• The Korean Journal of Pain
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• 제32권1호
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• pp.47-50
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• 2019

Background: It is uncommon for patients who have received a permanent implant to remove the spinal cord stimulator (SCS) after discontinuation of medication in complex regional pain syndrome (CRPS) due to their completely painless state. This study evaluated CRPS patients who successfully removed their SCSs. Methods: This 10-year retrospective study was performed on patients who had received the permanent implantation of an SCS and had removed it 6 months after discontinuation of stimulation, while halting all medications for neuropathic pain. Age, sex, duration of implantation, site and type of CRPS, and their return to work were compared between the removal and non-removal groups. Results: Five (12.5%, M/F = 4/1) of 40 patients (M/F = 33/7) successfully removed the permanent implant. The mean age was younger in the removal group ($27.2{\pm}6.4$ vs. $43.5{\pm}10.7$ years, P < 0.01). The mean duration of implantation in the removal group was $34.4{\pm}18.2$ months. Two of 15 patients (13.3%) and 3 of 25 patients (12%) who had upper and lower extremity pain, respectively, had removed the implant. The implants could be removed in 5 of 27 patients (18.5%) with CRPS type 1 (P < 0.01). All 5 patients (100%) who removed their SCS returned to work, while only 5 of 35 (14.3%) in the non-removal group did (P < 0.01). Conclusions: Even though this study had limited data, younger patients with CRPS type 1 could remove their SCSs within a 5-year period and return to work with complete pain relief.

• 대한족부족관절학회지
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• 제18권2호
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• pp.83-86
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• 2014

Postpoliomyelitis syndrome is a common neurological disorder that occurs in patients who have experienced paralytic poliomyelitis. Recently, as a result of vaccination against poliovirus, incidence of poliomyelitis is exceedingly low. However, many patients with postpolio syndrome may encounter anesthesia when undergoing surgery, such as for correction of foot deformity and other operations. We report on a 45-year-old woman who experienced paralysis of her contralateral limb after operation on the left foot under spinal anesthesia. Postoperative electromyography/nerve conduction study (EMG/NCS) was performed in order to determine the cause of paralysis. Motor power of the sequelae involved leg showed improvement with time and recovered fully to the preoperative level at six months after the index operation. A precise evaluation, including a physical examination and EMG/NCS, should be performed preoperatively when spinal anesthesia is planned for postpolio syndrome patients.

• 임상간호연구
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• 제26권3호
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• pp.365-373
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• 2020

Purpose: The purpose of this study was to evaluate the effect of preoperative warming to prevent hypothermia in surgery for patients undergoing total hip replacement arthroplasty under spinal anesthesia. Methods: A randomized experimental study was conducted. Data were collected at an S University hospital in Gyeonggido from December 3, 2019 to March 31, 2020. A random allocation program was used to randomize participants into intervention and control groups. A total of 90 participants were assigned to the study: 30 people were randomized to a pre-warming group using Bair Hugger forced-air warming blankets(Model 505) 30 minutes before surgery, 30 to a pre-warming group 15 minutes before surgery, or 30 to a control group. The findings from 88 participants were analyzed. For data analysis, χ2 test and ANOVA were used utilizing the SPSS 21.0 program. Results: The pre-warming group 30 minutes before surgery had significantly higher body temperature than the control group, from 30 minutes after inducing anesthesia to the end of anesthesia. Body temperature over anesthesia time showed significant differences among the three groups, but there were no statistically significant differences in interactions between time and groups. Conclusion: Warming patients' body for 30 minutes before surgery was effective in maintaining normal body temperature while preventing intraoperative hypothermia.

• The Korean Journal of Pain
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• 제22권1호
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• pp.21-27
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• 2009

Background: The neuropathic pain arising from nerve injury is difficult to treat and the therapeutic effects of opioid drugs remain debatable. Agonists acting at the ${\alpha}_2$ adrenergic and opioid receptors have analgesic properties and they act synergistically when co-administered in the spinal cord. The lack of subtype-selective pharmacological agents has previously impeded the synergistic effects that are mediated by the adrenergic receptor subtypes. Methods: We created neuropathic pain model by ligating the L5 spinal nerve in Sprague-Dawley rats (n = 18). We divided the rats into three groups (n = 6 for each group), and we administered intraperitoneal morphine (1 mg/kg, 3 mg/kg, 5 mg/kg) and then we measured the mechanical allodynia with using von-Frey filaments for 8 hours. We then injected morphine (5 mg/kg) intraperitoneally, twice a day for 2 weeks. We measured the tactile and cold allodynia in the morphine group (n = 9) and the saline group (n = 9). After 2 weeks, we decapitated the rats and harvested the spinal cords at the level of lumbar enlargement. We compared the ${\alpha}_2$ subtype mRNA expression with that of control group (n = 6) by performing real time polymerase chain reaction (RTPCR). Results: Intraperitoneal morphine reduced the neuropathic pain behavior in the dose-dependent manner. Chronic morphine administration showed an antiallodynic effect on the neuropathic pain rat model. The rats did not display tolerance or hyperalgesia. The expression of the mRNAs of the ${\alpha}_{2A}$, ${\alpha}_{2B}$, ${\alpha}_{2C}$ subtypes decreased, and morphine attenuated this effect. But we could not get statistically proven results. Conclusions: Systemic administration of morphine can attenuate allodynia during both the short-term and long-term time course. Morphine has an influence on the expression of ${\alpha}_2$ receptor subtype mRNA. Yet we need more research to determine the precise effect of morphine on the ${\alpha}_2$ subtype gene expression.

• Journal of Yeungnam Medical Science
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• 제7권2호
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• pp.121-130
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• 1990

영남대학교 마취과학교실에서 하지에 국한된 수술을 받는 환자 40예를 대상으로 각군 20예씩 0.5% 고비중 tetracaine 2ml와 0.5% 순수 bupivacaine 2.5ml을 사용하여 척추마취를 실시한 결과 다음과 같은 성적을 얻었다. 1. 각군의 연령, 성별, 신장 및 체중은 비슷하였다. 2. 양군 모두 감각차단이 $T_{12}$분절에 도달되는 시간은 4분정도였고, 감각차단 최고분절높이도 $T_{6-7}$이었으며 최고높이에 도달되는 시간도 20분 정도였다. 3. 운동차단정도도 양군이 비슷하여 10분에 대부분이, 20분이내에 전예에서 완전차단이 초래되었다. 4. Bupivacaine군은 감각차단이 $T_{12}$분절이상에서 유지된 시간이 3시간, 술후 진통시간이 7시간으로 tetracaine군보다 작용시 간과 진통시간이 의의있게 길었다(P<0.05). 5. 수축기 혈압의 감소는 bupivacaine군이 훨씬 적었으며(P<0.05), 혈압은 마취후 20~30분에 심하게 감소되었다. 6. 마취후 발생된 부작용은 전체 대상환자에서 두통(3예), 다리저림(5예), 배뇨곤란(3예) 및 배부통(4예) 등이었고 양군사이에 발생빈도의 차이는 없었다. 이 상의 결과로 bupivacaine 척추마취의 임상적 특징은 감각차단 및 운동차단이 나타나는 양상과 마취후 부작용은 고비중 tetracaine과 비슷하고, 고비중 tetracaine보다 혈압감소가 적고 작용시간이 걸고 술후 진통효과가 좋은 점등의 장점이 있으므로 0.5% 순수 bupivacaine은 하지수술을 위한 척추마취제로 유용하게 사용될 수 있을 것으로 사료된다.

• 임상간호연구
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• 제22권3호
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• pp.336-344
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• 2016

Purpose: The purpose of this study was to compare and analyze differences in effects of postoperative daily activity on headaches in patients who underwent surgery under spinal anesthesia. Methods: The study was conducted with 219 adults, 20 years or older. Official approval (Approval number: KMC IRB 1434-01) was received from K university hospital clinical trials review board. The research design was a nonequivalent control group non-synchronized design with a daily activities group and the bed rest group. Data was collected after receiving written consent from the participants. Results: There were no participants in either group who experienced headaches. Changes in a physiological index were also not significantly different between the daily activities group and the bed rest group. Conclusion: The results indicate that allowing daily activities in the ward, rather than maintaining bed rest for 6 hours, the existing method of nursing care for the prevention of postoperative headaches, in spinal anesthesia patients, is not detrimental to these patients post operatively.

• 한국융합학회논문지
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• 제8권1호
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• pp.97-106
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• 2017

본 융합연구의 목적은 척추마취하에서 전립선절제수술을 받는 환자의 불안, 피로 및 활력징후에 미치는 선호 음악요법의 효과를 확인하기 위함이다. 본 연구는 비동등성 대조군 전후시차설계에 따라 환자 45명을 대상으로 하였으며 실험군에게는 수술 중 선호하는 음악을 들려주었다. 자료는 수술 30분전, 수술 20분 경과, 수술 40분 경과, 및 마취회복실 입실직후에 구조화된 질문지와 직접 계측을 통해 수집하였으며 기술통계, ${\chi}^2-test$, Fisher's exact test, t-test 및 repeated measures ANOVA로 분석하였다. 연구결과 실험군의 불안과 피로수준은 대조군보다 유의하게 낮았다(p=.001; p=.020). 그러나 수축기혈압, 이완기혈압 및 맥박에서는 두 집단 간 유의한 차이가 없었다(p=.821; p=.473; p=.782). 이상의 연구결과를 통해 척추마취 전립선절제술을 시행하는 환자에게 수술 중 환자의 선호 음악요법을 제공하는 것은 수술 관련 불안과 피로를 완화하는 유용한 간호중재가 될 수 있음을 확인하였다.

• 한국산학기술학회논문지
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• 제14권5호
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• pp.2322-2328
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• 2013

본 연구는 2011년 8월 16일부터 2012년 7월 11일 사이에 고위 척추마취를 겪는 환자에서 나이에 따른 진정정도의 차이를 호흡기 및 순환기 생체징후의 변화와 함께 마취심도감시장치를 이용하여 객관적으로 알아보고자 하였다. 대상자는 하지나 하복부 수술을 시행할 예정인 20세에서 80세 사이의 성인 60명으로 하였으며, 나이에 따라 20세에서 50세 사이, 51세에서 80세 사이의 환자 군으로 나누었다. 두 그룹은 각각 30명의 환자를 대상으로 하였다. 두 군 모두에서 마취심도수치는 수술 전에 비해 낮게 나왔다. 수술 중 가장 낮은 마취심도수치는 노인 군에서 젊은이 군에 비해 낮았다. 가장 낮은 마취심도수치와 나이는 음의 상관관계를 보여주었다. 노인 군은 젊은이 군에 비해 수술 중 90% 이하의 낮은 산소포화도를 가진 환자수도 많았다. 고위 척추마취 하에서 노인 환자들은 젊은이에 비해 증가된 저산소혈증과 함께 깊은 진정 효과를 보였다.

• 동서간호학연구지
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• 제20권1호
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• pp.9-20
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• 2014

Purpose: The purpose of this research was to examine the effects of preferred music intervention on anxiety, vital signs and blood sugar of surgical patients undergoing spinal anesthesia. Methods: A quasi-experimental research with non-equivalent control group non-synchronized design was carried out. Subjects consisted of 40 patients (experimental group 20, control group 20) who were scheduled to undergo surgery with spinal anesthesia. During the operation, music individual patients preferred was provided to the experimental group. The data were collected from July 4 to November 10, 2011 and analyzed with descriptive statistics, t-test, chi-square test, ANCOVA and repeated measured ANCOVA using SAS (ver 9.2). Results: 1) Patient anxiety during the operation of the experimental group was significantly lower than the control group (F=93.77, p<.001). 2) There was no significant difference in diastolic blood pressure (F=.00, p=.979), Systolic blood pressure (F=.19, p=.668), heart rate (F=.00, p=.955), and blood sugar (F=.73, p=.399) between the experimental group and the control group. Conclusion: Letting patients hear their preferred music during surgery is an effective nursing intervention to relieve anxiety of patients undergoing surgery with spinal anesthesia.

• Journal of Korean Neurosurgical Society
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• 제40권5호
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• pp.384-386
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• 2006

Acute subdural hematoma is an exceptionally rare, but life-threatening complication of spinal anesthesia. The authors report here on a case of acute subdural hematoma in a 52-year-old male who underwent an arthroscopic knee joint operation under spinal epidural anesthesia due to tearing of the medial meniscus. He complained of headache after surgery. Computed tomography[CT] revealed acute subdural hematoma in the right fronto-tempo-parietal area. The headache progressed in spite of analgesics and bed rest; two weeks later, the CT showed subacute subdural hematoma with a mass effect. The patient improved after surgical decompression. The pathogenesis of subdural hematoma formation after dural puncture is discussed and we briefly review the relevant literature. Prolonged and severe postdural puncture headache[PDPH] should be viewed with suspicion and investigated promptly to rule out any intracranial complications. Immediate treatment of the PDPH with an epidural blood patch to prevent further CSF leakage should be considered.