• 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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• 제11권1호
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• pp.109-112
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• 1998

The sympathetic nervous system has been implicated as an important factor contributing to causalgia. Basis on reports of presence of opioid receptors in sympathetic autonomic ganglia, including human stellate ganglion, we administered morphine in stellate ganglion block for a patient with causalgia. The patient suffering from brachial plexus injury treated with stellate ganglion block in conjunction with physical therapy. Stellate ganglion block was performed in a paratracheal approach by injection of 1% lidocaine, or 0.25% bupivacaine 8 ml, with morpine 1 mg. Patient's symptoms were dramatically improved after 13 stellate ganglion blocks.

• The Korean Journal of Pain
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• 제13권2호
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• pp.218-223
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• 2000

Background: This study was conducted to evaluate the efficacy of a parenteral nonsteroidal anti-inflammatory agent for management of post-surgical pain and its effect on hospital stay and long-term surgical outcome. Methods: Total of 40 patients undergoing lumbar discectomy were randomly assigned to two groups, receiving either 1) 30 mg intravenous ketorolac upon surgical closure, every 6 hours for 36 hours, and morphine IV PCA (intravenous patient controlled analgesia), or 2) only morphine PCA. A blinded investigator recorded; the visual analog pain scores, total postoperative narcotic consumption, complications by morphine PCA, length of hospitalization (from surgery to discharge), and long-term outcome at 6 weeks. Results: The patients who received IV ketorolac and morphine PCA reported significantly lower visual analog pain scores than patients receiving only morphine PCA. Cumulative morphine doses were significantly lower in the ketorolac group (P<0.001). There was no significant difference between groups in the frequency of side effects related to morphine PCA. Mean length of hospitalization was longer for patients receiving only morphine PCA, but there was no statistical significance. Six weeks after surgery, four (20.0%) patients who received only morphine PCA suffered persistent back pain. In contrary, all those patients who received ketorolac were free of back pain at follow-up (P<0.05). Conclusions: These results suggest that intermittent IV bolus ketorolac, when used with opioid IV PCA is more effective than opioid IV PCA alone for postoperative pain following lumbar disc surgery. However, this strategy did not contribute to early discharge from hospital after lumbar disc surgery. The effect to long-term surgical outcome was not conclusive.

• The Korean Journal of Pain
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• 제11권1호
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• pp.1-6
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• 1998

Background: The role of nitric oxide(NO) in analgesia from opioids is controversial. On the one hand, IV morphine analgesia is enhanced by IV injection of NO synthase inhibitors. On the other hand, IV morphine results in increased release of NO in the spinal cord. There have been no behavioral studies examining the interaction between IV morphine and intrathecal injection of drugs which affect NO synthesis. Method: Rats were prepared with chronic lumbar intrathecal catheters and were tested withdrawal latency on the hot plate after 3~5 days of surgery. Antinociception was determinined in response to a heat stimulus to the hind paw before and after IV injection of morphine, 2.5 mg/kg. Twenty minutes after morphine injection, rats received intrathecal injection of saline or the NO synthase inhibitors, L-NMMA or TRIM, the NO scavenger, PTIO, or the NO synthase substrate, L-Arginine. Intrathecal injections, separated by 15 min, were made in each rats and measurements were obtained every 5 min. Result: Mophine produced a 60~70% maximal antinociceptive response to a heat stimulus in all animals for 60 min in control experiments. Intrathecal injection of idazoxane decreased antinociception of IV morphine. The NO synthase inhibitors and the NO scavenger produced dose-dependent decreases in antinociceptive effect of morphine, whereas saline as a control group and L-Arginine as the NO substrate had no effect on antinociception of morphine. Conclusion: The present study supports the evidences that systemic morphine increase the nitrite in cerebrospinal fluid and dorsal horn. These data suggest that the synthesis of NO in the spinal cord may be important to the analgesic effect of IV morphine and increased NO in spinal cord has different action from the supraspinal NO.

• 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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• 제10권2호
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• pp.179-184
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• 1997

Background: Ketorolac($Tarasyn^{(R)}$) is a non-steroidal anti-inflammatory drug(NSAID) which has shown to be an effective postoperative analgesic available parenterally, and when combined with morphine can reduce its requirement. The analgesic efficacy and adverse effects of continuous infusion of ketorolac added to morphine IV PCA was evaluated in 60 women after abdominal hysterectomy. Methods: Patients were assigned to receive either morphine intravenous(IV) bolus followed by morphine IV patient controlled analgesia(PCA), or ketorolac 30mg IV and continuous IV infusion at 4.0mg/hr in combination with the above regimen. The authors evaluated PCA morphine used, pain assessment(verbal pain intensity score and visual analogue scale) and side effects at 2, 4, 6 and 24hrs during pain control. Results: Continuous infusion of ketorolac decreased the PCA morphine usage significantly(30.4 ---> 19.6 mg : p=0.007) at 24hrs postoperatively. Significant differences were seen favoring ketorolac infusion in pain intensity and visual analogue scale both at rest and during movement. There were no differences in incidences of deep sedation, nausea & vomiting. But the ketorolac group they complained of dizziness more than morphine only group. Little pruritus was recorded in either groups. Conclusions: The authors conclude continuous IV infusion of ketorolac in conjunction with morphine PCA provide effective analgesia after low abdominal surgery.

• The Korean Journal of Pain
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• 제36권2호
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• pp.163-172
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• 2023

Background: Synaptic plasticity contributes to nociceptive signal transmission and modulation, with calcium/calmodulin-dependent protein kinase II (CaMK II) playing a fundamental role in neural plasticity. This research was conducted to investigate the role of CaMK II in the transmission and regulation of nociceptive information within the nucleus accumbens (NAc) of naïve and morphine-tolerant rats. Methods: Randall Selitto and hot-plate tests were utilized to measure the hindpaw withdrawal latencies (HWLs) in response to noxious mechanical and thermal stimuli. To induce chronic morphine tolerance, rats received intraperitoneal morphine injection twice per day for seven days. CaMK II expression and activity were assessed using western blotting. Results: Intra-NAc microinjection of autocamtide-2-related inhibitory peptide (AIP) induced an increase in HWLs in naïve rats in response to noxious thermal and mechanical stimuli. Moreover, the expression of the phosphorylated CaMK II (p-CaMK II) was significantly decreased as determined by western blotting. Chronic intraperitoneal injection of morphine resulted in significant morphine tolerance in rats on Day 7, and an increase of p-CaMK II expression in NAc in morphine-tolerant rats was observed. Furthermore, intra-NAc administration of AIP elicited significant antinociceptive responses in morphine-tolerant rats. In addition, compared with naïve rats, AIP induced stronger thermal antinociceptive effects of the same dose in rats exhibiting morphine tolerance. Conclusions: This study shows that CaMK II in the NAc is involved in the transmission and regulation of nociception in naïve and morphine-tolerant rats.

• The Korean Journal of Pain
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• 제9권2호
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• pp.385-389
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• 1996

Background: Nowadays, epidural morphine is commonly used in postoperative pain control. But epidural morphine may produce some side-effects, e.g. pruritus, nausea, vomiting, urinary retention and respiratory depression. Especially, pruritus is the most common complaint in pain-controlled patients by epidural morphine. So we evaluated whether addition of epidural butorphanol affects the degree of pruritus and pain score in pain controlled patients who by epidural morphine after hysterectomy. Methods: Group 1(N=15) received postoperative epidural 0.1% bupivacaine 100ml plus morphine 10 mg, group 2(N=15) received the mixture of butorphanol 2 mg with same regime as in group 1, group 3(N=15) received the mixture of butorphanol 4 mg with same regime as in group 1. All of the three groups received these solutions by infusion pump, 1 ml/hour, for postoperative 4 days. all groups received additional morphine 1.2 mg in 0.2% bupivacaine 6ml epidurally when the peritoneum was closed under general anesthesia. The severity of pain, pruritus, nausea and vomiting was estimated by 10 cm VAS(visual analogue scale) and somnolence by positive or negative during postoperative 4 days. Results: Severity of pruritus, but not nausea and vomiting was decreased in group 2 and 3 compared with group 1(p<0.05). Pain score was increased in group 3 at postoperative day(POD) 0 and 2 compared with group 1(p<0.05). Incidence of somnolence in group 1, 2 and 3 were $2.7{\pm}0.7,\;5.3{\pm}0.7$ and $10.0{\pm}1.0$ respectively. Conclusion: These results suggest that butorphanol reduce the degree of pruritus, the most common side effect of morphine, but increase the incidence of somnolence.

• The Korean Journal of Pain
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• 제9권2호
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• pp.380-384
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• 1996

Background: To determine the effectiveness of continuous epidural infusion of droperidol, combined with epidural morphine, in reducing nausea or vomiting associated with epidural morphine and minimizing the side effects of droperidol, 48 patients undergoing elective thoracic surgery were randomly assigned to one of two study groups. Methods: Patients received continuous infusion of epidural morphine(6.0 mg/day) following a bolus loading dose of 3.0 mg(Group A), or epidural mixture of morphine(6.0 mg/day) plus droperidol(5.0 mg/day) following a bolus loading dose(morphine 3.0mg, droperidol 1.5 mg)(Group B). For the first 48 postoperative hours, the incidence of nausea or vomiting, the need for antiemetic therapy, level of sedation, and adverse effects associated with droperidol were evaluated. Results: The incidence of nausea or vomiting and the number of patients who required antiemetic therapy were significantly less in Group B than in Group A(P<0.05). There were no significant differences between groups with regard to the adverse effects associated with droperidol such as mental depression, respiratory depression and abnormal movements(P=NS). Conclusion: We conclude that simultaneous titration of morphine and droperidol via epidural continuous infusion following epidural bolus injection of the mixture reduces nausea or vomiting associated with epidural morphine while it prevents the side effects of droperidol.

• The Korean Journal of Pain
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• 제11권1호
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• pp.47-53
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• 1998

Background: Epidural coadministration of opioids and local anesthetics has provided excellent analgesia during postoperative period. However, it is usually associated with the occurance of many side effects which were induced by epidural morphine. Low dose of intravenous naloxone has been known to reduce morphine-induced side effects without reversing analgesia, but the effect of epidural naloxone has not been defined in human study. Therefore we evaluated side effects and analgesia when naloxone was administered via epidural route. Methods: Eighty patients having epiduro-general anesthesia for hysterectomy were randomly assigned to one of four study groups. As a mean of postoperative pain control, all received 2 mg of epidural morphine bolusly at 1 hr before the end of surgery and continuous epidural infusion was started by Two-day Infusor containing morphine 4 mg in 0.125% bupivacaine 100 ml with either none of naloxone(Group 1, n=20), 2 ug/kg/day of naloxone(Group 2, n=20), 3 ug/kg/day of naloxone(Group 3, n=20) or 4 ug/kg/day of naloxone(Group 4, n=20). Study endpoints included visual analog scales(VAS) for pain, severity of nausea, itching, somnolence and respiratory depression. They were assessed at 2, 4, 8, 16, 32, and 48 hr postoperatively. Results: VAS for pain showed significant difference in Group 4 compared with Group 1 at all of the evaluation time. Itching score decreased significantly in Group 3 and 4 after 8 hr postoperatively and nausea score decreased significantly in Group 3 after 4 hr postoperatively. Alertness score decreased significantly in Group 3 and 4 especially in early postoperative period. Conclusion: This study suggests that epidural naloxone reduce morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect of epidural morphine.