• The Korean Journal of Pain
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• 제12권1호
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• pp.108-113
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• 1999

Background: There is some concern that the administration of epidural analgesia for pain relief during labor increases the likelihood of cesarean delivery. But, several investigators showed a decrease in the rate of emergency cesarean delivery after epidural analgesia. The purpose of this study was to compare the emergency cesarean rate between the two groups with and without epidural analgesia. Methods: We reviewed retrospectively the medical records for 7846 parturients admitted our hospital between January 1, 1995 and December 31, 1996 and whose attending physician anticipated a normal labor and vaginal delivery. The number of parturients with epidural analgesia using 0.25% bupivacaine with fentanyl were 2839 and parturients without epidural analgesia were 5017. Results: An administration of epidural analgesia was not associated with the incidence of cesarean rate. 149 (5.25%) of 2839 parturients in epidural group and 371 (7.31%) of 5017 parturients in non-epidural group underwent emergency cesarean section. Conclusions: Our retrospective study has shown that an administration of epidural analgesia neither decrease nor increase in the rate of emergency cesarean delivery when compared with a non-epidural analgesia.

• The Korean Journal of Pain
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• 제8권2호
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• pp.244-250
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• 1995

Many clinical and laboratory experiments have been developed to prevent or decrease post-operative pain. One of these methods is pre-operative administration of opioid. Recently there have been differing and debatable results reported of pre-operative treatment for post-operative pain management. It was our study to determine whether pre-operative epidural fentanyl prevented central facilitation or wind up of spinal cord from nociceptive afferent input through c-fibers. We evaluated the effect of epidural fentanyl 50 mcg 10 minutes before operation and 10 minutes before the end of surgery. 28 parturient women for Cesarean Section were randomly allocated to receive the epidural fentanyl either at 10 minutes before operation (Group 1, n=14) or 10 minutes before the end of surgery (Group 2, n=14). All of the 28 parturient women were anesthetized with epidural block using (22 ml of) 2% lidocaine supplemented with light general anesthesia ($N_2O$ 2 L/min-$O_2$, 2 L/min), we controlled post-operative pain with epidural PCA(patient controlled analgesia) infusion of meperidine and 0.07% bupivacaine. The action duration of epidural fentanyl from the end of surgery to the first requirement of analgesics with epidural PCA were not significantly different between the two groups. No significant differences between two groups were observed in VAS pain score at 1, 2, 3, 6, 12, 24, and 48 hours after the operation. The number of self administration of narcotics with PCA during 48 hours after surgery were the same between the two groups. The hourly infusion rates of demerol were the same. Pre-operative administration of fentanyl was not clinically effective compared to administration just before the end of surgery for postoperative pain control.

• The Korean Journal of Pain
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• 제27권2호
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• pp.139-144
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• 2014

Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from $7{\pm}1.0$ at baseline to $3.6{\pm}1.4$ on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.

• The Korean Journal of Pain
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• 제6권2호
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• pp.220-223
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• 1993

Administration of local anesthetics or morphine through epidural space has the effect of curbing postoperative increases in endocrine hormone. Other benefits include improving metabolic reaction and eliminating postoperative pain. However, repeated administration of local anesthetics through epidural space causes tachyphylaxis, and the unstable blockade of sensory nerve resulting in insufficient analgesia. Morphine has excellent postoperative analgesic effect, but complications including: itching, nausea, vomiting, urinary retention and respiratory depression may be associated with its administration. Sixty patients that fall into the category of ASA class I and II were randomly selected for the purpose of the experiment. Thirty patients were give 4 mg of morphine and the rest, 4 mg of morphine plus 80 ml of 0.25% bupivacaine administered through epidural space with the Baxter infuser. Analgesic effect was satisfactory in both groups. On the day of operation, the effect was stronger in group I (P<0.05) and on postoperative second day, group II showed better analgesic effect (P < 0.05). Group II had more patients who complained of itching (P < 0.05). Other complications were statistically insignificant. The findings indicate that administration of morphine through epidural space for postoperative pain management is an effective procedure. Baxter infuser was found to be very instrumental in pain control while reducing the chance of complications.

• 대한수의학회지
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• 제31권4호
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• pp.519-522
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• 1991

Pain reflex and anesthetic state in swine with xylazine epidural anesthesia were observed. In xylazine epidural anesthesia, dosages of 0.50mg/kg BW for analgesia of perineal region and 0.7550mg/kg for analgesia of low abdominal wall were required. Regional anesthesia was induced 5~20 min after epidural injection of xylazine and recovered 90~120 min after administration. The results indicated that xylazine as an epidural local anesthetic was useful in swine.

• The Korean Journal of Pain
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• 제27권4호
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• pp.345-352
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• 2014

Background: Epidural administration of dexamethasone has been suggested for pain control after minor orthopedic surgery. This study was conducted to assess its efficacy after such surgery, combined or not to IV dipyrone, IV parecoxibe or their combination. Methods: 91 patients were randomly assigned to seven groups. Patients were submitted to spinal bupivacaine anesthesia combined to epidural administration of either 10 ml saline or 10 mg dexamethasone diluted to 10-ml volume. Patients also received 10 ml IV saline or 1 gr dipyrone and/or 40 mg parecoxibe diluted to 10 ml with saline. Control group (CG) received epidural and IV saline. Dexamethasone group (DexG) received epidural dexamethasone and IV saline. Dipyrone group (DipG) received epidural saline and IV dipyrone. Dex-Dip G received epidural dexamethasone and IV dipyrone. Parecoxibe group (ParG) received epidural saline and IV parecoxibe. Dex-ParG received epidural dexamethasone and IV parecoxibe. Finally, Dex-Dip-ParG received epidural dexamethasone and IV dipyrone plus IV parecoxibe. Results: The CG expressed 4h of analgesia and sooner requested pain killer. DexG was similar to DipG or ParG or Dex-ParG (7-hours), and they requested less ketoprofen compared to the CG (P < 0.05). However, the Dex-DipG and the Dex-Dip-ParG resulted in longer time to demand pain killer (17-hours) and less ketoprofen consumption in 24-hours (P < 0.002). Adverse effects were similar among groups. Conclusions: The analgesia secondary to epidural dexamethasone was enhanced by IV dipyrone, while no effects were observed by the addition of IV parecoxibe.

• The Korean Journal of Pain
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• 제9권1호
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• pp.69-74
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• 1996

Background: Efficacy of spinal opioids for the treatment of intractable cancer pain has been reported by several authors. The epidural route seems to be a more reliable and effective method of pain control as compared to the intrathecal route which can lead to opioids by portal system. Methods: Medical records were reviewed of 18 patients who had been treated with epidural morphine via an implanted port-A-Cath from Mar. 1991 to Sep. 1994. Results: Patients were treated for a mean of 92 days. There were wide variation of dose requirements. The minimum daily dose ranged from 2 to 10mg, and maximum daily dose from 3 to 30 mg. Verbal rating scale were below moderate until 100th days after posrtal implantation. When 3 patients suffered from aggravated pain associated with vertebral metastasis. Five of 11 patients who were administered medication longer than 50 days reguired increased doses ranging from 3 mg to 25 mg which were higher as compared to initial doses. These patients also experienced pain due to vertebral metastasis. There were no report of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockade. Conclusion: Continuous epidural morphine administration via Port-A-Cath is an effective method with minimal complication.

• The Korean Journal of Pain
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• 제20권2호
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• pp.123-129
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• 2007

Background: Postoperative pruritus following the administration of epidural narcotics is a very common and undesirable side effect. Therefore, we evaluated the use of a combination of naloxone and sufentanil via patient controlled epidural analgesia to determine if the incidence of pruritus was decreased when compared to the use of sufentanil alone. Methods: Patients scheduled for subtotal gastrectomy under general anesthesia were enrolled in a prospective, double-blinded and randomized trial. All patients received a $20{\mu}g$ epidural bolus of sufentanil in 5 ml of 0.2% ropivacaine. Following administration of the epidural, patients in the sufentanyl group (S) received a continuous epidural comprised of sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine, whereas patients in the naloxone group (N) received an epidural infusion comprised of naloxone ($4{\mu}g/ml$) and sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine. The infusion rate, demand dose and lockout interval were 5 ml/hr, 0.5 ml and 15 minutes respectively. Next, the occurrence of postoperative analgesia and side effects were evaluated by blinded observers. Results: The incidence of pruritus (47.4% versus 20.0%, P = 0.013) and nausea (42 .1 % versus 20.0%, P = 0.043) were lower in group N than in group S. In addition, there were no significant differences observed in the visual analogue scale, the incidence of vomiting or the incidence of sedation. Furthermore, epidural infusion of naloxone at $0.25-0.4{\mu}g/kg/hr$ did not affect the requirement for postoperative sufentanil. Conclusions: Epidural naloxone reduces epidural sufentanil induced pruritus and nausea without reversing its analgesic effects.

• The Korean Journal of Pain
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• 제2권1호
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• pp.97-99
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• 1989

Epidural block is used extensively in each of the fields of surgical anesthesia, obstetric anesthesia, and diagnosis and management of acute and chronic pain. New developments in the understanding of pain conduction have extended the use of continuous epidural blockade to the administration of drugs that selectively block pain conduction while leaving sensation and motor power essentially unchanged. The safety and the reliability of spinal epidural catheter techniques have permitted relief of acute and chronic pain. However, one of the important aspects of the management of the epidural catheter is the possibility of epidural infection. We have experienced a case of epidural infection during control of post-herpetic neuralgia and discuss management of the epidural catheter in this article.

• The Korean Journal of Pain
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• 제12권2호
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• pp.205-210
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• 1999

Background: Epidural morphine for postoperative pain control has a serious risk of respiratory depression and other side effects such as pruritus, nausea and urinary retention. In recent years, it is known that epidural administration of ketamine potentiates the effect of epidural morphine, and so decrease the side effects of epidural morphine. This study was performed to evaluate the analgesic efficacy of epidurally administered ketamine and whether this epidural administration can decrease the amount of epidural morphine. Methods: Sixty patients scheduled for the elective cesarean section were randomly selected. All patients were given subarachnoid injection of tetracaine 9 mg. Group I received epidural bolus injection of 0.15% bupivacaine 10 ml with morphine 2 mg followed by a continuous infusion of 0.125% bupivacaine 100 ml containing morphine 4 mg after peritoneum closure, and group II received the same method as group I except for the addition of epidural ketamine 30 mg. Analgesic effects were assessed using Numeric Rating Score (NRS) and Prince Henry Score (PHS). Also, the degree of satisfaction and the incidence of the side effects were observed. Results: Analgesic effects were significant in both groups after drug administration. But NRS and PHS were not significantly different between two groups at all times. The incidence of nausea and vomiting was 11 out of 30 in group I and 9 out of 30 in group II and the incidence of itching was 11 out of 30 in group I and 8 out of 30 in group II. Number of patients using additional analgesics were 2 and 1 in group I and II, respectively. Conclusions: Epidural ketamine did not potentiate the analgesic effect of epidural morphine and could not decrease the side effect of epidural morphine.