• The Korean Journal of Pain
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• v.34 no.3
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• pp.271-287
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• 2021

Background: Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions. Methods: We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Conclusions: Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

• The Korean Journal of Pain
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• v.35 no.1
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• pp.33-42
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• 2022

Background: Cupressus arizonica Greene is a coniferous tree with great importance in fragrance and pharmaceutical industries. Essential oils from C. arizonica (EC) have shown potential antioxidant, and anti-microbial activities. This study aimed at investigating the anti-nociceptive and anti-inflammatory effects/mechanisms of EC. Methods: The EC was evaluated for anti-nociceptive and anti-inflammatory activities on male Wistar rats using a formalin test and carrageenan-induced paw edema, respectively. Also, we pre-treated some of the animals with naloxone and flumazenil in the formalin test to find out the possible contributions of opioid and benzodiazepine receptors to EC anti-nociceptive effects. Finally, gas chromatography/mass spectrometry (GC/MS) analysis was used to identify the EC's constituents. Results: EC in intraperitoneal doses of 0.5 and 1 g/kg significantly decrease the nociceptive responses in both early and late phases of the formalin test. From a mechanistic point of view, flumazenil administration 20 minutes before the most effective dose of EC (1 g/kg) showed a meaningful reduction in the associated anti-nociceptive responses during the early and late phases of the formalin test. Naloxone also reduced the anti-nociceptive role of EC in the late phase. Furthermore, EC at the doses of 1, 0.5, and 0.25 g/kg significantly reduced paw edema from 0.5 hours after carrageenan injection to 4 hours. GC/MS analysis showed that isolated EC is a monoterpene-rich oil with the major presence of α-pinene (71.92%), myrcene (6.37%), δ-3-carene (4.68%), β-pinene (3.71%), and limonene (3.34%). Conclusions: EC showed potent anti-nociceptive and anti-inflammatory activities with the relative involvement of opioid and benzodiazepine receptors.

• The Korean Journal of Pain
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• v.35 no.3
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• pp.303-310
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• 2022

Background: Open gastrectomy causes severe postoperative pain. Therefore, we investigated the opioid-sparing effect of the ultrasound-guided bilateral erector spinae plane block (ESPB) after open gastrectomy. Methods: Adult patients undergoing open gastrectomy were randomly assigned to either the ESPB group (ESPB + fentanyl based intravenous patient-controlled analgesia [IV-PCA]) or a control group (fentanyl based IV-PCA only). The primary outcome was total fentanyl equivalent consumption during the first 24 hour postoperatively. Secondary outcomes were pain intensities using a numeric rating scale at the post-anesthesia care unit (PACU) and at 3, 6, 12, and 24 hour postoperatively, and the amount of fentanyl equivalent consumption during the PACU stay and at 3, 6, and 12 hour postoperatively, and the time to the first request for rescue analgesia. Results: Fifty-eight patients were included in the analysis. There was no significant difference in total fentanyl equivalent consumption during the first 24 hour postoperatively between the two groups (P = 0.471). Pain intensities were not significantly different between the groups except during the PACU stay and 3 hour postoperatively (P < 0.001, for both). Time to the first rescue analgesia in the ward was longer in the ESPB group than the control group (P = 0.045). Conclusions: Ultrasound-guided ESPB did not decrease total fentanyl equivalent consumption during the first 24 hour after open gastrectomy. It only reduced postoperative pain intensity until 3 hour postoperatively compared with the control group. Ultrasound-guided single-shot ESPB cannot provide an efficient opioid-sparing effect after open gastrectomy.

• The Korean Journal of Pain
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• v.37 no.2
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• pp.119-131
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• 2024

There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic non-cancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dose-reducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.

• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.65-68
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• 1998

The neuropathic pains are not well controlled by common analgesics and opioid drugs in terminal cancer patients. The types of these pains are divided within the two cages, one is due to continuous central sensitization and the other is due to paroxymal peripheral sensitization. The mechanism of continuous central sensitization is the activity of dorsal horn neurones that are activated by C-fiber input. The tricyclic antidepressants, non-tricyclic antidepressants, and oral local anaesthesia probably produce analgesic effects in neuropathic pains through suppression of this activity. The mechanism of paroxymal peripheral sensitization is the hyper-excitability of peripheral neurones. The neuropathic pains due to peripheral sensitization respond relatively the anticonvulsants and baclofen that stabilize membranes and suppress paroxymal electrical discharge. The patients was a 38-year-old female who complained of hyperthemia on upper right extremity. The symptom of this patient was improved with anticonvulsant(dilantin 600mg).

• The Korean Journal of Pain
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• v.11 no.1
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• pp.109-112
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• 1998

The sympathetic nervous system has been implicated as an important factor contributing to causalgia. Basis on reports of presence of opioid receptors in sympathetic autonomic ganglia, including human stellate ganglion, we administered morphine in stellate ganglion block for a patient with causalgia. The patient suffering from brachial plexus injury treated with stellate ganglion block in conjunction with physical therapy. Stellate ganglion block was performed in a paratracheal approach by injection of 1% lidocaine, or 0.25% bupivacaine 8 ml, with morpine 1 mg. Patient's symptoms were dramatically improved after 13 stellate ganglion blocks.

• The Journal of the Korean dental association
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• v.49 no.6
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• pp.327-333
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• 2011

Clinically, treatment goal of neuropathic pain focused on not elimination of etiology but management and control of symptoms because we don't know certain about clear etiology of neuropathic pain yet. The drugs used for the management of neuropathic pain were classified as drugs with strong evidence for benefit(antidepressants, anticonvulsants, opioid analgesics etc.), modest evidence for benefit(mexiletine, carbamazepine, clonidine etc.), preliminary evidence for benefit(NSAIDs, dextromethorphan, topiramate etc.). Finally, the treatment for trigeminal neuralgia was outlined separately since this disorder responds to a different group of drugs than other neuropathic pain conditions.

• Journal of Hospice and Palliative Care
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• v.18 no.2
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• pp.105-111
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• 2015

Purpose: Fatigue, energy loss, feeling of helplessness, poor appetite, pain besides general weakness are major symptoms presented to terminally ill cancer patients. These symptoms are similar to those that appeared with adrenal insufficiency. Also, for terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. We studied the relationship of opioid agents and adrenal insufficiency. Methods: From November 2013 through June 2014, we monitored the serum level of cortisol and dehydroepiandrosterone sulfate (DHEAS, serum) in 55 cancer patients who were over 18 years old and were treated at a hospice center. We also checked the treatment period and dosage of opioid agents. Results: The DHEAS level, treatment period and dosage of opioid agents did not have significant correlation. Correlation between the serum cortisol level and the opioid agent treatment period was not significant either, but the serum cortisol level was positively correlated with the dosage of opioid agents (P value 0.0322). Conclusion: This study did not identify a novel link between treatment period, dosage of opioid agents and adrenal insufficiency. But, the DHEAS level was mostly below the normal level in patients who were treated with opioid agents.

• Journal of Korean Academy of Nursing
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• v.31 no.2
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• pp.206-220
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• 2001

The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients residing in hospice units. The convenient sample of this study consisted of 41 terminally ill cancer patients at three hospice units in university affiliated hospitals. Patients were interviewed with structured questionnaires three times at predetermined intervals: admission to the hospice unit (Time 1), one week later (Time 2), and two weeks later (Time 3). The data was collected from January 1998 to January 1999 and was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. 1. The mean age of the participants was approximately 55 years old. In terms of diagnosis, lung cancer showed the highest frequency (19.5%), followed by stomach cancer and rectal cancer (17.1%). The motive of seeking hospice unit admission was control (72. 2%), followed by spiritual care (50%), and symptom relief (38.9%). 2. Regarding the type of pain felt, the highest pain frequency the participants experienced was deep pain (55%), followed by multiple pain (25%), intestinal pain (10%), then superficial (5%) and neurogenic pain (5%). For the level of pain measured by VAS, there was no significant difference among the three time points; Time 1 (5.04$\pm$2.21), Time 2 (4.82$\pm$2.58) and Time 3(4.73$\pm$2.51). 3. There was significant change seen in spirituality and physical care in each time interval. Namely, the longer the length of admission at the hospice unit, the higher the importance of spirituality (p=0.0001) and the more the physical care the participants received (p=0.01). The opioid use at the three time points showed the following frequencies : Time 1 (75.6%), Time 2 (85.4%) and Time 3 (75.6%). 4. Regarding factors influencing pain, the pain level was significantly affected by the depression level (p〈0.01) and the opioid use (p〈0.1). These results were the most significant at the two time points (Time 1 and Time 2). At Time 3 (two weeks later), the pain level was significantly affected by the depression level (p〈0.05) and the amount of physical care the participants received (p〈0.1). In conclusion, the terminally ill cancer patients had moderate pain, were generally depressed, and were treated with opioid analgesics. As approaching death, the patients received more physical care due to increased physical symptoms experienced and they had a higher perception of the importance of spirituality. Thus, health care professionals need to provide continuous care for each of them to die comfortably physically, psycho- logically, and spiritually.

• Journal of Hospice and Palliative Care
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• v.13 no.1
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• pp.7-12
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• 2010

Purpose: To evaluate medications at the end of life care for terminal cancer patients during their last admission. Methods: Medical records of terminal cancer patients during their last admission from July 2003 to April 2008 at a district academic hospital were evaluated. Patient's characteristics, therapeutic drug classification during their last admission and on the patient's day of death, and the administrated route and number of medications on the patient's day of death were analyzed. Results: Total 81 patients were included. The median patient age was 63 years. The median length of admission was 18 days (range: 1~101). 54% of the patients had more than one comorbidities. The most frequently prescribed drugs during the last admission were opioid analgesics (63%), followed by antibiotics (58%) and antacids (53%). On the day of death, common medications were antibiotics (59%), antacids (58%), and opioid analgesics (46%). Intravenous injection was given to 81% of the patients and intramuscular injection was given to 16% of the patients on the day of patient's death. Number of medications prescribed to patients was between 0 and 11 (median: 3) and 12% (10/81) of the patients took over 8 medications including intravenous and oral drugs on the day of death. 6% (5/81) of the patients took potentially futile medications, like multivitamin or statin until the day of death. Conclusion: This study suggests that potentially futile medications and uncomfortable care were given to terminal cancer patients. Multicenter-based studies are necessary to diminish futile medications by essential medication at the end of life care for terminal cancer patients.