Development of the Geop-Pain questionnaire for multidisciplinary assessment of pain sensitivity / 대한마취과학회지

BACKGROUND: To assess the multidisciplinary aspects of pain, various self-rating questionnaires have been developed, but there have not been sufficient relevant studies on this topic in South Korea. The aim of this study was to develop a new pain sensitivity-related questionnaire in the Korean language that would be simple and would well reflect Koreans' senses. METHODS: A new pain assessment questionnaire was developed through a pre-survey on "geop", which is the Korean word expressing fear, anxiety, or catastrophizing. We named the new assessment questionnaire the Geop-Pain Questionnaire (GPQ). The GPQ was composed of 15 items divided into three categories and rated on a 5-point scale. As a preliminary study, internal consistency and test-retest reliability analyses were conducted. Subsequently, 109 individuals completed the GPQ along with three pain-related questionnaires translated into Korean (Pain Sensitivity Questionnaire [PSQ], Pain Anxiety Symptoms Scale [PASS], and Pain Catastrophizing Scale [PCS]), and the correlations were analyzed. RESULTS: All items in the GPQ showed appropriate internal consistency, and the test-retest reliability analysis showed no statistically significant differences. The correlations between the GPQ and the existing questionnaires revealed that the GPQ scores had mid-positive correlations with the PSQ scores and strong positive correlations with the PASS and PCS scores. CONCLUSIONS: This study attempted to develop a questionnaire assessing pain sensitivity multidimensionally using the Korean word geop for the first time. The self-rating GPQ showed high correlations with the existing questionnaires and demonstrated potential to be utilized as a pain prediction index in clinical practice.

Diagnosis and Treatment of Abdominal Cutaneous Nerve Entrapment Syndrome Using Ultrasonography

Abdominal cutaneous nerve entrapment syndrome is one of the abdominal wall-origin pain that develops in anterior cutaneous branches of 7th to 12th thoracic nerves passing through fibrous ring in rectus abdominis. Number of this condition has been misdiagnosed to visceral dysfunctions; therefore, delayed diagnosis leads to waste of cost and time. Injection of local anesthetics is a kind of useful technique for the purpose of the confirmed diagnosis with treatment in abdominal wall pain. Recently, the accuracy and safety of local anesthetics injection to muscle or nerve are significantly improved than the past times since ultrasound has been accepted as a substantial device in clinical area. Here, we report a case of abdominal cutaneous nerve syndrome, treated by ultrasound-guided nerve block accompanied with medical treatment.

Evaluation of palonosetron for the prevention of pain on injection of LCT/MCT propofol: Randomized controlled comparison with lidocaine

BACKGROUND: Long-chain triglyceride/medium-chain triglyceride (LCT/MCT) propofol is less painful than standard long chain triglyceride (LCT) propofol; however, there is still a need to reduce severe pain. 5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists have an analgesic effect during the injection of standard LCT propofol. This study compared the incidence of moderate-to-severe injection pain with LCT/MCT propofol using pretreatment with palonosetron versus pretreatment with saline or lidocaine. METHODS: This prospective, randomized double-blind study divided 98 patients scheduled for general anesthesia into three groups: control (n = 33), palonosetron (n = 32), and lidocaine (n = 33) groups. An 18-gauge intravenous catheter was inserted into the peripheral vein at the dorsum of the hand. The patient's vein was occluded by a rubber tourniquet at mid-forearm, and we then administered 2 ml of the pretreatment drug. One minute after venous occlusion, we released the tourniquet and administered LCT/MCT propofol 2 mg/kg for 10-15 seconds. The degree of pain on propofol injection was evaluated using a 4-point scale. RESULTS: The incidence of moderate-to-severe pain in the control, palonosetron, and lidocaine groups was 9.1, 15.6, and 12.1%, respectively. The incidence of overall pain was lower in the lidocaine group than in the control or palonosetron group. CONCLUSIONS: Palonosetron and lidocaine pretreatment does not reduce moderate-to-severe pain on injection of 1% LCT/MCT propofol. Lidocaine pretreatment reduced the overall incidence of injection pain.

A Pilot Study of the Correlation between the Numeric Rating Scale used to Evaluate "Geop" and Questionnaires on Pain Perception

BACKGROUND: The word "geop" is a unique Korean term commonly used to describe fright, fear and anxiety, and similar concepts. The purpose of this pilot study is to examine the correlation between the Numeric Rating Scale (NRS) score of geop and three different questionnaires on pain perception. METHODS: Patients aged 20 to 70 years who visited our outpatient pain clinics were evaluated. They were requested to rate the NRS score (range: 0-100) if they felt geop. Next, they completed questionnaires on pain perception, in this case the Korean version of the Pain Sensitivity Questionnaire (PSQ), the Pain Catastrophizing Scale (PCS), and the Pain Anxiety Symptoms Scale (PASS). The correlations among each variable were evaluated by statistical analyses. RESULTS: There was no statistically significant correlation between the NRS score of geop and the PSQ score (r = 0.075, P = 0.5605). The NRS score of geop showed a significant correlation with the PCS total score (r = 0.346, P = 0.0063). Among the sub-scales, Rumination (r = 0.338, P = 0.0077) and Magnification (r = 0.343, P = 0.0069) were correlated with the NRS score of geop. In addition, the NRS score of geop showed a significant correlation with the PASS total score (r = 0.475, P = 0.0001). The cognitive (r = 0.473, P = 0.0002) and fear factors (r = 0.349, P = 0.0063) also showed significant correlations with the NRS score of geop. CONCLUSIONS: This study marks the first attempt to introduce the concept of "geop." The NRS score of geop showed a moderate positive correlation with the total PCS and PASS score. However, further investigations are required before the "geop" concept can be used practically in clinical fields.

A suspected malignant hyperthermia managed without dantrolene sodium / 대한마취과학회지

No abstract available.

Male Chronic Pelvic Pain Syndrome

Male chronic pelvic pain syndrome (MCPPS) is defined as chronic pain, pressure, or discomfort localized to the pelvis, perineum, or genitalia of males lasting more than 3 months that is not due to readily explainable causes. Other names for the disorder include prostatodynia and chronic nonbacterial (abacterial) prostatitis, although it is unclear how the symptoms relate to the prostate. And it appears to be extensive variability in clinical presentation and may result in chronic neuropathic pain and neuromuscular pain. Therefore patients with MCPPS should be cared by multimodal treatment including antihyperalgesics, antidepressants and pain intervention procedures such as caudal block. We report successful care in two men with MCPPS.

The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia

BACKGROUND: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. METHODS: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-microg fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. RESULTS: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. CONCLUSIONS: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.

A questionnaire study investigating the prevalence of chronic postoperative pain / 대한마취과학회지

BACKGROUND: Chronic postoperative pain (CPOP) is defined as pain of at least 2 months duration after a surgical procedure. Until recently, it has been a neglected topic, because it can occur after a wide spectrum of operations; however, little is known regarding its underlying mechanism, prevalence, risk factors, and treatments. We investigated characteristics of CPOP after various operations via a questionnaire. METHODS: Patients were contacted at > 2 months after surgery, irrespective of sex, type of operation or anesthesia method, and a follow-up pain questionnaire was administered by phone. RESULTS: One hundred forty-five of 400 patients (36.3%) described CPOP. The prevalence of CPOP was significantly lower in laparoscopic surgery (29/159, 18.2%) than open surgery (116/241, 48.1%). The prevalence of CPOP was higher with the use of PCA (patient controlled analgesia), (45.3%) than without PCA (24.6%). There were no significant differences regarding sex, anesthetic method, or duration of operation. CONCLUSIONS: Our results indicate that the prevalence of CPOP may be related to use of an endoscope and PCA. However, it is difficult to completely explain the correlation, because this is a complex area of research. More research is needed to improve the quality of pain relief.

Factors Affecting Public Prejudice and Social Distance on Mental Illness: Analysis of Contextual Effect by Multi-level Analysis / 예방의학회지

OBJECTIVES: While there have been many quantitative studies on the public's attitude towards mental illnesses, it is hard to find quantitative study which focused on the contextual effect on the public's attitude. The purpose of this study was to identify factors that affect the public's beliefs and attitudes including contextual effects. METHODS: We analyzed survey on the public's beliefs and attitudes towards mental illness in Korea with multi-level analysis. We analyzed the public's beliefs and attitudes in terms of prejudice as an intermediate outcome and social distance as a final outcome. Then, we focused on the associations of factors, which were individual and regional socio-economic factors, familiarity, and knowledge based on the comparison of the intermediate and final outcomes. RESULTS: Prejudice was not explained by regional variables but was only correlated with individual factors. Prejudice increased with age and decreased by high education level. However, social distance controlling for prejudice increased in females, in people with a high education level, and in regions with a high education level and a high proportion of the old. Therefore, social distance without controlling for prejudice increased in females, in the elderly, in highly educated people, and in regions with a high education and aged community. CONCLUSIONS: The result of the multi-level analysis for the regional variables suggests that social distance for mental illness are not only determined by individual factors but also influenced by the surroundings so that it could be tackled sufficiently with appropriate considering of the relevant regional context with individual characteristics.

Differences in Obesity Rates Between People With and Without Disabilities and the Association of Disability and Obesity: A Nationwide Population Study in South Korea / 예방의학회지

OBJECTIVES: The objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities. METHODS: Mass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis. RESULTS: People with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities. CONCLUSIONS: These results show that people with physical disability have a higher vulnerability to obesity.

Relief of Postherpetic Neuralgia with Transforaminal Epidural Injection of Magnesium: A Case Report

Although postherpetic neuralgia (PHN) is a common chronic pain syndrome, the pathophysiology of this disorder is not well known and management is often very difficult. N-Methyl-D-Aspartate (NMDA) receptor antagonists are known to be effective in PHN, and magnesium, a physiological blocker of NMDA receptors, is widely used to treat various chronic pain disorders. Here, we present a case of the PHN refractory to conventional treatment, which was treated successfully with transforaminal epidural injection of magnesium sulphate at the affected dermatome.

A comparison of sufentanil and fentanyl for patient-controlled epidural analgesia in arthroplasty / 대한마취과학회지

BACKGROUND: The use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated. METHODS: Eighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 microg/ml) or sufentanil (group S1: sufentanil 0.5 microg/ml, group S2: sufentanil 0.75 microg/ml, and group S3: sufentanil 1.0 microg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery. RESULTS: Postoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3. CONCLUSIONS: The incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 microg/ml). Therefore, 0.5 microg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.

Relief of Postherpetic Neuralgia with Transforaminal Epidural Injection of Magnesium: A Case Report

Although postherpetic neuralgia (PHN) is a common chronic pain syndrome, the pathophysiology of this disorder is not well known and management is often very difficult. N-Methyl-D-Aspartate (NMDA) receptor antagonists are known to be effective in PHN, and magnesium, a physiological blocker of NMDA receptors, is widely used to treat various chronic pain disorders. Here, we present a case of the PHN refractory to conventional treatment, which was treated successfully with transforaminal epidural injection of magnesium sulphate at the affected dermatome.

Evaluation of a portable hemoglobin photometer for assessment of intra-operative hemoglobin concentrations

BACKGROUND: To evaluate the accuracy of a portable hemoglobin photometer, the HemoCue, during surgery, hemoglobin concentrations (Hb) of HemoCue were compared with those of the SYSMEX XE-2100, in the situation of bleeding. METHODS: Hemoglobin concentrations were measured with HemoCue and by the SYSMEX XE-2100 at the same time, on 100 blood samples obtained from patients who were bleeding more than 500 ml, during surgery. The limits of agreement between the two methods were calculated from the results according to the method of Bland & Altman. The results of HemoCue were adjusted by adding the mean bias, defining the corrected values, and reevaluated the agreement with the results of the SYSMEX XE-2100. RESULTS: The differences in results between the two methods were 1.12 +/- 0.37 g/dl. The limits of agreement were 0.38-1.86 g/dl, which means disagreement between the two methods. However, the corrected values represented agreement with the values of the SYSMEX XE-2100. The limits of agreement were -0.74-0.74 g/dl. CONCLUSIONS: The corrected Hb values of HemoCue were comparable to the values of SYSMEX XE-2100. It is useful to evaluate the hemoglobin concentration using HemoCue intraoperatively.

Prophylactic effect of dexamethasone in reducing postoperative sore throat / 대한마취과학회지

BACKGROUND: This study was performed to compare the effectiveness of prophylactic dexamethasone and postintubation dexamethasone in reducing the incidence and severity of postoperative sore throat (POST). METHODS: This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 60 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the prophylactic and postintubation groups received intravenous injection of 10 mg of dexamethasone 30 min before or after tracheal intubation, respectively. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. RESULTS: The severity scores of POST at 1 and 6 h after the operation were significantly lower in the prophylactic group than in the postintubation group. There were no significant differences in the incidence of POST during the 24 h after the operation between the two groups (22/32 in the prophylactic group vs. 27/34 in the postintubation group, P = 0.403). CONCLUSIONS: Intravenous injection of 10 mg of dexamethasone was more effective in reducing the severity of POST when administered before tracheal intubation compared with after tracheal intubation.

Patterns of Unintentional Domestic Injuries in Korea / 예방의학회지

OBJECTIVES: To investigate the patterns of unintentional home injuries in Korea. METHODS: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. RESULTS: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. CONCLUSIONS: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

The Effect of a Target Controlled Infusion of Low-Concentration Ketamine on the Heart Rate Variability of Normal Volunteers

BACKGROUND: Ketamine has an indirect sympathetic stimulation effect. We investigated heart rate variability (HRV) as a marker of cardiac autonomic function after a target controlled infusion (TCI) of ketamine with a plasma concentration of 30 or 60 ng/ml. METHODS: In 20 adult volunteers, the mean of the R wave to the adjacent R wave interval (RRI), the range of RRI, the root mean square successive difference of intervals (RMSSD), the total power, the low frequency (LF, 0.04-0.15 Hz) power, the high frequency (HF, 0.15-0.4 Hz) power, the normal unit HF (nuHF), the normal unit LF (nuLF), the LF/HF ratio and the SD1 and the SD2 in the Poincare plot were measured before and after a TCI of ketamine. We observed for any psychedelic symptoms or sedation. RESULTS: There were no differences in the mean and range of the RRI, RMSSD, total power, LF power, HF power, nuHF, nuLF, LF/HF ratio, SD1 and SD2 between before and after ketamine administration. The OAA/S score was higher and there were more psychedelic symptoms with a 60 ng/ml plasma concentration than with a 30 ng/ml plasma concentration. CONCLUSIONS: This study did not show any effect of a low plasma concentration of ketamine on the autonomic nervous system.

The effect of rocuronium on heart rate variability in diabetic patients / 대한마취과학회지

BACKGROUND: Clinically rocuronium, a muscle relaxant, has no significant inhibitory effect on the autonomic nervous system in the healthy population. However, there has been no study done on rocuronium in diabetic patients. Therefore, we used heart rate variability (HRV) as a biomarker to investigate cardiac autonomic function after rocuronium administration to diabetic patients. METHODS: In 21 diabetic adult patients, heart rate (HR), mean arterial blood pressure (BP), low frequency (LF, 0.04-0.15 Hz) power, high frequency (HF, 0.15-0.4 Hz) power, LF/HF ratio, SD1 and SD2 in the Poincare plot before induction of anesthesia, and immediately before and after rocuronium administration were calculated and compared. RESULTS: HR, mean BP, LF, LF/HF ratio and SD2 after rocuronium administration did not differ significantly from the measurements taken before rocuronium administration. HF and SD1 decreased significantly after rocuronium administration (P = 0.022, P = 0.019 respectively). Covariates such as age, gender, weight, duration of diabetes mellitus and hypertension did not alter the effect of rocuronium on the autonomic nervous system. CONCLUSIONS: Rocuronium produced a significant decrease in parasympathetic activity. Therefore, further study will be needed to determine whether vagal reduction caused by rocuronium could have potential to deteriorate hemodynamics in diabetic patients.

Thyroid surgery under monitored anesthesia care (MAC) / 대한마취과학회지

BACKGROUND: Thyroid surgery is usually performed under general anesthesia, but thyroid surgery under monitored anesthesia care (MAC) has become re-introduced. We report our experiences of 40 cases of thyroid surgery under MAC. METHODS: Forty patients were enrolled in this study. Bilateral superficial cervical plexus block (BSCPB) was performed by using 1% mepivacaine with 1 : 200,000 epinephrine. After BSCPB, patients were sedated with propofol and fentanyl. Postoperative pain, sore throat, hoarseness, and postoperative nausea and vomiting (PONV) were assessed. RESULTS: Mean postoperative pain VAS were 1.3, 1.2, 1.0, 0.8 and postoperative sore throat VAS 1.4, 1.4, 1.1, 0.9 at PACU (post-anesthesia care unit) and postoperative 3, 6, 12 h, respectively. The incidence of hoarseness was 25, 5, 2.5%, and 0% and PONV were 0, 5, 10%, and 7.5% at PACU and postoperative 3, 6, 12 h, respectively. CONCLUSIONS: Thyroid surgery under MAC may be a suitable alternative to general anesthesia.

The Socioeconomic Cost of Injuries in South Korea / 예방의학회지

OBJECTIVES: This study was conducted to estimate the socioeconomic cost of injuries in South Korea. METHODS: We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance (IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients' unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. RESULTS: The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW (Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6% (3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0% (1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4% (8.6 trillion KRW). CONCLUSIONS: In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.