• 기본간호학회지
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• 제14권3호
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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.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.384-388
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• 2001

A 51-year-old woman presented with sudden severe headache, vomiting, and right hemiparesis at first admission. Computed tomography(CT) scans revealed an hemorrhagic density at left basal ganglia. Preoperative cerebral angiography showed no vascular lesion. Under the diagnosis of hypertensive intracerebral hemorrhage(ICH), total extirpation of hematoma was done. The postoperative neurological condition improved gradually and discharged without any neurological sequelae. Two months later, she revisited with headache, vomiting and progressive right hemiparesis. CT scans at second admission showed an irregular rim enhanced mass with central low density with surrounding edema at the initial bleeding area. Repeated craniotomy was performed and the mass was partially removed. The histopathological diagnosis of the specimen was confirmed as glioblastoma. The authors report a glioblastoma, which occurred at initial ICH site and regarded as a brain abscess with literature review.

• Korean Journal of Acupuncture
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• 제23권1호
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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.

• The Korean Journal of Pain
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• 제5권2호
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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.

• The Korean Journal of Pain
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• 제10권2호
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• pp.196-202
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• 1997

Background: Various pain treatments have been administered to relieve patients suffering from postoperative pain. Among these, epidural or intravenous opiate administration is by far the most widly applied treatment in recent times. However it was our objective to device a more effective and safe means of postoperative analgesia. Methods: We studied 110 healthy pregnant women scheduled for delivery by elective cesarean section. EPI(epidural)-group is administered morphine 1.5 mg and 0.25% bupivacaine 8 ml as bolus dose, then, a mixture of morphine 6 mg and 0.125% bupivacaine 95 ml as continuous dose via epidural route. IV(intravenous)-group is administered nalbuphine 6~7 mg as bolus dose and nalbuphine 60~70 mg with 0.9% normal saline 90 ml as continuous dose via intravenous route, at the rate of 2 ml/hr for 2 days. We compared the analgesic efficacy and side effects of these two groups using VAS pain score and time duration of constant pain level. Results: VAS pain score was similar between the two groups, but pain duration was significantly shorter in EPI-group. Incidence of pruritus was significantly lower with the IV-group, of nausea and vomiting were similar for both groups, no respiratory depression for either groups. Conclusions: Although the EPI-group had better analgesic efficacy, the IV-group had lower incidence of side effects, and simplicity and safety methods of operation. Therefore, We propose further research and consideration of administering the kinds and doses of those medications prescribe to the IV group in conjunction with other drugs for safer and better efficacy of postoperative analgesia.

• 대한간호학회지
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• 제4권2호
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• pp.44-56
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• 1974

Very few studies regarding the effects of preoperative nursing intervention on children's welfare after surgery have been conducted. The purpose of this study was 1) to evaluate the effects of preoperative nursing instructions on children's physical recovery and emotional state after surgery and 2) to analyse the relationship between the effects of preoperative nursing instructions and the age and general anxiety of child. The study was conducted flow: August 15th to October 30th at Severance Hospital, Seoul, Korea. A total of 41 Pediatric surgical Patients, between the age of 4 to 14, participated in the study. Twenty patients, randomly selected, were visited by the experimenter in the evening before, surgery and received specific preoperative nursing instructions. These instructions were designed to alleviate emotional stress and were adopted to the age of child. The postoperative recovery of these patients were then compared with a randomly selected control group of 21 patients who received only the routine preoperative care by the staff in the hospital Dependent variable were vomiting, pain medication, ability to void, elevation of temperature, infection, the between surgery and hospital discharge and postoperative emotional stress which was measured by the vital signs. Because of the limitation of the sample size it was difficult to obtain valid statistical results. However, the analysis of the raw data indicates that: 1) the preoperative nursing instructions appears to promote physical recovery and it seems especially effective in preventing elevation of temperature and shortening the length of the hospital stay, 2) the preoperative nursing instruction also seems to be effective in relieving the child's emotional stress(situational anxiety) after surgery, 3) the patient's general anxiety level preparatively seems to be a predictor of postoperative problems, 4) the preoperative nursing instructions were an effective means of promoting physical recovery in every age group as long as the child understood the instructions. The above data would seem to indicate that all preoperative pediatric patients four years of age or older, if they can understand, should have preoperative nursing instruction in order to alleviate postoperative stress and enhance physical recovery. The level of general anxiety preparatively deserves special attention since the amount of nursing instruction needed seems to vary with tile level of anxiety.

• The Korean Journal of Pain
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• 제6권1호
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• pp.32-39
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• 1993

전북대학교 병원에 입원하여 하복부 수술을 받는 미국 마취과학회 전신상태 분류상 class I, II인 환자 40명을 대상으로 수술후 morphine(1군)과 ketorolac(2군)을 지속적으로 정주한 결과 다음과 같은 결론을 얻었다. 1) 1군과 2군 모두 수술후 통증에 의의 있는 감소를 보였으며 군 간의 차이는 없었다. 2) 1군에서 2군보다 부작용의 빈도가 많았다. 이상의 결과로 수술후 통증 관리에 있어서 morphine과 ketorolac의 지속적 정맥 주입 방법은 모두 효과적이었으며, ketorolac이 morphine보다 부작용의 발현 빈도가 더 적은것으로 보아 morphine을 대신할 수 있는 유용한 약물로 사료된다.

• The Korean Journal of Pain
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• 제26권1호
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• pp.32-38
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• 2013

Background: Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods: Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the $1^{st}$, $3^{rd}$, $7^{th}$ and $30^{th}$ postoperative days were determined from medical records. Results: Intrathecal morphine administration for $46.0{\pm}61.3$ days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the $7^{th}$ and $30^{th}$ postoperative days compared to the $1^{st}$ postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions: Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.

• The Korean Journal of Pain
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• 제32권3호
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• pp.206-214
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• 2019

Background: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB ($33.0{\mu}g$; interquartile range [IQR], $27.0-69.5{\mu}g$) than in the control group ($92.8{\mu}g$; IQR, $40.0-155.0{\mu}g$) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). Conclusions: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

• Journal of Gynecologic Oncology
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• 제29권6호
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• pp.92.1-92.9
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• 2018

Objective: To evaluate the effectiveness of the pulmonary recruitment maneuver (PRM) at the end of the operation to decrease laparoscopy-induced abdominal or shoulder pain after gynecological oncologic surgery. Methods: In total, 113 women undergoing laparoscopic surgery for malignant or premalignant gynecological lesions were assigned randomly to two groups: the PRM group (the patient was placed in the Trendelenburg position ($30^{\circ}$) and the PRM, consisting of two manual pulmonary inflations to a maximum pressure of $40cmH_2O$) (n=54) and the control group (n=52). Postoperative shoulder and abdominal pain was assessed 12, 24, and 48 hours later using a visual analog scale (0-10). In addition, the incidence of post-discharge nausea and vomiting was recorded until 48 hours after discharge. Results: Postoperative shoulder pain at 12 and 24 hours was significantly less severe in the PRM group ($2.2{\pm}0.5$ and $2.0{\pm}0.4$) than in the control group ($4.0{\pm}0.5$ and $3.9{\pm}0.4$; both p<0.001). The PRM significantly reduced the severity of upper abdominal pain at 12 and 24 h compared with the control group ($3.1{\pm}0.4$ and $2.9{\pm}0.4$ vs. $2.9{\pm}0.5$ and $4.9{\pm}0.5$; both p<0.001). The analgesic requirement during the postoperative period was similar in the two groups (control group, 78.8%; PRM group, 75.9%; p=0.719). Conclusion: The PRM effectively and safely reduced postoperative shoulder and upper abdominal pain levels in patients undergoing laparoscopic gynecological oncologic surgery. Trial registry at ClinicalTrials.gov, NCT01940042.