• Title/Summary/Keyword: Patient controlled

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Comparing neuromodulation modalities involving the suprascapular nerve in chronic refractory shoulder pain: retrospective case series and literature review

  • Dey, Saugat
    • Clinics in Shoulder and Elbow
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    • v.24 no.1
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    • pp.36-41
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    • 2021
  • Chronic shoulder pain not relieved by either conservative or surgical management is referred to as chronic refractory shoulder pain. This is a retrospective case series where chronic refractory shoulder pain patients were treated either with peripheral nerve stimulation (PNS) or with pulsed radiofrequency (p-RF) therapy to the suprascapular nerve. Both patients receiving PNS reported 100% pain relief for the first month. At the 3- and 6-month follow-ups, one patient continued to experience 100% relief while the other reported 90% relief. One patient undergoing p-RF experienced about 90% pain relief at both 1- and 3-month intervals and 0% relief at the 6-month interval. The other patient with p-RF experienced 33% relief at 1-month and 0% relief thereafter. No patient reported any complications. The results of previous randomized controlled trials evaluating the efficacy of p-RF administered to the suprascapular nerve were mixed, and there is a lack of published studies on PNS effects. Neuromodulation of the suprascapular nerve can be effective for chronic refractory shoulder pain patients. Larger scale randomized controlled trials comparing PNS and p-RF are needed to better understand their respective therapeutic capacity.

The Effect of Bilateral Femoral Nerve Block Combined with Intravenous Patient-controlled Analgesia after a Bilateral Total Knee Replacement (양측 슬관절 전치환술 후 정맥 내 통증자가조절 시 대퇴신경차단의 병용이 미치는 영향)

  • Chung, Mee Young;Kim, Chang Jae
    • The Korean Journal of Pain
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    • v.21 no.3
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    • pp.211-216
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    • 2008
  • Background: Postoperative pain after bilateral total knee replacement (TKR) is expected to be more severe than unilateral TKR. Intravenous patient-controlled analgesia (IV PCA) is less effective than other methods of pain management especially immediately after an operation even though it is an easily controlled method for managing pain. This study was designed to evaluate the effect of femoral nerve blocks combined with IV PCA after bilateral TKR for postoperative pain control. Methods: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) were given bilateral femoral nerve blocks with 12 ml of 0.25% bupivacaine and epinephrine 1 : 400,000 before extubation followed by an IV PCA. Main outcome measures included numerical rating pain score, cumulative opioid consumption, hourly dose during each time interval, and side effects. Results: The pain score in group II was significantly lower than that in group I immediately after recovery of awareness and at 3, 6, 12 hours postoperatively. Cumulative opioid consumption was significantly decreased in group II during the first 48 hours postoperatively. The hourly dose in group II was also significantly lower than that in group I until 12 hours postoperatively. There was no difference in side effects between the groups. Conclusions: We concluded that bilateral femoral nerve blocks improve analgesia and decrease morphine use during IV PCA after bilateral TKR.

A Development of the electronic controlled vaporizer for low flow anesthesia (저유량 마취를 위한 전자제어식 기화기 개발)

  • Oh, Yeong-Taek;Park, Jae-Hoon;Chang, In-Bae
    • Journal of Industrial Technology
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    • v.29 no.B
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    • pp.107-113
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    • 2009
  • For the environmental safety of the operating room and patient healthcare, the closed type rebreathing system is widely adopted. In order to reduce the anesthesia gas during surgery, the mixing ratio of anesthesia gas with breathing air should be precisely controlled. Generally, the breathing air passes through the vaporizer to mix the anesthesia gas, but there is a difficulty in controlling the mixing ratio precisely. In this paper, the stand-alone style vaporizer is designed and the operating characteristics are investigated. The vaporizer measures the temperature and pressure in the vaporizing chamber and chamber temperature is precisely controlled by proportional controlled heater. Exact quantity of anesthesia media is feeded by PID controlled peristaltic pump and vaporized gas is mixed with breathing air flow by PWM controlled solenoid valve. The experimental result shows that the vaporizer has an excellent command following performances that it can be applied to the low flow anesthesia system.

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Comparative Study of Postoperative Pain in Lower and Upper Abdominal Surgery Using Patient-Controlled Analgesia (통증 자가 조절법을 이용한 상복부와 하복부 수술 후 통증의 비교)

  • Ko, Seong-Hoon;Kim, Dong-Chan;Lee, Jun-Rye;Han, Young-Jin;Choe, Huhn
    • The Korean Journal of Pain
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    • v.13 no.2
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    • pp.208-212
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    • 2000
  • Background: We studied 250 patients who received intravenous patient-controlled analgesia (PCA) after lower and upper abdominal surgery to evaluate pain relief, analgesic consumption, patient's mood and side effects. Methods: We made total 60 ml of analgesic mixture with morphine 60 mg, ketorolac 180 mg, droperidol 5 mg and normal saline. Loading and bolus dose and lockout interval were 0.05 ml/kg, 1.0 ml and 7 min, respectively. The duration of operation and the length of skin incision were recorded. Visual analog scale (VAS) pain and mood scores, cumulative analgesic consumption, and incidence of side effect were evaluated. Results: In the upper abdominal surgery group (Group 2), the duration of operation and length of skin incision were longer than Group 1. The average postoperative pain scores at 6, 24, and 48 hours in lower (Group 1) vs upper (Group 2) abdominal surgery were $4.3{\pm}2.1$ vs $4.7{\pm}2.4$, $3.3{\pm}1.9$ vs $4.3{\pm}2.8$, and $2.4{\pm}2.7$ vs $3.2{\pm}2.1$, respectively. There were no significant differences in the cumulative analgesic consumption and number of analgesic demands and at 6, 24, 48 hours after the operation between two groups. Group 2 patients required significantly longer pain control using PCA as compared to Group 1 patients. There were no significant differences in the incidence of side effects between the two groups. Conclusions: There was little difference in postoperative pain after lower and upper abdominal surgery.

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The Postoperative Pain Control for the Benign Prostatic Hypertrophy: Continuous Epidural Pain Block versus Intravenous Patient-Controlled Analgesia (양성 전립선 비대증 환자의 술후 통증치료)

  • Park, Sun-Gyoo;Kim, Jin-Yun;Rah, Eun-Gil
    • The Korean Journal of Pain
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    • v.11 no.2
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    • pp.268-272
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    • 1998
  • Background: Postoperative bleeding is a common complication in transurethral resection of prostate (TURP). Some patients become restless and combative after operation, particularly when in pain, producing bleeding from the prostatic bed. So many patients may be necessary to pain control for reduce bleeding. The purpose of this study is to compare recently used two Methods for post-operative analgesia. Methods: We studied 40 patients, ASA physical staus 1, 2, undergone TURP under general anesthesia. The patients divided into two groups: continuous epidural pain control group (I, n=20) received an epidural bolus of morphine 2 mg and 1% lidocaine 10 ml followed by a epidural 0.08% bupivacaine 40 ml and morphine 4.5 mg (basal infusion rate 0.5 ml/hr), intravenous patient-controlled analgesia (IV-PCA) group (II, n=20) received an intravenous bolus of fentanyl $50\sim100{\mu}g$ followed by a IV-PCA morphine 30 mg, ketorolac 180 mg and droperdol 2.5 mg (basal infusion rate 0.5 ml/hr, bolus 0.5 ml, lock-out interval 15 min). This study conducted the analgesic efficacy, side effect and patient's satisfaction for 1 day after TURP. Results: Continuous epidural pain control group had more significant analgesia than IV-PCA at postoperative 30, 60 min, but no significant difference was observed later in both group. Nausea and pruritus were scantly developed in both group but the incidence was no significant differeance. Patients responded good satisfaction over 70% in both group. Conclusions: Postoperative continuous epidural pain block and IV-PCA are both effective Methods of postoperative pain control with lower incidence of side effects.

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The Effect of Preoperative Education about Patient Controlled Analgesia on Postoperative Pain Control of Elderly Receiving Total Knee Arthroplasty (수술 전 통증자가조절기 교육이 슬관절치환술 노인의 수술 후 통증에 미치는 효과)

  • Lee, Ji Heun;Kim, Hwa Soon;Lee, Young Whee;Kim, Soo Hyun
    • Journal of Korean Clinical Nursing Research
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    • v.20 no.1
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    • pp.28-39
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    • 2014
  • Purpose: The purpose of this study was to investigate the effect of preoperative education about patient controlled analgesia (PCA) on postoperative pain control for elderly after total knee arthroplasty. Methods: The study applied a quasi-experimental design. To prevent communication between experimental group and control groups, data from control group were collected before provision of preoperative education for the experimental group. A total of 50 elderly patients who underwent total knee arthroplasty and older than 65 years old participated in this study. The preoperative education about PCA was provided for the experimental group before surgery. The preoperative education program consisted of fifteen minute education about pain control, and PCA use, as well as demonstration of PCA use. Results: The experimental group had higher knowledge score about pain and PCA use, and more positive attitudes toward pain and use of analgesics after surgery than the control group. There was no significant difference in use of additional analgesics after surgery between the two groups. The experimental group had significantly lower pain score at 8, 24 and 36 hours after surgery than the control group. The experimental group had higher level of satisfaction about PCA use than the control group. Conclusion: The preoperative education about PCA, customized for elderly patients could be an effective nursing intervention for postoperative pain control after total knee arthroplasty.

A COMPARISON OF PATIENT-CONTROLLED ANALGESIA (PCA) AND INTRAMUSCULAR ANALGESIA AFTER ORTHOGNATHIC SURGERY (악교정 수술후 근주와 자가통증조절장치(PCA)의 제통효과 비교)

  • Park, Mi-Hwa;Kim, Jae-Hyun;Baek, Sang-Heum;Cha, Duwon;Lee, Sang-Han
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.31 no.3
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    • pp.260-265
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    • 2005
  • Patient-controlled analgesia (PCA) has been widely used for postoperative pain control in medical surgery parts. Conventional intramuscular analgesia (IMA) is also effective in postoperative pain control, but it has some disadvantages that depend on patients' perception of pain and the anxiety that they endure caused by the delay of the injection time. This study was conducted to assess the efficacy and postoperative outcomes of intravenous PCA compared to IMA injections in 36 patients (BSSRO). Three factors were compared: amount of pain in PCA and IMA group ; amount of pain according to the sex in PCA and IMA group and the amount of pain according to the analgesia use. Results of this study did not demonstrate a statistically significant difference in any of these, using a p value of 0.05. The results of this study were as follows. : 1. There was no statistically significant difference in VAS pain score between IMA group and PCA group. 2. There was no statistically significant difference according to the sex. 3. There was no statistically significant difference according to the amount of PCA. The history of PCA is about 30 years and many literatures have reported about its effects, complications, methods, advantages and disadvantages. So, this study has some limitations of small sample size to conclude the effects of PCA. But when the decision about the method for postoperative pain control has to be made, it should be made based on patient or physician preference and cost factors rather than on the trend.