• The Korean Journal of Pain
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• v.10 no.2
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• pp.191-195
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• 1997

Backgound: The present study was undertaken to determine whether fentanyl or bupivacaine is a better adjuvant to epidural morphine with respect to postoperative analgesic use and with fewer incidence of side effects. Methods: We evaluated the clinical effects in 62 patients having cesarean section, divided in 3groups randomly. Group I(n=19) was received epidural morphine 4 mg, group II(n=22) was received epidural morphine 2 mg plus fentanyl 50 ${\mu}g$ and group III(n=21) was received morphine 2 mg plus 0.25% bupivacaine 10 ml epidurally. We measured the first request time of analgesic for postoperative pain, the number of supplemental analgesics within 24 hours and the incidence of side effects postoperatively. Results: The first request time of analgesic for postoperative pain was significantly shorter in group III than in group I and II. The analgesic use in the first 24 hours was significantly more in group III than in group I and II. The side effects were significantly fewer incidence in group II than in group I and III. Conclusions: In conclusion, the combined use of epidural morphine and fentanyl provided better analgesia than the combined of epidural morphine and bupivacaine.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.185-190
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• 1997

Background: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of altered central processing which amplifies postoperative pain. A controversy exists over the effectiveness and clinical value of preemptive analgesia. We studied whether epidural bupivacaine and fentanyl prior to surgery could possibly affect postoperative pain and analgesic demands, as compared to administration of same at end of surgery. Methods: Forty patients scheduled for lower abdominal surgery were randomly assigned to one of two groups and prospectively studied in a double-blind method. Group 1(n=20) received epidural injection of 15 ml bupivacaine 0.25% with fentanyl 100 y g before surgery while group 2(n=20) received the same injection at the end of their surgery respectively. Postoperative analgesia consisted of basal plus patient-controlled mode of epidural bupivacaine and fentanyl from PCA system. Postoperative visual analog pain scores(VAPS), analgesics consumption, supplementary analgesics requirement and side effects were assessed for 3 postoperative days. Results: There were no significant difference in analgesics requirement and pain scores, at any time, during rest or after movement, in measurement between the groups. Conclusions: We conclude no clinical value of effectiveness in administering epidural bupivacaine-fentanyl before surgery as compared to administration after surgery.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.159-165
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• 1996

Background: Epidural analgesia has been widely used for postoperative pain relief. However, it is not known which regimen provides the best result due to many variety. The aim of this study is to evaluate the analgesia and side effects of epidural mixute of fentanyl, bupivacaine and clonidine, as one kind of regimen. Methods: One hundred adult patients scheduled for upper abdominal surgery under general anesthesia were evaluated. Epidural catheterization was done after operation. A bolus, 0.1% bupivacaine 10 ml containing fentanlyl 100 ${\mu}g$, was administered and followed up with continuous infusion of mixture of fntanyl 600 ${\mu}g$, 0.5% bupivacaine 20ml and clonidine 150 ${\mu}g$ at a rate of 2ml/hr for 50 hours. Analgesia was assessed using VAS, PHS and PRS. Side effects and number of patients who took additional analgesics were evalutated. Plasma samples were obtained to determine fentanyl concentration. Results: After the administrations of drugs, patients pain scores decreased notably, and pain relief scores increased significantly. Minimum side effects were noted. Twenty-one patients required additional analgesics. Plasma concentration of fentanyl was 0.07~0.14 ng/ml. Conclusion: Epidural infusion of mixture of fentanyl, bupivacaine and clonidine is an effective regimen for postoperative pain relief after upper abdominal surgery.

• The Korean Journal of Pain
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• v.12 no.1
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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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• v.19 no.1
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• pp.87-90
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• 2006

Background: There are many ways to provide superior analgesia for postoperative pain after abdominal surgery of which epidural analgesics with opioids and local analgesics are the most useful. In an effort to maximize the level of analgesia and to minimize the side effects, ketamine, midazolam, clonidine, and adrenalin can be co-administrated as an adjuvant. This study examined the analgesic effect and side effects of midazolam compared with those given an epidural injection of bupivacaine, fentanyl and ketamine. Methods: In a double blind randomized controlled trial, 50 patients received either fentanyl $0.3{\mu}g/kg/h$ and ketamine 0.1 mg/kg/h (Group FK) or fentanyl $0.3{\mu}g/kg/h$, ketamine 0.1 mg/kg/h and midazolam 0.4 mg/h (Group FKM), added to 0.125% of bupivacaine at a rate of as much as 2 ml/h, for patient controlled epidural analgesia (PCEA) after low abdominal surgery. Ten minutes before surgery, the patients received either 10 ml of 0.125% bupivacaine with 0.5 mg/kg of ketamine or 10 ml of 0.125% bupivacaine with the same amount of normal saline, added to fentanyl $50{\mu}g$. The pain score and the side effects were recorded at 1, 3, 6, and 24 hours after surgery. Results: There was no difference in the pain score except for the VAS on coughing 1 hour after surgery. FKM group had fewer side effects. Conclusions: There was a better analgesic effect and fewer side effects with the addition of epidural midazolam to bupivacaine and fentanyl with ketamine formula. However, more study on the dose and route of administration will be needed.

• 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.11 no.1
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• pp.91-95
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• 1998

Background: Quality of postoperative care may be improved by management of postoperative pain. Epidural anesthesia and analgesia have several advantages over general anesthesia and parenteral analgesics in managing the postoperative pain. We retrospectively reviewed records of obstetrical patients who underwent the cesarean sections under epidural anesthesia to evaluate perioperative analgesic use, side effects, and complications. Methods: All patients received epidural anesthesia consisting of 0.25% bupivacaine, 2% lidocaine and 100 ${\mu}g$ fentanyl, followed by epidural analgesia with 0.1% bupivacaine and 12.5 ${\mu}g$/ml fentanyl at rate of 2 ml/hr for 48 hours. Patients' records were reviewed for: medications administered for pain relief, incidence of nausea and vomiting and pruritus, and presence of respiratory or cardiovascular depression. Results: Over 18 months, 1,054 patients' records were reviewed. Average age was 27.8 years (18~43 years). 768 patients (72.9%) received no additional drugs for the pain relief. Intramuscular analgesics, ketoprofens, were one time administered to 247 patients (23.4%), 39 patients (3.7%) received two more dosages. The time of administration was $8.3{\pm}4.3$ hours postoperatively. Antiemetics, for example, low-dose droperidol, were administerd one time for 160 patients (15.2%), 5 patients (0.5%) received two or more administrations. The medication was administered $5.1{\pm}4.2$ hours postoperatively. Drugs for relief of pruritus, low-dose naloxone, were administered one time for 108 patients (10.2%), 10 patients (0.9%) received 2 or more dosages. The time of administration was $6.3{\pm}4.2$ hours postoperatively. None of the patients experienced cardiovascular nor respiratory (<8 breath/min) depression. Conclusions: Postoperative continuous epidural analgesia in combination with bupivacaine and fentanyl is an effective method of providing postoperative analgesia with low incidence of side effects.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.138-141
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• 2005

Background: There have been many attempts to alleviate pain after surgery, but there is no common approach to the control of postoperative pain. The use of epidural opioids, with local anesthetics, has been a widely employed formula to date. Ketamine, an N-methyl-d-aspartate receptor antagonist, has an excellent analgesic effect. Although there have been many reports on the dose and route of administrating analgesics, there have been few concerning the continuous epidural infusion of ketamine with fentanyl. We designed this study to find the effects of ketamine compared to those of epidurally injected bupivacaine and fentanyl, and used this trial to study any potential side effects. Methods: In a double blind trial, 55 patients received either fentanyl, $0.3{\mu}g/kg/h$ (Group F), or fentanyl, $0.3{\mu}g/kg/h$, and ketamine, 0.1 mg/kg/h (Group FK), added to 0.125% bupivacaine, at rates as high as 2 ml/h, for patient controlled epidural analgesia (PCEA) following a transabdominal hysterectomy. Ten minutes before the operation, patients received 10 ml of 0.125% bupivacaine, with either 0.5 mg/kg ketamine or the same amount of normal saline with $50{\mu}g$ fentanyl added. The pain scores and the side effects were recorded at 1, 3, 6 and 24 hour post operation. Results: There were no differences in the pain scores or side effects between the two groups. Conclusions: We failed to find any effect of the addition of epidural ketamine compared to the that of the bupivacaine and fentanyl formula. However, it is suggested that further investigations will be required on the dose and route of administration.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.34-41
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• 1997

Background : Patient-controlled analgesia(PCA) is a safe and effective technique for providing postoperative pain relief. Studies that compare epidural vs intravenous routes of opiate administration show conflicting results. We designed a prospective, randomized, controlled study to evaluate the safety and efficacy of epidural(EPI-PCA) morphine-bupivacaine versus intravenous (IV-PCA) nalbuphine when administered with a PCA system. Methods : Forty healthy women were randomly assigned to receive an epidural bolus of morphine 3 mg and 0.5% bupivacaine 10 ml, followed by a EPI-PCA with 0.01% morphine and 0.143% bupivacane (basal infusion 1 ml/hr, bolus 1 ml, lock-out interval 30 min) or intravenous bolus of nalbuphine 0.1 mg/kg followed by a IV-PCA with nalbuphine(basal infusion 1 mg/hr, bolus 1 ml, lock-out interval 20 min) for pain relief after cesarean delivery. This study was conducted for 2 days after cesarean section to compare the analgesic efficacy, side effects, patient satisfaction either as EPI-PCA or as IV-PCA. Results : EPI-PCA group had significant lower visual analog pain scale(VAS) at immediate postoperative period, whereas no significant difference was observed when pain was assessed at other time sequence. Urinary retention and pruritus were more frequent with EPI-PCA group, although the incidence of other side effects were the same. Conclusions : Although EPI-PCA with morphine-bupivacaine was of significantly lower VAS at immediate postoperative period, IV-PCA with nalbuphine is a safe and effective alternative to EPI-PCA with morphine-bupivacaine for providing pain relief after cesarean delivery. Further studies about IV-PCA with nalbuphine are needed to control the immediate postoperative pain and to further improve effective pain management.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.54-59
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• 1998

Background: Tramadol administered epidurally is known to have one-thirtieth the potency of morphine for treatment of pain following abdominal surgery. We designed a prospective, randomized, controlled study to evaluate the analgesic efficacy and safety of combined epidural infusion of bupivacaine and tramadol with 2-day infusor as ompared to bupivacaine and morphine combined epidural infusion. Methods: Sixty healthy women scheduled for Cesarean delivery were assigned randomly in double- blind fashion: Group 1 (n=20) were given a mixture of morphine 10 mg(1 ml), 0.5% bupivacaine 40 ml and normal saline(NS) 40 ml; Group 2(n=20) a mixture of tramadol 300 mg(6 ml), 0.5% bupivacaine 40 ml and NS 54 ml; Group 3(n=20) or a mixture of tramadol 500 mg(10 ml), 0.5% bupivacaine 50 ml and NS 50 ml, of continuous dose via epidural route following 1% lidocaine 6 ml as bolus dose for 48 hours postoperatively. We evaluated the analgesic efficacy and side effects of these three groups using visual analogue pain scale (VAPS) and verbal rating scale (VRS). Results: VAPS of group 1 and 3 were lower than group 2, and VAPS of group 1 was lower than group 3(12, 24, 36, 48 hours). VRS of group 1 and 3 were lower than group 2 (12, 24, 36 hours). There were incidences of pruritus was 16 patients in group 1. Conclusions: Tramadol does possess the analgesia effect of morphine, but has the added analgesia following increment. Further research to determine the most effective administration method and reguired dosage of tramadol is further needed.