• Title/Summary/Keyword: Analgesia pain

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The Effect of the Combined Analgesia of Epidural and Cryoanalgesia after Thoracotomy Surgery (개흉술 후 냉각요법과 경막외 Fentanyl 병용요법의 비교)

  • Shin, Jin-Woo;Choi, In-Cheol;Ha, Seung-Ill;Sim, Ji-Yeon;Lee, Cheong;Park, Seung-Ill;Yun, Chang-Seob
    • The Korean Journal of Pain
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    • v.14 no.1
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    • pp.68-75
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    • 2001
  • Background: Thoracotomy is the operation that produces the most postoperative pain, necessitating the highest requirements for postoperative analgesics. The common methods of treating postthoracotomy pain are the use of thoracic epidural analgesia, intemittent or continuous intercostal nerve blocks, intravenous narcotics and cryoanalgesia. We designed to assess the analgesic effect of epidural analgesia, cryoanalgesia and the combined analgesia in thoracic surgery. Methods: A prospective study was carried out in 59 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: C (cryoanalgesia), CE (cryoanalgesia and thoracic epidural analgesia), E (epidural analgesia). All patients had standard anesthesia with endotracheal intubation using a double lumen endotracheal tube, and one-lung ventilation. Subjective pain relief was assessed on a visual analog scale. Analgesic requirements, complications and the degree of satisfaction were evaluated during the 7 days following surgery. Results: Subjective pain relief was significantly better in Group CE and Group E in comparison with Group C (P < 0.05). Cryoanalgesia provided a better pain score on the 6th and 7th POD than the early postoperative periods. Analgesic requirements were higher in Group C than in the Group CE and Group E during the first POD. The incidence of side effects was similar in Group CE and Group E. Conclusions: If we can reduce the concentration of fentanyl and local anesthetics in combined analgesia of epidural and cryoanalgesia, the disadvantages of each method would be overcome and would be a better method of postthoracotomy pain control.

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Serratus Anterior Plane (SAP) Block Used for Thoracotomy Analgesia: A Case Report

  • Okmen, Korgun;Okmen, Burcu Metin;Uysal, Serkan
    • The Korean Journal of Pain
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    • v.29 no.3
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    • pp.189-192
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    • 2016
  • Thoracotomy is a surgical technique used to reach the thoracic cavity. Management of pain due to thoracotomy is important in order to protect the operative respiratory reserves and decrease complications. For thoracotomy pain, blocks (such as thoracic epidural, paravertebral, etc.) and pleural catheterization and intravenous drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDs], and opioids, etc., can be used. We performed a serratus anterior plane (SAP) block followed by catheterization for thoracotomy pain. We used 20 ml 0.25% bupivacaine for analgesia in a patient who underwent wedge resection for a lung malignancy. We provided analgesia for a period of close to seven hours for the patient, whose postoperative VAS (visual analog scale) scores were recorded. We believe that an SAP block is effective and efficient for the management of pain after thoracotomy.

High Thoracic Epidural Analgesia for the Control of Pain in Unstable Angina Pectoris -A case report- (불안정형 협심증 환자의 고위 흉부 경막외 진통 효과 -증례보고-)

  • Lee, Bong Jae
    • The Korean Journal of Pain
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    • v.19 no.2
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    • pp.271-274
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    • 2006
  • Unstable angina is a critical phase of coronary heart disease, with widely variable symptoms and prognoses. Recently, despite the advances in surgical revascularization, catheter-based revascularization and medical treatment, an increasing number of patients with angina pectoris are refractory to medical therapy and; therefore, can not be considered as candidates for coronary artery bypass grafting or interventional angioplasty. These patients are often treated with narcotics for pain relief, and forced to severely reduce their levels of activity and productivity. It has become clear that alleviating the pain caused by myocardial ischemia may be possible by altering the sympathetic afferent nerve fibers. Sympathetic blockade can be produced using high thoracic epidural analgesia. Herein, the case of a patient with intractable angina and poor ventricular function, who received high thoracic epidural analgesia to relieve ischemic chest pain, is reported.

Postoperative analgesic effects of the quadratus lumborum block in pediatric patients: a systematic review and meta-analysis

  • Insun Park;Jae Hyon Park;Hyun-Jung Shin;Hyo-Seok Na;Bon-Wook Koo;Jung-Hee Ryu;Ah-Young Oh
    • The Korean Journal of Pain
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    • v.37 no.1
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    • pp.59-72
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    • 2024
  • Background: This study assessed the postoperative analgesic efficacy and safety of the quadratus lumborum block (QLB) in pediatric patients. Methods: Electronic databases were searched for studies comparing the QLB to conventional analgesic techniques in pediatric patients. The primary outcome was the need for rescue analgesia 12 and 24 hours after surgery. Secondary outcomes covered the Face-Legs-Activity-Cry-Consolability Scale (FLACC) scores at various time points; parental satisfaction; time to the first rescue analgesia; hospitalization time; block execution time; block failure rates, and adverse events. Results: Sixteen randomized controlled trials were analyzed involving 1,061 patients. The QLB significantly reduced the need for rescue analgesia both at 12 and 24 hours after surgery (12 hours, relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.01, 0.88; 24 hours, RR: 0.51; 95% CI: 0.31, 0.70). In case of 24 hours after surgery, type 1 QLB significantly reduced the need for rescue analgesia (RR: 0.56; 95% CI: 0.36, 0.76). The QLB also exhibited lower FLACC scores at 1 hour (standardized mean difference [SMD]: -0.87; 95% CI: -1.56, -0.18) and 6 hours (SMD: -1.27; 95% CI: -2.33, -0.21) following surgery when compared to non-QLB. Among QLBs, type 2 QLB significantly extended the time until the first rescue analgesia (SMD: 1.25; 95% CI: 0.84, 1.67). No significant differences were observed in terms of parental satisfaction, hospitalization time, block execution time, block failure, or adverse events between QLB and non-QLB groups. Conclusions: The QLB provides non-inferior analgesic efficacy and safety to conventional methods in pediatric patients.

Acute pain management in the trauma patient population: are we doing enough? A prospective observational study

  • Kejela, Segni;Seyoum, Nebyou
    • Journal of Trauma and Injury
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    • v.35 no.3
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    • pp.151-158
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    • 2022
  • Purpose: There is a strong correlation between trauma and pain. Pain increases the rate of depression, posttraumatic stress disorder, and even mortality in trauma patients. Methods: This institution-based, provider-blinded and patient-blinded, observational study was conducted among trauma patients treated at Tikur Anbessa Specialized Hospital. Over the course of 3 months, this study included patients who had no prior pain management at other hospitals before presentation, and who presented within 24 hours of the traumatic event. Results: Of the 74 patients evaluated, none of the patients had their pain level scored. The researcher-provided pain scale showed a severe subjective pain score for 79.7% of the patients and a severe functional activity score for 59.5% of the patients. Analgesia was provided at an average of 55.4 minutes after presentation and all patients received either diclofenac or tramadol. Satisfactory pain reduction after analgesia was 28.8% for patients initially complaining of severe pain, 54.6% for moderate pain, and 66.7% for mild pain, with the difference being statistically significant (P<0.05). Forty percent of patients discharged home received no analgesia after the first dose provided upon presentation. Conclusions: Pain scoring was nonexistent during the course of the study. The poor utilization rate of analgesia combination and opioids led to unsatisfactory pain outcomes in patients evaluated and followed for 24 hours after presentation.

Epidural Analgesia for Labor Pain Management in a Parturient with HELLP Syndrome -A case report- (HELLP 증후군 산모에서 무통분만을 위해 시행한 경막외 진통법 -증례 보고-)

  • Yun, Chae-Sik;Lee, Jung-Yun;Hong, Sung-Ju;Lee, Jun-Hak
    • The Korean Journal of Pain
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    • v.12 no.2
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    • pp.253-257
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    • 1999
  • Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, a variant presentation of severe preeclampsia/eclampsia is associated with high maternal morbidity and mortality. Despite several advantages to the use of epidural analgesia for the management of labor pain in preeclamptic parturients, this procedure is relatively contraindicated in the presence of severe thrombocytopenia. Determining the pain management of choice depends on the parturient's condition, fetal well-being, and the urgency of the situation. We report a safe case of epidural analgesia in a HELLP syndrome parturient with severe thrombocytopenia for labor pain management without any neurologic complications or epidural hematoma.

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Continuous Lumbar Epidural Analgesia for Labor and Vaginal Delivery in Epileptic Pregnant Women (간질이 있는 산모에서 간질의 예방 및 분만통 감소를 위한 경막외 진통의 경험 1예 -증례 보고-)

  • Choi, So-Yong;Rim, Sung-Jin;Lee, Jung-Tae
    • The Korean Journal of Pain
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    • v.11 no.2
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    • pp.332-334
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    • 1998
  • A 25-year-old epileptic female patient scheduled for vaginal delivery, was referred to the pain clinic for the relief of labor pain. She had been taking anticonvulsant drugs, but suffered from seizure attacks three or four times a month. We had induced continuous lumbar epidural analgesia successfully and she subsequently gave birth to a healthy infant. So we report that continuous lumbar epidural analgesia should be considered as a safe method for reduction of labor pain and prevention of seizure attacks in epileptic pregnant women.

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Efficacy of rhomboid intercostal block for analgesia after thoracotomy

  • Okmen, Korgun
    • The Korean Journal of Pain
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    • v.32 no.2
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    • pp.129-132
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    • 2019
  • Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3-T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient's resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.

Effect of Preoperative Analgesia with Epidural Morphine in Upper Abdominal Surgery (상복부 수술 환자에서 경막외 Morphine의 술전 투여와 술중 투여시 진통 효과 비교)

  • Kim, Yun-Hee;Yoo, Rae-Ho;Ko, Seong-Hoon;Han, Young-Jin;Choe, Huhn
    • The Korean Journal of Pain
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    • v.11 no.1
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    • pp.41-46
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    • 1998
  • Background: Preoperative analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and therefore may preempt postoperative pain. Although preemptive analgesia has shown to decrease postinjury pain in animals, studies in human are not consistent. We studied whether epidural morphine injection before surgical incision could affect postoperative pain and analgesic demands, compared with injection after removal of specimen. Methods: Forty patients scheduled for radical subtotal gastrectomy were randomly assigned to one of two groups for prospective study in a double-blind manner. Group 1 received an epidural injection of 3 mg of morphine in 8 ml of 0.9% saline before surgical incision, and Group 2 after removal of specimen. Postoperative pain relief was provided with I.V. patient controlled analgesia (PCA) system. Numerical rating scales for pain and mood, Prince Henry Hospital scores for pain, cumulative PCA analgesic consumptions, and incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. Results: Cumulative PCA analgesic consumption in group 1 was significantly less than in group 2 at 2, 6 hours after surgery. Pain scores and the incidence of side effects were similar in both groups. Conclusions: Preoperative analgesia with epidural morphine showed little difference in patient controlled analgesic consumption after upper abdominal surgery compaired to intraoperative morphine.

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Perioperative Pain Management in the Patient with Complex Regional Pain Syndrome -A case report- (복합부위통증증후군 환자의 이환 부위 수술 전후의 통증관리 -증례보고-)

  • Jo, Ji Yon;Lee, Mi Geum;Lee, Hyo Min;Choi, Yun Suk;Yun, Hey Jeong;Lee, Chul Joong;Lee, Sang Chul;Kim, Yong Chul
    • The Korean Journal of Pain
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    • v.19 no.2
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    • pp.218-222
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    • 2006
  • Complex regional pain syndrome (CRPS) is a syndrome of pain and sudomotor or vasomotor instabilities. The perioperative pain management in CRPS patients is very important, as surgery can aggravate preexisting symptoms, especially when performed around the lesion site. Despite the increasing interest in CRPS research, little is known about the optimal perioperative treatment strategy for CRPS patients. Herein, the case of a female CRPS patient, who underwent elective surgery at the lesion site, is reported. As a preemptive analgesia, the patient was satisfactorily managed with two weeks of patient-controlled epidural analgesia, initiated 2 days prior to surgery. The techniques for the prevention of perioperative pain, including preemptive analgesia, as well as its importance, are discussed.