• The Korean Journal of Pain
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• v.11 no.2
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• pp.247-252
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• 1998

Background: Tonsillectomy is one of the most common operation in children. Postoperative pain and its sequelae are universal complaints of the patients. The purpose of this study was to evaluate the effects of nalbuphine on the posttonsillectomy pain in children. Methods: Fifty-four pediatric patients undergoing tonsillectomy under general anesthesia were randomly allocated to one of the 3 groups 1) control group who received no analgesics, 2) received IV nalbuphine before induction of anesthesia and 3) received IV nalbuphine after both tonsillectomy. In postanesthetic recovery room, comfort level in all patients was assessed using the objective pain scale (OPS). Systolic blood pressure, diastolic blood pressure and heart rate were measured at just before and immediately after extubation and postanesthetic recovery room. Results: The pain scale score in group 2 was significantly lower than group 1, but no significantly different with group 3. There were no significant differences in blood pressure among three groups. The heart rate in group 2 and 3 was significantly lower than group 1 only at immediately after arriving recovery room. Conclusions: Administration of nalbuphine before induction is more effective on postoperative pain control after tonsillectomy in children.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.178-182
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• 1996

Background: To evaluate the effect of prophylactic transdermal scopolamine in reducing nausea associated with postoperative epidural morphine. Methods: 30 healthy patients scheduled for cesarean section were given local anesthetics epidurally for surgical anesthesia. After delivery of the baby, transdermal scopolamine patch($Kimite^{(R)}$ Myung Moon Pharm. Co., Seoul, Korea) was applied to the study group(n=15) and placebo patch to the control group(n=15). Postoperative analgesia was provided soley with epidural morphine. Nausea was treated with metoclopramide. Results: During 24 hours postoperatively, the mean nausea score was significantly lower in the study group than in the control group. But the nausea incidence was not significantly different between the two groups. The mean number of times antiemetic drugs which were administered to patients were lower in the study group than in the control group($1.5{\pm}0.5$ vs $3.3{\pm}1.3$, p<0.05). Conclusion: Transdermal scopolamine patch provides antiemetic effect simply, continuously and safely, preventing nausea which could occur during administration of epidural morphine after cesarean section.

• The Korean Journal of Pain
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• v.24 no.1
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• pp.31-35
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• 2011

Background: Circumcision is a painful intervention frequently performed in pediatric surgery. We aim to compare the efficacy of caudal block versus dorsal penile block (DPNB) under general anesthesia for children undergoing circumcision. Methods: This study was performed between July 1, 2009 and October 16, 2009. Fifty male children American Society of Anesthesiolgists physical status classification I, aged between 3 and 12 were included in this randomized, prospective, comparative study. Anesthetic techniques were standardized for all children. Patients were randomized into 2 groups. Using 0.25% 0.5 ml/kg levobupivacain, we performed DPNB for Group 1 and caudal block for Group 2. Postoperative analgesia was evaluated for six hours with the Flacc Pain Scale for five categories; (F) Face, (L) Legs, (A) Activity, (C) Cry, and (C) Consolability. For every child, supplemental analgesic amounts, times, and probable local or systemic complications were recorded. Results: No significant difference between the groups (P > 0.05) was found in mean age, body weight, anesthesia duration, FLACC pain, and sedation scores (P > 0.05). However, on subsequent measurements, a significant decrease of pain and sedation scores was noted in both the DPNB group and the caudal block group (P < 0.001). No major complication was found when using either technique. Conclusions: DPNB and caudal block provided similar postoperative analgesic effects without major complications for children under general anesthesia.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.920-926
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• 1997

Remarkable effect of pain relief and prevention of the postoperative Complications after thoracotomy has been achieved by continuous intravenous analgesia. This study was carried out with thirty patients who underwent posterolateral thoraco tony. The patients were divided into three groups: Group I(n= 10), the patients with intermittent intramuscular analgesia(piroxicam 20 mg), Group II(n=10), the patients with continuous epidural analgesia(0.5% bupivacaine 30m1 + normal saline 30 ml + morphine 10 mg), and Group III(n= 10) the patients with controlled intravenous infusion of analgesics(fentanyl 2500 mfg +normal saline 10 ml). The results w re as follows; 1) There were no significant changes of vital signs, between groups. 2) Tidal volume and FVC were significantly improved in the group II and III compared with the group I during the first postoperative day. 3) A significant reduction of immediate post-thoracotomy pain was achieved in the group II and III compared with the group I. 4) The limitation of motion in the operative side was less in the group II and III compared with the group I. 5) A signi(icant reduction of the postoperative analgegics consumption was noticed in group II and III. 6) Significant complications were not occured during follow-up period in all groups.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.151-158
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• 1996

Background: Buprenorphine, a new synthetic thebaine derivative, is a partial agonist of the opioid $\mu$-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continuous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc, in spite of effective postoperative analgesia. Methods: The present study was undertaken to compare the analgesic properties and side effects of continuous epidural infusion of buprenorphine combined with bupivacaine, and morphine combined with bupivacaine in 90 patients following elective gynecologic lower abdominal surgery. At the end of surgery, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B group) combined with 0.25% bupivacaine 10ml, and subsequent continuous infusion doses were 6 mg morphine plus 0.125% bupivacine 100 ml (M group) and 0.6mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B, group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room, 1 hr, 4 hr, 8 hr, 24 hr, 36 hr, and 48 hr after the epidural injection. Results: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group (P<0.05), and the number of patients requiring additional analgesics was significantly higher in the 0.15B group than in the M group and 0.3B group (P<0.05). Signs of respiratory depression were not noted, and the incidence of pruritus, nausea, and vomiting was slightly lower in the 0.15B group and 0.3B group than in the M group, and the incidence of sedation and urinary retention was similar in three group. The subjective rating of satisfaction was better in the 0.3B group than in the M group and 0.15B group (P<0.05). Conclusion: The above results suggest that continuous epidural infusion of buprenorphine combined with low-dose bupivacaine is an advisable method of postoperative analgesia.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.203-207
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• 1997

Background: To date, there are no controlled studies assessing the effect of metoclopramide administered epidurally to prevent nausea and vomiting associated with epidural morphine for postoperative analgesia. This study was undertaken to determine the effectiveness of continuous epidural infusion of metoclopramide, combined with epidural morphine, in reducing nausea or vomiting associated with epidural morphine and minimizing the side effects of metoclopramide. Methods: Sixty patients undergoing elective gynecologic surgery were randomly assigned to one of two study groups. Patients received continuous epidural morphine infusion (6.0 mg/day) following a bolus loading dose of 3.0 mg (Group A), or epidural mixture of morphine (6.0 mg/day) plus metoclopramide (20 mg/day) following a bolus loading dose (morphine 3.0 mg, metoclopramide 10 mg)(Group B). For the first 24 postoperative hours, incidence of nausea or vomiting, need for antiemetic therapy, level of sedation, degree of pain and pruritus, and adverse effects associated with metoclopramide were evaluated. Result: Incidence of nausea or vomiting and number of patients who required antiemetic therapy were significantly less in Group B, than in Group A (P<0.05). There were no significant differences between groups with regard to adverse effects associated with metoclopramide such as sedation, extrapyramidal reaction and other side effects (P=NS). Conclusion: We conclude simultaneous titration of morphine and metoclopramide via epidural continuous infusion following epidural bolus injection of the mixture reduces nausea or vomiting associated with epidural morphine while preventing side effects of metoclopramide.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.14 no.3
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• pp.315-322
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• 2007

Purpose: The purpose of this study was to examine the effect of three kinds of modes using bolus button of PCA on level of pain and side effects of analgesic and amount of drug consumption in post-operative patients according to whether the medication is controlled by the patient, the caregiver or the nurse. Method: The participants were 684 patients using PCA after an operation. The data collection period was from March 19 to April 6, 2007. Results: It was found that there were statistical differences in gender, age, type of surgery, pain on first post-operative day, amount of drug consumption, nausea, and vomiting. The ratio for patient controlled medication was 55.7% for women, and 70.5% for men, and for care-giver controlled medication, 35.1% for women, and 20.0% for men. Average pain scores for the first post-operative day were $3.9{\pm}2.2$ for patient controlled medication and $4.5{\pm}2.3$ for care-giver controlled medication. There were statistical differences according to mode used for PCA for amount of drug consumptions, nausea and vomiting but not for pain, operation day or pruritus. Conclusion: This study was carried out to examine risks according to who controls the PCA for post-operative patients. The results can help to develop education program for everyone who is involved in PCA, patients, caregivers, nurses and doctors.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.31-36
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• 1995

Post-tonsillectomy pain in children is a difficult problem to manage. We examined the effect of 10% aerosol lidocaine for the post-tonsillectomy analgesia. ASA physical status I or II, between five and thirteen years of age were assigned, in a randomized fashion, into two groups. The Group I, 30 patients, received a total dose of 4 mg/kg of ten percent aerosol lidocaine on the tonsillar beds. Lidocaine was administered at the end of the surgical procedure. The Group II, 30 patients, were not sprayed with lidocaine aerosol. The postoperative pain scores were assessed by a "red and white" visual analoge pain scales (VAPS). VAPS values were obtained at one and eight hours after the operation. Values of one hour after the operation in the group I and II were $20.83{\pm}10.01$ and $34.50{\pm}10.53$, values of eight hours after the operation were $17.33{\pm}9.07$ and $23.5{\pm}11.08$. The post-tonsilectomy pains were significantly lower in the group I compared with the group II at one and eight hours after the operation. In conclusion, 4 mg/kg of ten percent aerosol lidocaine applied directly on the tonsillar beds was showen a superior, immediate post-tonsillectomy analgesic technique.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.74-79
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• 1988

Caudal narcotic analgesia was assesses after the injection of 3mg morphine diluted in 30ml (physiologic) saline into the sacral canal in 15 Patients after upper abdominal surgery, in 20 patients after lower abdominal surgery under general anesthesia, and in 20 patients after perianal surgery under caudal block. Pain relief was evaluated by the subsequent need for systemic analgesics. All eases had considerable relief from pain an4 the morphine was effective for 12 or more hours. There were no significant differances between pain relief of the upper abdominal and lower abdominal surgery group, upper abdominal and perianal surgery group, and lower abdominal and perianal surgery group (p>0.05, p>0.05, p>0.05). It is suggested that the morphine, which was administered into the sacral, cannal, reached the subarachnoid space and produced it's effect by direct action on the specific opiate receptors in the substantia gelatinosa of th.8 posterior horn cell of the spinal cord. Consequently, whether analgesia from epidural narcotics appears to be segmental in distribution or not is still in controversy.