• The Korean Journal of Pain
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• 제19권2호
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• pp.187-191
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• 2006

Background: Patient-controlled epidural analgesia (PCEA), using a local anesthetic-opioid mixture, has been effectively applied after total knee replacement (TKR) surgery, which is associated with intense postoperative pain that requires postoperative analgesia for both rehabilitation and the pain itself. However, adverse opioid-related effects, such as nausea, vomiting and pruritus, are commonly encountered. It was our hypothesis that the adverse opioid-related effects could be reduced by the addition of naloxone, an opioid antagonist, to a mixture of fentanyl-ropivacaine PCEA. Methods: In 120 patients undergoing elective TKR surgery, epidural or combined spinal-epidural (CSE) anesthesia was performed and PCEA applied. In the control group (n = 65), 0.16% ropivacaine and $3{\mu}g/ml$ fentanyl ($2.4{\mu}g/ml$ for those older than 65 yrs) were administered. In the naloxone group (n = 55), naloxone ($2{\mu}g/ml$) was coadministered with the above regimen. The incidence and severity of postoperative nausea and vomiting, and the frequency of pruritus, the visual analog score (VAS) and the PCEA volume used were assessed 6 and 24 hrs after surgery. Results: The incidence of nausea and vomiting during the early postoperative period, and those of pruritus during the late postoperative period were significantly lower in the naloxone group. The VAS pain scores, the PCEA volume used and amount of rescue IV meperidine were similar in the two groups. Conclusions: A small dose of naloxone mixed with an opioid significantly reduces the incidence and severity of adverse opioid-related effects in PCEA, without reducing the analgesic effect.

• The Korean Journal of Pain
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• 제30권4호
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• pp.287-295
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• 2017

Background: Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. Methods: We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. Results: Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05). Conclusions: Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management.

• Journal of Chest Surgery
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• 제32권6호
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• pp.495-503
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• 1999

배경: 본 연구에서 저자 등은 태아양 모델을 이용하여 태아 심폐우회술의 기술적인 측면에서의 가능성을 실험하고 심폐우회술과 관계된 태아의 혈역학과 태반기능에 관한 기초자료를 얻고자 하였다. 대상 및 방법: 제태기간 120~150일 되는 11마리의 태아양을 이용하여 정중흉골절개하에 주폐동맥과 우심이에 각각 12 G, 14~18 F 크기의 도관을 삽관하여 30분 동안 심폐우회술을 시행하였다. 어미양은 케타민 정주를 이용한 전신마취를 시행하였고 태아양에 대하여는 근육이완제만을 사용하였다. 실험군을 롤러펌프와 인공 막성산화기(Micro-safe, Polystan 회사제, 덴마아크)를 이용한 군(8마리, 산화기군)과 바이오펌프(Bio-pump, Bio-Medicus 회사제, 미국)와 태반을 산화기로 이용한 군(3마리, 태반군)으로 이분하여 혈류, 태아 혈역학 및 태반기능을 관찰하였다. 결과: 태아양의 평균체중은 3.6$\pm$1.3(1.9~5.2) kg이었다. 산화기군에서 심폐기 가동 중에는 평균동맥압 69.8~82.6 mmHg, 평균동맥혈산소분압치 201.7~220.9 mmHg, 평균심방압 4.1~4.3 mmHg, 평균심박동수 169~182 /min, 평균혈류 140.3~164.0 ml/kg/min로 유지되었으나 체외순환을 정지하는 순간부터 급격한 심기능 및 가스소견의 악화가 관찰되어 평균동맥압 29.0~57.4 mmHg, 평균동맥혈이산화탄소분압치 61.9~77.1 mmHg 등이었다. 태반군에서는 심폐우회 시작 직후 평균 44.7 mmHg에서 14.4 mmHg로 급격한 혈압 강하가 관찰되었고 이때 혈류는 평균 74.3~97.0 ml/kg/min 였다. 가스소견 역시 평균동맥혈이산화탄소분압치와 pH가 각각 평균 61.9~129.6 mmHg, 6.7~6.8이었으며 체외순환 정지후에는 심실세동으로 혈역학 측정이 불가능하였다. 결론: 연구자 등은 본 연구를 통하여, 비록 태아의 장기생존을 위한 태아 혈역학의 유지 및 태반혈류의 확보에는 어려움을 겪었으나 양모델을 이용한 실험적 태아 심폐우회술을 시도하여 태아 심장수술의 기술적인 측면에서의 가능성을 확인하였다. 향후 프로스타글란딘 억제제의 추가, 태아에 전척추마취의 적용, 펌프의 개선 및 순환회로의 축소화 등의 수정된 태아 체외순환에 관한 연구가 계속되어야 할 것으로 사료된다.