• Journal of Dental Anesthesia and Pain Medicine
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• 제20권5호
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• pp.313-323
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• 2020

Background: Previous studies have investigated the effects of dexamethasone injections into the pterygomandibular space and compared them to those of controls; however, the effects of dexamethasone injections before and after lower third molar surgery on postoperative complications have not been studied. This research investigated the postoperative sequelae of dexamethasone injections before and after surgery into the pterygomandibular space. The aim of this study was to evaluate the effects of preoperative and postoperative injections of 4 mg of dexamethasone into the pterygomandibular space on postoperative pain, facial swelling, and the restriction of mouth opening following lower third molar surgical removal. Methods: Twenty-seven participants with bilateral symmetrical lower impacted third molars were included in this study. Each participant was randomly allocated to one of two groups. Group A received injections of 1 ml dexamethasone (4 mg/mL) and 1 mL placebo into the pterygomandibular space before and after surgery, respectively. Group B received the same doses of placebo before surgery and dexamethasone after surgery. Results: A significant restriction of mouth opening on the second postoperative day was observed in both groups. Nonetheless, the postoperative restriction of mouth opening, facial swelling, postoperative pain, and analgesic consumption after lower third molar surgical removal were not significantly different in the two groups. Conclusions: Regardless of the time of administration, dexamethasone injections into the pterygomandibular space resulted in satisfactory control of the postoperative sequelae of the mandibular third molar surgical removal.

• 대한약침학회지
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• 제3권1호
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• pp.141-155
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• 2000

This study was designed to evaluate the analgesic effect of bee venom (BV) Acupuncture into different treatment points, Chok-samni (ST36) and blank loci of the gluteal muscle and back. We investigated neuronal activity in the spinal cord using the Fos immunohistochemical technique according to the pretreatment with different concentrations of BV, thirty minutes before the formalin injection. The results were summarized as follows: 1. The number of Fos-like immunoreactive (Fos-LI) neurons in L2 segment of the saline-formalin treated group was significantly increased in NECK and VENT of the spinal cord as compared with that of the room control group. However, there was no significant change in the number of the Fos-LI neurons in L2 segment of the BV-formalin treated group as compared with that of the room control group. 2. The number of Fos-LI neurons in L3-5 segment of the saline-formalin group was significantly increased in all the regions of 142 the spinal cord as compared with that of the room control group. However, the Fos-LI neurons in L3-5 segment of the BV-formalin treated group was dramatically decreased in all the regions of the spinal cord as compared with that of the saline-formalin group. Therefore, these results indicated that the BV acupuncture suppressed the nociceptive neuronal activities in L3-5 of the spinal cord induced by formalin injection. 3. There was a strong positive correlation between the formalin-induced pain behavior and the number of the Fos-LI neurons in L3-5 segment.

• 대한약침학회지
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• 제12권2호
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• pp.67-75
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• 2009

Objectives : This study was performed to developing orally administered analgesics and locally injected pharmacopuncture analgesics like opioids. Methods : Literary investigation on the origin of poppy (Papaver somniferum L) and other narcotics was conducted to examine the potential of developing orally administered analgesics and locally injected pharmacopuncture analgesics. Opium is a gum-like mass derived from air-dried white fluid of immature fruit of the poppy. Opium contains approximately 20 types of alkaloids including morphine, codeine, thebaine, papaverine and others. Natural opioids and synthetic alkaloid derivatives are the constituents of opioid analgesics and their effects and side-effects depend on the peculiarities of receptors. An extreme caution is required in the selection of proper dosage, proper analgesic types, and indications for successful pain management. Results and Discussion : With the enactment of "Narcotic control protocol", herbs such as cannibis and poppy are no longer available for use by Korean medicine doctors, and these doctors are faced with difficulty in managing severe pain in the clinical environment. A systematic consideration is inevitable for overcoming the limitation on these analgesics.

• The Korean Journal of Pain
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• 제6권1호
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• pp.32-39
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• 1993

전북대학교 병원에 입원하여 하복부 수술을 받는 미국 마취과학회 전신상태 분류상 class I, II인 환자 40명을 대상으로 수술후 morphine(1군)과 ketorolac(2군)을 지속적으로 정주한 결과 다음과 같은 결론을 얻었다. 1) 1군과 2군 모두 수술후 통증에 의의 있는 감소를 보였으며 군 간의 차이는 없었다. 2) 1군에서 2군보다 부작용의 빈도가 많았다. 이상의 결과로 수술후 통증 관리에 있어서 morphine과 ketorolac의 지속적 정맥 주입 방법은 모두 효과적이었으며, ketorolac이 morphine보다 부작용의 발현 빈도가 더 적은것으로 보아 morphine을 대신할 수 있는 유용한 약물로 사료된다.

• The Korean Journal of Pain
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• 제6권1호
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• pp.60-66
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• 1993

The clinical effects of epidural nalbuphine were compared to those of epidural morphine in sixty Cesarean delivery. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered nalbuphine 5 mg(Group N5), nalbuphine 10 mg(Group N10) or morphine 3 mg(Group M3) through an indwelling epidural catheter at the time of peritoneal closure. During the first postoperative 24 hours, their analgesic effects were evaluated by visual analogue scale(0-10), respiration rates and Trieger dot test. The severity of side effects(0-2) was also evaluated. The results were as follows ; 1) The number of patients who needed additional epidural analgesics was least in group M3 (p<0.05). There was no significant difference between group N5 and group N10. 2) The duration between the first and second epidural administration was ; 19.2 hours in group M3, 8.6 hours in group N10 and 5.4 hours in group N5. There was a significant difference each group (p<0.05). 3) From the fourth post operative hour, both groups receiving nalbuphine showed a higher VAS score compared to group M3(p<0.05). 4) The incidence of pruritus, nausea, vomiting and voiding difficulty were more severe in group M3 compared with the other groups. However the severity did not increase with increasing nalbuphine dosage. 5) There were no patients showing objective sedation or low respiration rate(10 times/minute). We concluded that epidural administration of nalbuphine 5 mg or 10 mg is one way of post operative pain control. Its side effects were less than epidural morphine, but it is a less convenient in the method of analgesia.

• The Korean Journal of Pain
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• 제6권1호
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• pp.55-59
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• 1993

Using a visual analogue scale, we compare the effect of patient-controlled analgesia and conventional intramuscular opioid regimen in 68 patients undergoing lower abdominal or gynecological surgery. We also recorded the incidence of side effects. We checked visual analogue scale 4 hours interval for 30 cases managed by patient-controlled analgesia and 38 cases of conventional intramuscular opioid group managed by obstetrician. We maintained fentanyl $0.33{\mu}g/kg/hr$ and set self administrable bolus dose $5.0{\mu}g$(lockout interval: 15 min) in patient-controlled analgesia group. Conventional intramuscular bolus injection group were administered meperidine 50 mg for 4 hour interval. Mean visual analogue scale scores obtained by patient-controlled analgesia group and intramuscular bolus injection group were $2.49{\pm}0.67$ and $4.53{\pm}1.28$(p<0.05). Side effects such as; no significant incidence of respiratory depression, urinary retention, postural hypotension, nausea, vomiting and pruritus were developed by either group. These results suggest that patient-controlled analgesia was more effective method compared with conventional intraumuscular opioid injection regimen for post-operative pain management.

• The Korean Journal of Pain
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• 제20권2호
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• pp.190-194
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• 2007

Complex regional pain syndrome (CRPS), which is a syndrome that is defined by pain and sudomotor and/or vasomotor instability, is usually resistant to conventional treatment. Here, a case involving a 30-year-old male patient with CRPS type I who showed severe intractable right shoulder pain with allodynia and hyperalgesia despite being treated with oral medications, nerve blocks including thoracic sympathetic neurolysis, and spinal cord stimulation is described. The patient frequently visited the emergency room due to severe uncontrollable breakthrough pain. Although a favorable effect was observed in response to intermittent ketamine infusion therapies that were performed on an outpatient basis, acute exacerbation of pain occurred frequently during the night and could not be controlled. Therefore, subcutaneous ketamine infusion therapy using a patient-controlled analgesic system was attempted and found to effectively control acute exacerbation of pain during 6 weeks of infusion without serious complications.

• The Korean Journal of Pain
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• 제20권2호
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• pp.123-129
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• 2007

Background: Postoperative pruritus following the administration of epidural narcotics is a very common and undesirable side effect. Therefore, we evaluated the use of a combination of naloxone and sufentanil via patient controlled epidural analgesia to determine if the incidence of pruritus was decreased when compared to the use of sufentanil alone. Methods: Patients scheduled for subtotal gastrectomy under general anesthesia were enrolled in a prospective, double-blinded and randomized trial. All patients received a $20{\mu}g$ epidural bolus of sufentanil in 5 ml of 0.2% ropivacaine. Following administration of the epidural, patients in the sufentanyl group (S) received a continuous epidural comprised of sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine, whereas patients in the naloxone group (N) received an epidural infusion comprised of naloxone ($4{\mu}g/ml$) and sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine. The infusion rate, demand dose and lockout interval were 5 ml/hr, 0.5 ml and 15 minutes respectively. Next, the occurrence of postoperative analgesia and side effects were evaluated by blinded observers. Results: The incidence of pruritus (47.4% versus 20.0%, P = 0.013) and nausea (42 .1 % versus 20.0%, P = 0.043) were lower in group N than in group S. In addition, there were no significant differences observed in the visual analogue scale, the incidence of vomiting or the incidence of sedation. Furthermore, epidural infusion of naloxone at $0.25-0.4{\mu}g/kg/hr$ did not affect the requirement for postoperative sufentanil. Conclusions: Epidural naloxone reduces epidural sufentanil induced pruritus and nausea without reversing its analgesic effects.

• The Korean Journal of Pain
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• 제27권2호
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• pp.152-161
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• 2014

Background: According to the reports of the World Health Organization 20% of world population suffer from pain and 33% of them suffer to some extent that they cannot live independently. Methods: This is a cross-sectional study which was conducted in the emergency department (ED) of Valiasr Hospital of Arak, Iran, in order to determine the causes of delay in prescription of analgesics and to construct a model for prediction of circumstances that aggravate oligoanalgesia. Data were collected during a period of 7 days. Results: Totally, 952 patients participated in this study. In order to reduce their pain intensity, 392 patients (42%) were treated. Physicians and nurses recorded the intensity of pain for 66.3% and 41.37% of patients, respectively. The mean (SD) of pain intensity according to visual analogue scale (VAS) was 8.7 (1.5) which reached to 4.4 (2.3) thirty minutes after analgesics prescription. Median and mean (SD) of delay time in injection of analgesics after the physician's order were 60.0 and 45.6 (63.35) minutes, respectively. The linear regression model suggested that when the attending physician was male or intern and patient was from rural areas the delay was longer. Conclusions: We propose further studies about analgesics administration based on medical guidelines in the shortest possible time and also to train physicians and nurses about pain assessment methods and analgesic prescription.

• The Korean Journal of Pain
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• 제26권1호
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• pp.46-50
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• 2013

Background: Postoperative pain is one of the most prevalent and bothersome issues found in the surgical department. Nowadays, there are various methods of acupuncture used for relieving pain without the complications found in some routine postoperative analgesics. These methods could be especially useful for high risk patients prone to complications from analgesics, such as transplantation recipients. The aim of this study was to evaluate the efficacy of electro-acupuncture on postoperative pain control after inguinal surgeries. Methods: Ninety male patients, who were referred to our department with indications of inguinal surgery, were included in the study and randomly divided into two groups, such as acupuncture and control. We used electro-acupuncture for the acupuncture group and no actual acupuncture (but placed needle electrodes similar to the acupuncture group) for the control group. Postoperative pain was quantified by a blind observer in both groups using a visual analogue scale (VAS) standard score before being compared. Results: Pain intensity and analgesic use were significantly higher in the control group (P < 0.05). In the acupuncture group, the VAS pain scores were significantly lower than the control group at 0.5, 1 and 2 hours post operation. When the opioid related side effects were compared for each group, the results showed that the number of subjects who experienced dizziness in the acupuncture group was significantly lower than the control group (P < 0.05). Conclusions: Acupuncture in patients, after inguinal surgery, can reduce the need of analgesics, which also directly reduces the complications that may occur when analgesics are used in relieving pain postoperatively.