• Journal of Korean Clinical Nursing Research
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• v.15 no.2
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• pp.67-75
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• 2009

Purpose: Postoperative nausea and vomiting(PONV) is a common problem after general anesthesia. The aim of this prospective, double-blind randomized study was to compare the effect of Propofol-Remifentanil vs. Sevoflurane inhalational anesthetics on PONV after laparoscopic cholecystectomy. Methods: Forty patients (ASA physical status 1, 2) scheduled for elective surgery participated in the study. Twenty of them received total intravenous anesthesia (TIVA group) with Propofol-Remifentanil, and the rest were given Sevoflurane inhalational anesthetics (inhalation group). The TIVA group was induced with Propofol 5mcg/ml and Remifentanil 3~4mcg/ml. The anesthesia was maintained with the continuous infusion of Propofol 2~3mcg/ml and Remifentanil 2~3mcg/ml IV. The inhalation group was induced with Pentotal Sodium 5mg/kg and 3~4mcg/kg/hr IV Remifentanil. Maintenance was obtained with 1.5~2.0 vol% Sevoflurane. Results: The subjects in TIVA group reported less PONV than those in Sevoflurane inhalation anesthesia group. Conclusion: Propofol-Remifentanil anesthesia (TIVA group) was considered a satisfactory anesthetic technique in reducing PONV in patients with laparoscopic cholecystectomy.

• Clinical Pain
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• v.18 no.1
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• pp.36-39
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• 2019

Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.74-78
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• 2000

Background: Epidural Adhesiolysis is an interventional pain management technique for patients with low back pain. In addition to local anesthetics and corticosteroid, hypertonic saline (NaCl) are used for the technique. Present study was aimed to compare analgesic and adverse effects of two different concentration of hypertonic saline in Epidural Adhesiolysis. Methods: Fifty-three subjects with low back pain with radiculopathy were assigned to one of two epidural adhesiolysis treatment groups: 8% (Group I, n=26) or 10% (Group II, n=27) hypertonic saline. 17 G epidural needle was inserted at sacral hiatus and catheter was advanced untill its tip was located at lesion site under fluoroscopic guidance. Subjects in all treatment groups received epidural corticosteroid and local anesthetic. And then, hypertonic saline injection via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) at post-epidural adhesiolysis 1, 2, 3 days, 1 week, and 1, 3 months. We also looked for complications of epidural adhesiolysis at different concentration of hypertonic saline. Results: Statistical analysis demonstrated that NRS was not significantly different between two groups during 3 months after epidural adhesiolysis. There were no major differences of complications between two groups and disappeard after a few months without residual sequelae. Conclusions: We conclude that epidural adhesiolysis using 8% hypertonic saline is effective for relief of low back pain with proven lumbosacral fibrosis without any residual sequelae compared with 10%.

• The Korean Journal of Pharmacology
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• v.27 no.2
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• pp.99-108
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• 1991

The effect of racemic Ketamine HCl was observed on excitable membranes of sciatic nerve fibres and toe muscles from frog. Ketamine significantly depressed the amplitude of the action potential, maximum rate of rise and that of fall of action potentials of sciatic nerve by dose-dependent and time-course manner, and also it produced the inhibition of $K^+-contracture$ in toe muscle. We used two different ways of sucrose gap method to to obtain the better results from sciatic nerve. We observed and compared the effect of ketamine on sciatic nerve with naloxone, 4-AP (4-aminopyridine) and TEA (Tetraethylammonium). Naloxone significantly but not totally blocked the effect of ketamine both on nerve and on skeletal muscle. 4-AP or TEA by itself had a significant depressant effect on the action potentials on nerve by central perfusion (extracellular perfusion), but both of these drugs did not much affect the action of Ketamine on nerve. The reversibility of effect of Ketamine (10 mM) was observed both on nerve and on skeletal muscles when exposed to drug for short duration. The effects of racemic ketamine described may provide to support that one of the mechanisms of the action of Ketamine on nerve and on muscles of frog might be related to non-specifically effect on receptors within the ion channels $(K^+-channel,\;Na^+-channel\;or\;slow\;Ca^{++}\;channel)$ at higher dose which produces anesthetic effect and also it interacts specifically with one of the opioid receptors or subtype of these receptors which is sensitive to Naloxone at lower dose which produces analgesia.

• Journal of Acupuncture Research
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• v.15 no.2
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• pp.17-28
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• 1998

The present study was designed to investigate the effect of different stimulation-duration of high frequency electroacupuncturet(EA) treatment on the neuronal activities in the spinal cord and brainstem using Fos immunohistochemical technique. Three different stimulus-duration was used in this experiment : 30minutes, 1 hour and 2 hours. The summerized results were summerized as follow : 1. The number of Fos expression was significantly increased in the spinal cord dorsal horn depending upon the increase of stimulus-duration (P<0.05). Otherwise, there was no significant difference between 30 minutes EA treated group and anesthetic control. 2. High frequency EA biphasic stimulation significantly enhanced the Fos expression in the DR, middle and rostral portion of PAG LD, and caudal PAG LV after 1 hour and 2 hours treatment. The number of Fos immunoreactive neuron in the brainstem was increased accorcting to the length of stimulus-duration. Those results indicate that at least 1 hour EA treatment was necessary to increase the neuronal activities in the spinal cord and brainstem. Those basic data from this study can be applied to establish the effective treatment of EA for pain control in the clinical field.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.70-74
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• 1999

Background: Preemptive analgesia has been suggested recently as an another technique of postoperative pain control. Combination of low dose opioid and NSAIDs was used to lessen systemic opioid side effect, however, the use of NSAIDs may hinder their side effects in perioperative period. The local application of small dose at the target site can be effective without systemic effect. The aim of this study is evaluating the additive effect and side effect of transdermal piroxicam as preemptive adjuvant to intravenous nalbuphine on pain relief after major abdominal surgery. Methods: We reviewed the records of patients received piroxicam patch for preemptive analgesia before operation and compared it with control group. Two sheets of piroxicam patch to the skin incision site for 12 hours before operation were attached (Group 1, n=20) and no patch were applied (Group 2, n=20). Both groups were received nalbuphine continuously after operation using two days infuser (2 ml/hr) containing 80 mg (96 ml). Pain is evaluated by VAS score at each time; 30 min, 1, 6, 12, 24, 36, 48 hours after operation and side effects of NSAIDs were observed for 3days postoperatively. Results: There was no significant VAS score difference between two groups following time in progress. And no significant side effect was noted in both groups, either. Conclusion: There is no preemptive or synergistic analgesic effect of piroxicam patch attached at planned operation site before operation.

• The Korean Journal of Physiology and Pharmacology
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• v.4 no.1
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• pp.25-31
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• 2000

ATP-sensitive potassium channels ($K_{ATP}$ channels) play an important role in insulin secretion from pancreatic beta cells. We have investigated the effect of propofol on $K_{ATP}$ channels in cultured single pancreatic beta cells of rats. Channel activity was recorded from membrane patches using the patch-clamp technique. In the inside-out configuration bath-applied propofol inhibited the $K_{ATP}$ channel activities in a dose-dependent manner. The half-maximal inhibition dose (ED50) was $48.6{\pm}8.4\;{\mu}M$ and the Hill coefficient was $0.73{\pm}0.11.$ Single channel conductance calculated from the slope of the relationship between single channel current and pipette potential $(+20{\sim}+100\;mV)$ was not significantly altered by propofol $(control:\;60.0{\pm}2.7\;pS,\;0.1\;mM\;propofol:\;58.7{\pm}3.5\;pS).$ However, mean closed time was surely increased. Above results indicate that propofol blocks the $K_{ATP}$ channels in the pancreatic beta cells in the range of its blood concentrations during anesthesia, suggesting a possible effect on insulin secretion and blood glucose level.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.61-69
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• 2021

Background: Inferior alveolar nerve block (IANB) using lidocaine 2% is commonly used for anesthetizing primary mandibular molars; however, this technique has the highest level of patient discomfort compared to other local anesthesia techniques. Therefore, alternative anesthesia techniques are necessary. The aim of this study was to evaluate the efficacy of a single buccal infiltration of 4% articaine with IANB using 2% lidocaine, for the bilateral extraction of primary mandibular molars. Methods: The present study was conducted on 30 patients aged between 6 and 9 years, who required the extraction of bilateral primary mandibular molars. The patients were randomly divided into two groups as follows: In the first session, Group A received IANB with lidocaine 2% and group B received infiltration with articaine 4%. In the second session, another injection method was performed on the opposite side. The Wong-Baker Facial Pain scale (WBFPS), Face Leg Activity Cry, and Consolability (FLACC), and physiologic parameters were used to assess pain perception. Results: The independent t-test showed no statistically significant difference in blood pressure and heart rate before and after extraction (P > 0.05). The mean FLACC index in the lidocaine and articaine groups was 0.89 and 1.36, respectively; there was no statistically significant difference between them (P > 0.05). According to the results of the chi-square test, there was no statistically significant difference between the groups for WBFPS (P > 0.05). Conclusion: The articaine infiltration technique may be an alternative to the IANB for the extraction of primary mandibular molars.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.173-185
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• 2024

Background: Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam. Methods: A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded. Results: In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54±17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide. Conclusion: The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.

• The Korean Journal of Pain
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• v.33 no.4
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• pp.378-385
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• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.