• The Korean Journal of Pain
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• v.33 no.1
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• pp.81-89
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• 2020

Background: For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks. Methods: Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 ㎍/kg dexmedetomidine (maximum volume 4 mL/side). Results: The modified children's hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects. Conclusions: Addition of dexmedetomidine 0.5 ㎍/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.99-102
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• 1992

Severe intractable pain with paresthesia and severe dyspnea produced by lung cancer involving both brachial plexuses, refractory to ordinary pharmacologic approaches, was managed by epidural morphine and bupivacaine administration with the continuous Baxter infusion system. Chest pain, which is somatic pain in character, was well managed with the epidural morphine and bupivacaine administrations. However paresthesia and tingling sensation of the hand and forearm were poorly controlled by epidural morphine, and were finally managed by bolus epidural injections of bupivacaine. Supportive therapy included epidural steroid injection and TENS, but the effect was not satisfactory. Severe dyspnea seemed to aggrevate cancer related pain.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.64-73
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• 1988

Recent studios have shown that narcotic drags produce an unusually intense, prolonged and segmental analgesic action in man whoa injected into the spinal subarachnoid or epidural space (Wang et al, 1979; Behar et al, 1979; Cousins et al, 1979; Magora et a., 1980, Johnston and McCaughey, 1980). Since 1960, many investigators claimed that low molecular weight(LMW) dextran increased the clinical duration of lidocaine(Loder, 1960; Loder, 1962), tetracaine (Chinn and Wirjoatmadja, 1967) and bupivacaine(Kaplan et al, 1975) in man but the mechanism of the action of dextran was unclear. But Curtiss and Scurlock(1979), and Buckled and Fink(1979) claimed that LMW dextran has no effect on the duration of action of bupivacaine in animal studies. The present study was performed to evaluate the clinical efficacy of analgesia by the thoracic epidural injection of morphine and bupivacaine mixture for the relief of pain due to fractured or contused ribs, to evaluate the duration of analgesic effect by the use of the above mixture in a hypertonic solution(dextran 70 or 50% dextrose in water) and to observe the possibility of improvement in the lung function after the pain block. The complications following the pain block were also observed. The 50 single thoracic epidural injections of the mixture were divided into three groups : Group 1(n=15) served as a control group and drags used for the relief of pain were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}1.64\;mg$), 0.5% bupivacaine($3.10{\pm}1.04\;ml$) and 0.9% saline($3.64{\pm}1.11\;ml$). Group 2(n=16) serves as an experimental group and drugs were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}0.72\;mg$), 0.5% bupivacaine($3.06{\pm}0.77\;ml$) and dextran 70($3.75{\pm}1.29\;ml$). Group 3 (n=19) served as an experimental group and drags were as follows(Mean$\pm$S.D.) : morphine($2.42{\pm}0.51\;mg$), 0.5% bupivacaine($3.21{\pm}0.71\;ml$) and 50% dextrose in water($3.58{\pm}1.11\;ml$). The results are were follows: 1) The Dumber of patients who obtained excellent and good analgesic effects following the block were greater in the experimental Croup 2(94%) and Group 3 (90%) than theme of the control Group 1 (80%). 2) The duration of pain relief which lasted more than 3 days after the epidural block was longer in the experimental Group 2 (81%) and Group 3 (75%) than those of the control Croup 1(67%). 3) The pulmonary reserve(FVC%+FEV 1.0%) of 27 cases who were treated by the pain block between 1 and 31 drys following the chest injury was increased to about 13% than those before the block, and that of 13 cases between 32 and 82 days following the chest injury was decreased to about 4% than those before the block. 4) Of the complications following the pain block, there were 5 cased(10%) of nausea within 2 hours following the block, 4 cases(8%) of vomiting after 2 hours following the block, 10 cases(20%) of pruritus after 3~4 hours following the block, 17 cases(34%) of transient urinary retention which tasted 8 to 19 hours, 3 cases(6%) of headache within 2 hoers following the block and 2 cases(4%) of dural puncture. In conclusion, it is suggested that the clinical duration of analgesic effect produced by morphine and bupivacaine mixture can be prolonged by addition of the hypertonic solution to the mixture.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.7-11
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• 2001

Background: Although several mechanisms of causalgia, which results from a partial injury to the peripheral nerve trunk, have been proposed, whether or not antidromic impulses from the injured neurons contribute to the development of the mechanical hyperalgesia has not been studied. The purpose of this experiment is was to investigate the role of antidromic impulses to the peripheral sensory receptor site on the development of mechanical hyperalgesia in a rat model of peripheral neuropathy. Methods: Rats were prepared with tight ligation of by tightly ligating the left fifth and sixth lumbar spinal nerves. The effect of bupivacaine pretreatment on the development of mechanical hyperalgesia was evaluated by injecting 0.5% bupivacaine (0.3 ml) into the plantar surface of the left hind paw before the skin incision was made. For the control group, normal saline (0.3 ml) was injected instead of bupivacaine. To measure the mechanical hyperalgesia, paw withdrawal thresholds were measured using a series of von Frey hairs. Mechanical hyperalgesia was measured a the day before, and 1, 2, 3, 4, 7, and 14 days after the surgery. Results: The control group showed decreased withdrawal thresholds from the day after the surgery (the values were $14.0{\pm}0.5$, $8.9{\pm}1.3$, $8.4{\pm}1.6$, $6.9{\pm}1.2$, $8.8{\pm}1.5$, $10.5{\pm}1.3$, and $8.6{\pm}1.3$ g; at -1, 1, 2, 3, 4, 7, and 14 days after the surgery, respectively). However, withdrawal thresholds of the bupivacaine-pretreated group showed increased withdrawal thresholds for three days after the surgery ($14.5{\pm}0.3$, $12.6{\pm}1.4$, $12.7{\pm}1.1$, $10.5{\pm}1.3$ g; at 1, 1, 2, 3 days after the surgery). Conclusions: Our result suggests that antidromic impulses to the peripheral sensory receptors are at least partly responsible for the initial development of mechanical hyperalgesia in a rat model of peripheral neuropathy.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.604-608
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• 2000

Objective : The purpose of this non randomized prospective study was to verify the effect of pain control in small doses of epidural morphine and bupivacaine through continuous infusion for 48 hours. Patients and Methods : Thirty-five patients who underwent spine surgery including laminectomy, fusion with fixation were assigned into two groups ; pain control group(n＝20) and control group(n＝15). Pain score was measured on a visual analogue scale(VAS). A continuous infusor was used to give morphine and bupivacaine continuously via indwelling epidural catheter which was placed before closure of muscles in pain control group. Results : Mean scores(VAS) of pain control group were between 1.3 and 2.1 from the 30 min to the 72 hour, but the lowest mean score in the control group was about 2.6 at the 72 hour. Although a number of extra-analgesics were used in control group, differences of mean scores were statistically significant till 24 hour in pain control group. The patients in pain control group was less painful than the patients in control group from 24 hour till 72 hour, but it was statistically insignificant. There were some side effects such as nausea/vomiting, pruritus, urinary retention which existed transiently, but there was no respiratory depression. Conclusion : It was concluded that the early postoperative pain can be easily and safely controlled with continuous infusion of epidural morphine and bupivacaine in small doses.

• Journal of Veterinary Clinics
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• v.26 no.3
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• pp.205-211
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• 2009

Perioperative pain relief is essential in veterinary practice. However, the cat is one of the most poorly understood species regarding pain control management. Ovariohysterectomy(OHE) produces considerable postoperative pain in cats. Practitioners are often reluctant to administer analgesics due to lack of familiarity with available drugs, concern about side effects, or frustration with the need for record keeping of controlled substances. The purpose of this study was to determine if intraperitoneal administration of bupivacaine can provide relief of pain following OHE in cats. Twelve healthy female cats were randomly divided into two groups. OHE was performed under general inhalation anesthesia. Just prior to complete closure of the linea alba, 6 cats in SAL group received 0.88 ml/kg 0.9% saline, 6 cats in BUP group received 4.4 mg/kg 0.75% bupivacaine diluted to an equivalent volume with saline in the intraperitoneal space. Cats were scored at 0, 1, 2, 4, 8, 12 and 24 hours post-extubation by one observer. Cats were evaluated using a visual analogue scale(VAS) and composite pain scale(CPS) that included physiologic variables. There were no significant differences in body weight, anesthesia time, surgery time, and incision length between the two groups. Cats in the BUP group had significantly(p<0.05) lower VAS-pain scores than cats in the SAL group at 4, 8, 12 hours after surgery. Cats in the BUP group had significantly lower CPS scores than cats in the SAL group at 8, 12 hours after surgery. No adverse side effects were observed. These results support that the intraperitoneal administration of bupivacaine following OHE can be used for the prevention of postoperative pain and pain-induced behavioral changes in cats.

• Proceedings of the PSK Conference
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• 2003.04a
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• pp.299.2-300
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• 2003

Various bupivacaine-Ioaded microspheres were prepared with poly (d,l-Iactide) (PLA) by solvent extraction method. The internal solution of polymer(PLA R104) and drug in glacial acetic acid was introduced into the external phase of polyvinylpyrrolidone (PVP K-30) in polyethyleneglycol (PEG), and emulsified to be an oil-in-oil (o/o) emulsion. The o/o emulsion was poured to the buffer solution. (omitted)

• The Korean Journal of Pain
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• v.13 no.1
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• pp.84-88
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• 2000

Background: An increase in the maximum level of sensory blockade (MLSB) following an epidural top-up in combined spinal epidural anesthesia (CSE) may be achieved by a volume effect as the volume of local anesthetic compresses the dural sac, by a local anesthetic effect, or by a combination of both effects. This study was conducted to investigate the contribution of each of these effects. Methods: Sixty patients scheduled for lower limb surgery under CSE were randomly allocated to one of three groups of twenty patients each. Using the needle-through needle technique, all patients received a subarachnoid dose of 10 mg hyperbaric 0.5% bupivacaine. At 30 min after subarachnoid injection, an epidural top-up with saline 10 ml (group II) or 0.5% bupivacaine 10 ml (group III) was administered; patients in group I received no epidural top-up. The level of sensory blockade was assessed at 5, 10, 15, 20, 25, 30 min after subarachnoid injection and at 5, 10, 15, 20, 25, 30 min after epidural top-up. Results: There was no significant difference in the MLSB and the onset time of MLSB among group I-III. Conclusions: We concluded that the epidural top-up with saline 10 ml or 0.5% bupivacaine 10 ml which injected at 30 min after subarachnoid injection did not significantly increase the level of subarachnoid block in lower extremity surgical patients.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.286-292
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• 1995

Buerger's disease(Thromboangiitis Obliterans) is characterized by peripheral arterial occlusion of the extremities in young smokers, and leading to ischemia of the tissue and gangrene. Most of these patients suffered from severe pain. therapy for Buerger's disease not enable to undergo reconstructive arterial surgery has been discouraging while multiple modes of analgesics have advanced. Eight subjects who had been operated due to Buerger's disease or diagnosed with this disease were evaluated retrospectively. Continuous epidural block was done at L 2~3 or L3~4 intervertebral space and multiday continuous infusor was connected to epidural catheter. The content of the infusor was clonidine-bupivacaine or clonidine-morphine-bupivacaine mixture. The minimum dose of clonidine was 75 ${\mu}g/day$ and the maximum 450 ${\mu}g/day$. The results were as follows: The analgesia produced by clonidine was superior to any other analgesics. 2) The incidence of the side effects produced by clonidine-bupivacaine mixture were less than that of clonidine-morphine-bupivacaine mixture. 3) Minimum dose of clonidine for the pain relief was required more than 225 ${\mu}g$ per day. From the above results, we recommend that clonidine is an effective agent to provide pain relief for the patients with Buerger's disease.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.106-111
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• 2008

Background: Chronic pain after thoracotomy has been recently reproduced in a rat model that allows investigating the effect of potentially beneficial drugs that might reduce the incidence of allodynia or alleviate pain. Local anesthetics produce antinociception in normal animals and alleviate mechanical allodynia in animals with nerve injury although their mechanisms of action may differ in these situations. Our purpose of this study was to test whether the preoperative intercostal nerve block of bupivacaine could prevent the development of allodynia in a rat model of chronic postthoracotomy pain. Methods: All male Sprague-Dawley rats were anesthetized and the right 4th and 5th ribs were exposed surgically. The pleura were opened between the ribs to which a retractor was placed and was opened 10 mm in width. Retraction was maintained for one hour. Total 1 mg of 0.5% bupivacaine was injected at the intercostal nerves before (n = 17) or after (n = 16) surgery. A control group (n = 25) that underwent rib retraction did not receive any drug. Rats were tested for mechanical allodynia using calibrated von Frey filaments applied around the incision site during the three weeks following surgery. Results: The incidence of development of mechanical allodynia in the group that received intercostal injection with bupivacaine before surgery was significantly lower than that in the control group (P < 0.05). Conclusions: Preoperative intercostal nerves block around the surgical incision before thoracotomy may decrease the incidence of postthoracotomy pain syndrome.