• The Korean Journal of Pain
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• 제8권2호
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• pp.266-271
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• 1995

Recently, continuous epidural infusion of narcotics and local anesthetics have been used for postoperative pain relief. This study was designed to compare the analgesic efficacy and side effects of continuous epidural infusion of narcotics and local anesthetics with those of intramuscular administration of meperidine, for postoperative pain relief after cesarean section. Forty patients were divided into 2 groups of 20 patients each ; Continuous epidural group and control (IM meperidine) group. Before each operation, the epidural group had an epidural catheter placed (L1-2) and following each operation, a bolus of 1%~8ml of lidocaine was injected, followed by continuous infusion of morphine 3 mg/day, fentanyl 300g, 2% mepivacaine 20 ml, 0.5% bupivacaine 20 ml and normal saline 40 ml. The control group received meperidine 50mg IM injection as needed. We evaluated analgesic efficacy with VAS (Visual analogue scale) and side effect at 1, 6, 12, 24, 36 and 48 hour intervals after the operation. The results were as follows: 1) Continuous epidural group was superior to the control group with respect to postoperative analgesia. 2) Side effects (pruritus, nausea & vomiting) were more frequent in the epidural group.

• The Korean Journal of Pain
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• 제14권1호
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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.

• The Korean Journal of Pain
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• 제12권1호
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• pp.21-26
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• 1999

Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of central nervous system (CNS) and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative low dose epidural bupivacaine and morphine could affect postoperative pain, changes plasma cortisol, and serum glucose. Methods: Thirty patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. General anesthesia was induced in all patients and after that, epidural blocks were done except the control group (n=10) patients. Preoperative block group (n=10) received 0.5% bupivacaine 50 mg and morphine 2 mg epidurally as a bolus before operation and followed by 0.1% bupivacaine $5\;mghr^{-1}$ and morphine $0.2\;mghr^{-1}$ for 10 hours. Postoperative block group (n=10) received the same doses of bupivacaine and morphine under the same method postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative pain by visual analogue scores (VAS), analgesic requirement (first requirement time, total amounts used), side effects, plasma cortisol level and serum glucose level were compared. Results: Until postoperative 6 hrs, VAS of control group was higher than those of the epidural groups. No difference was observed in VAS between the two epidural groups. First analgesics requirement time and total amounts of used analgesics were not different between the two epidural groups, but first analgesic requirement time of preoperative block group was significantly prolonged compared with control group. Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Low dose preoperative epidural bupivacaine and morphine could not reduce postoperative pain, plasma cortisol level and serum glucose level compared with postoperative block group.

• The Korean Journal of Pain
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• 제12권2호
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• pp.211-216
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• 1999

Background: Transdermal fentanyl patch (TDFP) is a simple, noninvasive analgesic with continuous effect. The aim of this study was to evaluate the postoperative analgesic effect of TDFP. Methods: Sixty healthy patients undergoing cesarean section were divided into 3 groups. Postoperative pain was controlled with different methods; Group I: application of TDFP-$25{\mu}g/hr$, Group II: intramuscular injection of ketoprofen; Group III: continuous epidural block. Pain scores (numerical rating scale, NRS), number of patients who needed additive ketoprofen injections and side effects were recorded at 8, 20, 32, 44 hours postoperatively. Results: There was no significanant difference in pain score between Group I and Group II. The numbers of patients who need additive ketoprofen injections were lower in group I than group II. Pruritis (25%), nausea/vomiting (10%), leg numbness (40%) was experienced in group III, but not in Group I & II. Conclusions: TDFP-$25{\mu}g/hr$ for postoperative pain control is simpler and more convinient than intramuscular injection of analgesics.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.286-289
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• 2010

A 55-year old woman with advanced stage non-small cell lung cancer was admitted to hospital for the management of severe chest pain, which measured 7 out of 10 on a numerical rating scale (NRS). Despite palliative radiation and the application of multiple epidural blocks, she continued to experience severe cancer pain. We gradually increased the dose of transdermal fentanyl patches from $500{\mu}g/hr$ to $3,650{\mu}g/hr$, for 3 months without any significant side effects. Concomitantly, adjuvant therapy with antidepressants and anticonvulsants were added, decreasing the patient's pain to NRS 3~4 down from 7. After being transferred to a hospice clinic, her chest pain was well-controlled below NRS 4 by means of strong opioid medications, including the highest dose of transdermal fentanyl $4,050{\mu}g/hr$ for more than 16 months.

• The Korean Journal of Pain
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• 제11권2호
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• pp.214-219
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• 1998

Pain is one of the most frequent and disturbing symptom of cancer patients. And almost of cancer patients are afraid of a attacks of pain related to cancer. Caring for the cancer patient can be divided into two phases. The phase of "active treatment" involves various interventions-surgical, chemical or radiological- that are designed to prolong the patient's life. "Terminal care" is the period from the end of active treatment until the patient's death. But in the majority of clinical settings, cancer pain is not being managed adequately results from a lack of education about how to treat the cancer pain management in the safest and most effective way during terminal phase. Althought organic factors represent the most important cause of their pain, it is also important to deal with the patient's psychological reactions and to take account of his or her social and family environment if treatment for chronic cancer pain is to prove adequate. Thus we try to evaluate a kinds of cancer related to pain, degree of pain, effectiveness of drugs, and patient's responses to management. In regard to the satisfaction for pain relief in pain clinics at Pusan National University Hospital(PNUH) are about 70% in patients and 90% in family. Average life expectancy in cancer patients are about 140 days (3 days- 5.7 years). Cancer patients are complained of several discomfortness (above 30 kinds) such as, pain associated with cancer (75%), nausea and vomitting (38%), sleeping disorder (38%), anorexia (38%), dyspnea (32%), constipation (31%), etc. Distributions of cancer associated with pain are stomach cancer (21%), lung cancer (16%), cervix cancer (10%), anorectal and colon cancer (8.6%), hepatoma (8%), pancreatic cancer (3%). About 1/3 of patients are suffer from incident pain in 3~5 times in a day especially in moving, coughing, and exercise. Methods for drug delivering system before death are transdermal fentanyl patch (42%), intravenous PCA (21%), oral intake of opioid (17%), epidural PCA (14%), etc.

• Tuberculosis and Respiratory Diseases
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• 제62권2호
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• pp.140-143
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• 2007

심한 암통증을 호소하는 폐암 환자에서 고용량 펜타닐 첩포($600{\mu}g/hr$)를 이용하여 통증의 완화를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제30권9호
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• pp.920-926
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• 1997

개흉술후 동통으로 발생할 수 있는 술후 합병증을 예방하고 동통을 경감시킬 수 있는 방법중의 하나인 마약성 진통제의 정주요법으로 술후 괄목할만한 진통효과를 보았다. 총 30명의 후측방 개흉술 및 늑골절제를 시행받은 환자를 대상으로 통상적인 진통제의 근주를 시행한 환자 10명을 I 군으로, 경막외 신경차단을 시행한 환자 10명을 II군으로 그리고 환자 자가조절에 의한 지속적 정주 요법을 시행한 환자 10명 III군으로 구분하여 조사하였다. 연구 결과는 혈압, 심박수, 호흡수 및 동맥혈 가스 분석상 세 군간에 유의한 차이는 없었으나 II군과 III 군이 I군보다 기침 및.심호흡을 현저하게 잘하였다. 술후 2시간 후의 일회호흡량(tidal volume)의 회복률은 I군이 58.2$\pm$5.9%, II군이 77.9$\pm$ 11.7%, III군이 84.1 :5.8%로, III군은 II군보다, II군은 I군보다 유의한 차이가 있었다(p<0.05). 술후 2,8시간 후에 실시한 노력성 폐활량(forced vital capacity)의 회복률은 II군 및 III군 은 비슷하였으나, 각각 I군보다는 통계학적으로 유의하게 호전되었다(p< 0.05). 수술후의 통증은 II, III군 이 I군에 비하여 현저하게 감소하였으며, 수술측 부위의 운동도 원할하였고, 진통제 투여량에서도 I군보 다 감소 소견을 보였으며 수술후 회복도 보다 용이 하였다. 결론적으로 마약성 진통제의 지속적 정주요법 은 술후 폐기능 회복과 동통 완화 효과가 우수하였으며, 경막외 신경차단법과 비슷한 결과를 보였으나 수 술직후 2시간째의 폐기능 회복률에 있어서는 마약성 진통제의 정주요법이 경막외 신경차단법 보다 다소 효과가 좋았다..0%로 유의한 차이를 보였다(p<0.05). 조직형별 5년 생존율은 편평상피세포암이 43.1%, 선암이 23.3%, 거대세포암이 30.3%였다(p>0.05).치료법이며 앞으로 장기적인 추적검사가 필요하리라 생각된다.ricuspid valve pouch 19례), 우심실 유출로폐쇄(4례), 아급성심내막염(1례) 및 동반질환을 부가적인 수술적응으로 삼았다. 6. 수술후 관찰결과 사망률은 없었고, 잔존 심실중격결손증도 없었다. 이상의 결과로 경삼첨판륜 절개방법(TATV)은 삼침판맹낭을 가지고 있는 막성주위형 심실중격결손증 (PMVSD) 수술시 좋은 방법이며, 또한 막성주위형 심실중격결손증(PMVSD)에서 수술시 시야를 좋게하고 수술후 삼첨판폐쇄부전에 악영향을 미치지 않는 결과로 안전하고 효과적인 방법으로 사료된다.량치가 뜻하는 의 미는 서로 달랐으며, 암조직내에서 대조조직내보다 CYFRA 21-1 치가 더 낮게 나온 것은 암세포내 에서는 세 포질 성분의 고갈로 인한 것으로 추정되며 암세포의 활동성과는 무관한 것으로 판단된다. EGF-R은 세포벽내에 존재하는 수용체로서 암세포의 증식에 따라 증가하는 양상을 보이며 대조조직보다는 암세포에서 유의한 증가를 보이는 것은 종양 증식과 암표지자로서 의의가 있는 것으로 판단된다.것이 수술 결과를 좋게 하는 방법이라고 사료된다.료의 축적을 통한 신생대동맥근위부 확쏭 진행여부에 주의를 기울여야하겠다.록 mosaic 형태로 외래유전자가 발현되었지만 대조구에서 87.0% (26/30개) 배반포기가 $\beta$-Gal 활력을 보인 반면, G418 처리구에서는 모든 배반포기가 $\beta$-Gal 활력을 보였다 (P<0.05). 그러나 대조구 및 G418 처리구의