• The Korean Journal of Pain
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• 제11권2호
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• pp.241-246
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• 1998

Background: Opioids and local anesthetics have been administered epidurally for the purpose of the postoperative analgesia. However opioids have a serious risk of respiratory depression and local anesthetics have the risks of hypotension, sensory block, or motor one. In recent years, reports of spinal administration of midazolam for acute postoperative pain control have appeared in the literature. This study was performed to observe the effect of epidural midazolam in patient-controlled analgesia (PCA) device. Methods: Forty-five patients scheduled for the elective total hysterectomy were randomly selected; epidurally take morphine only (group I, n=15), morphine plus 0.1% bupivacaine (group II, n=15), or morphine plus midazolam (group III, n=15). The visual analogue scale (VAS) at rest and with movement, the sedation score, the degree of the satisfaction, the total amounts of a morphine usage, and the incidence of the side effects were observed. Rusults: The VAS at rest of group II and III were decreased significantly than that of group I. The VAS with movement of group III was significantly decreased than that of group I and II. The sadation score and the cumulative dose of a morphine were statistically insignificant within groups. Conclusion: Epidural morphine plus midazolam was proven to be clinically effective in the post-operative pain control especially for the pain with movement, compared with epidural morphine only and morphine plus 0.1% bupivacaine.

• Archives of Reconstructive Microsurgery
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• 제19권2호
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• pp.93-96
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• 2010

We report a case of 44 years old male patient with neuroma-in-continuity of ulna nerve. In the patient's past history, he had received operative treatment for the open supracondylar fracture of right distal humerus and ulnar nerve injury at 10 years ago, and neurolysis was tried 2 times due to severe neuropathic pain. Despite of these operations, the symptom was not improved. In operative field, we noticed neuroma-in-continuity and decided to resect the neuroma until normal nerve fascicle was noted. The nerve cable graft was done with auto sural nerve on the defect site and the nerve was wrapped with small saphenous vein. At post operative 7 months, pain was markedly decreased and sensory recovery was slightly improved and patient was satisfied with the result.

• 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 Korean Biological Nursing Science
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• 제16권3호
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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.

• Archives of Plastic Surgery
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• 제48권4호
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• pp.361-365
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• 2021

Background Pain in the postoperative body contouring patient has traditionally been managed with narcotic medication. In an effort to minimize side effects and prevent addiction, plastic surgeons are searching for novel ways to provide adequate analgesia, one of which is nerve blocks. This study was conducted with a meta-analysis that evaluates the efficacy of these blocks for patients who undergo breast surgery. Methods A search of the PubMed/MEDLINE database for articles including the terms "post-operative analgesia" OR "postoperative pain management" AND "in plastic surgery" OR "in cosmetic surgery" OR "in elective surgery" in February 2019 generated five studies on elective breast augmentation and reduction mammoplasty that reported pain scores and quantities of opioids consumed. Independent samples t-tests, one-way analysis of variance, and a random effects model were implemented for evaluation. Results A total of 317 patients were identified as having undergone body contouring of the breast, about half of which received a nerve block. Pain scores on a 1-10 scale and opioid dose-equivalents were calculated. Those who were blocked had an average score of 2.40 compared to 3.64 for those who did not (P<0.001), and required an average of 5.20 less narcotic doses (P<0.001). Pain relief following subpectoral augmentation was best achieved with type-II blocks as opposed to type-I and type-II with serratus plane (P<0.001). Conclusions The opioid epidemic has extended to all surgical specialties. Implementation of a nerve block seems to be an efficacious and cost-effective mechanism to not only help with post-operative pain, but also lower the need for narcotics, especially in subpectoral augmentation.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권2호
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• pp.95-102
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• 2016

Background: Surgery on the lower impacted third molar usually involves trauma in the highly vascularized loose connective tissue area, leading to inflammatory sequelae including postoperative pain, swelling, and general oral dysfunction during the immediate post-operative phase. This study aimed to investigate the effectiveness of preoperative injection of a single dose of 8 mg dexamethasone for postoperative pain control in lower third molar surgery. Methods: A controlled, randomized, split-mouth, prospective study involving lower third molar surgery was performed in 31 patients. The randomized sampling group was preoperatively injected, after local anesthesia, with a single dose of dexamethasone (8 mg in 2 ml) through the pterygomandibular space; 2 ml of normal saline (with no dexamethasone) was injected as a placebo. Results: The pain VAS score was significantly different on the day of the operation compared to the first post-operative day (P = 0.00 and 0.01, respectively), but it was not significantly different on the third and seventh postoperative day between the control and study groups. There was a significant reduction in swelling on the second postoperative day, and a difference between the second postoperative day and baseline value in the study group (P < 0.05). Trismus was highly significantly different on the second postoperative day and between baseline and second postoperative day between the groups (P = 0.04 and 0.02, respectively). Descriptive statistics and independent-samples t- test were used to assess the significance of differences. Conclusions: Injection of 8 mg dexamethasone into the pterygomandibular space effectively reduced the postoperative pain and other postoperative sequalae.

• The Korean Journal of Pain
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• 제31권2호
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• pp.93-101
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• 2018

Background: Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. Methods: Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv $25{\mu}g$ fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. Results: VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption ($30.8{\pm}7{\mu}g$ in group 1 vs. $69{\pm}18{\mu}g$ in group 2, and $162{\pm}3$ in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. Conclusions: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

• 한국산학기술학회논문지
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• 제18권5호
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• pp.412-419
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• 2017

본 연구는 본 연구는 전신마취 하에 복강경 수술을 받은 환자를 대상으로 수술 후 반좌위가 수술 회복성과 통증에 미치는 영향을 규명하고 향후 복강경 수술환자 간호에 대한 근거기반 간호중재의 기초자료로 사용되도록 시도되었다. 본 연구는 전신마취하에 복강경 수술을 받은 비뇨기과 혹은 산부인과 환자를 대상 사전동의 후 진행되었으며, 실험처치로 실험군에게는 반좌위룰 대조군에게는 기존 앙와위를 수술직후부터 24시간까지 취하게 하였다. 수술후 회복성을 확인하기 위해 회복실저류시간, 장운동 회복기간, 자가배뇨 회복기간, 수술후 병동 체류기간을 측정하였고, 통증에 대한 영향을 확인하기 위해 수술일부터 수술 2일째 까지 VAS로 통증강도를 측정하였다. 수집된 자료는 SPSS Win 20.0을 이용하여 실수, 백분율, 평균, 표준편차, Chi-square test, Independent t-test 반복측정 분산분석(Repeated Measures ANOVA)로 분석하였으며 그 결과는 다음과 같다. 첫째, 대상자의 수술회복성은 수술 후 회복실 체류시간(t=-0.284, p=.506), 수술 후 최초 가스배출시간(t=-0.837, p=.407), 수술 후 최초 대변배출시간(t=0.665, p=.509), 유치도뇨관 삽입시간(t=1.635, p=.109), 유치도뇨관 제거 후 자가배뇨시간(t=1.427, p=.165), 수술 후 병동체류시간(t=0.290, p=.773)으로 실험군과 대조군의 유의한 차이가 없었다. 둘째, 대상자의 통증은 주효과인 통증에서 실험군과 대조군간의 유의한 차이를 보였으며(F=4.851, p=.032), 세 시점간의 통증의 변화도 유의한 차이를 나타내었다(F=24.200, p=<.001). 이상과 같이 본 연구에서 복강경 수술 후 반좌위는 수술회복성에 영향을 미치지 않지만 통증에는 효과가 있었다. 따라서 복강경 수술환자에게 반좌위는 통증을 완화시키고 안위를 개선하는데 유용한 간호중재임이 확인되었다.

• 동서간호학연구지
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• 제15권2호
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• pp.82-90
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• 2009

Purpose: The purpose of this study was to compare the degree of preoperative anxiety and postoperative pain among volunteer and non-volunteer donors in living liver transplantation. Methods: The 32 volunteer and 32 non-volunteer donors were recruited from a university hospital after obtaining research approval. The data were analyzed by $x^2$, t, ANOVA tests and Pearson's correlation coefficients using SPSS 12.0 program. Results: There were no significant differences in pre-operative anxiety between the two groups. However, the non-volunteer donors had significantly more severe pain for 3 post-operative days, measured by visual analogue scale (VAS) and non-verbal pain behavior scale (non-VPBS), compared to that of the volunteer donors. There was a significant correlation between preoperative state anxiety and postoperative non-VPBS score. Conclusions: These results showed that liver donors who belonged to the non-volunteer group needed much more active postoperative pain management and psychological support than the volunteer group.

• Journal of Chest Surgery
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• 제17권1호
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• pp.144-149
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• 1984

Diaphragmatic eventration is a rare condition in primary diaphragmatic diseases and is found rarely in clinical experience. Diaphragmatic eventration means abnormally high position of diaphragm, which is caused acquired, paralytic or congenital, nonparalytic etiologic origins. This report is presented a symptomatic diaphragmatic eventration of 50 years old woman, who had complained coughing and left chest pain since I year ago prior to admission in Kosin Medical College, Gospel Hospital. A patient who had established accurate diagnosis at pre-operative period. There had been post-operative course uneventfully.