• The Korean Journal of Pain
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• v.19 no.2
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• pp.192-196
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• 2006

Background: Epidural opioids are commonly used for postoperative analgesia. However, the side effects of epidural opioids include respiratory depression, sedation, pruritus, nausea, vomiting and urinary retention. Meperidine, due to its intermediate lipid solubility and local anesthetic properties, permits postoperative analgesia. The aim of this study was to compare meperidine alone to meperidine coupled with bupivacaine, and to determine the effects of epidural meperidine without bupivacaine, when used for epidural analgesia following hepatectomy abdominal surgery. Methods: Patients received thoracic epidural analgesia with meperidine alone (3.5 mg/ml in saline) or with additional bupivacaine (0.15%) for 2 days after surgery. Postoperative pain was assessed using a visual analog scale (VAS) pain score 2 days after the operation, with the incidence and dose supplementation also evaluated. Postoperative side effects were assessed using a 3 grade system. Results: No significant difference was found between the two groups in terms of age and weight, or in the pain scores, side effects, incidence and dose supplementation. Conclusions: 3.5 mg/ml epidural meperidine at a dose of 2 ml/hr provides effective postoperative analgesia.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.188-192
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• 1994

Recently, epidural morphine has been administrated to decrease patients' systemic stress responses such as: suffers, endocrine responses and impairment of pulmonary function, etc. Epidural morphine provided excellent analgesic effect, but incomplete sensory blockade as compared to epidural local anesthetics, which has sympathetic blockade effect and tachyphylaxis. Therefore, the authors surmised that low dose bupivacaine on low dose epidural morphine improved postoperative pain with greater sensory analgesia than epidural morphine alone. The effect of low dose bupivacaine on epidural morphine analgesia for postoperative pain was evaluated in seventy patients. They were physical status I-III by ASA classification. Patients were randomly divided into 2 groups and they were administrated morphine 2.5 mg only (group I), morphine 2.5 mg plus 0.125% bupivacaine (group II) through epidural catheter 1 hour before the end of the operation. During postoperative second days, their analgesic effects were evaluated by visual analogue scale (0-10). Side effects were also evaluated. The results were as follows, 1) On the day of the operation, VAS score showed significant differences between two groups (morphine group $3.20{\pm}0.16$, morphine plus bupivacaine group $2.77{\pm}0.08$; p < 0.05). 2) On the postoperative and second day, there were no statistical differences between the groups according to VAS score. 3) The incidence of pruritus, nausea, and vomiting were no differences in both groups. 4) None of the patients showed objective sedation or a low respiratory rate (< 10 bpm). We concluded that epidural administration of low dose bupivacaine on the epidural morphine analgesia was an effective method to decrease postoperative pain with little change in frequencies of side effects compared to epidural morphine alone.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.68-75
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• 2001

Background: Thoracotomy is the operation that produces the most postoperative pain, necessitating the highest requirements for postoperative analgesics. The common methods of treating postthoracotomy pain are the use of thoracic epidural analgesia, intemittent or continuous intercostal nerve blocks, intravenous narcotics and cryoanalgesia. We designed to assess the analgesic effect of epidural analgesia, cryoanalgesia and the combined analgesia in thoracic surgery. Methods: A prospective study was carried out in 59 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: C (cryoanalgesia), CE (cryoanalgesia and thoracic epidural analgesia), E (epidural analgesia). All patients had standard anesthesia with endotracheal intubation using a double lumen endotracheal tube, and one-lung ventilation. Subjective pain relief was assessed on a visual analog scale. Analgesic requirements, complications and the degree of satisfaction were evaluated during the 7 days following surgery. Results: Subjective pain relief was significantly better in Group CE and Group E in comparison with Group C (P < 0.05). Cryoanalgesia provided a better pain score on the 6th and 7th POD than the early postoperative periods. Analgesic requirements were higher in Group C than in the Group CE and Group E during the first POD. The incidence of side effects was similar in Group CE and Group E. Conclusions: If we can reduce the concentration of fentanyl and local anesthetics in combined analgesia of epidural and cryoanalgesia, the disadvantages of each method would be overcome and would be a better method of postthoracotomy pain control.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.268-272
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• 1998

Background: Postoperative bleeding is a common complication in transurethral resection of prostate (TURP). Some patients become restless and combative after operation, particularly when in pain, producing bleeding from the prostatic bed. So many patients may be necessary to pain control for reduce bleeding. The purpose of this study is to compare recently used two Methods for post-operative analgesia. Methods: We studied 40 patients, ASA physical staus 1, 2, undergone TURP under general anesthesia. The patients divided into two groups: continuous epidural pain control group (I, n=20) received an epidural bolus of morphine 2 mg and 1% lidocaine 10 ml followed by a epidural 0.08% bupivacaine 40 ml and morphine 4.5 mg (basal infusion rate 0.5 ml/hr), intravenous patient-controlled analgesia (IV-PCA) group (II, n=20) received an intravenous bolus of fentanyl $50\sim100{\mu}g$ followed by a IV-PCA morphine 30 mg, ketorolac 180 mg and droperdol 2.5 mg (basal infusion rate 0.5 ml/hr, bolus 0.5 ml, lock-out interval 15 min). This study conducted the analgesic efficacy, side effect and patient's satisfaction for 1 day after TURP. Results: Continuous epidural pain control group had more significant analgesia than IV-PCA at postoperative 30, 60 min, but no significant difference was observed later in both group. Nausea and pruritus were scantly developed in both group but the incidence was no significant differeance. Patients responded good satisfaction over 70% in both group. Conclusions: Postoperative continuous epidural pain block and IV-PCA are both effective Methods of postoperative pain control with lower incidence of side effects.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.363-367
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• 1996

Background: Recently postoperative pain control with continuous epidural analgesia has been increased. This study aimes to evaluate backpain following continuous epidural analgesia by pressure threshold meter (algometer). Methods: After informed consent, 50 ASA physical status I or II patients undergoing elective gynecologic surgery were selected. After placing epidural catheter, patients received morphine 0.05mg/kg with 0.25% bupivacaine 5 ml followed by continuous infusion of 0.125% bupivacaine 100 ml with morphine 4 mg for 48 hours. backpain was measured by pressure algometer over lumbar paraspinalis at the L4 level, 5 and 7 cm from the midline on preoperative, operation day, 1st, 2nd, 3rd, and 4th postoperative days. Results: Postoperative mean pressure thresholds of were higher than preoperative value (p<0.05). Conclusion: The continuous epidural analgesia dose not provide or aggravate postoperative backpain, but it must be evaluated for long term follow-up.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.368-373
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• 1996

Background: The purpose of this study was to determine whether there is any advantage for a continuous background infusion during patient controlled epidural analgesia(PCEA) for postoperative pain control. Methods: 60 patients scheduled for elective cesarean section under epidural anesthesia were assigned randomly in a double-blind fashion to receive fentanyl and bupivacaine by PCEA with or without background infusion for 48 hours postoperatively. Results: Total amount of fentanyl and bupivacaine consumption and degree of sedation were not significantly different between the two groups. Visual analogue scale(VAS) pain scores at 24, 36, and 48h and sleep disturbance were significantly lower in background infusion group. Conclusion: Administration of fentanyl with bupivacaine by continuous background infusion is appropriate for PCEA for postcesarean section pain control.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.191-195
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• 1997

Backgound: The present study was undertaken to determine whether fentanyl or bupivacaine is a better adjuvant to epidural morphine with respect to postoperative analgesic use and with fewer incidence of side effects. Methods: We evaluated the clinical effects in 62 patients having cesarean section, divided in 3groups randomly. Group I(n=19) was received epidural morphine 4 mg, group II(n=22) was received epidural morphine 2 mg plus fentanyl 50 ${\mu}g$ and group III(n=21) was received morphine 2 mg plus 0.25% bupivacaine 10 ml epidurally. We measured the first request time of analgesic for postoperative pain, the number of supplemental analgesics within 24 hours and the incidence of side effects postoperatively. Results: The first request time of analgesic for postoperative pain was significantly shorter in group III than in group I and II. The analgesic use in the first 24 hours was significantly more in group III than in group I and II. The side effects were significantly fewer incidence in group II than in group I and III. Conclusions: In conclusion, the combined use of epidural morphine and fentanyl provided better analgesia than the combined of epidural morphine and bupivacaine.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.192-198
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• 1988

Sixty patients, of ASA physical status class I for elective operations in the lower abdomen, perineum, or lower extremities, were studied in a comparative prospective trial to evaluate the efficacy of epidural morphine and ketamine for postoperative analgesia. They were divided into two groups: an epidural morphine sulfate group (EMS group; 30 patients), and an epidural ketamine hydrochloride group (EKH group; 30 patients). Indwelling epidural catheters were placed in the patients' lumber areas (L3-4) and then all patients were anesthetized with thiopental, nitrous oxide, and halothane. After the patients had fully recovered from the anesthesia, the analgesic agents were administered epidurally via the catheter when the patients complained of pain in the postoperative period. The groups were given either 0.1 mg/kg of morphine sulfate or 0.5 mg/kg of ketamine hydrochloride administered in a volume of 10 ml of normal saline. Patients were observed for the onset and duration of postoperative analgesia and for other effects. Total doses were $5.7{\pm}0.6\;mg$ of morphine sulfate in the EMS group and $27.9{\pm}3.3\;mg$ of ketamine hydrochloride in the EKH group. The onset of analgesia was detectable within 35 min.($23.5{\pm}6.3$ min) in 86.7% (26 cases) of the EMS group and within 10 min. ($7.8{\pm}3.7$ min.) in 76.7% (23 cases) of the EKH group. Mean duration of postoperative analgesia was $22.3{\pm}2.1\;hr$. in the EMS group. In the EKH group, the duration of analgesia was shorter and variable, the range of duration was from 2 hr. to 24 hr., Cardiopulmonary changes were statistically insignificant ih both groups. Side effects such as nausea, vomiting, urinary retention, pruritus, dizziness, and headache were observed in EMS group. In the EKH group, there was no discomfort except dizziness (3 cases) and headache (1 case). Epidural ketamine was a safe technique for postoperative analgesia, but because of the variability and relative shortness in the duration of analgesia the use of this technique will require further clinical trials.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.185-190
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• 1997

Background: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of altered central processing which amplifies postoperative pain. A controversy exists over the effectiveness and clinical value of preemptive analgesia. We studied whether epidural bupivacaine and fentanyl prior to surgery could possibly affect postoperative pain and analgesic demands, as compared to administration of same at end of surgery. Methods: Forty patients scheduled for lower abdominal surgery were randomly assigned to one of two groups and prospectively studied in a double-blind method. Group 1(n=20) received epidural injection of 15 ml bupivacaine 0.25% with fentanyl 100 y g before surgery while group 2(n=20) received the same injection at the end of their surgery respectively. Postoperative analgesia consisted of basal plus patient-controlled mode of epidural bupivacaine and fentanyl from PCA system. Postoperative visual analog pain scores(VAPS), analgesics consumption, supplementary analgesics requirement and side effects were assessed for 3 postoperative days. Results: There were no significant difference in analgesics requirement and pain scores, at any time, during rest or after movement, in measurement between the groups. Conclusions: We conclude no clinical value of effectiveness in administering epidural bupivacaine-fentanyl before surgery as compared to administration after surgery.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.91-95
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• 1998

Background: Quality of postoperative care may be improved by management of postoperative pain. Epidural anesthesia and analgesia have several advantages over general anesthesia and parenteral analgesics in managing the postoperative pain. We retrospectively reviewed records of obstetrical patients who underwent the cesarean sections under epidural anesthesia to evaluate perioperative analgesic use, side effects, and complications. Methods: All patients received epidural anesthesia consisting of 0.25% bupivacaine, 2% lidocaine and 100 ${\mu}g$ fentanyl, followed by epidural analgesia with 0.1% bupivacaine and 12.5 ${\mu}g$/ml fentanyl at rate of 2 ml/hr for 48 hours. Patients' records were reviewed for: medications administered for pain relief, incidence of nausea and vomiting and pruritus, and presence of respiratory or cardiovascular depression. Results: Over 18 months, 1,054 patients' records were reviewed. Average age was 27.8 years (18~43 years). 768 patients (72.9%) received no additional drugs for the pain relief. Intramuscular analgesics, ketoprofens, were one time administered to 247 patients (23.4%), 39 patients (3.7%) received two more dosages. The time of administration was $8.3{\pm}4.3$ hours postoperatively. Antiemetics, for example, low-dose droperidol, were administerd one time for 160 patients (15.2%), 5 patients (0.5%) received two or more administrations. The medication was administered $5.1{\pm}4.2$ hours postoperatively. Drugs for relief of pruritus, low-dose naloxone, were administered one time for 108 patients (10.2%), 10 patients (0.9%) received 2 or more dosages. The time of administration was $6.3{\pm}4.2$ hours postoperatively. None of the patients experienced cardiovascular nor respiratory (<8 breath/min) depression. Conclusions: Postoperative continuous epidural analgesia in combination with bupivacaine and fentanyl is an effective method of providing postoperative analgesia with low incidence of side effects.