• 대한관절경학회지
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• 제2권2호
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• pp.119-123
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• 1998

In order to obtain a good result in Arthroscopic ACL Reconstruction by immediate postoperative physical therapy, sufficient analgesia was needed. This study analyzes the analgesic effect of the intra-articular injection with ketorolac, Morphine together with bupivacaine in 80 male patients who had Arthroscopic ACL Reconstruction. On completion of the surgery under spinal anesthesia, the knee was injected with 30ml of 0.25% bupivacaine. Each of the study group received ketorolac and/or morphine, either through parenteral or intra-articular. Total amount of the drug used by Patient Controlled Analgesia(PCA) and Visual Analgesia Scale(VAS) for pain were measured and analyzed. The group which received intra-articular ketorolac or Morphine had a better analgesic effect than other group which received none. The group which received both did not do better in analgesic effect. Intra-articular infusion with either ketorolac or Morphine improved postoperative analgesia in Arthroscopic ACL Reconstruction surgery. However, combined injection did not offer more advantage.

• The Korean Journal of Pain
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• 제2권2호
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• pp.194-197
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• 1989

Epidural morphine provides excellent analgesia for the management of postoperative pain, but nausea and vomiting are a commonly reported side effect. Scopolamine, a belladona alkaloid, is an effective antiemetic when nausea is induced by morphine. Transdermal scopolamine patches have the advantage of delivering a constant low dosage of the drug over a prolonged period. To evaluate the efficacy of prophylacitic transdermal scopolamine in reducing nausea or vomiting associated with postoperative epidural morphine analgesia, I studied 60 healthy adult patients. The patients were divided into 3 groups, each group consisting of 20 patients. Group 1; no scopolamine for control Group 2; transdermal scopolamine placebo patch Group 3; transdermal scopolamine patch All patients were anesthetized by epidural injection of 2% lidocaine 15 ml and 0.5% bupivacaine 10 ml with morphine 4 mg. A Comparison with the control group, the placebo group, and Group 3, indicated, that the transdermal scopolamine reduced the incidence of nausea or vomiting associated with postoperative epidural morphine analgesia (group 1; 35%, group 2; 25%, group 3; 10%). However there were no statistically significant differences between groups at a level of p>0.05.

• The Korean Journal of Pain
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• 제7권1호
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• pp.106-112
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• 1994

45세 여자 환자에서 요하지통의 치료를 위해 triamcinolone 40 mg과 0.125% bupivacaine 10 ml를 경막외로 주입한후 24시간에 걸쳐 하지마비 및 해리성 감각소설이 발생하였다. 그 원인은 분명하지 않으나 선행절환의 악화, 급성 횡단성 척수염, 전척수동맥증후군, 그리고 신경독성등이 추정된다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권3호
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• pp.209-212
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• 2016

Lidocaine, a local anesthetic commonly used in dental treatments, is capable of causing allergies or adverse effects similar to allergic reactions. However, the frequency of such occurrences in actual clinical settings is very rare, and even clinical tests on patients with known allergies to local anesthetics may often show negative results. When adverse effects, such as allergy to lidocaine, are involved, patients can be treated by testing other local anesthetics and choosing a local anesthetic without any adverse effects, or by performing dental treatment under general anesthesia in cases in which no local anesthetic without adverse effects is available. Along with a literature review, the authors of the present study report on two cases of patients who tested positive on allergy skin tests for lidocaine and bupivacaine and subsequently underwent successful dental treatments with either general anesthesia or a different local anesthetic.

• 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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• 제19권1호
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• pp.91-95
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• 2006

Background: Opioid delivered by epidural patient-controlled analgesia (PCA) is effective in relieving pain after surgery, but it is associated with side effects, such as nausea, vomiting, pruritus, respiratory depression, and urinary retention. The purpose of this study was to compare hydromorphone related side effects and the quality of analgesia when naloxone was added to epidural PCA regimen. Methods: Fifty-two thoracotomy patients with PCA were allocated blindly into two groups. Patients in group H (n = 26) received continuous epidural hydromorphone ($16{\mu}g/ml$) in 0.1% bupivacaine; patients in group N (n = 26) received an epidural infusion containing naloxone ($2{\mu}g/ml$) and hydromorphone ($16{\mu}g/ml$) in 0.1% bupivacaine. The basal rate of PCA was 4 ml/hr and the demand dose was 1.5 ml with a lockout time of 15 min. Pain intensity, sedation, pruritus, nausea and vomiting, respiratory depression were checked at 6, 12, 24 hours postoperatively. Results: The Visual Analog Scale (VAS) scores were significantly lower in group H than in group N. There were no significant differences in the overall incidence of pruritus, nausea and sedation between the two groups. Conclusions: Continuous epidural infusion of naloxone combined with hydromorpho-ne is not effective in reducing the incidence and severity of pruritus induced by epidural hydromorphone.

• The Korean Journal of Pain
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• 제9권2호
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• pp.385-389
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• 1996

Background: Nowadays, epidural morphine is commonly used in postoperative pain control. But epidural morphine may produce some side-effects, e.g. pruritus, nausea, vomiting, urinary retention and respiratory depression. Especially, pruritus is the most common complaint in pain-controlled patients by epidural morphine. So we evaluated whether addition of epidural butorphanol affects the degree of pruritus and pain score in pain controlled patients who by epidural morphine after hysterectomy. Methods: Group 1(N=15) received postoperative epidural 0.1% bupivacaine 100ml plus morphine 10 mg, group 2(N=15) received the mixture of butorphanol 2 mg with same regime as in group 1, group 3(N=15) received the mixture of butorphanol 4 mg with same regime as in group 1. All of the three groups received these solutions by infusion pump, 1 ml/hour, for postoperative 4 days. all groups received additional morphine 1.2 mg in 0.2% bupivacaine 6ml epidurally when the peritoneum was closed under general anesthesia. The severity of pain, pruritus, nausea and vomiting was estimated by 10 cm VAS(visual analogue scale) and somnolence by positive or negative during postoperative 4 days. Results: Severity of pruritus, but not nausea and vomiting was decreased in group 2 and 3 compared with group 1(p<0.05). Pain score was increased in group 3 at postoperative day(POD) 0 and 2 compared with group 1(p<0.05). Incidence of somnolence in group 1, 2 and 3 were $2.7{\pm}0.7,\;5.3{\pm}0.7$ and $10.0{\pm}1.0$ respectively. Conclusion: These results suggest that butorphanol reduce the degree of pruritus, the most common side effect of morphine, but increase the incidence of somnolence.

• 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.

• The Korean Journal of Pain
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• 제14권2호
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• pp.214-217
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• 2001

Background: Intra-articular injection is a commonly performed procedure in patients with degenerative osteoarthritis of the knee. Several drugs are used for relief of pain in such cases. Local anesthetics, clonidine and steroids have been confirmed to be effective when used in an intra-articular injection. Ketorolac has recently become one of the most commonly used and potent NSAIDs. There have been many studies about the effect of ketorolac. Methods: Sixty-four patients were divided into 2 groups. In Group I (n = 31), 0.5% bupivacaine 3 ml and sodium hyaluronate 20 mg were used and in Group II (n = 33), 0.5% bupivacaine 3 ml, sodium hyaluronate 20 mg and ketorolac 5 mg were used. We observed the pain relief scale (PRS) at 15 minutes, 1 week and 1-3 months after injection. Results: After 15 minutes, PRS scores were $6.6{\pm}2.7$ (Group I) and $5.1{\pm}3.1$ (Group II), so there was a statistical difference between the two groups. After 1 week, the PRS scores were $5.9{\pm}2.0$ (Group I) and $5.8{\pm}2.4$ (Group II). At 1-3 months later, PRS scores were $5.6{\pm}3.0$ (Group I) and $5.1{\pm}2.7$ (Group II). Thus, there were no significant statistical differences between the two groups at 1 week or 1-3 months later, although some patients were more satisfied with pain relief in Group II at 1-3 months. Conclusions: Ketorolac provides more rapid pain relief of degenerative arthritis when used in intra-articular injection. And there was no statistical difference of effect after 1 week or 1-3 months later. Further studies are required on the effect of the intra-articular use of ketorolac.

• The Korean Journal of Pain
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• 제23권3호
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• pp.190-197
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• 2010

Background: Conventional spinal saddle block is performed with the patient in a sitting position, keeping the patient sitting for between 3 to 10 min after injection of a drug. This amount of time, however, is long enough to cause prolonged postoperative urinary retention. The trend in this block is to lower the dose of local anesthetics, providing a selective segmental block; however, an optimal dose and method are needed for adequate anesthesia in variable situations. Therefore, in this study, we evaluated the question of whether only 1 min of sitting after drug injection would be sufficient and safe for minor anorectal surgery. Methods: Two hundred and sixteen patients undergoing minor anorectal surgery under spinal anesthesia remained sitting for 1 min after completion of subarachnoid administration of 1 ml of a 0.5% hyperbaric bupivacaine solution (5 mg). They were then placed in the jack-knife position. After surgery, analgesia levels were assessed using loss of cold sensation in the supine position. The next day, urination and 11-point numeric rating scale (NRS) for postoperative pain were assessed. Results: None of the patients required additional analgesics during surgical manipulation. Postoperative sensory levels were T10 [T8-T12] in patients, and no significant differences were observed between sex (P = 0.857), height (P = 0.065), obesity (P = 0.873), or age (P = 0.138). Urinary retention developed in only 7 patients (3.2%). In this group, NRS was $5.0{\pm}2.4$ (P = 0.014). Conclusions: The one-minute sitting position for spinal saddle block before the jack-knife position is a safe method for use with minor anorectal surgery and can reduce development of postoperative urinary retention.