• The Korean Journal of Pain
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• 제7권2호
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• pp.193-198
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• 1994

The analgesic efficacy and side-effects of combined continuous epidural infusion of bupivacaine and morphine, in comparison with intramuscular (IM) administration of narcotics, for postoperative pain relief after cesarean section and hysterectomy were evaluated. We divided 60 patients into 4 groups randomly. IM (meperidine) group after cesarean section (Group 1, n = 20); Continuous epidural group after cesarean section (Group 2, n=20); IM (meperidine) group after hysterectomy (Group 3, n=10); Continuous epidural group after hysterectomy (Group 4, n=10). Following each operation, the epidural groups had an epidural catheter placed ($L_{2{\sim}3}$ or $L_{3{\sim}4}$), and a bolus of 1.5mg of morphine was injected, and followed by continuous infusion of 0.3% bupivacaine 2ml/hour and morphine 2.5mg/day for 48 hours. The IM groups had received meperidine 50mg IM injection every 4 hours as needed. We evaluated analgesic efficacy with VAS (visual analogue scale) at 1, 2, 24, 48, and 72 hours after operation. The side-effects (nausea &, vomiting, respiratory depression, pruritus and urinary retention) were evaluated with 4 points scale at day 1, 2, and 3 after operation. The results were as follows 1) The continuous epidural (bupivacaine+morphine) groups were superior to the IM (meperidine) groups with respect to postoperative analgesia at 1, 2, and 24 hours after cesarean section, and at 1, 2, 24, and 48 hours after hysterectomy. 2) Vomiting were more frequent in the epidural groups 2 days after cesarean section. 3) Pruritus was more frequent in the epidural groups 1 and 2 days after cesarean section.

• 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.

• Archives of Pharmacal Research
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• 제16권2호
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• pp.83-88
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• 1993

opioid pure agonists, morphine, meperidine and methadone, were used to investigate the effect on the opioid receptor of fron sciatic nerve fibers using sucrose gap apparatus. When applied extracellularly by perfusion, morphine, methadone and meperidine significantly depressed the amplitude of the action potential in frog sciatic nerve fibers as a dose-dependent $(10^{-10}\;M-10^{-2}\;M)$ manner. The depression with morphine or methadone was partially antagonized by the simultaueous treatment with a lower $(10^{-10}\;M-10^{-8}\;M)$ concentration of naloxone, but that of meperidine was not blocked. When the three opioid agonists were applied intracellularly by placing it in a compartment with a cut end of the sciatic nerve fibers, all of themn depressed the amplitude of the action potentials by similar potency, and these reductions significantly blocked by pretreatment of lower concentration $(10^{-10}\;M-10^{-8}M)$ of naloxone. These results support the previous findings by other workers that the stereospecific opioid receptors of this preparation are located on or near the intracellular opening of the sodium channels which are sensitive to naloxone.

• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 1992년도 제1회 신약개발 연구발표회 초록집
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• pp.40-40
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• 1992

opiate receptor들의 중추신경계에서의 분포 및 작용에 관한 실험물은 널리 알려져 있어 그 웅용 방법도 많이 있으나, 말초에 있는 opiate receptor의 존재 및 약물작용을 관찰하는 실험은 별로 알려진 것은 없다. 저자는 214mM의 sucrose 용역을 이용하여 전기적 자극에 따른 말초신경 및 말초조직(근육)에서의 opiate receptor애 대한 작용을 관찰하였다. 실험은 3분류의 약물을 이용하였다. 1) Pure agonists: morphine, meperidine, methadone, 2) Agonist-antagonist: buprenorphine 3) Pure antagonist: naloxone 위의 약물들을 이용하여 excitable cell membrane(좌골신경 및 근육)에서 일어나는 potential의 변화를 관찰하여 다음과 같은 결과를 얻었다. a. pure agonists들은 좌골신경 및 근육절편에서 action potentials을 의의있게 억제시켰으며 meperidine이 가장 강한 작용을 보였다. b. 이들의 작용은 naloxone 투여로 억제되었다. c. Agonist-antagonist인 buprenorphine은 투여용량 및 동시 투여한 pure agonist의 종류에 따라 biphasic pattern을 나타내었다. d. opiates 작용기전 및 약물작용장소를 알고자 두 종류, 즉 single 및 double technique을 사용하여 비교하였다.

• The Korean Journal of Pain
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• 제5권2호
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• pp.229-233
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• 1992

Recently a non-electronic, disposable and portable infusor, Baxter $Infusor^{(R)}$, has developed for delivering not only a continuous drug infusion but also extradoses of medication on a demand basis. The present study examined the impact of two methods of pain management on recovery in 20 patients undergoing upper abdominal surgery for stomach cancer. One group, 10 patients, received IV meperidine in the recovery room and IM meperidine on the ward on a PRN basis(PRN group). In the other group, 10 patients, a loading dose of nalbuphine 0.1mg/kg was given when the patient first complained of pain in the recovery room and patient controlled analgesia with IV nalbuphine, 0.5mg/kg day for continuous infusion, was initiated and continued for 72 hours(PCA group). The devices for PCA group was Baxter Infusor with patient control module which had flow rate 0.5ml/hr and lockout time was 15 min. As results of this study, the patients of PCA group get less pain than PRN group on operation day, the first and second days after surgery. VAPS values are $6.47{\pm}1.64$ vs $4.44{\pm}1.38$, $5.02{\pm}1.22$ vs $2.62{\pm}0.93$ and $3.22{\pm}1.47$ vs $2.02{\pm}0.71$ respectively pertaining to PRN and PCA groups(p<0.05). In conclusion, PCA group with IV nalbuphine provided more effective postoperative analgesia than PRN group with conventional meperidine IM.

• The Korean Journal of Pain
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• 제14권1호
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• pp.76-82
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• 2001

Background: Postoperative nausea and vomiting (PONV) are common after general anesthesia and patient controlled analgesia (PCA) using opioids. This study was designed to compare the effectiveness of ondansetron plus dexamethasone versus ondansetron alone in the prevention of PONV in a patient undergoing a PCA. Methods: We studied 166 ASA I, and II in-patients undergoing general anaesthesia for major gynecological surgery. After induction of anesthesia, Group 1 (n = 64) received intravenous (IV) dexamethasone 10 mg and Group 2 (n = 102) received IV saline 2 ml before the surgical incision. Each patient received IV meperidine 50 mg as a loading dose. Meperidine 5 mg/kg, ketorolac 3.6 mg/kg and ondansetron 8 mg diluted in 40 ml solutions were connected to PCA pump for postoperative pain control. Mean arterial blood pressure, heart rate, pain score and symptom-therapy score were checked at 1, 4, 8, 16, 24, and 36 hours after the PCA connection. Results: For Group 1 and Group 2, respectively, the overall incidence of PONV was 12.5% and 23.5%. The pain scores were lower in patients receiving a combination of ondansetron and dexamethasone than those on ondansetron alone at 4 hr (P < 0.05), 8 hr (P < 0.05) and 16 hr (P < 0.05). Conclusions: This study suggests that the combination of ondansetron and dexamethasone is not more effective than ondansetron alone in the prevention of postoperative nausea and vomiting in women having PCA following major gynecological surgery but is more effective for pain control.

• The Korean Journal of Pain
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• 제30권2호
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• pp.134-141
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• 2017

Background: Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery. Methods: Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels. Results: Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group. Conclusions: Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability.

• The Korean Journal of Pain
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• 제6권1호
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• pp.55-59
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• 1993

Using a visual analogue scale, we compare the effect of patient-controlled analgesia and conventional intramuscular opioid regimen in 68 patients undergoing lower abdominal or gynecological surgery. We also recorded the incidence of side effects. We checked visual analogue scale 4 hours interval for 30 cases managed by patient-controlled analgesia and 38 cases of conventional intramuscular opioid group managed by obstetrician. We maintained fentanyl $0.33{\mu}g/kg/hr$ and set self administrable bolus dose $5.0{\mu}g$(lockout interval: 15 min) in patient-controlled analgesia group. Conventional intramuscular bolus injection group were administered meperidine 50 mg for 4 hour interval. Mean visual analogue scale scores obtained by patient-controlled analgesia group and intramuscular bolus injection group were $2.49{\pm}0.67$ and $4.53{\pm}1.28$(p<0.05). Side effects such as; no significant incidence of respiratory depression, urinary retention, postural hypotension, nausea, vomiting and pruritus were developed by either group. These results suggest that patient-controlled analgesia was more effective method compared with conventional intraumuscular opioid injection regimen for post-operative pain management.

• Natural Product Sciences
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• 제5권3호
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• pp.142-147
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• 1999

Tiliacora racemosa Colebr. belonging to the family Menispermaceae is the biggest store-house of diphenyl bisbenzylisoquinoline (DBBI) alkaloids. Exhaustive chemical processing of the root of T. racemosa by the application of modern separation techniques yielded a DBBI alkaloid which was identified as tiliacorine using sophisticated spectroscopic methods (UV, IR, $1^H-NMR$, Mass). Tiliacorine potentiated the sleeping time induced by standard hypnotics viz. chlorpromazine (CPZ), pentobarbitone (PB) and diazepam (DZ) in a dose dependent manner. Tiliacorine potentiated the analgesic action of standard analgesic agents viz., morphine and meperidine. It was also found to possess anti convulsive activity in the strychnine induced convulsion model.

• Archives of Plastic Surgery
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• 제39권3호
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• pp.249-252
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• 2012

Nicolau syndrome is a rare complication of intramuscular injection consisting of ischemic necrosis of skin, soft tissue, and muscular tissue that arises locoregionally. The characteristic pattern is pain around the injection site, developing into erythema, a livedoid dermatitis patch, and necrosis of the skin, subcutaneous fat, and muscle tissue. Three patients were injected with drugs (diclofenac sodium, ketoprofen, meperidine) for pain relief. Three patients complained of pain, and a skin lesion was observed, after which necrosis developed on their buttocks. Each patient underwent debridement and coverage. The wound healed uneventfully. We report three cases of Nicolau syndrome in the buttocks following diclofenac intramuscular injection.