• 대한치과마취과학회지
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• 제9권2호
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• pp.98-103
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• 2009

Background: Despite increasing popularity of dental implants, there is limited information on the pain experience associated with the surgical implant placement under general anesthesia. The aim of this study was to assess the characteristics of patient-reported pain and efficacy of patient controlled analgesia after implant surgery under general anesthesia. Methods: Total 39 patients who underwent implant surgery under general aensthesia were enrolled. In PCA group (n=30), patients received patient controlled analgesia (fentanyl 700 mg and ketorolac 150 mg) set to basal rate 1 ml/h, bolus 1 ml, and lockout interval 10 min. In control group (n=9), patients received ketorolac 30 mg intravenously when they feel painful. We evaluated pain intensity using VAS score at the end and after 12 hr of the operation and recorded the number of bolus injection as a surrogate of rescue therapy. We compared the VAS data, the frequency of complication between two groups. Results: The self reported pain was highest at 1 hous after surgery in both groups. However, the intensity was not severe (PCA group = 5.7, control group = 5.6), and decreased gradually thereafter. Total demand bolus number was less than 6 in nearly 65% patients. And there was no significant difference in the frequency of complications such as nausea, vomiting and dizziness between both groups. Conclusions: The Pain following the surgical placement of dental implants was generally mild and gradually decreased with time. There was no difference in complications between control group and PCA group.

• The Korean Journal of Pain
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• 제11권1호
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• pp.69-73
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• 1998

Background: The postoperative pain in children and adolescents is most commonly managed by intramuscular injections of NSAIDs or opioids. This approach may result in fluctuating plasma drug levels and cycles of pain, comfort, and sedation. Patient-controlled analgesia(PCA) is a method of analgesia administration that consists of a computer-driven pump with a button that the patient may press to administer a small dose of analgesic drug. Materials & Methods: Forty ASA physical status 1 or 2 children and adolescents were divided into two groups. In the PRN group, patients received intramuscularly diclofenac(Valentac$^{(R)}$) on a p.r.n. basis. The PCA group patients received a mixture of nalbuphine and ketorolac by WalkMed$^{(R)}$PCA infusor. Analgesic efficacy was evaluated with NRS(numerical rating scale) and Faces Pain Rating Scale. The side effects were evaluated. Results: The patients of PCA group had less pain than those of PRN group. Complications were similar in both group. Conclusions: PCA with nalbuphine and ketorolac is a safe and effective methods of pain relief in children and adolescents after surgery, and is better accepted than intramuscular injections.

• 대한치과마취과학회지
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• 제10권2호
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• pp.209-213
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• 2010

Anxiety and fear is two main factors that keep patients from going to dental clinic. Especially, patients may feel implants operations are more traumatic. Intravenous conscious sedation for dental treatment can make patient comfortable and relaxable. Midazolam is more popular for sedation for dental treatment, but target-controlled infusion (TCI) of propofol and remifentanil is gaining wide popularity. A 54-year-old female patient who had severe dental phobia was referred to our dental hospital. She had past history of 2 times of hyperventilation and syncope during dental treatment. The patient showed a lot of dental anxiety and fear to dental treatments and stress reduction protocol was needed. We administered intravenous conscious sedation using target controlled infusion system with remifentanil and propofol. During sedation, we monitored the status of consciousness with bispectral index and vital signs. Dental treatment could be finished successfully without any problems.

• 여성건강간호학회지
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• 제20권3호
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• pp.204-214
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• 2014

Purpose: This study was to investigate the effects of the provision of concrete information about patient-controlled analgesia (PCA) in hysterectomy patients. Methods: Study design was a nonequivalent control group non-synchronized pre- and post-test design. Sixty subjects participated were assigned to experimental group (30 patients) or control group (30 patients) at one university hospital. Concrete information about PCA was composed of three sections: explanation with a leaflet, practice of using PCA, and question and answer session. Results: The experimental group who received concrete information about PCA before surgery had statistically higher knowledge level about PCA, more positive attitude toward pain control analgesia, a lower pain score, and a higher satisfaction level of the use of PCA post-surgery compared to the control group who received general information before surgery. Conclusion: Provision of concrete information about PCA was an effective nursing intervention that reduced post-operative pain for patients and increased their satisfaction with using PCA. It is recommended that concrete information about PCA be provided by nurses to promote the use of PCA and consequently reduce patient's pain post-surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권3호
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• pp.165-173
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• 2016

Dentists often sedate patients in order to reduce their dental phobia and stress during dental treatment. Sedatives are administered through various routes such as oral, inhalation, and intravenous routes. Intravenous administration has the advantage of rapid onset of action, predictable duration of action, and easy titration. Typically, midazolam, propofol or dexmedetomidine are used as intravenous sedatives. Administration of these sedatives via infusion by using a syringe pump is more effective and successful than infusing them as a bolus. However, during intravenous infusion of sedatives or opioids using a syringe pump, fatal accidents may occur due to the clinician's carelessness. To prevent such risks, smart syringe pumps have been introduced clinically. They allow clinicians to perform effective sedation by using a computer to control the dose of the drug being infused. To ensure patient safety, various alarm features along with a drug library, which provides drug information and prevents excessive infusion by limiting the dose, have been added to smart pumps. In addition, programmed infusion systems and target-controlled infusion systems have also been developed to enable effective administration of sedatives. Patient-controlled infusion, which allows a patient to control his/her level of sedation through self-infusion, has also been developed. Safer and more successful sedation may be achieved by fully utilizing these new features of the smart pump.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권1호
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• pp.42-48
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• 2006

Open reduction and rigid internal fixation is the most popular treatment method for maxillofacial fracture patients, and it is unevitable that postoperative pain can be developed. Many surgeons including oral & maxillofacial surgeons have made constant efforts to decrease postoperative pain. This study is a comparison of postoperative analgesia and intramuscular analgesia in patients with mandibular fractures. In this study, twenty-one patients (Experimental group) were randomly selected and they were injected with IV patient-controlled analgesia (PCA; Walkmed$^{(R)}$, USA). For control group another twenty-one patients were injected with intramusclar non-steroid anti-inflammatory drugs (Rheoma$^{(R)}$, Samsung Pharm. Co.). And then, we measured visual analogue scale (VAS) scores from first postoperative day to second day at regular time interval. The following results were uptained; 1. In patient group who with open reduction and rigid internal fixation, there was significant difference of postoperative analgesic effect during the first postoperative day(p<0.05). 2. In patient group with over 90 minutes surgery time, there was significant difference of postoperative analgesic effect during the first and second postoperative day when compared between experimental group and control group(p<0.05). 3. In patient group with less than 90 minutes surgery time, there was no significant difference of postoperative analgesic effect during the first and second postoperative day when compared between experimental group and control group(p>0.05). 4. In patient group with surgery of open reduction using rigid internal fixation at single fractured site, there was no significant difference of postoperative analgesic effect during the first and second postoperative day when compared between experimental group and control group(p>0.05). 5. In patient group with surgery at two fractured sites, there was significant difference of postoperative analgesic effect during the first postoperative day when compared between experimental group and control group(p<0.05). As mentioned above, it suggest that patient-controlled analgesia is more effective for postoperative pain relief than intramuscular injection in patients with rigid internal fixation by open reduction after mandibular fracture occurred. Especially, it is considered that in patient with more than 90 minutes surgery time or in cases with multiple fractured sites had more effective results with PCA therapy than conventional intramuscular analgesics.

• 한국융합학회논문지
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• 제7권5호
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• pp.43-49
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• 2016

본 연구의 목적은 자가통증조절기를 사용하는 수술 후 환자를 위한 간호 활동 목록을 개발하는데 있다. 간호 활동 목록을 개발하기 위하여 본 연구의 첫 번째 단계에서는 문헌고찰 및 포커스 그룹 인터뷰를 이용한 간호 활동 목록을 개발하였고 두 번째 단계에서는 간호 활동의 중재 내용 타당도 조사를 시행하였다. 본 연구는 5명의 마취과 전문의와 6명의 성인 및 기본 간호학 교수, 1명의 급성통증관리 전문간호사를 대상으로 하였으며, 본 연구를 통하여 수술 후 자가통증조절기를 사용하는 환자를 위한 12개의 항목을 개발하였다. 중재 내용 타당도의 검증에서 모든 항목이 .92에서 1.0으로 타당하였다. 본 연구 결과는 수술 후 자가통증조절기를 사용하는 환자의 간호를 위한 간호 실무에 유용하게 활용될 수 있을 것으로 판단된다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권2호
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• pp.117-128
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• 2022

Background: Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. Methods: In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups. Results: Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO₂ was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO₂ levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05). Conclusion: The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.

• 기본간호학회지
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• 제17권4호
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• pp.498-507
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• 2010

Purpose: The purpose of this study was to evaluate the effects of preoperative PCA (Patient-Controlled Analgesia) education on pain, patient attitude, and patient satisfaction in surgical patients. Methods: The study was a quasi-experimental research design. The participants were 54 patients who were admitted for surgery at I hospital in G city, Korea. Of the 54 patients, 26 were assigned to the experimental group and the rest to the control group. The PCA education was provided in the nurses' station, individually to patients in the experimental group the day before their operation. Multimedia and brochure, and a real PCA model were used. The control group received only verbal education about PCA. Results: The postoperative pain scores were significantly different for lapse of time in the experimental group compare to the control group. Patient attitude toward using pain medicine was significantly more positive in the experimental group than in the control group. The postoperative patient satisfaction with pain management was significantly higher in the experimental group than in the control group. Conclusion: The study findings indicate that preoperative PCA education could be an effective nursing intervention for pain management of surgical patients.

• 대한치과마취과학회지
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• 제2권2호
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• pp.97-100
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• 2002

Background: Patient-controlled sedation (PCS) has been blown for a safe and effective sedative method on the same pharmacological concepts of patient-controlled analgesia. Many different kinds of infusion devices have been used but they often have too long nominal infusion rate and lockout time. $Perfuser^{\circledR}$ fm (B. Braun, Germany) is a new PCA device with 999.9 ml/hr nominal infusion rate and minimum 1 min lockout time. In this study, the feasibility of propofol PCS using $Perfuser^{\circledR}$ fm was examined in order to provide a safe satisfactory sedation for dental patients. Methods: Eleven healthy patients presenting for oral surgery were studied. Propofol PCS was performed using $Perfuser^{\circledR}$ fm, which was set to deliver a bolus dose of 5 mg with 999.9 ml/hr nominal infusion rate and 1 min lockout time. Propofol loading dose was randomly assigned to a bolus dose ${\times}$ 0, 2, and 3 (initial bolus). Patients were told to press the bolus button as often as they needed to relieve discomfort. Results: Total infused dose of propofol was mean 1.8 mg/kg/hr and D (Delivery)/A (Attempt) ratio was mean 72.8%. All patients was awake and there were no clinically significant intraoperative side effects during the sedation. Almost all patients were very satisfied with this type of PCS. Conclusion: Propofol PCS using $Perfuser^{\circledR}$ fm infusion pump provided good conscious sedation for dental procedures.