• The Korean Journal of Pain
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• 제14권1호
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• pp.61-67
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• 2001

Background: Usually, lumbar epidural block is performed on the $L_{3-4}$ interspace. This study was designed to evaluate the analgesic efficacy and shortening of labor duration comparing the $L_{1-2}$ and $L_{3-4}$ interspace epidural blocks in nulliparous normal vaginal deliveries and then investigates side effects following the blocks. Methods: Eighty healthy nulliparous women were divided into two groups, $L_{1-2}$ (n = 40) and $L_{3-4}$ (n = 40). Epidural blocks, lumbar epidural block were performed at the $L_{1-2}$ and $L_{3-4}$ interspace with a catheter advancing 3 cm cephalad. The initial dose of 12 ml (0.167% bupivacaine, fentanyl $50{\mu}g$ and clonidine $75{\mu}g$) was injected epidurally at 4 cm dilatation of cervix and severe pain of labor. If a visual analogue scale (VAS) score was more than 4 points, an additional dose was administered epidurally using the same volume as the above mentioned, but with the exception that the bupivacaine was diluted to 0.1 percentage. The maternal blood pressure, pulse rate, respiration rate and fetal heart rate were measured at 10 min intervals for the first 30 min, at 15 min interval for the next 30 min and at 30 min interval for the last one hour following the blocks. The duration of the first (active) and second stages of labor was counted and the neonatal Apgar score was recorded at one and five min after delivery. The degree of motor block, pruritus, nausea and vomiting were also noted. Results: The patients in group $L_{1-2}$ had lower pain scores than group $L_{3-4}$ at 5, 20, 30, 60 mins. The duration of 1st and 2nd labor stage in the $L_{3-4}$ epidural block were $272{\pm}33.5$ min, $49.2{\pm}27.4$ min respectively but those in the $L_{1-2}$ epidural block were $253.5{\pm}32.5$ min, $37.3{\pm}22.3$ min, respectively. Conclusions: We concluded the analgesic efficacy and shortening of labor duration in $L_{1-2}$ epidural block was better than those in $L_{3-4}$ epidural block. Maternal hemodynamic change, motor block. pruritus, nausea, vomiting and Apgar score showed no significant differences between the two groups.

• The Korean Journal of Pain
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• 제35권4호
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• pp.475-487
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• 2022

Background: Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients' quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians' experiences with opioid use in South Korea. Methods: Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions. Results: A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%). Conclusions: The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

• Tuberculosis and Respiratory Diseases
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• 제44권1호
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• pp.85-92
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• 1997

목적 : 말기암 환자에서 발생하는 악성 흉막삼출액의 치료로 흉관삽입후 경화제를 주입하여 흉악유착을 유발하는 대증요법이 많이 이용된다. 그러나 이들 경화제의 종류 및 투여방법에 따라서 그 효과 및 부작용은 달라진다. 이에 대표적으로 이용되는 경화제인 doxycycline 과 bleomycin의 단기간의 효과 및 부작용을 비교 분석하기 위하여 본 연구를 실시하였다. 방법 : 1993년 l월부터 1995년 9월까지 세포조직학적으로 악성 흉막전이가 확인되었으며 증상완화를 위해서 반복천자가 필요하였던 34명(폐암 28 명, 기타암 6명)을 대상으로 무작위로 doxycycline (16례)과 bleomycin(18례)를 흉막강내에 주입하여 입원기간 중의 단기간의 치료반응과 처치시에 생기는 부작용을 비교하였다. 그리고 치료 반응군과 실패군에서의 중앙생 존기간을 조사하였다. 성적 : Doxycycline 군의 성공률은 87.5 %로 bleomycin 군의 50.0%보다 유의하게 높았다(p=0.02). 부작용으로 통증은 두 군사이에 유의한 차이는 없었으나 발열, 오심은 bleomycin군에서 유의하게 많이 생겼다(각각 p=0.01. 0.04). 그러나 이들 대부분의 부작용은 대증요법으로 호전되었다. 치료약제의 종류에 상관없이 치료반응군의 중앙생존기간은 11개월로 치료 실패군의 5개월보다 유의하게 연장되었다(p<0.01). 결론 : 이상의 성적으로 경화제를 이용한 흉막유착술은 악성 흉막삼출액을 가진 환자의 대증요법으로 효과가 좋았다. Doxycline과 bleomycin을 비교해 보면 doxycycline이 부작용도 적었고 단기간의 치료성적도 우수하였다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6257-6261
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• 2012

Objective: To investigate the safety and efficacy of transcatheter arterial chemoembolization (TACE), combined with portal vein embolization (PVE), and high intensity focused ultrasound (HIFU) sequential therapy in treating patients with hepatocellular carcinoma (HCC). Methods: Patients with inoperative HCC were treated by two methods: in the study group with TACE first, then PVE a week later, and then TACE+PVE every two months as a cycle, after 2~3 cycles finally HIFU was given; in the control group only TACE+PVE was given. Response (CR+PR), and disease control rate (CR+PR+SD), side effects, overall survival and time to progress were calculated. Results: Main side effects of both groups were nausea and vomiting. No treatment related death occurred. In the study group, 32 patients received TACE for overall 67 times, PVE 64 times, and HIFU 99 times; on average 2.1, 2 and 3.1 times for each patient, respectively. In the control group, 36 patients were given TACE 78 times and PVE 74 times, averaging 2.2 and 2.1 times per patient. Effective rate: 25.0% in study group and 8.3% in control group (p>0.05). Disease control rates were 71.9% and 44.4%, respectively (p<0.05). In patients with portal vein tumor thrombus, the rate reduced over 1/2 after treatment was 69.2%(9/13) in the study and 21.4%(3/14) in the control group (p<0.05). Rate of AFP reversion or decrease over 1/2 was 66.7%(16/24) in study and 37%(10/27) (p<0.05) in control group. Median survival time: 16 months in study and 10 months in control group. PFS was 7months in study and 3 months in control group. Log-rank test suggested that statistically significant difference exists between two groups (p=0.024). 1-, 2- and 3-year survival rates were 56.3%, 18.8% and 9.3% in study, while 30.6%, 5.6% and 0 in control group, respectively, with statistically significant difference between two groups (by Log-rank, p = 0.014). Conclusions: The treatment of TACE+PVE+HIFU sequential therapy for HCC increases response rate, prolong survival, and could thus be a safe and effective treatment for advanced cases.

• The Korean Journal of Pain
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• 제6권2호
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• pp.213-219
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• 1993

수술후 통증관리에 있어서 경막외 buprenorphine의 유용성을 알아보기 위하여 상복부 수술을 받은 환자에 있어서 morphine 2 mg 및 4 mg, buprenorphine 0.15 mg, 및 0.3 mg을 경막외로 각각 투여하여 혈압과 맥박의 변화, 작용발현기간, 작용 지속 시간, 부작용의 발생을 관찰하여 다음과 같은 결과를 얻었다. 1) 모든 군에서 혈압 및 맥박의 유의한 변동은 초래하지 않았다. 2) 작용 발현은 morphine 2 mg군에서는 약물 주입후 30분에, 나머지 군에서는 15분에 유의하게 나타났다. 3) 진통 지속 시간은 morphine 2 mg 군에서는 $10.79{\pm}3.64$시간이었고, morphine 4 mg군에서는 $21.13{\pm}4.36$시간, buprenorphine 0.15 mg군에서는 $15.19{\pm}3.12$시간, buprenorphine 0.3 mg군에서는 $33.94{\pm}3.97$시간이었다. 4) 부작용의 발생은 buprenorphine군에서 오심, 구토가 많았으며, 졸림증이 현저하게 많았고, 소양감과 배뇨 곤란은 morphine군에서 많았다. 이상의 결과로 수술후의 통증관리에 있어서 경막외로의 buprenorphine주입은 유용한 방법이며, 경막 외 morphine에 비해 장점과 단점을 아울러 포함하고 있다고 사료된다.

• 혜화의학회지
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• 제21권1호
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• pp.79-85
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• 2012

Objective : This study was aimed to report a patient accompanied by alcoholic derogation acute abdominal pain treated with oriental medicine combined with conventional treatment. Methods : A 36 year old female patient complained of acute abdominal pain for one year from Apr. 2009. She had treated at local general hospital. But the symptom was not reduced. Instead, it was aggravated on Jul. 2010. The main symptoms were left flank pain, chest discomfort, nausea and anorexia. The patient was treated by oriental medicine (herbal medicine (Chunggan-plus), acupuncture, moxibustion, etc) combined with conventional medicine from Jul. 10th, 2010 to Jul. 17th, 2010. We observed the patient with evaluation of laboratory test and imaging scan. Results : Most of the symptoms of the patient were improved. Especially, the abdominal pain were disappeared from grade 3 to grade 0. No side effects were noted during treatment. Conclusion : This results suggest that the oriental medicine combined with western medicine may effective to treat alcoholic derogation acute abdominal pain.

• The Korean Journal of Pain
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• 제12권2호
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• pp.211-216
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• 1999

Background: Transdermal fentanyl patch (TDFP) is a simple, noninvasive analgesic with continuous effect. The aim of this study was to evaluate the postoperative analgesic effect of TDFP. Methods: Sixty healthy patients undergoing cesarean section were divided into 3 groups. Postoperative pain was controlled with different methods; Group I: application of TDFP-$25{\mu}g/hr$, Group II: intramuscular injection of ketoprofen; Group III: continuous epidural block. Pain scores (numerical rating scale, NRS), number of patients who needed additive ketoprofen injections and side effects were recorded at 8, 20, 32, 44 hours postoperatively. Results: There was no significanant difference in pain score between Group I and Group II. The numbers of patients who need additive ketoprofen injections were lower in group I than group II. Pruritis (25%), nausea/vomiting (10%), leg numbness (40%) was experienced in group III, but not in Group I & II. Conclusions: TDFP-$25{\mu}g/hr$ for postoperative pain control is simpler and more convinient than intramuscular injection of analgesics.

• The Korean Journal of Pain
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• 제13권1호
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• pp.55-59
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• 2000

Background: Intrathecal injection of morphine is widely used in the management of postoperative pain because it provides long-lasting analgesia. Intramuscular caroverine and tiaprofenate are used to produce postoperative pain relief. This study was designed to evaluate the analgesic efficacy and quality of sleep achieved with intrathecal morphine and those of intramuscular caroverine and tiaprofenate in transurethral resection of the prostate (TURP). Methods: Forty patients undergoing elective TURP were randomly allocated into 2 groups as follows: Group M (n=20); 0.25 mg of morphine hydrochloride mixed in 7.5 mg of 0.5% hyperbaric bupivacaine was administered at the time of induction of spinal anesthesia. Group S (n=20); 7.5 mg of 0.5% hyperbaric bupivacaine was administered intrathecally and caroverine and tiaprofenate intramuscularly at every 8 hr and 12hr postoperatively for management of postoperative pain. We evaluated the analgesic efficacy with visual analog scale (VAS), quality of sleep, and side effects. Results: VAS at 6, 12 and 24 hours after operation were significantly less (p<0.01) in the group M than in the group S. Group M was superior to group S with respect to quality of sleep (p<0.01). In the group M, the incidence of nausea was 30% (6/20) and that of pruritus was 35% (7/20) and clinical respiratory depression did not occur. Conclusions: Intrathecal 0.25 mg morphine provides good postoperative analgesic effect. but intramuscular caroverine and tiaprofenate does not.

• 한국생활과학회지
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• 제17권1호
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• pp.171-179
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• 2008

This study focuses on 130 estheticians currently working in and around Daegu and Gyeongbuk region, in order to find out the current state of affairs and side effects related to aromatherapy. This paper is based on a survey. SPSS win 11.0 program was used for the analysis of descriptive statistics and independent t-test. According to the result of analysis, about 33% of the estheticians have had allergy experience. And in terms of installation of an air ventilation fan, which is the most important facility in an treatment room, more than half (50.8%) replied they did not have one. There was a statistically significant difference between those estheticians suffering from allergy and those who did not, in symptoms of stuffy nose/rhinitis (P<0.01) and dry skin/itchiness (P<0.5). (Allergy symptoms from the 33% of estheticians were limited to those which occurred after he or she began career) On work related symptoms, those who had work history at hospitals/clinics or apothecaries were compared. A statistically relevant difference was confirmed between those estheticians with therapy experience and those who had none, in all symptoms except headaches and drowsiness/weariness. In other words, there was difference in symptoms such as dryness of skin/itchiness (P<0.01), stuffy nose/rhinitis, dry throat, tension/nervousness, dizziness, tired eyes(P<0.5), nausea, having trouble with focusing, and fatigue(P<0.1). Those estheticians who had a history of treatment especially suffered most from dryness of skin and itchiness. The rate of regular check-ups and the use of masks, employed for self protection, was lower than average (amounting to 5 points), with the use of masks especially having the lowest average (1.7) points.

• 대한임상독성학회지
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• 제10권1호
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• pp.33-36
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• 2012

Opioids are the one of the most commonly used drugs to control cancer pain all over the world. But, we should not overlook the potential risk of opioid intoxication because they have well-known detrimental side effects. The opioid intoxication can be diagnosed thorough various clinical manifestations. The altered mental status, respiratory depression, and miosis is very representative clinical features although these symptoms don't always appear together. Unfortunately the opioid-toxidrome can be varied. A 42 years old man came to our emergency room after taking about 900 mg morphine sulfate per oral. He was nearly alert and his respiration was normal. Even though his symptoms didn't deteriorated clinically, serial arterial blood gas analysis showed increase in PaCO2. So we decided to use intravenous naloxone. Soon, he was fully awaked and his pupils size was increased. After a continuous infusion of intravenous naloxone for 2 hours, PaCO2 decreased to normal range and his pupil size also returned to normal after 12 hours. Though the levels of serum amylase and lipase increased slightly, his pancreas was normal according to the abdominal computed tomography. He had nausea, vomit, and whole body itching after naloxone continuous infusion, but conservatively treated. We stopped the continuos infusion after 1 day because his laboratory results and physical examinations showed normal. As this case shows, it is very important to prescribe naloxone initially. If you suspect opioid intoxication, we recommend the initial use of naloxone even though a patient has atypical clinical features. In addition, we suggest intranasal administration of naloxone as safe and effective alternative and it's necessary to consider nalmefene that has a longer duration for opioid intoxication.