• Archives of Plastic Surgery
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• v.47 no.4
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• pp.324-332
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• 2020

Background The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction. Methods A 7-year retrospective cohort study (2008-2015) of a single-surgeon's DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression. Results The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients' mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001). Conclusions Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

• Korean Journal of Clinical Pharmacy
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• v.28 no.4
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• pp.279-284
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• 2018

Objective: To compare the analgesic effects and adverse drug reactions (ADRs) of fentanyl intravenous patient-controlled analgesia (ivPCA) with nefopam, a centrally acting analgesic agent with demonstrated opioid sparing activity, as compared to ketorolac in a tertiary teaching hospital. Methods: A retrospective evaluation of electronic medical records was conducted on patient records including either nefopam or ketorolac with opioid ivPCA for post-operative pain management in general surgery department from January to December 2014. The status of pain control and ADRs were collected. Results: Out of 6,330 general surgery cases, nefopam was given in 153 prescriptions (6.9%) and ketorolac in 81 prescriptions (3.6%). The level of pain control was not different between two groups (70.9% vs. 75.3%; p = 0.51), but ADRs were more frequently reported in nefopam group (9.8% vs. 2.5%; p < 0.05). New ADRs of hot flushes (n = 1) and paresthesia in hands (n = 1) were reported in nefopam group and they were unlisted in the approved package insert. No serious ADRs were reported in both groups. Conclusion: Our findings presented that nefopam showed a similar analgesic effect and higher ADR rates compared to ketorolac as an adjuvant to fentanyl iv PCA for post-operative pain management in general surgery patients in South Korea.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.652-663
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• 2023

Objective : This study compared the quality of recovery (QoR) after minicraniotomy for clipping of unruptured intracranial aneurysms (UIAs) between patients with and without scalp nerve block (SNB). Methods : Patients were randomly assigned to the SNB (SNB using ropivacaine with epinephrine, n=27) and control (SNB using normal saline, n=25) groups. SNB was performed at the end of surgery. To assess postoperative QoR, the QoR-40, a patient-reported questionnaire, was used. The QoR-40 scores were measured preoperatively, 1-3 days postoperatively, at hospital discharge, and 1 month postoperatively. Pain and intravenous patient-controlled analgesia (IV-PCA) consumption were evaluated 3, 6, 9, and 12 hours and 1-3 days postoperatively. Results : All QoR-40 scores, including those measured 1 day postoperatively (primary outcome measure; 155.0 [141.0-176.0] vs. 161.0 [140.5-179.5], p=0.464), did not significantly differ between the SNB and control groups. The SNB group had significantly less severe pain 3 (numeric rating scale [NRS]; 3.0 [2.0-4.0] vs. 5.0 [3.5-5.5], p=0.029), 9 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.048), and 12 (NRS; 3.0 [2.0-4.0] vs. 4.0 [3.0-5.0], p=0.035) hours postoperatively. The total amount of IV-PCA consumed was significantly less 3 hours postoperatively in the SNB group (2.0 [1.0-4.0] vs. 4.0 [2.0-5.0] mL, p=0.044). Conclusion : After minicraniotomy for clipping of UIAs, SNB reduced pain and IV-PCA consumption in the early postoperative period but did not improve the QoR-40 scores.

• Women's Health Nursing
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• v.20 no.2
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• pp.173-183
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• 2014

Purpose: This study was done to examine current status of women's health nursing practicum and identify necessary core nursing skills in this practicum area. Moreover, one syllabus and evaluation sheets for women's health nursing clinical practicum at one university were reviewed. Methods: A survey design was used with 81 educators who were teaching maternity or women's health nursing and its practicum. Results: Most clinical sites for practicum were university hospitals (43.0%), women's hospitals (32.7%), or general hospitals (17.3%); but the majority (77.8%) of educators expressed difficulty in finding appropriate practicum places. Common teaching and learning methods were clinical guides for practicum (44.6%), e-learning content (30.2%), and simulation (23.6%). Core nursing skills for this practicum included assessment of stages of labor, preparation of uterine-fetal monitoring devices and interpretation of results, monitoring uterus and fetal activity, and performing Leopold's maneuver. For postpartum care, the following were included; postpartum fundal massage, assessment of breast engorgement, fundus height, and episiotomy sites, inserting urinary catheter, and teaching the use of patient-controlled analgesia. Conclusion: To improve the quality of clinical practicum, development of a clear course syllabus, standardized clinical guidebook, and core nursing skills is required and should be shared with all relevant nurse educators.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.138-141
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• 2005

Background: There have been many attempts to alleviate pain after surgery, but there is no common approach to the control of postoperative pain. The use of epidural opioids, with local anesthetics, has been a widely employed formula to date. Ketamine, an N-methyl-d-aspartate receptor antagonist, has an excellent analgesic effect. Although there have been many reports on the dose and route of administrating analgesics, there have been few concerning the continuous epidural infusion of ketamine with fentanyl. We designed this study to find the effects of ketamine compared to those of epidurally injected bupivacaine and fentanyl, and used this trial to study any potential side effects. Methods: In a double blind trial, 55 patients received either fentanyl, $0.3{\mu}g/kg/h$ (Group F), or fentanyl, $0.3{\mu}g/kg/h$, and ketamine, 0.1 mg/kg/h (Group FK), added to 0.125% bupivacaine, at rates as high as 2 ml/h, for patient controlled epidural analgesia (PCEA) following a transabdominal hysterectomy. Ten minutes before the operation, patients received 10 ml of 0.125% bupivacaine, with either 0.5 mg/kg ketamine or the same amount of normal saline with $50{\mu}g$ fentanyl added. The pain scores and the side effects were recorded at 1, 3, 6 and 24 hour post operation. Results: There were no differences in the pain scores or side effects between the two groups. Conclusions: We failed to find any effect of the addition of epidural ketamine compared to the that of the bupivacaine and fentanyl formula. However, it is suggested that further investigations will be required on the dose and route of administration.

• Women's Health Nursing
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• v.10 no.2
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• pp.128-135
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• 2004

Purpose: Women who undergo gynecological surgery have moderate and severe sensation and distress of pain despite the advent of patient controlled analgesia (PCA). The purposes of this study were to describe perception of non-pharmacological therapy for postoperative pain control and examine changes of pain sensation and distress in women who had gynecological surgery. Method: The sample consisted of 52 women who were having gynecological surgery. Subjects who agreed to participate in the study were asked for their opinion about non-pharmacological approaches for postoperative pain control using a structured study questionnaire. Pain sensation and distress were assessed by VAS in the morning and afternoon for 2 days following the surgery. Result: About 50% of the subjects thought that non-pharmacological methods such as relaxation, music, massage, or meditation would be helpful for their postoperative pain control. If both pharmacological and non-pharmacological therapy were given for pain control, 96% of subjects reported it would be effective. Nurses can apply techniques of relaxation, deep breathing, meditation, and music therapy to surgical patients along with PCA. Expected sensation and distress of pain was high, but pain levels gradually decreased over time. However, subjects experienced moderate levels of pain postoperatively although they used PCA. Conclusion: The effect of a combined method of pharmacological and non-pharmacological approach needs to be tested if postoperative pain is to be decreased more.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.235-240
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• 1998

Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of CNS and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative intravenous morphine could affect postoperative pain and change plasma cortisol and serum glucose levels. Methods: Thirty eight patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. Control group (n=11) did not received intravenous morphine, preoperative group (n=13) received intravenous morphine (0.1 mg/kg as a bolus 10 min before operation and followed by 1.5 mg/hr for 10 hours), postoperative group (n=14) received the same doses and method of intravenous morphine of preoperative group postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative visual analogue scores (VAS), analgesic requirement (first request time, total amounts used), side effects, plasma cortisol and serum glucose levels were compared. Results: VAS were different between control group and the other two goups, but were not different between preoperative and postoperative group. Total amounts of used fentanyl were not different among groups, but first request time were significantly delayed in the preoperative group compared with the other two groups ($66.2{\pm}33.9$ vs $39.0{\pm}15.4$ and $45.0{\pm}14.9$ min respectively, p<0.05). Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Above dosage of preoperative and postoperative morphine has analgesic effect, but could not block surgical stress induced plasma cortisol and serum glucose increase.

• The Korean Journal of Pain
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• v.22 no.3
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• pp.234-240
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• 2009

Background: The purpose of this study was to compare the analgesic effect of 0.25% and 0.5% levobupivacaine for real time ultrasound guided single-injection femoral nerve block for the patients who are undergoing bilateral total knee arthroplasty (TKA). Methods: Femoral nerve block was done to all patients with 20 ml of 0.9% normal saline on one leg and 20 ml of 0.25% levobupivacaine on the other leg for group I (n = 16) and 0.5% levobupivacaine for group II (n = 15) with 1:200,000 epinephrine and using real-time ultrasound and a nerve stimulator. The data concerning the verbal numerical rating scale (VNRS) for each leg, the consumption of the intravenous patient-controlled analgesia (IV PCA) and the demands for the additional analgesics was collected at 0, 1, 6, 12, 24 and 48 hours after the operation. Results: The legs on which femoral nerve block was done with levobupivacaine showed a lower VNRS score than the legs with normal saline in either group I or group II. The VNRS scores between the two legs, the consumption of the IV PCA and the demand for additional analgesics showed no significant differences between the groups. Conclusions: Our results demonstrate that single-injection femoral nerve block using real-time ultrasound with either 0.25% levobupivacaine or 0.5% levobupivacaine 20 ml provides a good effect for the postoperative pain control after TKA.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.9-15
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• 2011

배경: 술 후 통증은 술 후 합병증의 발생가능성을 증가시키며 생체기능의 회복을 방해한다. 술 후 통증을 효과적으로 조절하기 위해선 통증의 정도를 객관적으로 평가하는 것이 필요하다. 술 후 통증은 수술의 침습도와 관련이 높을 가능성이 많다. 본 연구에서는 수술 침습도의 정도와 술 후 통증의 정도 사이의 상관관계를 확인하고자 한다. 방법: 총 153명의 환자를 수술의 침습도에 따라 4개의 그룹으로 나누었다(그룹 1: 악성종양 수술 (malignancy surgery), 그룹 2: 양악수술(bimaxillary surgery), 그룹 3: 양성 종양수술(benign cancer surgery) 그룹 4: 임플란트 & 골절 수술(implant & frature)) 수술이 끝나갈 무렵 fentanyl 700 ${\mu}g$, ketorolac 1,500 mg (총 용적 120 ml)가 포함된 자가통증조절장치를 정맥로에 연결하였다. 술 후 통증의 정도는 시각통증등급(visual analogue scale)을 이용하여 측정하였고 자가통증조절장치의 총 사용시간, 투여된 진통제의 양, bolus 투여 총 횟수를 측정하였다. 결과: 술 후 시각통증등급은 술 후 1일부터 3일까지 그룹 1, 2 군에서 유의하게 높았다. 또한 시각통증등급 3점 이상의 통증을 호소하는 환자의 비율 역시 그룹 1, 2 군에서 유의하게 높았다. 진통제 총 투여용량 및 자가로 주입한 진통제의 양 역시 그룹 1, 2군에서 3, 4 군에 비해 유의하게 높은 것을 확인하였다. 결론: 본 연구결과 외과적 수술의 침습도가 술 후 통증의 정도를 결정하는데 있어 중요한 요소임 을 확인하였다.

• Korean Journal of Clinical Pharmacy
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• v.28 no.2
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• pp.81-87
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• 2018

Objective: There have been many cases of spontaneous adverse drug reactions to fentanyl at a regional pharmacovigilance center in the hospital. To assess the factors causing the adverse drug reactions reported in patients receiving fentanyl patient-controlled analgesia (PCA) monotherapy or in combination with fentanyl transdermal therapeutic system (TTS) for acute post-operative pain management. Methods: We conducted a retrospective cohort study with all patients prescribed fentanyl PCA for pain management after orthopedic surgery at a single university hospital from June 2012 to May 2013. We analysed the factors causing adverse drug reactions reported by a spontaneous reporting system in patients receiving fentanyl PCA monotherapy and those receiving fentanyl TTS in combination with fentanyl PCA. Results: Based on the spontaneous adverse drug reaction reporting, the risk ratio for the incidence rate of adverse drug reaction in the fentanyl TTS combination therapy group was 3.04 (95 % CI: 2.4-4.00, P < 0.0001), which was approximately 3-fold higher than that reported for fentanyl PCA monotherapy. Only 60 % of the adverse drug reactions were reported. Conclusion: It is inappropriate to add fentanyl TTS to fentanyl PCA to manage post-operative acute pain. There is a need to improve adverse drug reaction reporting. We expect that regular analysis of adverse drug reactions reported at regional pharmacovigilance centre would aid in appropriate drug utilization by patients.