Preemptive Analgesia of Butorphanol for Hysterectomy / 대한마취과학회지

BACKGROUND: It is necessary to reduce hyperexcitable sensations induced by painful stimulus by preventing central sensitization, so called preemptive analgesia. We observed the effect of butorphanol on postoperative pain after hysterectomy so as to direct analgesic action based on elucidation of the preemptive effect. METHODS: We selected thirty-six patients undergoing elective total abdominal hysterectomy, ASA Physical Status I or II, and employed a double-blind cross-over design. Patients were randomly allocated to one of both groups, receiving intravenous butorphanol 2 mg, either preincisionally or postoperatively. Anesthesia was induced with thiopental and maintained with isoflurane. Patients received meperidine on request for postoperative pain. Patients checked the VAS of spontaneous incisional pain and movement-associated pain by themselves.The time of first demand for postoperative meperidine and the amount of postoperative meperidine for the first 6 hours and 6 to 48 hours were recorded. RESULTS: At 5 hours after surgery, the postoperative VAS score of the preincisional group was lower than that of the postoperative group, and at 24 hours after surgery, the former was also lower than the latter. The first time of demand for postoperative meperidine was earlier in the postoperative group than in the preincisional group. The amount of meperidine for the postoperative first 6 hours was less in the preincisional group than in the postoperative group. CONCLUSIONS: Preincisional intravenous butorphanol reduced the intensity of spontaneous incisional pain and movement-associated pain, regarded as a preemptive effect of butorpahnol, in the early postoperative period.

Comparison of Continuous Epidural Analgesia with Fentanyl-Bupivacaine Versus Intravenous Patient-Controlled Analgesia with Morphine for Postoperative Pain Control / 대한마취과학회지

BACKGROUND: The postoperative pain control has improved with use of continuous epidural analgesia(CEA) and intravenous patient-controlled analgesia (IV-PCA). We compared the efficacy and safety of CEA using fentanyl-bupivacaine with IV-PCA using morphine in the postoperative pain control after total hysterectomy. METHODS: Sixty women undergoing hysterectomy were assigned to receive an epidural bolus of morphine 1 mg and 0.125% bupivacaine 10 ml, followed by a CEA with 0.00036% fentanyl and 0.075% bupivacaine at a rate of 5 ml/hr(CEA group) or intravenous bolus of morphine 2 mg followed by a IV-PCA with 0.1% morphine(IV-PCA group). Visual analog scales(VAS) for pain were recorded at 1, 6, 12, 24 and 48hr postoperatively and side effects and degree of satisfaction were noted. RESULTS: Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group throughout the study period. The average pain scores using VAS in two groups were less than 4. There were no significant differences in side effects and degree of satisfaction between two groups. CONCLUSIONS: The continuous epidural infusion of fentanyl and bupivacaine provided better postoperative analgesia than IV-PCA morphine. The average pain scores of IV-PCA group was less than 4 and the incidence of side effects and degree of satisfaction were not significantly different between two groups. So, we think IV-PCA morphine is a convenient and effective alternative to CEA fentanyl -bupivacaine in patients declining to receive CEA.

Analgesic Effects of Preoperative Versus Postoperative Tiaprofenic Acid in Pediatric Tonsillectomy & Adenoidectomy / 대한마취과학회지

BACKGROUND: The aim of this study was to investigate the pre-emptive effect of preoperative intravenous tiaprofenic acid in children aged 4~11 years after tonsillectomy and adenoidectomy. METHODS: We compared in 45 children the effect of preoperative with postoperative tiaprofenic acid (5 mg/kg) on pain after tonsillectomy and adenoidectomy, which was approved by Ethics Committee. Informed consents were obtained from all their parents. After induction of anesthesia, patients were allocated randomly to receive a tiaprofenic acid intravenously either before (n=15) or immediately after (n=15) surgery. The control group was received saline (n=15). Postoperative pain was rated on a faces scale for postoperative 48 hours. Tiaprofenic acid was given when patient complained pain. The cumulative pain score within 3 hours and 48 hours, time to the first analgesic administration, total requirement of analgesics for 48 hours and the first time of swallowing 50 ml water were checked. RESULTS: Postoperative pain score of the preoperative group was significantly lower than the postoperative group at 9, 42, and 48 hours after operation. The cumulative pain scores during the first 3 hours were 15+/-4 (p <0.05 vs postoperative), 21+/-7 and 22+/-5 in pre, postoperative and saline groups respectively. The cumulative pain scores for 48 hours were 40+/-18 (p <0.05 vs postoperative), 61+/-17 and 63+/-18 in pre, postoperative and saline groups respectively. The times of the first swallowing were 6 (5~6)(p <0.05 vs postoperative) hours, 7 (6.7~9)hours, and 8 (4.5~8.7)hours after operation in pre, postoperative, and saline groups respectively. CONCLUSIONS: Preoperative tiaprofenic acid in the tonsillectomy and adenoidectomy was effective on the reducing the intensity of the postoperative pain. The time to the first swallowing was shorter in the preoperative than postoperative group. The results of this study support the theory of pre-emptive analgesia.

The Effects of Combination of Fentanyl with Morphine in Intravenous Patient-Controlled Analgesia / 대한마취과학회지

Background: The highly lipid soluble opioid, fentanyl, has a rapid onset and short duration of action. The present study was designed to examine the analgesic efficacy and side effects of the combination of fentanyl with morphine in patients using intravenous PCA. Methods: Patients were randomly assigned to receive one of three PCA regimens: M4 group (40 mg morphine+90 mg ketorolac+1.5 mg dorperidol), M2F2 group (20 mg morphine+200 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol), or M2F4 group (20 mg morphine+400 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol). All patients were given initial loading dose of 0.1 mg/kg morphine plus 1 mg droperidol at the end of surgery. Pain score, side effects, and overall satisfaction were assessed at 30 min, 1 hr, 8 hr, 24 hr, and 48 hr postoperatively. Results: The pain score was significantly higher in the M2F2 group than in the M4 group and M2F4 group during 1 hr and 8 hr postoperatively. The total opioid consumption was significantly greater in the M2F4 group than in the M4 group. Patient satisfaction was better in the M2F4 than other two groups. There were no differences in the overall incidence of side effects among three groups. Conclusions: The present results suggest that the combination of fentanyl with morphine for intravenous patient-controlled analgesia is a useful method, and the double dose of fentanyl in comparison with the equipotent morphine dose is recommended in the early postoperative period.

Comparison of Preoperative with Postoperative Tiaprofenic Acid on Pain after Adult Local Tonsillectomy / 대한마취과학회지

BACKGREOUND: The aim of this study was to compare the pre-emptive effect of preoperative with postoperative tiaprofenic acid in adult local tonsillectomy. METHODS: We compared in forty adults the effect of preoperative with postoperative tiaprofenic acid on pain after tonsillectomy in a double-blind, randomized study, which was approved by the Ethics Committee. Informed consents were obtained. Patients were allocated randomly to receive a tiaprofenic acid (200 mg) intravenously either before (n=20) or immediately after (n=20) surgery. Postoperative pain was rated by self-rating visual analog scale for the first 24 hours. Tiaprofenic acid (200 mg) was given when patient complained pain. Time to the first analgesic administration, total requirement of analgesics for 48 hours and the first time of swallowing 100 ml water were checked. RESULTS: Postoperative 1 hour pain score of the preoperative group was significantly lower than postoperative groups (p<0.05). Times to the first analgesic administration, the total requirement of analgesics for 48 hours and the times of the first swallowing of 100 ml water were not significantly different between the two groups. CONCLUSIONS: Preoperative intravenous tiaprofenic acid (200 mg) in adult local tonsillectomy was effective on the reducing the intensity of the postoperative pain only 1 hour after operation. The use of preoperative tiaprofenic acid in adult local tonsillectomy was associated with a more calm recovery. The results of this study do not support the theory of preemptive analgesia.

Influence of Droperidol on Postoperative Nausea and Vomiting during Patient-Controlled Analgesia with Fentanyl / 대한마취과학회지

INTRODUCTION: Patient-controlled analgesia (PCA) has become an important means for postoperative analgesia with parenteral opioid, but postoperative nausea and vomiting (PONV) remains a major problem using a PCA system. The present study was designed to assess the antiemetic effectiveness of droperidol in patients using an intravenous PCA during the first 24 hours after surgery. METHODS: For the postoperative analgesia, 80 patients underwent orthopedic surgery were randomly allocated to receive PCA with either a mixture of 3.75 mg droperidol and fentanyl 2500 microgram after initial bolus of 1.25 mg droperidol as the FD group, or a mixture of saline and fentanyl 2500 microgram as the FS group at the end of surgery. RESULTS: The incidence of PONV showed 52.5% in FS group and 15% in FD group respectively (P<0.05). The incidence of PONV was 2~3 times more in women (76% in FS group & 25% in FD group) than men (35% in FS group & 9% in FD group). CONCLUSION: The addition of droperidol to fentanyl in a PCA system reduces the PONV during the first 24 hours after surgery.

Effect of Intravenous Ketorolac on Postoperative Pain after Tonsillectomy in Small Children / 대한마취과학회지

BACKGROUND: Ketorolac has been used to inhibit some types of postoperative pain and reduce opioids requirement. The purpose of this study is to determine if the intravenous administration of ketorolac immediately before surgery would reduce pain in the immediately postoperative period. METHODS: The children were divided into three groups randomly. Two groups were anesthetized with propofol and fentanyl. The children of one of these group (group 2) received ketorolac 1 mg/kg during the induction of anesthesia. The children of third group received ketorolac 1 mg/kg during the induction of anesthesia and anesthetized with enflurane. Pain was assessed on the arrival in the recovery room and 15minute, 30minute and 60minute thereafter. RESULTS: Pain behavior score (PBS) and faces scale (FS) on the arrival in the recovery room in group 2 were lower than those of group 1 significantly. PBS and FS at 15 min, 30 min and 60 min after arrival in the recovery room in group 3 were higher than those of group 2. CONCLUSIONS: Intravenous administration of ketorolac during anesthetic induction has postoperative analgesia after tonsillectomy and adenoidectomy in 87 children.

Postoperative Analgesia with Meperidine in Cesarean Section Patients / 대한마취과학회지

BACKGROUND: Perioperative noxious stimuli and inflammation may induce peripheral and central sensitization. Together, these changes contribute to the state of postinjury pain hypersensitivity found postoperatively. Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurones and may therefore, reduce postoperative pain. We studied whether or not intravenous meperidine infusion before induction could affect postoperative pain and analgesic consumption when compared with intravenous meperidine infusion at peritoneum closure. METHODS: Female patients scheduled for cesarean section were randomly assigned to one of two groups for prospective study. Group I (n=10) received intravenous meperidine (0.5 mg/kg) 5 minutes before induction of anesthesia and group II (n=10) received the same treatment at peritoneal closure. Both groups had a continuous infusion of meperidine (5 mg/hr) immediately after intravenous bolus meperidine. Postoperative pain relief was provided with intravenous meperidine from a PCA system (Walkmed , Medex, USA). Postoperative visual analogue pain scores (VAS), meperidine consumption and side effects were examined and compared between the groups for two postoperative days. RESULTS: At two hours post surgery VAS at rest were below 3 in both groups and were not statistically significant. VAS on motion were slightly higher than VAS at rest in both groups and were not statistically significant. There was no significant difference in meperidine consumption. There were minor side effects such as nausea, somnolence, dizziness and pruritus, but no patients needed any treatment and all of them were satisfied. CONCLUSION: Preemptive or postincisional intravenous PCA with meperidine was equally effective for postoperative analgesia after cesarean section, with minor side effects. These results suggested that there was no reason for applying preemptive analgesia for cesarean section patients. Further studies will be needed to evaluate preemptive effects of intravenous meperidine or other analgesics in cesarean section patients.