• The Korean Journal of Pain
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• 제8권1호
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• pp.93-98
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• 1995

Arthritis is one of the most common disease of mankind. Major of arthritis is osteoarthritis(OA), but the cause is not clear and the characters are chronic and often progressive. So the management and the pain control of OA are very difficult and adequate ways of controlling it have not been discovered. In the present study we investigated the effects of Knee Intra-articular Injection(KII) of lidocaine with aspirin on OA of the knee. Thirty OA patients with Visual Analogue Scale(VAS) above 8 were studied and they were divided into two groups as follows; Group I(n=15); KII with 1% lidocaine 5 ml Group II(n=15); KII with 2% lidocaine 2 ml and aspirin 2 ml(180 mg, diluted with normal saline) In two groups, KII was done 2 times a week for 4 weeks and we compared the changes of VAS between two groups. The results were as follows; 1) Before the KII, initial mean VAS of group I and II was 8.8 and 8.9. After KII 2 times, VAS of group I and II was 6.6 and 6.4. These deceases were statistically significant, but there was no significant difference of VAS between two groups. 2) After KII 4 times, VAS of group I and II was 6.3 and 5.5, significant decrease was observed in group II. 3) After KII 6 times and 8 times, VAS of group I and II was not decreased anymore, but the VAS of group II was maintained in significant decreased state that of group I. We experienced that KII of lidocaine with aspirin was more effective than that of lidocaine only. So we suggest that KII of mixed solution of lidocaine and apsirin may be one of treatments for OA of the knee.

• The Korean Journal of Pain
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• 제8권1호
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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.

• The Korean Journal of Pain
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• 제10권2호
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• pp.170-178
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• 1997

Background: The analgesic efficacy and safety of propacetamol, an injectable prodrug of acetoaminophen, in combination with intravenous morphine PCA were studied in 40 patients after gynecological surgery requiring lower abdominal incision. Methods: Using a double-blind, randomized, parallel-group design, the effects of four(every 6 hr) intravenous injections of 2 g propacetamol(=1 g acetoaminophen) were compared with four injections of placebo(PL) immediately after surgery. Efficacy of cumulative dose of morphine and number of boluses requested was assessed over 24 hours by automated recording on the PCA device. It was assessed on pain scores rated on a ten-point verbal scale along with vital signs, $K^+$, glucose, BUN, creatinine, PT and PTT were measured along with stress hormones(epinephrine, norepinephrine and cortisol). Results: There were no differences in demographic data between two groups. Propacetamol group demonstrated approximately 21% morphine sparing effect compared to placebo group($33.1{\pm}10.4$ mg vs $41.4{\pm}8.0$ mg). No significant differences noted in $K^+$, glucose, BUN, Creatinine, PT and PTT levels. There were significant increases in norepinephrine and cortisol in placebo group postoperatively, compared to preoperative values. At the same time, propacetamol group also showed significant changes in these hormones. Both group revealed high degree of patient satisfaction. Conclusion: Propacetamol showed significant morphine sparing effect to some degree. Side effects were much less in propacetamol group with subsequently high patient satisfaction. The secretion of stress hormone were not blocked by postoperative propacetamol injections. Authors concluded that propacetamol should be considered as an excellent adjuvant analgesics in postoperative pain control in opioid patient controlled analgesia.

• The Korean Journal of Pain
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• 제10권2호
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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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• 제12권1호
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• pp.70-74
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• 1999

Background: Preemptive analgesia has been suggested recently as an another technique of postoperative pain control. Combination of low dose opioid and NSAIDs was used to lessen systemic opioid side effect, however, the use of NSAIDs may hinder their side effects in perioperative period. The local application of small dose at the target site can be effective without systemic effect. The aim of this study is evaluating the additive effect and side effect of transdermal piroxicam as preemptive adjuvant to intravenous nalbuphine on pain relief after major abdominal surgery. Methods: We reviewed the records of patients received piroxicam patch for preemptive analgesia before operation and compared it with control group. Two sheets of piroxicam patch to the skin incision site for 12 hours before operation were attached (Group 1, n=20) and no patch were applied (Group 2, n=20). Both groups were received nalbuphine continuously after operation using two days infuser (2 ml/hr) containing 80 mg (96 ml). Pain is evaluated by VAS score at each time; 30 min, 1, 6, 12, 24, 36, 48 hours after operation and side effects of NSAIDs were observed for 3days postoperatively. Results: There was no significant VAS score difference between two groups following time in progress. And no significant side effect was noted in both groups, either. Conclusion: There is no preemptive or synergistic analgesic effect of piroxicam patch attached at planned operation site before operation.

• The Korean Journal of Pain
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• 제12권1호
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• pp.95-100
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• 1999

Background: About 75% of terminal cancer patients have severe pain. For the treatment of these patients, physicians usually use potent opioid analgesics. But many of the cancer patients were not controlled by IV or IM injection of opioids. In spite of the untreatable nature of the patient's illness, they should be hospitalized only for pain control. In that case, epidural opioid injection is one of the most effective methods in pain management. Methods: We retrospectively analyzed 126 terminal cancer patients who were treated with epidural morphine for pain management from 1993-97. In the routine procedure, an epidural catheter was inserted into the epidural space and tunnelled subcutaneously, exiting out from the anterior chest or abdomen. Morphine was used as the main analgesic and Multiday Infusor$^{(R)}$ (Baxter, 0.5 ml/h) as a continuous infusion system. Results: 1. Mean treatment time was 55 days (range; 3~373). 2. Mean daily epidural start mg dose of morphine was 8 mg (range; 2~20). 3. Mean daily dose at termination was 19 mg (range; 4~60) 4. 94 patients were controlled with continuous infusion but 32 patients needed additional bolus doses of morphine. 5. heter-associated subcutaneous infection occurred in 2 patients (1.6%). Conclusion: Terminal cancer pain management administered by a tunnelled epidural catheter is a simple, inexpensive method with a very small rate of infection.

• The Korean Journal of Pain
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• 제12권1호
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• pp.48-53
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• 1999

Background: Despite the popularity of epidural bupivacaine-morphine infusions for postoperative pain management, the optimum concentrations and dosages of bupivacaine have not been determined. At present, due to the disadvantages conferred by intense motor block and the increased risk of toxicity, many trials focus on reducing bupivacaine concentration and thus the evaluation of concentrations less than 0.1% may be warranted. Methods: Forty patients having epiduro-general anesthesia for hysterectomy were randomly assigned to one of two study groups. As a mean of postoperative pain control, all received 2 mg of epidural morphine bolusly 1 hr before the end of surgery and continuous epidural infusion was started using a two-day Infusor containing 4 mg of morphine in 100 ml of 0.125% bupivacaine (Group 0.125B, n=20) or 100 ml of 0.0625% bupivacaine (Group 0.0625B, n=20). Study endpoints included visual analog scales (VAS) for pain during rest and movement, sensory change and motor blockade. They were assessed at 2, 4, 8, 16, 24, 32, 40 and 48 hrs postoperatively. Results: For VAS during rest, no significance could be found between two groups over the course of study. But for VAS during movement, the 0.125B group showed more satisfactory results especially during early postoperative periods. For the incidence of complications, the 0.125B group revealed greater frequency of sensory change (25.0%) and motor blockade (10.0%) compared with the 0.0625B group. Conclusion: This study suggests that 0.0625% bupivacaine with morphine via epidural route was sufficient for pain control during rest but it was not satisfactory during movement especially in early postoperative periods. We also recommend that careful attention to motor blockade should be paid when using 0.125% bupivacaine.

• The Korean Journal of Pain
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• 제2권2호
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• pp.145-154
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• 1989

Pain is a common and important clinical symptom, and treatments aimed at relieving pain have a central position in medical practice. Recently Transcutaneous Electrical Nerve Stimulation (TENS) has been effectively used to control acute and chronic conditions that produce pain. But the mechanism of analgesia resulting from TENS remains obscure. In order to investigate the analgesic effect of TENS and it's action mechanism, TENS was applied in 40 rabbits with different frequencies, low frequency (2Hz) and high frequency (100Hz), for 20 minutes. And the pain threshold was measured by the temperature before and after stimulation, and an attempt was made to antagonize the stimulation effect with naloxone pretreatment (0.4 mg/kg) The results are as follows: 1) Both low frequency and high frequency TENS resulted in increasing the pain threshold significantly (Both p<0.01). 2) Naloxone pretreatment could antagonize the effect of increasing the pain threshold with low frequency TENS significantly (p<0.01), but not with high frequency TENS. Plasma beta-endorphin was measured by radioimmunoassay using an Beta-Endorphin Kit (Immunonuclear Corporation, Stillwater, Minnesota, USA) and Automatic Gamma Scintillation Counter (Micromedic System 4/2000) before and after stimulation. An attempt was made to reverse the stimulation effect with naloxone pretreatment (0.4 mg/kg). The results are as follows: 1) Low frequency TENS resulted in increasing the level of plasma beta.endorphin significantly (p<0.01), but high frequency TENS did not. 2) Naloxone pretreatment could reverse the effect of increasing the plasma beta-endorphin level with low frequency TENS significantly (p<0.01).

• The Korean Journal of Pain
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• 제28권1호
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• pp.22-31
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• 2015

Background: The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors. Methods: Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed. Results: Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable. Conclusions: The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.

• Journal of Pharmaceutical Investigation
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• 제36권4호
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• pp.253-262
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• 2006

This study was performed to investigate the effects of treatment for dermatitis using the herbal gel preparations. Scutellariae Radix(SR) and Zingiberis Rhizoma(ZR) were used for the purpose of herbal preparations. Baicalin, baicalein are the ingredients of SR, having biological effects like anti-inflammatory, anti-oxidative, anti-bacterial and antiallergic action. 6-Gingerol is one of the ingredients of ZR having biologicai effects like anti-inflammatory and analgesic action. The three types of hydrogels(SRE, SRH, SZH) were formulated with Carbopol 940, Labrasol, Triethanolamine etc. Baicalin was hydrolysed to baicalein by $\beta$-glucuronidase for the purpose to increase rate of skin permeation. Content of ingredients by HPLC determination, rate of skin permeation using Franz type diffusion cell, anti-oxidative activity for the free radical, hydroxyl radical, superoxide, anti-inflammatory by using carrageenan injection, efficacy on the dermatitis induced by 2,4-dinitro-chlorobenzene(DNCB) were experimented. Baicalein showed higher permeability than baicalin, so it is considered that baicalein was more suitable form than baicalin for transdermal absorption by its lipophilic property. In the anti-oxidative experiments, SZH gel was the most effective scavenging activity than the other gels in all experiments. In anti-inflammatory test, SRM and SZH gel more decreased edma rapidly than SRE gel. In case of using SZH gel, treatment period for the dermatitis was more declined than that of other gel groups. These results suggests that the SZH hydrogel could be suitable preparations for the treatment of dermatitis.