture are not refined for a desired effect and not produced by sterile standard processes under strict medical surveillance. We report a case of a 44-yr-old male patient who had multiple abscesses in the psoas region with fever, right low back and hip pain that began after the pharmacopuncture treatment. This case shows that although pharmacopuncture has been practiced widely, it is important that the appropriate aseptic technique should be used to prevent severe infections and other complications.

Unilateral pulmonary edema after two-jaw surgery: A case report / 대한마취과학회지

Pulmonary edema is usually bilateral, but can be uncommonly unilateral. Although unilateral pulmonary edema (UPE) can occur owing to various etiologies, it usually occurs at a patient who has an underlying defect or abnormality in the cardiopulmonary system except a case of negative-pressure pulmonary edema. Especially UPE following general anesthesia is a rare complication in a healthy patient. Re-expansion pulmonary edema (REPE) as a cause of UPE mostly occurs when a chronically collapsed lung is rapidly re-expanded after pneumothorax. There are some reports associated with REPE following one-lung ventilation used to facilitate surgery, in which there is no chronically collapsed lung. There are, however, little reported cases of a more acute form of this complication following re-expansion after atelectasis due to only several minutes of an inadvertent main stem bronchial intubation during operation. A report of the occurrence of UPE in a healthy, young male undergoing two-jaw surgery is described.

Cervical Spinal Cord Stimulation in a Patient with Complex Regional Pain Syndrome Type 2 at the Middle Finger: A case report / 대한마취과학회지

Complex regional pain syndrome (CRPS) is quite difficult to comprehend and manage, of which etiology and pathophysiological mechanisms have not been fully understood. CRPS is classified as either type 1 (without any known nerve injury) or type 2 (with apparent nerve or tissue injury). Spinal cord stimulation is a restorative therapy that currently offers the best chances of obtaining long-term pain relief in CRPS patients with pain that has not responded to other treatments such as physical therapy or analgesic medications. A 45 years old male patient referred to our pain clinic due to uncontrolled pain at the middle finger for 4 years after crushing injury. He was diagnosed with CRPS type 2 and treated with medication, stellate ganglion block, thoracic sympathetic block, and pulsed radiofrequency therapy, but their effects were transient and not satisfactory. A percutaneous spinal cord stimulation (SCS) with a single quadripolar electrode was tried and the patient's finger pain was improved significantly (from VAS 10 to 2). SCS is an effective treatment for CRPS type 2 which results from crushing injury when alternative therapies fail.

Comparison of Total Intravenous Anesthesia and Sevoflurane-Alfentanil Anesthesia for Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: The aim of this prospective, double-blind randomized study was to compare the clinical properties of sevoflurane-alfentanil with propofol-remifentanil anesthesia in patients undergoing a laparoscopic cholecystectomy. METHODS: Forty patients (ASA physical status 1, 2) scheduled for elective surgery received total intravenous anesthesia (TIVA group) with remifentanil and propofol or sevoflurane-alfentanil. The TIVA group was induced with propofol 5 microgram/ml and remifentanil 4.5 ng/ml. The anesthesia was maintained with a continuous infusions of propofol 2.5 microgram/ml and remifentanil 3 ng/ml. The sevoflurane-alfentanil group was induced with alfentanil 15 microgram/kg and propofol 1.5 mg/kg IV. Maintenance was obtained with 2.0 vol% sevoflurane and a bolus of alfentanil 10microgram/kg IV where needed. RESULTS: There were no significant differences in the systolic and diastolic blood pressure and heart rate between the two groups. There were no significant differences in the time to eye opening, the time to extubation, post-anesthetic recovery room stay time and the incidence of postoperative nausea and vomiting between the two groups. CONCLUSIONS: Propofol-remifentanil (TIVA) and sevoflurane-alfentanil both provided satisfactory anesthesia for a laparoscopic cholecystectomy.

The Effect of Ketamine Added to a Ropivacaine Supuraclavicular Brachial Plexus Blockade / 대한마취과학회지

BACKGROUND: In addition to its general anesthetic effect, ketamine has a local anesthetic-like action by a peripheral mechanism. We evaluated the effects of injecting ketamine 45 mg in a supraclavicular brachial plexus blockade (SBPB) with 0.5% ropivacaine 150 mg. In addition, we evaluated the incidence of side effects. METHODS: Thirty four adult patients scheduled for upper extremity surgery were randomly allocated to one of three groups; group 1 (placebo group, n = 10) received 0.5% ropivacaine 30 ml for SBPB and intravenous saline 0.9 ml, group 2 (ketamine group, n = 13) received 0.5% ropivacaine 30 ml with ketamine 0.9 ml (45 mg) for SBPB, and group 3 (control group, n = 8) received 0.5% ropivacaine 30 ml for SBPB and intravenous ketamine 0.9 ml (45 mg). At 1-minute intervals after SBPB, patients were assessed for loss of shoulder abduction, elbow flexion, and wrist flexion, and for loss of pinprick sensation in the deltoid, radial, median, and ulnar dermatomes. Side effects and sedation scores were recorded at 5-minute intervals after SBPB. Before discharge, patients were asked when full sensation or motor function recovered. RESULTS: The speeds of onset for both the motor and sensory blocks were similar in all three groups. The duration of postoperative analgesia and paralysis were similar in the three groups. Side effects were experienced by 62% of patients in group 2 and by 100% of patients in group 3. CONCLUSIONS: We found that the addition of ketamine (45 mg) to brachial plexus blockade does not offer either a quicker onset or a longer duration of anesthesia when using 0.5% ropivacaine SBPB, and it caused a relatively high incidence of side effects.

A Comparison of the Laryngeal Tube, Laryngeal Mask Airway ClassicTM and Laryngeal Mask Airway ProsealTM during General Anesthesia / 대한마취과학회지

BACKGROUND: The laryngeal tube is a variant of the esophageal obturator airway. We compared laryngeal tube (LT), laryngeal mask airway classicTM (LMA) and laryngeal mask airway ProsealTM (PLMA) as a airway management device during general anesthesia. METHODS: Forty-five fasted healthy adult patients were enrolled in this study into one of three groups in a randomized, single-blinded protocol. Group 1 was to receive LT for airway management, LMA for Group 2, and PLMA for Group 3. General anesthesia was induced identically in three groups with thiopental sodium 5 mg/kg followed rocuronium 0.6 mg/kg. 90 seconds later, LT, LMA or PLMA was placed for airway management. Blood pressure and heart rate were measured immediately pre-induction control value, post-insertion of device 0 min, 1 min, 3 min and 5 min. We also compared times of insertion, the amounts of secretion, blood stain, and postoperative sore throat. RESULTS: There was no significant change of SBP, DBP and HR within three groups. All the groups showed stable hemodynamic results. The success rate on the first attempt was 93.6% (14/15, Group 1), 93.6% (14/15, Group 2) and 86.6% (13/15, Group 3). Minimum cuff volume to prevent gas leakage was 69.9+/-0.5 ml (Group 1), 11.1+/-4.3 ml (Group 2) and 11.9+/-3.2 ml (Group 3). The corresponding cuff pressure was 61.6+/-22.0 cmH2O (Group 1), 4.8+/-0.9 cmH2O (Group 2) and 4.6+/-1.5 cmH2O (Group 3). Moderate, severe sore throat was 20% (3/15, Group 1), 6.6% (1/15, Group 2) and 6.6% (1/15, Group 3). Moderate, profuse secretion was 40% (6/15, Group 1), 20% (3/15, Group 2) and 13.3% (2/15, Group 3). There was a 20% (3/15, Group 1) and 13.3% (2/15, Group 3) blood stain. But there was no blood stain for the Group 2. There was a 20% (3/15) gas leakage in Group 1, so we had to insert gas intermittently, but there were no gastric distension, regurgitation, aspiration, hypoxia, airway obstruction and laryngospasm in all three groups. CONCLUSIONS: All the groups revealed stable hemodynamics, no serious complications such as regurgitation, aspiration, hypoxia and airway obstruction during general anesthesia. But we did not find any evidence that LMA and PLMA have the remarkable advantages than laryngeal tube. So we suggested that laryngeal tube could be an alternative airway management device, even though further study will be needed.

The Effects of GABA-receptor Antagonists on the Spinal Cord Stimulation-induced Antinociception in Cats / 대한마취과학회지

BACKGROUND: Spinal cord stimulation (SCS) is a clinical off spring of the gate-control theory and known as an effective treatment for pain from a neurogenic origin. The prolonged pain relief following a short stimulation period is believed to be related with the GABAergic system. The aims of this study were to see if the SCS, similar to that being used in clinical condition, suppressed the nociceptive transmission in the spinal dorsal horn, and if so, which type of GABA receptor may be involved in the antinociceptive process. METHODS: The cord dorsum potential (CDP) was recorded at the dorsal root entry zone of the lumbosacral enlargement for a long time period (60 min) in response to electrical stimulation of the dorsal root, respectively, after SCS in anesthetized cats. CDP was recorded after intrathecal application of bicuculline (GABA (A) receptor antagonist) and phaclofen (GABA (B) receptor antagonist) and 20 min after SCS that followed the intrathecal application of bicuculline or phaclofen. Asigma- and C-fiber wave responses were differentiated according to the conduction velocity. RESULTS: The C-fiber wave decreased significantly after SCS but the Asigma-fiber wave did not on the CDP. After intrathecal administration of bicuculline, the Asigma- and C-fiber waves increased significantly and bicuculline also prevented a SCS-induced reduction of the C-fiber wave. Phaclofen did not change the amplitude of Asigma- and C-fiber wave. When the phaclofen was administered intrathecally, SCS did not decrease the amplitude of the Asigma- and C-fiber waves. CONCLUSIONS: In conclusion, the present results indicate that SCS suppresses C-fiber transmission of acute nociceptive electrical stimuli and both GABA (A) and (B) receptors mediate the long-lasting antinociceptive effect of SCS.

Pain after a Laparoscopic Cholecystectomy: Comparison between Somatic Pain and Visceral Pain / 대한마취과학회지

BACKGROUND: It is known that pain after a laparoscopic cholecystectomy is less compared with an open cholecystectomy. There are various methods of pain relief used but a controversy exists over the effectiveness and value of intraperitoneal local anesthetics. The aim of this study was to investigate which components of pain were more predominant for pain after a laparoscopic cholecystectomy, somatic pain or visceral pain. METHODS: Twenty-four patients who received an elective laparoscopic cholecystectomy were selected. General anesthesia was induced with thiopental sodium and succinylcholine, and maintained with vecuronium and isoflurane. After surgery, the degree of postoperative somatic pain (superficial, sharp and definite in the abdominal wall) and visceral pain (dull, vague and/or colicky in the peritoneal cavity) was assessed at postoperative 1, 3, 6, 9, 24 and 36-hour by a 10 cm-visual analogue scale (VAS) scores and other complaints were recorded. RESULTS: VAS scores of somatic pain were significantly higher than those of visceral pain at all the recorded times. CONCLUSIONS: Somatic pain was predominant after a laparoscopic cholecystectomy compared with visceral pain and it should be helpful to treat pain after a laparoscopic cholecystectomy.

Clinical Effects of Ketamine on Ropivacaine in Brachial Plexus Blockade / 대한마취과학회지

BACKGROUND: Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanisms. We evaluated the additive effects of ketamine (30 mg) on 0.5%, and 0.75% ropivacaine (total 30 ml) for an interscalene brachial plexus blockade (IBPB). METHODS: Thirty five adult patients scheduled for major forearm or hand surgery were prospectively randomized to receive one of the following solutions. Group 1 received 0.75% ropivacaine 28 ml with normal saline 2 ml, group 2 received 0.75% ropivacaine 28 ml with 5% ketamine 0.6 ml and normal saline 1.4 ml, group 3 received 0.75% ropivacaine 20 ml with normal saline 10 ml, and group 4 received 0.75% ropivacaine 20 ml with 5% ketamine 0.6 ml and normal saline 9.4 ml. At 1 minute intervals after IBPB, patients were assessed to determine loss of shoulder abduction, elbow flexion, wrist flexion and loss of pinprick in the deltoid, radial, median, and ulnar dermatomes. At 5 minute intervals after IBPB, pulse rate, blood pressure, sedation score and level of discomfort were assessed. Before discharge, patients were asked to document when incisional discomfort began and when full sensation and motor control returned to the arm. RESULTS: The onset time of loss of pinprick and motor blockade were similar. Duration of sensory and motor blockade were similar in all groups. Hemodynamic changes and sedation scores were not significantly different in all groups. CONCLUSIONS: We demonstrated that 30 mg of ketamine didn't enhance the onset and duration of sensory or motor blockade of ropivacaine during the 0.75% or 0.5% ropivacaine IBPB.

The Preemptive Analgesic Effect of Intravenous Ketamine after Lumbar Spine Instrumentation / 대한마취과학회지

BACKGROUND: Well-localized and noxious stimuli are found to produce long-lasting neuronal sensitization. Ketamine is a NMDA receptor antagonist and exerts antinociceptive effects in many pain tests. The aim of this study was to investigate the pre-emptive and analgesic sparing effect of intravenous ketamine in adults aged 30-53 after lumbar spinal instrumentation surgery. METHODS: We compared the effects of preoperative and postoperative intravenous ketamine 0.5 mg/kg on pain after lumbar spinal instrumentation in a double-blind, randomized study in 30 adult patients. After the induction of anesthesia, patients were allocated randomly to receive ketamine intravenously either before (n = 15) or immediately after (n = 15) surgery. Patients were instructed to ask for analgesics whenever they required pain relief and all demands were recorded. Intravenous patient-controlled analgesia (PCA) using butorphanol 16 mg and ketorolac 150 mg was introduced after recovery from general anesthesia. Visual analogue scale (VAS) pain scores were recorded at 1, 2, 3, 4, 5, 6, 9, 12, 24, 36 and 48 hours postoperatively and the total infusion dose of PCA drugs were assessed at 24 hours postoperatively. RESULTS: VAS scores in the preoperative group were significantly lower than in the postoperative group during the first 9 hours after cessation of the operation. The total infusion dose of PCA drugs was significantly lower in the preoperative group (butorphanol 9.1 +/- 0.3 mg, ketorolac 85.3 +/- 2.5 mg) than postoperative group (butorphanol 10.7 +/- 0.2 mg, ketorolac 100.3 +/- 2 mg) (P < 0.05). No serious adverse reactions occurred. CONCLUSIONS: Preoperative intravenous ketamine 0.5 mg/kg in lumbar spinal instrumentation is more effective in reducing postoperative analgesic requirements than it is when given after the operation.

The Preemptive Analgesic Effect of Bupivacaine Infiltration on Postoperative Pain after Inguinal Herniorrhaphy / 대한마취과학회지

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of central sensitization, which amplifies the postoperative pain. In this study, we investigated the preemptive effect of local infiltration of bupivacaine on postoperative pain after inguinal herniorrhaphy. METHODS: Thirty adult patients scheduled for inguinal herniorrhaphy were randomly assigned to one of two groups. 0.25% bupivacaine 20 ml was infiltrated in the surgical wound site either 15 min before skin incision or immediately after skin closure. Postoperatively, visual analogue scale (VAS) at rest and movement were assessed. Also the time to the first request for postoperative analgesic and the total dose of postoperative analgesics were assessed. In addition, the number of patients who didn't require any analgesics during the postoperative period were assessed. RESULTS: The VAS at rest and movement was not significantly different between the two groups. The time to the first request for postoperative analgesic, the total dose of supplemental analgesics and the number of patients who didn't require any analgesics were not significantly different. CONCLUSIONS: In pain after inguinal herniorrhaphy, we could not demonstrate the pre-emptive analgesic effect of preincisional bupivacaine infiltration. Traction pain after inguinal herniorrhaphy was sustained during the study period and this kind of pain was not inhibited (or prevented) by local infiltration of bupivacaine.

Comparisons of Two Solutions of Ropivacaine/Fentanyl with Different Volume for Postoperative Epidural Analgesia / 대한마취과학회지

BACKGROUND: Ropivacaine is a new local anesthetic approved for epidural analgesia. The addition of fentanyl improves analgesia from epidural ropivacaine. We studied the effects of two solutions of ropivacaine/fentanyl for postoperative pain after a total abdominal hysterectomy. METHODS: Twenty five female patients scheduled for an elective total abdominal hysterectomy were prospectively randomized to receive one of two solutions. Group 1 (n = 13) received 0.2% ropivacaine and 5 microgram/ml of fentanyl at a rate of 2 ml/hour (bolus: 10 ml). Group 2 (n = 12) received 0.08% ropivacaine and 2 microgram/ml fentanyl at a rate of 5 ml/h (bolus: 25 ml) postoperative for two days. After an epidural bolus injection, we assessed the blood pressure, pulse rate, respiratory rate, visual analog scale (VAS), level of sensory block, motor block and sedation score among the two groups. Additional analgesic requirements and side effects such as nausea, itching and urinary retention were assessed for 48 hours post operation. RESULTS: There were no significant differences in the blood pressure, pulse rate and respiratory rate between the two groups. The sum of VAS for 48 hours, the level of sensory block after an epidural bolus injection, additional analgesics, and the number of patients showing motor blockade were similar. Although statistically insignificant, the incidence of nausea, and urinary retention in group 2 was higher than group 1. CONCLSIONS: Both the continuous epidural infusion of 0.2% ropivacaine with fentanyl (2 ml/hour) and 0.08% ropivacaine with fentanyl (5 ml/h) showed similar quality of analgesia on postoperative pain. To reduce the side effect of fentanyl, the volume of ropivacaine/fentanyl solution is important.

Postoperative Pain Evaluation: Facial Rating Scale Compared with Visual Analogue Scale / 대한마취과학회지

BACKGROUND: Although visual analogue scale (VAS) is a good self-assessment method for postoperative pain, faces pain scale (FPS) may be also used as objective assessment method in patients with unavailable of VAS. We investigated the usefulness of facial rating scale (FRS), the variants of VAS and FPS, compared with VAS in postoperative adult patients. METHODS: One hundred and six, ASA 1 or 2, patients undergoing elective surgery under general anesthesia were educated VAS (10 cm) and FRS. One hour after operation, patients' self-reported VAS and FRS were measured in the recovery room. The scores were analyzed by Spearman's correlation and Intraclass correlation. RESULTS: Correlations indicated a highly significant relationship between VAS and FRS (Spearman's correlation coefficient = 0.84, Intraclass correlation coefficient = 0.92, both of P < 0.01). CONCLSIONS: FRS may be useful for self-reported pain assessment instead of VAS in postoperative adult patients.