• The Korean Journal of Pain
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• v.9 no.2
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• pp.368-373
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• 1996

Background: The purpose of this study was to determine whether there is any advantage for a continuous background infusion during patient controlled epidural analgesia(PCEA) for postoperative pain control. Methods: 60 patients scheduled for elective cesarean section under epidural anesthesia were assigned randomly in a double-blind fashion to receive fentanyl and bupivacaine by PCEA with or without background infusion for 48 hours postoperatively. Results: Total amount of fentanyl and bupivacaine consumption and degree of sedation were not significantly different between the two groups. Visual analogue scale(VAS) pain scores at 24, 36, and 48h and sleep disturbance were significantly lower in background infusion group. Conclusion: Administration of fentanyl with bupivacaine by continuous background infusion is appropriate for PCEA for postcesarean section pain control.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.138-141
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• 1997

Rib fracture due to intense pain, may restrict patients from inadequate coughing. These conditions may produce varying degrees of complications such as atelectasis, pneumonia and arterial hypoxemia. Thoracic epidural analgesia has been used to treat pain associated multiple rib fractures because of its marked improvement in vital capacity and dynamic lung compliance. However, there are complications related to thoracic epidural analgesia which may include damage to spinal cord, perforation of dura, respiratory depression, decrease heart rate and arterial blood pressure. We experienced such a case of cardiac arrest during thoracic epidural analgesia while treating a patient for multiple rib fractures.

• 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.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.291-295
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• 1997

Technique of epidural analgesia is generally regarded a safe procedures which is widely applied in postoperative and chronic pain control. Incidence of neurologic complications following epidural analgesia are rare; however, increasing number of published reports describing transient or permanent neurologic complications following such procedures have been appearing more frequently. We report two cases of neurologic complications following epidural analgesia as we believe it is important to draw the attention of other anesthesiologist to the possibility of existence of other complications of significant medicolegal consequences.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.439-442
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• 1996

Continuous epidural analgesia has been used widely for chronic pain control, especially in cancer patients. As one of the complications, paraplegia developed during continuous epidural analgesia may be caused by epidural abscess, epidural hematoma, neural damage, chronic adhesive arachnoiditis, anterior spinal artery syndrome, delayed migration of extradural catheter into subdural space or subarachnoid space and preexisting disease. A 55-years-old male with lung cancer was implanted with continuous thoracic epidural catheter for pain control. Twenty days after catheterization, moderate back pain, weakness of lower extremity and urinary difficulty were developed. We suspected epidural abscess at first and made differential diagnosis with MRI which showed metastatic cancer at T2-4 spine, And compressed spinal cord was the main cause of the lower extremity paralysis.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.430-433
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• 1996

It is common practice to use epidural catheter for anesthesia or for postoperative analgesia and other kinds of pain control. However, Intraspinal infection associated with this practice is rare event. We report a case of spinal subdural abscess occuring in patient who had recently received epidural catheterization. The cause in this case is not certain, although infection from the epidural catheter is the best possibility. We recommand an aseptic technique in all procedure for epidural or spinal analgesia.

• 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.

• 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.

• Women's Health Nursing
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• v.18 no.2
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• pp.126-134
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• 2012

Purpose: This research was done to compare obstetric pain, anxiety and cervical dilatation between an epidural analgesia group and a control group. Methods: Participants were assigned to the experimental or control group depending on their decisions for pain relief. Subjective / objective obstetric pain, anxiety level and cervical dilatation were measured and ANOVA was used for comparison of groups and paired t-test to make pre-post comparisons. Results: Homogeneity of pain, anxiety and cervical dilatation were assessed at the latent phase. Cervical dilatation was larger in the control group than the experimental group, at both the active and the transitional phase (F=22.9, p<.001; F=39.9, p<.001 respectively). The degree of pain and anxiety were not significantly different between the groups. Within the experimental group, subjective / objective pain and anxiety level were significantly lower post-analgesia compared to pre-analgesia in the active phase. All variables, except for sweating in the objective pain measurement, changed significantly at the transient phase. Conclusion: The results of this evidence-based research indicate that epidural analgesia while effective in relieving pain and anxiety may have an adverse effect on the cervix during labor stage I. Epidural analgesia should be used carefully during cervical dilatation in labor stage I.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.205-208
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• 2011

Objective : Retrospective analysis to compare the effect and complication of epidural patient-controlled analgesia (epidural PCA) with intravenous patient-controlled analgesia (IV PCA) for the treatment of the post-operative pain after posterior lumbar instrumented fusion. Methods : Sixty patients who underwent posterior lumbar instrumented fusion for degenerative lumbar disease at our institution from September 2007 to January 2008 were enrolled in this study. Out of sixty patients, thirty patients received IV PCA group and thirty patients received epidural PCA group. The pain scale was measured by the visual analogue scale (VAS) score. Results : There were no significant difference between IV PCA group and epidural PCA group on the PCA related complications (p=0.7168). Ten patients in IV PCA group and six patients in epidural PCA group showed PCA related complications. Also, there were no significant differences in reduction of VAS score between two groups on postoperative 2 hours (p=0.9618) and 6 hours (p=0.0744). However, postoperative 12 hours, 24 hours and 48 hours showed the significant differences as mean of reduction of VAS score (p=0.0069, 0.0165, 0.0058 respectively). Conclusion : The epidural PCA is more effective method to control the post-operative pain than IV PCA after 12 hours of spinal fusion operation. However, during the first twelve hours after operation, there were no differences between IV PCA and epidural PCA.