• The Korean Journal of Pain
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• 제29권3호
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• pp.189-192
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• 2016

Thoracotomy is a surgical technique used to reach the thoracic cavity. Management of pain due to thoracotomy is important in order to protect the operative respiratory reserves and decrease complications. For thoracotomy pain, blocks (such as thoracic epidural, paravertebral, etc.) and pleural catheterization and intravenous drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDs], and opioids, etc., can be used. We performed a serratus anterior plane (SAP) block followed by catheterization for thoracotomy pain. We used 20 ml 0.25% bupivacaine for analgesia in a patient who underwent wedge resection for a lung malignancy. We provided analgesia for a period of close to seven hours for the patient, whose postoperative VAS (visual analog scale) scores were recorded. We believe that an SAP block is effective and efficient for the management of pain after thoracotomy.

• The Korean Journal of Pain
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• 제11권2호
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• pp.332-334
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• 1998

A 25-year-old epileptic female patient scheduled for vaginal delivery, was referred to the pain clinic for the relief of labor pain. She had been taking anticonvulsant drugs, but suffered from seizure attacks three or four times a month. We had induced continuous lumbar epidural analgesia successfully and she subsequently gave birth to a healthy infant. So we report that continuous lumbar epidural analgesia should be considered as a safe method for reduction of labor pain and prevention of seizure attacks in epileptic pregnant women.

• The Korean Journal of Pain
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• 제19권2호
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• pp.271-274
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• 2006

Unstable angina is a critical phase of coronary heart disease, with widely variable symptoms and prognoses. Recently, despite the advances in surgical revascularization, catheter-based revascularization and medical treatment, an increasing number of patients with angina pectoris are refractory to medical therapy and; therefore, can not be considered as candidates for coronary artery bypass grafting or interventional angioplasty. These patients are often treated with narcotics for pain relief, and forced to severely reduce their levels of activity and productivity. It has become clear that alleviating the pain caused by myocardial ischemia may be possible by altering the sympathetic afferent nerve fibers. Sympathetic blockade can be produced using high thoracic epidural analgesia. Herein, the case of a patient with intractable angina and poor ventricular function, who received high thoracic epidural analgesia to relieve ischemic chest pain, is reported.

• The Korean Journal of Pain
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• 제10권2호
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• pp.291-295
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• 1997

Technique of epidural analgesia is generally regarded a safe procedures which is widely applied in postoperative and chronic pain control. Incidence of neurologic complications following epidural analgesia are rare; however, increasing number of published reports describing transient or permanent neurologic complications following such procedures have been appearing more frequently. We report two cases of neurologic complications following epidural analgesia as we believe it is important to draw the attention of other anesthesiologist to the possibility of existence of other complications of significant medicolegal consequences.

• Journal of Ginseng Research
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• 제16권2호
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• pp.93-98
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• 1992

This study examined the Influence of ginseng total saponins (GTS) on the analgestic action and tolerance development of pentazocine in mice. Pentazocine prolonged the latency to response in the tail flick rather than in the tail pinch test. The analgesic effect of pentaEocine was antagonized by naloxone and completely eliminated by pretreatment u·ith f-chlorophenylalanine (PCPA). GTS provented the pentasocine-incuced analgesia ann inhibited the development of tolerance to pentazocine. The antagonistic effect of GTS on the pentazocine-induced analgesia was abolished by 5-HTP, but not by L-DOPA. These results suggest that GTS inhibits the analgesic action of pentazocine by the interaction with serotonergic neuron.

• The Korean Journal of Pain
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• 제32권2호
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• pp.129-132
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• 2019

Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3-T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient's resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.

• The Korean Journal of Pain
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• 제10권1호
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• pp.21-27
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• 1997

Background : Previous studies have proven beneficial in labor analgesia to use subarachnoid sufentanil(alone or with adjuvant) on parturients in early first stage of labor. We designed this prospective study to evaluate analgesic efficacy and side effects of subarachnoid sufentanil plus bupivacaine in women with cervical dilatation of 7 cm greater. Methods : This was an open-label, nonrandomized trial of 32 parturients in late first stage labor who requested labor analgesia. After signing the consent form each patient received subarachnoid sufentanil (10 ${\mu}g$) and bupivacaine (2.5 mg). Patients were asked to rate their verbal pain score (0-10 scale) before regional anesthesia and 5 minutes after subarachnoid injection, and every 20 minutes thereafter until delivery or request for additional analgesia. Blood pressure, pruritus, Bromage motor block score, mode of delivery and need for supplemental analgesics were recorded. Results : Thirty women were included in the study. Mean pain scores (mean${\pm}$SD) were $8.7{\pm}1.0$ pre-spinal, $0.7{\pm}1.5$ 5 minutes post-injection, and remained less than 5 for 130 minutes after spinal injection. Of 30 patients, 24 had unassisted vaginal delivery, 4 instrumental vaginal delivery (vacuum), and 2 cesarean delivery. Of 28 patients who delivered vaginally, 19 did not require supplemental analgesics and had a delivery pain score of 5 or lower. Blood pressure decreased in three patients after spinal analgesia (p<0.05), which necessitated treatment. The Bromage motor block score was 0 in 26 patients and 1 in 4 patients. Pruritus was noted in 22 patients. Conclusion : Subarachnoid sufentanil-bupivacaine provides rapid analgesia for an effective duration of approximately 130 minutes in parturients in late first stage of labor.

• The Korean Journal of Pain
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• 제11권1호
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• pp.41-46
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• 1998

Background: Preoperative analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and therefore may preempt postoperative pain. Although preemptive analgesia has shown to decrease postinjury pain in animals, studies in human are not consistent. We studied whether epidural morphine injection before surgical incision could affect postoperative pain and analgesic demands, compared with injection after removal of specimen. Methods: Forty patients scheduled for radical subtotal gastrectomy were randomly assigned to one of two groups for prospective study in a double-blind manner. Group 1 received an epidural injection of 3 mg of morphine in 8 ml of 0.9% saline before surgical incision, and Group 2 after removal of specimen. Postoperative pain relief was provided with I.V. patient controlled analgesia (PCA) system. Numerical rating scales for pain and mood, Prince Henry Hospital scores for pain, cumulative PCA analgesic consumptions, and incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. Results: Cumulative PCA analgesic consumption in group 1 was significantly less than in group 2 at 2, 6 hours after surgery. Pain scores and the incidence of side effects were similar in both groups. Conclusions: Preoperative analgesia with epidural morphine showed little difference in patient controlled analgesic consumption after upper abdominal surgery compaired to intraoperative morphine.

• Journal of Yeungnam Medical Science
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• 제17권1호
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• pp.12-20
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• 2000

The memory of pain can be more damaging than its initial experience. Several factors arc related the directions of pain memory: current pain intensity, emotion, expectation of pain, and peak intensity of previous pain. The possible mechanisms behind the memory of pain are neuroplastic changes of nervous system via peripheral and central sensitization. Peripheral sensitization is induced by neurohumoral alterations at the site of injury and nearby. Biochemicals such as K+, prostaglandins, bradykinin, substance P, histamine and serotonin, increase transduction and produce continuous nociceptive input. Central sensitization takes place within the dorsal horn of spinal cord and amplifies the nociceptive input from the periphery. The mechanisms of central sensitization involve a variety of transmitters and postsynaptic mechanisms resulting from the activations of NMDA receptors by glutamate. and activation of NK-1 tachykinnin receptors by substance-P and neurokinnin. The clinical result of peripheral and central sensitization is hyperalgesia, allodynia, spontaneous pain, referred pain, or sympathetically maintained pain. These persistent sensory responses to noxious stimuli arc a form of memory. The hypothesis of preemptive analgesia is that analgesia administered before the painful stimulus will prevent or reduce subsequent pain and analgesic requirements in comparison to the identical analgesic intervention administered after the painful stimulus, by preventing or reducing the memory of pain in the nervous system. Conventionally, pain management was initiated following noxious stimuli such as surgery. More recently, however many have endorsed preemptive analgesia initiated before surgery. Treatments to control postsurgical pain are often best started before injury activates peripheral nociceptors and triggers central sensitization. Such preemption is not achieved solely by regional anesthesia and drug therapy but also requires behavioral interventions to decrease anxiety or stress. Although the benefit of preemptive analgesia may not be obvious in every circumstance, and in many cases may not sufficient to abolish central sensitization, it is an appropriate and human goal of clinical practice.

• The Korean Journal of Pain
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• 제9권1호
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• pp.63-68
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• 1996

Background; Epidural analgesia for controlling labor pain has recently gained world-wide popularity. However, many patients scheduled for continuous epidural analgesia voice concern over harmful effects to their fetus and other possible complications such as hemodynamic changes, back pain and neurologic sequelae etc. The aim of this study was to evaluate the hemodynamic changes with and without epidural block as a measure to determine the safety of epidural analgesia during labor and delivery. Methods: Twenty healthy subjects were divided equally into two groups(Group 1 without epidural block, and Group 2 with epidural block) and serial hemodynamic measurements were taken in all subjects with transcutaneous impedence cardiography. The epidural catheter was inserted at the level of $L_{3,4}$ in Group 2 and analgesia was maintained using 0.25% bupivacaine mixed with fentanyl. Results: Cardiac output increased slightly with cervical dilatation in both groups, but no significant differences were found between the two groups. Similarly, no significant differences were found in blood pressures between the two groups. Stroke volume and end-diastolic volume indices were slightly decreased in group 1 and slightly increased in group 2. However, there were no significant differences between the two groups. The ejection fraction was nearly constant and ranging 56~59%. Conclusion: We concluded epidural analgesia for labor and delivery is a safe technique for the parturients since results indicated no significant differences in hemodynamic changes, as compared to the control group.