• Journal of Aquaculture
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• v.22 no.1
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• pp.63-67
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• 2009

In order to establish optimum anesthesia concentration, we tested the efficacy of clove oil at five different concentrations in large sized (mean SL $17.1{\pm}2.21\;cm$) and small sized (mean SL $0.6{\pm}0.06\;cm$) dark-banded rockfish Sebastes inermis. Optimal anesthesia concentration for dark-banded rockfish was $150\;mgL^{-1}$ in both large and small sized fish. In general, fish exposed to higher anesthetic doses were rapidly induced but took longer to recover (P<0.05). Recovery time of small sized fish was longer than large sized fish in lower concentrations, while recovery time of large sized fish was longer than small sized fish in higher concentration (P<0.05). Using the established optimum aesthetic concentration, we evaluated the physiological response of dark-banded rockfish to clove oil by measuring plasma cortisol and glucose levels. Following administration of $150\;mgL^{-1}$ clove oil at $20^{\circ}C$ (optimum breeding temperature), plasma cortisol level was highest ($42.2{\pm}11.318{\mu}g/dL$) after 0 hour, while plasma glucose level was highest ($52.5{\pm}10.61\;mg/dL$) after 1 hour. Plasma cortisol and glucose concentrations required 6 and 2 hours, respectively, to return to pre-exposure levels.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.49-59
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• 2021

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.6
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• pp.293-302
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• 2023

This review paper delves into the comparative study of epinephrine and phenylephrine as vasoconstrictors in dental anesthesia, exploring their histories, pharmacological properties, and clinical applications. The study involved a comprehensive literature search, focusing on articles that directly compared the two agents in terms of efficacy, safety, and prevalence in dental anesthesia. Epinephrine, with its broad receptor profile, has been a predominant choice, slightly outperforming in the context of prolonging dental anesthesia and providing superior hemostasis, which is crucial for various dental procedures. However, the stimulation of beta-adrenergic receptors caused by epinephrine poses risks, especially to patients with cardiovascular conditions. Phenylephrine, a selective alpha-1 adrenergic agonist, emerges as a safer alternative for such patients, avoiding the cardiovascular risks associated with epinephrine. Moreover, its vasoconstrictive effect may not be as deleterious as that of epinephrine, due to its selective action. This review reveals that despite the potential benefits of phenylephrine, epinephrine continues to dominate in clinical settings, due to its historical familiarity, availability, and cost-effectiveness. The lack of commercially available pre-made phenylephrine dental carpules in most countries, except Brazil, and a knowledge gap within dental academia regarding phenylephrine, contribute to its limited use. This review concludes that while both agents are effective, the choice between them should be based on individual patient conditions, availability, and the practitioner's knowledge and familiarity with the agents. The underuse of other vasoconstrictors like levonordefrin and the unavailability of phenylephrine in pre-mixed dental cartridges in many countries highlights the need for further exploration and research in this field. Furthermore, we also delve into the role of levonordefrin and examine the rationale behind the exclusion of phenylephrine from commercially available pre-mixed local anesthetic carpules, suggesting a need for a responsive approach from pharmaceutical manufacturers to the distinct needs of the dental community.

• Journal of Chest Surgery
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• v.57 no.3
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• pp.291-299
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• 2024

Background: Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods. Methods: We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME). Results: Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N: 108.53, group S: 16.61; p<0.01). Conclusion: SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.2
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• pp.130-140
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• 2024

Objective: To assess whether local anesthetic infiltration could minimize the carotid baroreceptor reflex (CBR) which has an incidence after carotid artery stenting (CAS) that varies from 29% to 51%. Methods: This retrospective single-center study included 51 patients (mean age, 70.47 years) who underwent CAS for carotid stenosis. The groups included patients who underwent CAS for asymptomatic ischemic stroke (n=41) or symptomatic disease (n=10). Preprocedural percutaneous lidocaine injections (PPLIs) were administered to 70.6% and 5.9% of patients who underwent elective CAS and emergency CAS, respectively. Results: Among patients who received PPLIs, the mean degree of stenosis was 80.5% (95% confidence interval [CI]: ±10.74, 51-98%). The mean distance from the common carotid artery bifurcation to the most stenotic lesion (CSD) was 8.3 mm (95% CI: ±0.97, 6.3-10.2 mm); the mean angle between the internal carotid artery and common carotid artery (CCA) trunk (IAG) was 65.6° (95% CI: ±2.39, 61-70°). Among patients who did not receive PPLIs, the mean degree of stenosis was 84.0% (95% CI: ±8.96, 70-99%). The mean CSD was 5.9 mm (95% CI: ±1.83, 1.9-9.9 mm); the mean IAG was 60.4° (95% CI: ±4.41, 51-70°). The procedure time was longer in the PPLI group than in the no PPLI group (28.19 [n=39] vs. 18.88 [n=12] days) (P=0.057); the length of intensive care unit stay was shorter in the PPLI group (20.01 [n=36] vs. 28.10 [n=5] days) (P=0.132). Conclusions: Targeted PPLI administration to the carotid bulb decreased aberrant heart rates and blood pressure changes induced by carotid stent deployment and balloon inflation. As CBR sensitivity increases with decreasing distance to the stenotic lesion from the CCA bifurcation, PPLIs may help stabilize patients during procedures for stenotic lesions closer to the CCA.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.4
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• pp.285-295
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• 2024

Background: In human dentition, the most commonly impacted teeth are the mandibular third molars (M3M). The removal or extraction of these teeth often causes anxiety in patients due to the perceived pain involved in the process. Therefore, pain must be effectively managed using anesthesia. The use of newer local anesthetic drugs can help minimize side effects and drug interactions. Traditionally, adrenaline is used as a vasoconstrictor along with lignocaine. When combined with lignocaine, the alpha agonists dexmedetomidine and clonidine can extend the duration of anesthesia, thereby reducing the need for additional pain-relieving medications. Methods: This study used a randomized, triple-blind, parallel-arm design. Sixty patients were screened, and 45 systemically healthy patients requiring unilateral surgical removal of impacted mandibular third molars with similar difficulty (moderate-to-difficult according to the Modified Pederson's Index) were included in the study. Patients were allocated into three groups as follows: Group A: 2% Lignocaine Hydrochloride with 1:100,000 Adrenaline, Group C: 2% Lignocaine Hydrochloride with 15 ㎍/mL Clonidine, and Group D: 2% Lignocaine Hydrochloride with 1 ㎍/mL Dexmedetomidine. The evaluated parameters were the time of onset of anesthesia, depth of anesthesia, hemodynamic parameters, and duration of postoperative analgesia. Results: Group D had a faster onset of action and prolonged duration of postoperative analgesia compared with Groups A and C. No statistically significant differences were observed between the three groups in terms of the depth of anesthesia and hemodynamic parameters. Conclusion: Group D exhibited a significantly more rapid onset of anesthesia than Groups A and C, and the postoperative analgesic effect in Group D was significantly prolonged (7.22 hours) compared with that in Groups A (4.54 hours) and C (2.1 hours). Patients receiving the Group D solution experienced an extended period of comfort without the need for analgesics for up to 7.22 hours post-procedure.

• The Korean Journal of Rehabilitation Nursing
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• v.1 no.1
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• pp.51-60
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• 1998

The result of studying papers about management of lower back pain published in domestic and foreign nursing and medical magazines in these 10 years is as follows ; 1. General characteristic of lower back pain ; 1) In sex distribution, there were more men than women in 5 papers and more women than men in 4 papers among 9 papers surveryed. 2) In age distribution, thirties to forties of patients had more lower back pain as surveyed by general hospitals and fifties to sixties of patients had more lower back pain as surveyed by oriental medical hospitals. 3) In cause factor, there were 50 to 65% of sprain, 32 to 44% of herniated intervertebral disc and 13 to 29% of degenerative changes. 4) In symtom distribution, there were 26 to 57% of lower back pain, 42 to 65% of lower back pain with radiating pain and 34 to 99% of paravertevral muscle spasm. 5) In period of pain management distribution, 18 to 40% of patients experienced pain for less than 6 months and 59 to 82% of them experienced pain for more than 6 months in 3 papers among 4 papers. 6) In surveying the treatment, 66 to 88% of patients had conservative treatment and there were treatments of general hospital, oriental medicine, self remedy and traditional practice in conservative treatment. 7) In job distribution, 12 to 50% of them were housekeepers, 23 to 31% office workers, 4.6 to 36% blue color workers and 11 to 15% students. 2. As psychological character lower back pain paients had anxiety, depression, anger-hostility, phobic anxiety, neurasthenia, hypochondriasis, and interpersonal sensitivity. 3. To distinguish the cause of lower back pain, plain lumbar roentgenogram, straight leg rasing test, eletromyelogic findings, somatosensory evoked potentials CT and MRI were performed. 4. To relieve lower back pain. epidural adhesiolysis, epidulal injection of local anesthetic in mixture with steroid, lumbar spinal root block, low level laser therapy, acupuncture like transcutaneous nerve stimulation(AL TENS), topical capsaicin and lumbar orthotics were used in medical field, and relaxation technique was used in nursing field. 5. Mckenzie's extension exercise and William's flexsion exercise for lower back pain were used in medical field and Yoga exercise was applied in nursing field. 6. The more school education and self efficacy were high, the better they had active coping lower back pain positively and the less self efficacy was the more they had serious pain. As a result of studying the paper there have been very little research for lower back pain in nursing fields of Korea and foreign countries. Because 60 to 80% of population expeience lower back pain at least more than once, it is necessary to develop the study and clinical practice for management of lower back pain.

• Journal of the Korean Society of Food Science and Nutrition
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• v.24 no.6
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• pp.1026-1038
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• 1995

Although aloe lost a lot of its previous popularity in modern clinical uses as medicine numerous scientific researches still have claimed the beneficial properties(curing and general tonic effect) of aloe gel. Whereas considerable contradictory reports have helped to confuse the aloe gel issue and continually aroused controversy about aloe gel efficacy. However health food, cosmetic and medicinal products made from aloe gel are widely available in the world market especially in U.S.A. so the growing of Aloe plant and the processing of A. vera gel have become big industries in some countries. In some previous papers the salicylic acid, one of the common trace gel components, was thought to have an analgetic and antinflammatory effect. Large amount of Mg ion in the gel was suggested to act as anesthetic, Mg-lactate as antihistamic, and Aloctin A(a glycoprotein) as wound healer by promoting the cell growth. The carboxypeptidase and bradykinase activity in the gel were proposed to have the pain relieving and antiinflammatory effect. But any of thes etheories concerining the physiological action of the trace gel components has not been demonstrated by modern pharmacology, and failed to be supported by clinical research. It was suggested by some research workers that trace amount of anthraquinone compounds in the gel play an important role to act as false substrate inhibitors for PG and TX production(antiprostanoid effect), by which, they believed, inflammation, burn and frostbite, and infected wound could be healed. This hypothesis has not been substantiated. Butthe suggested antimicrobial action, antidiabetic, and antidotic effect of aloe gel are likely to be attributed to the trace anthraquinone compounds. In a lot of recent experimental reports it has been claimed that aloe gel polysaccharides(acetylglucomannan, acetylmannan, and glycoprotein) have the antimicrobial, antinflammatory, antitumour, and infected wound healing effect by immunoenhancement. It is hoped that these effects will be soon documented in clinical studies, then the controversy on aloe gel beneficial effect will cease. In the 30 days subchronic toxicity test the lowest observed adverse effect level of acemannan(acetylmannan) on dog was 5.0 mg/kg, IP. But the aloe gel is generally agreed to be harmless and non toxic even for the internal use such as health food. In the case of idiosynrasy one must keep the delayed type hypersensitivity reaction of aloe gel in mind. In conclusion it seem to be impossible to simply refuse a lot of evidences made by research workers who have claimed aloe gel's beneficial effects and to deny the fact that there had been long therapeutic histories of Aloe plants.

• The Korean Journal of Pain
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• v.2 no.2
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• pp.155-166
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• 1989

Bonica defined, that reflex sympathetic dystrophy (RSD) may develop pain, vasomotor abnoramalities, delayed functional recovery, and dystrophic changes on an affected area without major neurologic injury following trauma, surgery or one of several diseased states. This 45 year old male patient had been crushed on his left shoulder by a heavily laden rear car, during his job street cleaning about 10 years ago (1978). At first the pain was localizea only to the site of injury, but with time, it spreaded from the shoulder to the elbow and hand, with swelling. X-ray studies in the local clinic, showed no bone abnormalities of the affected site. During about 10 years following the injury, the had recieved several types of treatments such as nonsteroidal analgesics, steroid injections into the glenoidal cavity (10 times), physical therapy, some oriental herb medicines, and acupuncture over a period of 1~3 months annually. His shoulder pain and it's joint dysfunction persisted with recurrent paroxysmal aggrevation because of being mismanaged or neglected for a sufficiently long period these fore permiting progression of the sympathetic imbalance. On July 14 1988 when he visited our clinic. He complained of burning, aching and had a hyperpathic response or hyperesthesia in touch from the shoulder girdle to the elbow and the hand. Also the skin of the affected area was pale, cold, and there was much sweating of the axilla and palm, but no edema. The shoulder girdle was unable to move due to joint pain with marked weakness. We confirmed skin temperatures $5^{\circ}C$ lower than those of the unaffected axilla, elbow and palm of his hand, and his nails were slightly ridged with lateral arching and some were brittle. On X-ray findings of both the shoulder AP & lateral view, the left humerus and joint area showed diffuse post-traumatic osteoporosis and fibrous ankylozing with an osteoarthritis-like appearance. For evaluating the RSD and it's relief of pain, the left cervical sympathetic ganglion was blocked by injecting 0.5% bupivacaine 5 ml with normal saline 5 ml (=SGB). After 15 minutes following the SGB, the clinical efficacy of the block by the patients subjective score of pain intensity (=PSSPI), showed a 50% reduction of his shoulder and arm pain, which was burning in quality, and a hyperpathic response against palpation by the examiner. The skin temperatures of the axilla and palm rose to $4{\sim}5^{\circ}C$ more than those before the SGB. He felt that his left face and upper extremity became warmer than before the SGB, and that he had reduced sweating on his axilla and his palm. Horner's sign was also observed on his face and eyes. But his deep shoulder joint pain was not improved. For the control of the remaining shoulder joint pain, after 45 minutes following the SGB, a somatic sensory block was performed by injecting 0.5% bupivacaine 6 ml mixed with salmon calcitonin, $Tridol^{(R)}$, $Polydyn^{(R)}$ and triamcinolone into the fossa of the acromioclavicular joint region. The clinical effect of the somatic block showed an 80% releif of the deep joint pain by the PSSPI of the joint motion. Both blocks, as the above mentioned, were repeated a total of 28 times respectively, during 6 months, except the steroid was used just 3 times from the start. For maintaining the relieved pain level whilst using both blocks, we prescribed a low dose of clonazepam, prazocin, $Etravil^{(R)}$, codeine, etodolac micronized and antacids over 6 months. The result of the treatments were as follows; 1) The burning, aching and hyperpathic condition which accompanied with vaosmotor and pseudomotor dysfunction, disappeared gradually to almost nothing, within 3 weeks from the starting of the blocks every other day. 2) The joint disability of the affected area was improved little by little within 6 months. 3) The post-traumatic osteoporosis, fibrous ankylosis and marginal sclerosis with a narrowed joint, showed not much improvement on the X-ray findings (on April 25, 1989) 10 months later in the follow-up. 4) Now he has returned to his job as a street cleaner.