• The Korean Journal of Pain
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• v.20 no.1
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• pp.50-53
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• 2007

Background: Continuous epidural catheterization is a popular and effective procedure for postoperative analgesia. However, continuous epidural catheterization has associated complications such as venous puncture, dural puncture, subarachnoid cannulation, suboptimal catheter placement, and paresthesia because the tip of the epidural catheter touches thenerves of the dura in the epidural space. In this study, we compared the incidence of paresthesia in two different lengths of epidural catheter insertion. Methods: One hundred women undergoing gynecologic or orthopedic surgery were enrolled in this prospective, double-blinded, randomized study. All patients were randomly divided into two groups based on the insertion length of the epidural catheter 2 cm (group A) or 4 cm (group B). A Tuohy needle was inserted in the lumbarspinal region with a bevel directed cephalad by use of the median approach, and then the epidural space was confirmed by the loss of resistance technique with air. While the practitioner inserted an epidural catheter into the epidural space, a blind observer checked for paresthesia or withdrawal movement. Results: In 97 included patients, 30.6% of the patients in group A (n = 49) had paresthesia, versus 31.3% in group B (n = 48). Withdrawal movements were represented in 2% and 6% of the patients in group A and group B, respectively. There was no difference in the incidence of paresthesia and withdrawal movement between the two groups. Conclusions: There is no clear relationship for the incidence of catheter-related paresthesia according to the catheter length inserted into the epidural space for epidural analgesia.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.42-47
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• 1997

Background : This study was designed to evaluate the continuous effects of single intravenous injection of antiemetics on nausea and vomiting during continuous morphine injection for postoperative pain control. Methods : Prior to the study, we divided patients into two major groups according to the type of surgery performed intra-abdominal(Open: O) and non intra-abdominal(Close: C). When patients regained orientation after routine general anesthesia, enflurane-$O_2-N_2O$, we injected bolus dose of morphine and started continuous injection of morphine for postoperative pain control(Group I; Control). After bolus injection and just before continuous injection, we injected single dose of droperidol(Group II) or ondansetron(Group III). Mean arterial blood pressure, heart rate, pain score and symptom-therapy score were checked at 10 minutes, 4, 8, 16, 24, 36 hours after continuous morphine injection. Results : The pain score of group III was lower than group II(10 min.) and group I(24, 36 hours) in the open group. Symptom-therapy score of group III(10 min., 4, 24 hours) and group II(10 min.) were lower than group I in the open group. In the close group, symptom-therapy score of group III(8 hours) was lower than group I. Conclusions : Single intravenous injection of antiemetics have a tendency of lowering symptom-therapy score for 36 hours in spite of their relatively short elimination half-life.

• The Korean Journal of Pain
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• v.23 no.3
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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.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.37-42
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• 1995

The intermittent injection of analgesics is a inadquate method for postoperative pain control. Recently a non-electroic, disposable and portable infusor (Boxter Two Day $Infusor^R$) has been developed which can deliver analgesics with 2 ml/h speed continuousely. The present study examined the effects of three methods of pain management on recovery in 306 patients undergoing elective surgery in Wonkwang University Hospital. Group 1 (n=106) received i.m. $Valentac^R$ on a PRN basis. Group 2 (n=100), initial 2 mg of bolus morphine was followed by 48 mg of continuous infusion. Group 3 (n=100), initial 2 mg of morphine followed by morphine 18 mg-ketorolac 120 mg. We evaluated an analgesic efficacy with NRS (numerical rating scale) at 12, 24, 36, 48, 60 and 72 hours after the operation. The side effects (nausea, vomiting, pruritus, sedation and respiratory depression) were evaluated. In group 1, we asked major concern before operation and efficacy of pain control with pain severity (no pain, mild pain, moderate pain, sever pain). The results were as follows: 1) Major concern before operation is pain (40%). 2) 53% of patients suffered pain in group 1. 3) Morphine and morphine-ketorolac infusion groups were superior to the i. m. ($Valentac^R$) group with respect to postoperative analgesia. 4) In group 3 (morphine-ketorolac), there was no pruritus and mild nausea and vomiting.

• Journal of Korean Biological Nursing Science
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• v.19 no.2
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• pp.86-97
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• 2017

Purpose: Postoperative nausea and vomiting (PONV) is very common among postoperative orthopedic surgical patients with patient-controlled analgesia (PCA), especially for narcotics. Therefore, the purpose of this study was to investigate the effects of an evidence-based PONV management protocol on nursing and patient outcomes. Methods: A methodological study was conducted to develop PONV protocol and a quasi-experimental study to evaluate the effectiveness of protocol. The preliminary PONV protocol was drawn by conducting a systematic review and by reviewing clinical guidelines and best practice recommendations. Validation of the content was done by expert clinicians, and the clinical applicability was evaluated by staff nurses and patients. The effect was evaluated in clinical outcomes associated with PONV and nursing outcomes. Results: In the experimental group, the occurrence of vomiting (z= 2.147) was significantly decreased, the maintenance PCA (${\chi}^2=4.212$) and the satisfaction of patients (z= 5.007) were significantly higher. In the outcomes of nurses, the PONV knowledge of nursing care (z = 3.791), awareness (z = 2.982) and self-efficacy (z= 2.745) were higher in the experimental group. The attitude towards evidence-based nursing practice (z= 2.446) was significantly positive. Conclusion: The results show that an evidence-based approach to the implementation of PONV care is effective in improving patient clinical outcomes and quality of care.

• The Korean Journal of Pain
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• v.26 no.1
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• pp.32-38
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• 2013

Background: Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods: Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the $1^{st}$, $3^{rd}$, $7^{th}$ and $30^{th}$ postoperative days were determined from medical records. Results: Intrathecal morphine administration for $46.0{\pm}61.3$ days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the $7^{th}$ and $30^{th}$ postoperative days compared to the $1^{st}$ postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions: Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.

• The Korean Journal of Pain
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• v.32 no.2
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• pp.87-96
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• 2019

Background: This study was performed in order to examine the effect of intrathecal sec-O-glucosylhamaudol (SOG), an extract from the root of the Peucedanum japonicum Thunb., on incisional pain in a rat model. Methods: The intrathecal catheter was inserted in male Sprague-Dawley rats (n = 55). The postoperative pain model was made and paw withdrawal thresholds (PWTs) were evaluated. Rats were randomly treated with a vehicle (70% dimethyl sulfoxide) and SOG ($10{\mu}g$, $30{\mu}g$, $100{\mu}g$, and $300{\mu}g$) intrathecally, and PWT was observed for four hours. Dose-responsiveness and ED50 values were calculated. Naloxone was administered 10 min prior to treatment of SOG $300{\mu}g$ in order to assess the involvement of SOG with an opioid receptor. The protein levels of the ${\delta}$-opioid receptor, ${\kappa}$-opioid receptor, and ${\mu}$-opioid receptor (MOR) were analyzed by Western blotting of the spinal cord. Results: Intrathecal SOG significantly increased PWT in a dose-dependent manner. Maximum effects were achieved at a dose of $300{\mu}g$ at 60 min after SOG administration, and the maximal possible effect was 85.35% at that time. The medial effective dose of intrathecal SOG was $191.3{\mu}g$ (95% confidence interval, 102.3-357.8). The antinociceptive effects of SOG ($300{\mu}g$) were significantly reverted until 60 min by naloxone. The protein levels of MOR were decreased by administration of SOG. Conclusions: Intrathecal SOG showed a significant antinociceptive effect on the postoperative pain model and reverted by naloxone. The expression of MOR were changed by SOG. The effects of SOG seem to involve the MOR.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.106-113
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• 2021

Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander. Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups. Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar. Conclusions: The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.54-57
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• 1997

Background : The tonsillar region is innervated by the sensory components of the glossopharyngeal nerve(IX) which communicates with certain part of cervical sympathetic ganglion. Some authors suggest stellate ganglion block(SGB) is effective for treatment of recurrent tonsillitis. The goal of this study was to evaluate the effect of SGB in controlling pain after tonsillectomy. Methods : Forty five patients, evaluated to ASA class 1 and 2, scheduled for tonsillectomy under general anesthesia were randomly assigned to 1 of 3 groups (group I: control; group II: SGB with 1% lidocaine 5 ml; group III: SGB with 2% lidocaine 2.5 ml plus 0.5% bupivacaine 2.5 ml), SGB was performed at the end of surgery. Postoperative pain was assessed with Numeric Rating Scale(NRS) NRS assessment was made 30, 60, 90 min, 2 h, 4 h, 24 h, 48 h after tonsillectomy. Results : Pain scores, after 30 min in group II, III and 60, 90 min in group III were significantly lower than group I(p<0.05). Conclusions : We found SGB was effective in controlling pain after tonsillectomy but further studies are required needs to prolong duration of relief..

• The Korean Journal of Pain
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• v.14 no.2
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• pp.171-175
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• 2001

Background: This purpose of this study is to compare the analgesic efficacy, occurrence of motor block and other side effects of 48 hr continuous postoperative epidural infusions with 0.125% ropivacaine with fentanyl or 0.15% ropivacaine with fentanyl. Methods: Forty patients undergoing Cesarean section were randomly allocated into two groups. Both groups received epidural injection of 2.0% lidocaine 19 ml and 0.75% ropivacaine 2-5 ml with fentanyl $50{\mu}g$ for 20 minutes before surgery. Following surgery, a continuous epidural infusion using a two- day infusor was given for 40 minutes for post-operative pain control. Group 1 (n = 20) then received 0.125% ropivacaine and 6 ug/ml of fentanyl at a rate of 2 ml/h. Group 2 (n = 20) received 0.15% ropivacaine and 6 ug/ml of fentanyl at the same rate. Visual analog scales (VAS) for pain during rest and movement, sensory change and motor blockade were assessed for 48 hr after surgery. Results: There were no significant differences in VAS for pain during rest or movement. The incidence of side effects was similar in both groups. Conclusions: Using 0.125% ropivacaine with fentanyl via an epidural route provided similar pain relief and side effects as 0.15% ropivacaine with fentanyl.