• The Korean Journal of Pain
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• v.5 no.2
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• pp.221-228
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• 1992

The effect of epidural nalbuphine on pruritus, nausea, vomiting, voiding difficulties and/or analgesia induced by epidural morphine was determined in sixty Cesarian delivery patients. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered morphine 3 mg only(group A), nalbuphine 5 mg with morphine 3 mg(group B), or nalbuphine 10 mg with morphine 3 mg(group C) at the time of peritoneal closure. During postoperative 24 hours their analgesic effects were evaluated by visual analogue scale(0~10). Respiratory rates, Trieger dot test and severity of side effects(0~2) were also evaluated. The results were as follows; 1) Analgesic duration of the first epidural administration was significantly long in group A than other groups, but there was no difference between that of group B and group C. 2) Pruritus was more severe in group A than other groups but the severity was decreased by increasing nalbuphine dosage. 3) Nausea and or vomiting was mild in group C and the incidence of nausea and/or vomiting combined with pruritus was decreased by increasing nalbuphine dosage. 4) Voiding difficulties was more severe in group A than other groups but the severity was not decreased by increasing nalbuphine dosage. 5) None of the patients had objective sedation or low respiration rate(< 10 times/minute). We concluded that epidural administration of nalbuphine 10 mg with morphine 3mg for post-Cesarean section pain management is one of good methods to reduce side effects induced by epidural morphine.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.1
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• pp.29-37
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• 2023

Background: A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Methods: This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies. Results: Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively). Conclusion: We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).

• Korean Journal of Acupuncture
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• v.23 no.1
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• pp.95-109
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• 2006

Objectives : There has been a considerable debate about how to best control for placebo effects in clinical trials of acupuncture. Recently several sham needles were developed and validated. This study aimed at summarising the validation studies of these needles and evaluating the outcomes of the randomised controlled trials (RCTs) using them. Methods : Computerised literature searches were performed using 'acupuncture' AND 'placebo OR sham' with a limitation of the results to RCTs in Medline via PubMed and the Cochrane Library. Only formally validated sham needle controlled studies were included. Data were extracted regarding study design, condition, sample size, credibility testing, intervention and outcomes. Methodological quality was assessed using a modified Jadad scale. Results : Three validated sham needles by Streitberger, Park, and Fink, were identified. Acupuncture's effectiveness for various conditions was tested using these needles in 12 RCTs. Real acupuncture was superior to sham acupuncture for rotator cuff tendonitis and hypertension. No significant differences between real acupuncture and sham acupuncture emerged for chemotherapy-related nausea and vomiting, postoperative nausea and vomiting, menstrually related migraine, acute stroke rehabilitation, chronic/episodic tension-type headache, neutrophil respiratory burst in healthy volunteers, alcohol withdrawal symptoms and chronic poststroke leg spasticity. Conclusions : The new sham devices have been adequately validated and may be useful tools for investigating specific research question. In spite of the sham needle's limits, the results of RCTs using such devices tend to suggest that the clinical effects of acupuncture are largely due to a placebo response.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.14 no.3
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• pp.315-322
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• 2007

Purpose: The purpose of this study was to examine the effect of three kinds of modes using bolus button of PCA on level of pain and side effects of analgesic and amount of drug consumption in post-operative patients according to whether the medication is controlled by the patient, the caregiver or the nurse. Method: The participants were 684 patients using PCA after an operation. The data collection period was from March 19 to April 6, 2007. Results: It was found that there were statistical differences in gender, age, type of surgery, pain on first post-operative day, amount of drug consumption, nausea, and vomiting. The ratio for patient controlled medication was 55.7% for women, and 70.5% for men, and for care-giver controlled medication, 35.1% for women, and 20.0% for men. Average pain scores for the first post-operative day were $3.9{\pm}2.2$ for patient controlled medication and $4.5{\pm}2.3$ for care-giver controlled medication. There were statistical differences according to mode used for PCA for amount of drug consumptions, nausea and vomiting but not for pain, operation day or pruritus. Conclusion: This study was carried out to examine risks according to who controls the PCA for post-operative patients. The results can help to develop education program for everyone who is involved in PCA, patients, caregivers, nurses and doctors.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.192-196
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• 2006

Background: Epidural opioids are commonly used for postoperative analgesia. However, the side effects of epidural opioids include respiratory depression, sedation, pruritus, nausea, vomiting and urinary retention. Meperidine, due to its intermediate lipid solubility and local anesthetic properties, permits postoperative analgesia. The aim of this study was to compare meperidine alone to meperidine coupled with bupivacaine, and to determine the effects of epidural meperidine without bupivacaine, when used for epidural analgesia following hepatectomy abdominal surgery. Methods: Patients received thoracic epidural analgesia with meperidine alone (3.5 mg/ml in saline) or with additional bupivacaine (0.15%) for 2 days after surgery. Postoperative pain was assessed using a visual analog scale (VAS) pain score 2 days after the operation, with the incidence and dose supplementation also evaluated. Postoperative side effects were assessed using a 3 grade system. Results: No significant difference was found between the two groups in terms of age and weight, or in the pain scores, side effects, incidence and dose supplementation. Conclusions: 3.5 mg/ml epidural meperidine at a dose of 2 ml/hr provides effective postoperative analgesia.

• The Korean Journal of Pain
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• v.4 no.1
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• pp.20-25
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• 1991

During the past decade the use of epidural opioids for treatment of chronic as well as postoperative pain has increased Epidural droperidol significantly reduced the side effects of epidural morphine without any appreciable toxicity, except possibly sedation. The purpose of this study was to assess the side effects and potentiation of analgesia of epidural morphine by dose-related droperidol. The results were as follows: 1) Duration of analgesia and pain score: There was no significant difference between morphine and dose-related droperidol groups. 2) Pruritus: Droperidol did not affect the incidence of pruritus with epidural morphine (P>0.05). 3) Nausea and vomiting: Significantly fewer patients experienced nausea and vomiting (16.7%) with droperidol 2.5mg(P<0.001). 4) Hypotensive episode Hypotension occurred in the groups with droperidol 1.25 mg (27. 8%) and 2.5mg(33.3%). 5) Sedation: It there was increased severity and incidence of sedation with dose related epidural droperidol. 6) Respiratory depression: There was no patient with respiratory depression in the morphine or droperidol group. 7) Extrapyramidal symptoms and others: There was no extrapyramidal symptom in the group with morphine and 0.25 mg droperidol, but 3 patients in the group with l.25 mg droperidol and 5 patients in the group with 2.5 mg droperidol how extrapyramidal symptoms. One patient in droperidol 2.5 mg developed suspicious NMS. It is suggested that the use of epidural droperidol to reduce the side effects of morphine may not be appropriate.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.4
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• pp.382-387
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• 1999

The concept of PCA(Patient Controlled Analgesia) was first described in 1968, by Sechzer. The earliest descriptions of actual self-administered PCA machines were by Forrest et al. In gastric bypass surgery, cesarian section, orthopedic surgery etc, PCA is widely used in the control of postoperative pain. Previous Studies have shown that PCA provides effective pain-control for the postoperative patient. The postoperative pain-control is a problem that should be solved in surgery. Especially in orthognathic surgery, it is not same as in the case of maxillofacial trauma surgery or of tumor surgery: most orthognathic surgery patients are under operation not accustomed to pains, and difficulties in pain-complaint due to IMF(Intermaxillary fixation), postoperative nausea, and vomiting are additional problem. In this study, we have compared PCA and IM analgesics with respect not only to time request but also to the quality of postoperative pain control.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.193-198
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• 1994

The analgesic efficacy and side-effects of combined continuous epidural infusion of bupivacaine and morphine, in comparison with intramuscular (IM) administration of narcotics, for postoperative pain relief after cesarean section and hysterectomy were evaluated. We divided 60 patients into 4 groups randomly. IM (meperidine) group after cesarean section (Group 1, n = 20); Continuous epidural group after cesarean section (Group 2, n=20); IM (meperidine) group after hysterectomy (Group 3, n=10); Continuous epidural group after hysterectomy (Group 4, n=10). Following each operation, the epidural groups had an epidural catheter placed ($L_{2{\sim}3}$ or $L_{3{\sim}4}$), and a bolus of 1.5mg of morphine was injected, and followed by continuous infusion of 0.3% bupivacaine 2ml/hour and morphine 2.5mg/day for 48 hours. The IM groups had received meperidine 50mg IM injection every 4 hours as needed. We evaluated analgesic efficacy with VAS (visual analogue scale) at 1, 2, 24, 48, and 72 hours after operation. The side-effects (nausea &, vomiting, respiratory depression, pruritus and urinary retention) were evaluated with 4 points scale at day 1, 2, and 3 after operation. The results were as follows 1) The continuous epidural (bupivacaine+morphine) groups were superior to the IM (meperidine) groups with respect to postoperative analgesia at 1, 2, and 24 hours after cesarean section, and at 1, 2, 24, and 48 hours after hysterectomy. 2) Vomiting were more frequent in the epidural groups 2 days after cesarean section. 3) Pruritus was more frequent in the epidural groups 1 and 2 days after cesarean section.

• Archives of Plastic Surgery
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• v.44 no.4
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• pp.276-282
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• 2017

Perioperative hypertension is a phenomenon in which a surgical patient's blood pressure temporarily increases throughout the preoperative and postoperative periods and remains high until the patient's condition stabilizes. This phenomenon requires immediate treatment not only because it is observed in a majority of patients who are not diagnosed with high blood pressure, but also because occurs in patients with underlying essential hypertension who show a sharp increase in their blood pressure. The most common complication following facelift surgery is hematoma, and the most critical risk factor that causes hematoma is elevated systolic blood pressure. In general, a systolic blood pressure goal of <150 mm Hg and a diastolic blood pressure goal of >65 mm Hg are recommended. This article discusses the causes of increased blood pressure and the treatment methods for perioperative hypertension during the preoperative, intraoperative, and postoperative periods, in order to find ways to maintain normal blood pressure in patients during surgery. Further, in this paper, we review the causes of perioperative hypertension, such as anxiety, epinephrine, pain, and postoperative nausea and vomiting. The treatment methods for perioperative hypertension are analyzed according to the following 3 operative periods, with a review of the characteristics and interactions of each drug: preoperative antihypertensive medicine (atenolol, clonidine, and nifedipine), intraoperative intravenous (IV) hypnotics (propofol, midazolam, ketamine, and dexmedetomidine), and postoperative antiemetic medicine (metoclopramide and ondansetron). This article focuses on the knowledge necessary to safely apply local anesthesia with IV hypnotics during facelift surgery without the assistance of an anesthesiologist.

• Korean Journal of Bronchoesophagology
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• v.4 no.2
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• pp.171-176
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• 1998

Postoperative pain following tonsillectomy remains a significant obstacle to speedy recovery and smooth convalescence. Inadequate analgesia causes poor oral intake and influences the length of hospital stay and ability to return to normal activity. Patient Controlled Analgesia (PCA) is a method of analgesia adminstration that consists of a computer driven pump with a button that the patient may press to adminster a small dose of analgesic drug. The aim of this study was to examine whether Intravenous Patient Controlled Analgesia (IV-PCA) can reduce postoperative pain after tonsillectomy. The 100 patients undergoing tonsillectomy with general anesthesia were divided into two groups. The PCA group patients (n=80) received a mixture of nalbuphine and ketorolac by Walkmed PCA infusor during first 48 postoperative hours. In control group (n=20), the patients received oral acetoaminophen (Tyrenol) regularly and tiaprofenic acid (Surgam) intramuscularly on a p.r.n basis. Analgesic efficacy was evaluated with visual linear analogue scale (VAS) and the adverse effects were evaluated with 4 point scale. The patients of PCA group had less pain than those of control group. The adverse effects in the PCA group were nausea and vomiting. This study suggests that IV-PCA may be safe and effective method of pain control after adult tonsillectomy and is better accepted than oral or intramuscular pain medications.