• 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.

• 대한간호학회지
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• 제27권2호
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• pp.401-410
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• 1997

An acute pain is the common experience following surgery. Pain is a most miserable experience in person and most preoperative patients have fear o! postoperative pain. In nursing, it is very important to understand and relieve the pain of post oprative patients as much as possible. This study was designed to compare the descriptive patterns of pain between group of Patient Controlled Analgesia and group of traditional Muscular Injection in surgcal patients. This information can be utilited as data of understanding nursing care and treatment planning for pain in surgical patients. The subjects in this study were 45 post-hysterectomy patients in Gynecology ward in C. N. U. H., in Taejon. Data was collected from May 12 to June 27. 1996. The instrumants used for this study were subjective Visual Analog Scale, Objedive nonverbal pain scale composed of Facial Apperance. Vocal Sound Change, and Sweating score. and the Melzack's Mcgill pain Qusetionaire. nine Items of Developmental Pain Intensity Scale by Lee En Ok. Analysis of data was done by using S. P. S. S. percentage, t-test, x²-test. ANOVA, and Repeated measure ANOVA. Results were obtained as follows. 1. Hypothesis 1 : There was very highly statistically significant difference in subjective self-report pain score(Visual Analog Scale) between PCA Group and IM Group(P=0.0001). 2. Hypothesis 2 : There was very highly statistically significant difference in muscle strength score (Visual Analog Scale) between PCA Group and IM group(P0.0001). 3. Hypothesis 3 : There was very highly statistically significant difference in facial appearance score between PCA Group and IM group(P=0.0001). 4. Hypothesis 4 : There was very highly statistically significance difference in vocal sound change score between PCA Group and IM group(P=0.0001). 5. Hypothesis 5 : There was no statistically significant difference sweating scores between PCA group and IM group(F=2.50, P=0.1220). But, postoperation time of 12, 24 was statistically difference between two groups(P=0.0001). So, it was partially supported. 6. Hypothesis 6 : There was very highly statistically significant difference in vocabulary pain score between PCA Group and IM group. 7. Hypothesis 7 : There was very highly statistically significant difference in amounts of total analgesic between PCA Group and IM group. There was very highly statistically significant difference in Visual Analog Pain Score, Facial Appearance Score, Vocal Sound Change Score, Vocabulary Score, amounts of total analgesic between PCA group and IM group. So, It is verified to asses of postoperative pain with VAS, Checklist of facia appearance, vocal sound change, and sweating, and Vocabulary Scale.

• The Korean Journal of Pain
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• 제9권1호
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• pp.145-150
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• 1996

The purpose of this study was to evaluate and compare the effectiveness of ilioinguinal-hypogastric nerve blocks(IHNB) and caudal block in producing post-orchiopexy and post-heniorrhaphy analgesia in children. Forty consenting healthy children, ages 3~10yr, were randomly assigned to receive caudal bupitvacaine (0.125%, 0.5ml/kg), or IHNB bupivacaine (0.25%, 0.3 ml/kg). Blocks were performed following the induction of general anesthesia, be fore the operation. Pre-anesthetic medication in form of atropine 0.01 mg/kg, droperidol 0.05 mg/kg were given intramuscularly one hour before induction to 40 children. Children were induced with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously. Anesthesia was maintained with oxygen-nitrous oxide ($FiO_2$ 0.3) and ethrane. When the patients stabilized after induction. IHNB was done in the supine position and caudal block was done in the lateral position. The local anaesthetic was injected after negative aspiration. Postoperative pain was assessed with face pain rating scale (RPRS) at rest on discharge of recovery room, and 5 hours after discharge of recovery room, and the "red and white" visual analogue scale (VAS) at rest and mobilization from supine to sitting position on discharge of recovery room, and 5 hours after discharge of recovery room. Post-operative recovery was quiet and comfortable, without side effect. Relief of ain was complete in both IHNB group and caudal group. Surgeons, parents and recovery room personnel were satisfied. There were no surgical or anesthetic complications. In our study, the postpoerative pain scores were similar in both IHNB group and caudal group. IN conclusion, we found that both IHNB and caudal blocks before the start of surgery for orchiopexy & herniorrhaphy are safe and effective in controlling the postoperative pain of children.

• Journal of Korean Neurosurgical Society
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• 제66권6호
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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.

• Journal of Chest Surgery
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• 제42권2호
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• pp.233-237
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• 2009

배경: 하지정맥류의 외래수술을 위한 마취로 Bupivacaine에 fentanyl을 첨가하여 시행한 척추마취가 적당한지 알아보고자 하였다. 대상 및 방법: 척추마취를 이용하여 하지정맥류 수술을 받은 30명을 대상으로 하였다. 척추마취제로 bupivacaine 4mg과 fentanyl 25ug을 사용한 군(FB4군)과 bupivacaine 8mg을 사용한 군(B8군)으로 분류하였다. 두 군 간 적정한 마취유지, 수술중 심혈관계 합병증, 감각 및 운동차단회복시간, 수술 후 합병증을 비교 분석하였다. 결과: 마취성공은 두 군 간 통계적으로 차이가 없었다(13 of 15 [FB4군], 15 of 15 [B8군]). 두 군 모두 수술 중 통증 때문에 전신마취로 전환은 없었다. 수술 중 치료가 필요한 심혈관계 합병증은 두 군 모두에서 없었다. Modified Bromage scale로 측정한 척추마취 후 두 시간째 수술측과 비수술측 운동차단정도는 FB4군에서 통계적으로 유의하게 낮았다(p<0.05). 척추마취로부터 감각 및 운동차단회복은 FB4군이 B8군보다 유의하게 빨랐다(p<0.05). 맘대로소변보기는 통계적으로 유의한 차이는 없었으나(6.5시간 대 4.5시간 [p=0.143]) 배뇨 장애로 넬라톤 카테터를 삽입한 경우는 B8군에서는 2예 있었고 FB4군에서는 없었다. 결론: bupivacaine 4mg과 fentanyl 25ug을 이용한 척추마취는 수술 중 심혈관계의 안정성이 유지되고 적당한 감각차단이 이루어지고 수술 후 운동차단 시간을 감소시켜 빠른 보행이 가능하여 하지정맥류 외래수술에 적당한 마취방법이라고 생각된다.

• 대한정형외과학회지
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• 제53권6호
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• pp.513-521
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• 2018

목적: 본 연구는 상지 수술에서 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술의 유용성 및 합병증을 조사하기 위해 시행하였다. 대상 및 방법: 2017년 3월부터 2017년 5월까지 총 103건에서 초음파 유도 액와 상완 신경총 차단술을 시행하였다. 초음파 및 프로브는 Siemens Acuson X300의 VF13-5 transducer를 사용했다. 수술 부위가 차단한 신경의 해부학적 감각 분포 범위에 포함되는 경우 대상에 포함하였으며, 다발성 손상으로 2시간 이상의 수술 시간이 예상되는 경우와 상완부의 수술은 제외했다. 술기는 lidocaine HCl 2% 20 ml, ropivacaine 0.75% 20 ml, 0.9% normal saline 10 ml로 조성된 50 ml의 혼합액으로, 2명의 정형외과 의사에 의해 동일한 방법으로 시행되었으며, 술기의 성공률(수술 시 마취 유도 상태 여부), 마취 유도 시간(천자침 제거 후 근력과 감각이 모두 소실될 때까지의 시간), 가능한 상지 수술 범위, 수술 후 무통 지속 시간(완전 마취 유도와 수술 후 수술 부위 통증 발생까지의 시간) 및 합병증을 조사하였다. 결과: 술기를 시행한 2명의 의사 간 결과값의 차이는 없었다. 초음파 유도 액와 상완 신경총 차단술에 소요된 needling time은 평균 5.5분(2.5-13.2분), 완전 마취 유도에 걸린 시간은 평균 18.4분(5-40분)이었으며 103명의 환자 중 100명에서 마취가 성공하여 97.1%의 성공률을 보였다. 무통 지속 시간은 평균 402.8분(141-540분)이었다. 마취 후 1예에서 어지러움, 4예에서 구역, 구토 증상을 보였고, 2예에서 입 주변이 얼얼한 증상을 보였으나 7예 모두 당일 완전히 호전되었으며, 총 103예 중 3예에서는 마취 실패로 수술실에서 2예에서 국소 마취제를 추가 투여하였고, 1예에서 전신 마취로 전환하여 수술을 하였다(3예/103예, 2.9%). 결론: 일부 주관절을 포함한 상지 수술에서 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술은 빠르고 쉽게 마취를 가능하게 하여 수술 대기 시간을 줄일 수 있으며 높은 마취 성공률을 얻을 수 있게 하고 용량 선택적 마취가 가능하게 하는 안전한 술기로 판단된다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권3호
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• pp.129-135
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• 2020

Background: Postoperative fluid retention is a factor that causes delay in recovery and unexpected adverse events. It is important to prevent intraoperative fluid retention, which is putatively caused by intraoperative release of stress hormones, such as ADH (anti-diuretic hormone) or others. We hypothesized that intraoperative analgesia may prevent pathological fluid retention. We retrospectively explored the relationship between analgesics and in-out balance in surgical patients from anesthesia records. Methods: Anesthetic records of 80 patients who had undergone orthognathic surgery were checked in this study. Patients were anesthetized with either TIVA (propofol and remifentanil) or inhalational anesthesia (sevoflurane and remifentanil). During surgery, acetated Ringer's solution was infused for maintenance at a rate of 3-5 ml/kg/h at the discretion of the anesthetist. The perioperative parameters, including the amount of crystalloid and colloid infused, and the amount of urine and bleeding were checked. Furthermore, we checked the amount and administration rate of remifentanil during the surgical procedure. The correlation coefficient between the remifentanil dose and the in-out balance or the urinary output was analyzed using the Pearson correlation coefficient. The contributing factor to fluid retention, including urinary output, was statistically examined by means of multivariate logistic regression analysis. Results: A significant positive correlation was found between remifentanil dose and urinary output. Urinary output less than 0.04 ml/kg/min was suggested to cause positive fluid balance. Although in-out balance approaches zero balance with increase in remifentanil administration rate, no contributing factor for near-zero fluid balance was statistically picked up. The remifentanil administration rate was statistically picked up as the significant factor for higher urinary output (> 0.04 ml/kg/min) (OR, 2,644; 95% CI, 3.2-2.2 × 10⁶) among perioperative parameters. Conclusions: In conclusion, remifentanil contributes in maintaining the urinary output during general anesthesia. Although further prospective study is needed to confirm this hypothesis, it was suggested that fluid retention could be avoided through suppressing intraoperative stress response by means of appropriate maintenance of remifentanil infusion rate.

• Journal of Chest Surgery
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• 제55권2호
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• pp.118-125
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• 2022

Background: A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program. Methods: Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1-3, 4-6, and 7-9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters. Results: In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1-3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4-6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7-9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7-9 months post-ERATS (p=0.06). Conclusion: The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.

• Clinics in Shoulder and Elbow
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• 제15권1호
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• pp.1-7
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• 2012

목적: 사각근간 상완 신경총 차단 하 회전근 개 복원술 후 다중 통증 조절법을 통한 초기통증 조절의 유용성을 확인해 보고자 하였다. 대상 및 방법: 회전근 개 전층 파열로 관절경 하 회전근 개 복원술을 시행한 80명의 환자들을 대상으로 하였다. 전례에서 술 전 마취로 사각근간 상완 신경총 차단을 시행하였고 수술 후 견봉하 공간에 Bupivacaine 유치 도관을 통한 일회성 통증 조절만 시행한 A군 (Group A : Local analgesia group)과 유치 도관 주사에 추가하여 경구 약물로 아편양 제재, 아세트아미노펜-트라마돌 복합제, 선택적 COX2 억제제를 사용하는 다중 통증 조절법을 시행한 B군 (Group B : Multimodal control group)으로 나누어 비교하였다. 수술 당일 야간, 술 후 1, 2, 3일 및 술 후 2주의 주간과 야간의 통증 점수 (visual analogue scale, VAS), 입원 중 추가 투여한 ketolorac 주사의 횟수와 약물과 관련된 부작용에 대해 비교, 분석을 하였다. 결과: 수술 당일 야간, 술 후 1, 2, 3일, 술 후 2주의 주간 및 야간의 평균 VAS는 A군에서 각각 7.4점, 7점/6.8점 (주/야), 4.5점/5.2점, 4.8점/5.0점, 2.2점/2.7점 이었으며 B군에서 각각 6.5점, 4.3점/5.4점, 3.2점/4.3점, 3.0점/4.1점, 2.4점/2.5점으로 수술 당일 야간과 수술 후 1,2,3일의 주간통 및 술 후1일의 야간통에서 각각 유의한 감소를 보였다 (p<0.05). A군과 B군의 하루 당 평균 ketolorac 투여 횟수는 각각1.1회, 0.5회였고 부작용의 차이는 없었다. 결론: 관절경적 회전근 개 복원술 후 다중 통증 조절법을 통한 초기 통증 조절은 효과적인 진통조절을 보여 환자의 만족도를 높일 수 있는 방법으로 생각되었다.