• The Korean Journal of Pain
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• v.19 no.2
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• pp.187-191
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• 2006

Background: Patient-controlled epidural analgesia (PCEA), using a local anesthetic-opioid mixture, has been effectively applied after total knee replacement (TKR) surgery, which is associated with intense postoperative pain that requires postoperative analgesia for both rehabilitation and the pain itself. However, adverse opioid-related effects, such as nausea, vomiting and pruritus, are commonly encountered. It was our hypothesis that the adverse opioid-related effects could be reduced by the addition of naloxone, an opioid antagonist, to a mixture of fentanyl-ropivacaine PCEA. Methods: In 120 patients undergoing elective TKR surgery, epidural or combined spinal-epidural (CSE) anesthesia was performed and PCEA applied. In the control group (n = 65), 0.16% ropivacaine and $3{\mu}g/ml$ fentanyl ($2.4{\mu}g/ml$ for those older than 65 yrs) were administered. In the naloxone group (n = 55), naloxone ($2{\mu}g/ml$) was coadministered with the above regimen. The incidence and severity of postoperative nausea and vomiting, and the frequency of pruritus, the visual analog score (VAS) and the PCEA volume used were assessed 6 and 24 hrs after surgery. Results: The incidence of nausea and vomiting during the early postoperative period, and those of pruritus during the late postoperative period were significantly lower in the naloxone group. The VAS pain scores, the PCEA volume used and amount of rescue IV meperidine were similar in the two groups. Conclusions: A small dose of naloxone mixed with an opioid significantly reduces the incidence and severity of adverse opioid-related effects in PCEA, without reducing the analgesic effect.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.257-265
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• 1995

Patient-Controlled Analgesia (PCA) has been widely used for postoperative pain relief. Meperidine is useful for PCA and has efficient analgesia, rapid onset, and low incidence of adverse effect. To compare the analgesic effect, total dose and hourly dose, side effect and neonatal status of breast feeding with meperidine via intravenous or epidural PCA for 48 hours after Cesarean Section, 40 parturient women undergoing elective Cesarean Section were randomly divided into two groups. Each respective group of 20 parturient women received meperidine via one of the intravenous PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after epidural block with 2% lidocaine 20ml combined with general anesthesia with only $N_2O$ and $O_2$ (EpiPCA group) when they first complained of pain in recovery room. Following the administration of analgesic initial dose, parturient women of IVPCA group were allowed intravenous meperidine 10 mg every 8 minutes when they felt pain. The EpiPCA group received additional bolus dose of meperidine 2 mg and bupivacaine 0.7 mg were administered every 8 minutes as requested the patients with hourly continuous infusion of meperidine 4 mg and bupivacaine 1.4 mg. Data was collected during the 48 hours observation period including visual analog scale (VAS) pain scores, total meperidine dose, hourly dose during 48 hours and each time interval, incidence of adverse effect, satisfaction, and neonatal status with breast feeding. VAS pain scores of analgesic effect in EpiPCA group was significantly lower than in IVPCA group at 2 hours after the initial pain after Cesarean Section. Total dose and hourly dose of meperidine significantly reduced in EpiPCA group. Hourly dose of meperidine at each time interval significantly reduced during first 6 hours and from 12 hours to 24 hours in EpiPCA group. The side effects in IVPCA group were mainly sedation, nausea, and local irritation of skin. And EpiPCA group experienced numbness and itching. The degree of satisfaction of parturient women was 88.2 % in IVPCA group and 85.7 % in EpiPCA group. We did not observe any sedation, abnormal behavior, or seizure like activity in any neonates of breast feeding. From the above results we conclude that epidural PCA was more efficiently analgesic, less sedative, and consumptional, and safer for neonate than intravenous PCA, and could be an alternative method to intravenous PCA.

• The Korean Journal of Pain
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• v.34 no.2
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• pp.210-216
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• 2021

Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

• Journal of Korean Biological Nursing Science
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• v.16 no.3
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• pp.226-234
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• 2014

Purpose: This prospective study was designed to investigate the incidence of acute postoperative pain (APP) ${\geq}4$ and the risk factors of APP${\geq}$ for the first 48 hours after surgery. Methods: Data from 531 surgical patients were collected from November, 2009 to May, 2010. APP was assessed from the time of arrival at the Post Anesthetic Care Unit (PACU) to the end of the post-operative 48 hours. Risk factors of APP${\geq}$ were analyzed by logistic regression analysis. Results: The incidence of APP ${\geq}4$ was 58.8% for the first postoperative 4 hours; 33.5%, 24 hours; 11.1%, 48 hours. The score of pain was 5.55, the highest on arriving at PACU; 5.03 at postoperative 30 minutes; 4.03 at 1 hour; 3.96 at 4 hours; 2.76 at 24 hours; 1.44 at 48 hours Risk factors for APP ${\geq}4$ were females (Odds ratio [OR], 1.94; p=.013), general anesthesia (OR, 4.29; p<.001) and patient controlled analgesia (PCA) (OR, 2.83; p<.001) at 4 hours after operation; body mass index (BMI) ${\geq}25$ (OR, 1.80; p=.009), duration of surgery ${\geq}1$ hour (OR, 2.87; p=.037), general anesthesia (OR, 3.99; p<.001) and PCA (OR, 6.23; p<.001) at 24 hours; general anesthesia (OR, 3.53; p=.003) and PCA (OR, 3.01; p=.013) at 48 hours. Conclusion: Surgical patients with BMI ${\geq}25$, PCA and general anesthesia seem to have a higher incidence of pain ${\geq}4$ through the first postoperative 48 hours.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.253-257
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• 1998

Background: The purpose of this study was to examine the extent and evaluation of pain after total abdominal hysterectomy (TAH) and to establish correlation between three types of pain; pain at rest, pain with movement and pain with coughing (maximum pain). Methods: The present study compared quality of pain during pain management in 48 patients undergoing TAH. Patients received i.v. meperidine as loading dose in the recovery room and PCA with nalbuphine 90 mg, ketorolac 180 mg, buprenorphine 0.9 mg, droperidol 5 mg, plasma solution A 28 ml for 3 days. The PCA device used was the Baxter infusor$^{(R)}$ (PCA module PC-19-55, 0.5 ml/hr basal rate, 15 minute lockout interval). Patients were then interviewed on Operative Day (OPD), Postoperative Day 1, 2, and 3 (POD 1, 2 and 3) to assess their pain on a visual analogue scale (VAS) of 0 (none) to 10 (worst imaginable). Results: The mean pain score at rest was 2.0 on OPD and decreased to 0.7 on POD 3. The mean pain score with movement was 3.2 on OPD and decreased to 1.6 on POD 3. The mean pain score with coughing was 4.2 on OPD and decreased to 2.2 on POD 3. Conclusions: Patients' experience of three types of postoperative pain emphasizes the need for more effective pain management.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.172-177
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• 1996

We performed a study of epidural patient controlled analgesia of meperidine with or without 0.08% bupivacaine for 48 hours after Cesarean section. 51 parturients were randomly assigned to one of two treatment groups : 1) epidural 0.2% meperidine group(n:24) and 2) epidural combined group with 0.2% meperidine and 0.08% bupivacaine(n:27). All parturients used patient controlled analgesia with loading dose, 2 ml/hour continuous infusion, 1 ml bolus infusion and lockout time, 8 minutes. visual analog scales after loading doses were not significantly different in either groups. The total quantity of meperidine consumption and hourly consumption were significantly lower in the combined group than meperidine group(P<0.05). The cumulative amount of meperidine consumption were also significantly lower in the combined group than meperidine group at 6, 12, 24 and 48 hours. In combined group the hourly consumption of meperidien from 3 hours to 12 hours after loading dose was significantly lower than those of meperidine group. Above 90% of parturients were satisfied in both groups. Side effects were: numbness (2), thigh weakness (1), nausea (1), headache (1) and back pain (2) in epidural meperidine group. There were no case needed specific treatment in both groups. We conclude that analgesic effects were similar in both groups, however the amount of meperidine consumption was less for meperiding group than combined group.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.166-171
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• 1996

The purpose of this study is to compare the postoperative analgesic effect of morphine and meperidine, employing intravenous patient controlled analgesia after cesarean section. Among fifty nine parturients undergoing cesarean section with general anesthesia, 32 were administered morphine designated as 'morphine group', and 27 parturient administered meperidine as 'meperidine' group, during 48 hours after commencement of PCA. Doses administered, based on potency for this setting, were equivalent to 1 mg morphine or 10 mg meperidine. Loading dose was administered when parturient first complained of pain after cesarean section. This was followed with bolus dose, 1 mg for morphine group and 10 mg for meperidine group, with a lockout interval of 8 minutes between doses wherever parturient requested additional analgesia. Visual analog scale(VAS) pain scores during rest were significantly lower at only 1 and 2 hour for the meperidine group, than morphine group. Loading dose and cumulative dose at 1, 2 and 3 hours were significantly lower for meperidine group than the morphine group. There were no significant difference in total dose and hourly dose for 48 hours and cumulative dose at 6, 12, 24, and 48 hours between both groups. More than 90% of the parturients from both groups were satisfied with the analgesic effects of pain relief. Morphine group experienced side effects such as: pruritus, sedation and dizziness. Meperidine group had sedation, dizziness, nausea and local irritation. Neither group required any specific treatment for any of the above side effects. We conclude that meperidine had greater analgesic effect at early stage of post-operative period.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.179-184
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• 1997

Background: Ketorolac($Tarasyn^{(R)}$) is a non-steroidal anti-inflammatory drug(NSAID) which has shown to be an effective postoperative analgesic available parenterally, and when combined with morphine can reduce its requirement. The analgesic efficacy and adverse effects of continuous infusion of ketorolac added to morphine IV PCA was evaluated in 60 women after abdominal hysterectomy. Methods: Patients were assigned to receive either morphine intravenous(IV) bolus followed by morphine IV patient controlled analgesia(PCA), or ketorolac 30mg IV and continuous IV infusion at 4.0mg/hr in combination with the above regimen. The authors evaluated PCA morphine used, pain assessment(verbal pain intensity score and visual analogue scale) and side effects at 2, 4, 6 and 24hrs during pain control. Results: Continuous infusion of ketorolac decreased the PCA morphine usage significantly(30.4 ---> 19.6 mg : p=0.007) at 24hrs postoperatively. Significant differences were seen favoring ketorolac infusion in pain intensity and visual analogue scale both at rest and during movement. There were no differences in incidences of deep sedation, nausea & vomiting. But the ketorolac group they complained of dizziness more than morphine only group. Little pruritus was recorded in either groups. Conclusions: The authors conclude continuous IV infusion of ketorolac in conjunction with morphine PCA provide effective analgesia after low abdominal surgery.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.123-129
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• 2007

Background: Postoperative pruritus following the administration of epidural narcotics is a very common and undesirable side effect. Therefore, we evaluated the use of a combination of naloxone and sufentanil via patient controlled epidural analgesia to determine if the incidence of pruritus was decreased when compared to the use of sufentanil alone. Methods: Patients scheduled for subtotal gastrectomy under general anesthesia were enrolled in a prospective, double-blinded and randomized trial. All patients received a $20{\mu}g$ epidural bolus of sufentanil in 5 ml of 0.2% ropivacaine. Following administration of the epidural, patients in the sufentanyl group (S) received a continuous epidural comprised of sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine, whereas patients in the naloxone group (N) received an epidural infusion comprised of naloxone ($4{\mu}g/ml$) and sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine. The infusion rate, demand dose and lockout interval were 5 ml/hr, 0.5 ml and 15 minutes respectively. Next, the occurrence of postoperative analgesia and side effects were evaluated by blinded observers. Results: The incidence of pruritus (47.4% versus 20.0%, P = 0.013) and nausea (42 .1 % versus 20.0%, P = 0.043) were lower in group N than in group S. In addition, there were no significant differences observed in the visual analogue scale, the incidence of vomiting or the incidence of sedation. Furthermore, epidural infusion of naloxone at $0.25-0.4{\mu}g/kg/hr$ did not affect the requirement for postoperative sufentanil. Conclusions: Epidural naloxone reduces epidural sufentanil induced pruritus and nausea without reversing its analgesic effects.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.156-158
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• 1995

Total spinal anesthesia is a well documented serious life threatening complication which results from an attempted spinal or epidural analgesia. We had an accidental total spinal anesthesia associated with a cranial nerve paralysis and an eventual unconsciousness during epidural analgesia. A 45-year-old female with an uterine myoma was scheduled for a total abdominal hysterectomy under the epidural analgesia. A lumbar tapping for the epidural analgesia was performed in a sitting position at a level between $L_{3-4}$, using a 18 gauge Tuohy needle. Using the "Loss of Resistance" technique to identify the epidural space, the first attempt failed; however, the second attempt with the same level and the technique was successful. The epidural space was identified erroneously. However, fluid was dripping very slowly through the needle, which we thought was the fluid from the normal saline which was injected from the outside to identify the space. Then 20 ml of 2% lidocaine was administered into the epidural space. Shortly after the spinal injection of lidocaine, many signs of total spinal anesthesia could be clearly observed, accompanied by the following progressing signs of intracrainal nerve paralysis: phrenic nerve, vagus nerve, glossopharyngeal nerve and trigeminal nerve in that order. Then female was intubated and her respiration was controlled without delay. The scheduled operation was carried out uneventfully for 2 hours and 20 minutes. The patient recovered gradually in th4e reverse order four hours from that time.