• Journal of Korean Neurosurgical Society
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• v.60 no.1
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• pp.54-59
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• 2017

Objective : Postoperative pain is one of the major complaints of patients after lumbar fusion surgery. The authors evaluated the effects of intravenous patient controlled analgesia (IV-PCA) using fentanyl or sufentanil on postoperative pain management and pain-related complications. Methods : Forty-two patients that had undergone surgery with lumbar instrumentation and fusion at single or double levels constituted the study cohort. Patients were equally and randomly allocated to a sufentanil group (group S) or a fentanyl group (group F) for patient controlled analgesia (PCA). Group S received sufentanil at a dose of $4{\mu}g/kg$ IV-PCA and group F received fentanyl $24{\mu}g/kg$ IV-PCA. A numeric rating scale (NRS) of postoperative pain was applied before surgery, and immediately and at 1, 6, and 24 hours (hrs) after surgery. Oswestry disability index (ODI) scores were obtained before surgery and one month after surgery. Opioid-related side effects were also evaluated. Results : No significant intergroup difference was observed in NRS or ODI scores at any of the above-mentioned time points. Side effects were more frequent in group F. More specifically, nausea, vomiting rates were significantly higher (p=0.04), but pruritus, hypotension, and headache rates were non-significantly different in the two groups. Conclusion : Sufentanil displayed no analgesic advantage over fentanyl postoperatively. However, sufentanil should be considerable for patients at high risk of GI issues, because it had lower postoperative nausea and vomiting rates than fentanyl.

• Journal of Korean Clinical Nursing Research
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• v.30 no.1
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• pp.45-53
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• 2024

Purpose: This study aimed to investigate the effectiveness of preoperative patient-controlled analgesia(PCA) education program on older patients with spine surgery. Methods: A quasi-experimental research with a non-equivalent control group pretest-posttest design was conducted to investigate the impact of a PCA education program before surgery on postoperative pain, pain knowledge and attitudes, and frequency of additional analgesic use. The sample size for experimental and control group was 55 respectively. Results: The experimental group, which underwent the PCA education program, had lower postoperative pain scores compared to the control group. Furthermore, the experimental group exhibited a higher level of knowledge on PCA (p<.001) and more positive attitudes toward analgesic use (p<.001). While there was a significant difference in the use of opioid analgesics for additional pain relief between two groups (p<.001), there was no significant difference in the use of non-opioid analgesics. Conclusion: The implementation of the PCA education program was found to increase knowledge and positive attitudes on the use of PCA. Moreover, it significantly alleviated pain, particularly during physical activity, within initial 48 hours after spinal surgey in older patients. Therefore, the findings of this study supported that the PCA education program could be used as a preoperative intervention to alleviate postoperative pain for older patients with spinal surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.1
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• pp.1-8
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• 2016

Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.75-82
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• 1996

Background: Nerve blocks, including epidural analgesia, can be risky for terminal cancer pain patients in generally poor conditions. We performed this study to evaluate the efficacy of intravenous patient-controlled analgesia(PCA) to treat severe pain of terminally ill cancer patients during the last days of life. Methods: We explained the patient's poor general condition to relatives and received a written consent to administer PCA. The starting dose of opioid for PCA in cancer pain management was based on previous 24-hour dose. Previous 24-hour opioid dose was converted to intramuscular morphine equivalent. The concentration of opioid mixed into Basal Bolus $Infusor^{(R)}$ was controlled to allow for one half of the previous 24-hour equianalgesic dose to infuse continuously. Patients controlled their pain by pushing the PCA module themselves. Patients were observed by pain service team. Some discharged patients were treated at home until death. Results: Forty eight patients received PCA for last two years. The most common reason receiving a PCA was the patient's poor general condition(52.0%). The mean starting dose of PCA was $20.6{\pm}16.2$ mg of morphine. Over eighty percents of the patients were in good or tolerable state of analgesia. Half of the patients expired within one week. The mean duration of PCA was $8.7{\pm}7.0$ days. The problems during PCA were: difficulty in maintaining intravenous routes, early loss of mentality after starting PCA, hypotension and nausea. Conclusion: We concluded that PCA, if correctly, is an effective, relatively safe and readily controllable method of pain management in terminally ill cancer patients during the last days of life. For future considerations, terminal patients may expire at the comfort of their own homes after the resolution of legal problems regarding using opioid in home care.

• 대한상한금궤의학회지
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• v.5 no.1
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• pp.93-100
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• 2013

Objective : This study aims to explain the effect of Osuyu-tang on an acne vulgaris which a Soeumbyeong patient has. Methods : This is a case report on a female patient who has been suffering from acne vulgaris which is not controlled by normal dermatological treatments. According to Diagnostic system based on Shanghanlun provisions, Osuyu-tang was provided for fifty days. Results : After a series of Osuyu-tang treatments, the patient's symptoms and result of KAGS improved. Conclusions : This case study showed an effectiveness of using Osuyu-tang according to Diagnostic system based on Shanghanlun provisions on acne.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.161-165
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• 1994

We have experienced a case of ventricular septal defect due to blunt chest trauma. A 22 year old male patient was admitted due to chest pain after Motor cycle accident on July 1st,1993. On 5th hospital day, sudden onset of dyspnea was noted and auscultation represented newly developed systolic murmur. A cardiac catheterization and Left ventriculogram revealed ruptured septum at the apical portion. Because there was open wound on anterior chest wall and congestive heart failure was medically controlled, the patient was discharged for elective operation. He was readmitted on August 14th, 1993.At operation, ventricular septal defect was found in apico-posterior muscular septal area, about 2.0 x 1.5 cm in size. The defect was repaired by double velour patch with interrupted suture and ventriculotomy was closed with Teflon felt. The patient`s postoperative course was uneventful and discharged 10 days postoperatively without complication. The patient have been followed up~ for 2 months. He is on functional class I with small amount of residual shunt at the ventricular septum.

• Archives of Obesity and Metabolism
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• v.1 no.1
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• pp.43-45
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• 2022

Intensive lifestyle modifications and anti-obesity medications are essential for obesity treatment. Antiobesity medications should be selected according to the patient's comorbidities, symptoms, and preferences. This case report describes the treatment of a morbidly obese patient with a history of depression, who complained of tingling and numbness after total thyroidectomy for papillary thyroid cancer. Very low-dose controlled-release phentermine/topiramate was prescribed and intensive lifestyle modifications were encouraged. As a result, the patient effectively lost weight and reached a near-normal weight without adverse drug effects. This implies that even an off-label anti-obesity medication low dose may be better for some patients, and the most important factor in obesity treatment is patient-tailored treatment.

• 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 Periodontal and Implant Science
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• v.39 no.3
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• pp.311-320
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• 2009

Purpose: The aim of the present study was to analyze 7-year cumulative survival rate (CSR, %) of dental implants in the controlled diabetic patients and to evaluate the influence of the position, diameter and length of fixture, bone quality, age, gender and the method of maxillary sinus elevation on the survival rate. Methods: The data of 342 placed implants in the 104 diabetic patients collected between 1995 and 2007 at the Department of Periodontology in Yonsei University Hospital were analyzed. Results: Seven-year CSR of the 342 dental implants in the 104 controlled diabetic patients was 96.5%. The survival rates of the placed implants according the position have no statistically significant difference. The survival rates according to the length or diameter of the fixtures have no statistically significant difference. The survival rates according to the bone quality were 100% (Type I), 97.1% (Type II), 97.7% (Type III) and 85.7%(Type IV). The difference between the survival rate of Type I, II and III and that of Type IV was statistically significant. The survival rates according to patient gender were 96.8% (male), 95.5% (female). The survival rates according to patient age were 100% (${\leq}59$), 93.8% (${\geq}60$). The survival rates according to the method of sinus elevation in the maxillary posterior area were 96.8% (without sinus elevation), 92.9% (lateral approach) and 89.8% (crestal approach). Conclusions: Dental implants can be used successfully in the controlled diabetic patients. In case of upper posterior region which has poor bone density and older patients, the implant treatment should be more properly planed, executed, and followed-up.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.1
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• pp.19-35
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• 2024

Background: This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Methods: Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 ㎍/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 ㎍/kg, 1-minute), and group 3 (high dose group, 0.2 ㎍/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO₂, respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times. In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Results: Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. Conclusion: PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.