• 한국임상수의학회지
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• 제16권1호
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• pp.69-74
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• 1999

This study was performed to evaluate the anesthetic effects of the epidural administration of tiletamin-zolazepam and lidocaine to rats. Blood pressure, heart rate, respiratoty rate and blood chemistry were examined according to the time lapse, after the administration of tiletamine-zolazepam, lidocaine or saline. The results obtained were as follows. 1, Tiletamine-zolazepam group revealed fast anesthesia onset time (p＜0.01) and also revealed prolonged ambulation time compared with lidocaine group (p＜0.01). 2. In the effects of blood pressure, tiletamine-zolazepam group revealed significantly higher value than lidocaine group or saline group, and revealed the highest value at 20 minutes after administration. According to the time lapse, blood pressure of tiletamine-zolazepam group was recovered and showed similar value with lidocaine group and control group at 90 minutes after administration. 3. In the effects of heart rate, tiletamine-zolazepam group revealed significantly lower value than lidocaine group or saline group and revealed the lowest value at 30 minutes after administration, and recovered similar value with pre-administration at 90 minutes after administration. 4. In the effects of respiratory rate, lidocaine group revealed significantly lower value at 30 minutes administration compared with 0 and 60 minutes after administration (p＜0.01). Tiletamine-zolazepam group also revealed significantly lower value at 30 minutes compared with 0 and 60 minutes after administration (p<0.01). The changes at 60 minutes after administration, lidocaine group revealed lower value than saline or tiletamine-zolazepam group, and tiletamine-zolazepam group revealed similar value with 0 minutes. 5. In the effects of tidal volume, lidocaine group revealed significantly lower value than saline group (p＜0.001) and tiletamine-zolazepam group also revealed lower value than saline group, at 30 minutes after administration. The values at 60 minutes after administration, revealed similar results with that of 30 minutes after administration. 6. In the blood chemistry, the values of alanine transminase (ALT), aspartate transminase(AST) and creatinine did not reveal significant results at 60 minutes after administration. The values of ALT at 60 minutes slightly decreased compared with pre-administration, and revealed normal level.

• The Korean Journal of Pain
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• 제34권1호
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• pp.114-123
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• 2021

Background: Evaluation of the effectiveness of caudal epidural injection on pain, spine mobility, disease activity, and activity of daily living in axial spondyloarthritis (SpA) patients. Methods: A total sample of 47 patients were registered in this study. They were randomly assigned into 2 groups; Group I received caudal epidural injections, ultrasound-guided, with 1% lidocaine hydrochloride mixed with triamcinolone, whereas Group II did not receive any injections. All participants fulfilled the ASAS criteria for axial SpA. Outcome measures were as follows: visual analogue scale, Oswestry disability index (ODI), modified Schober test, lateral lumbar flexion, and Ankylosing Spondylitis Disease Activity Score (ASDAS) with assessment at baseline, 2 weeks, and 8 weeks post-treatment. This clinical trial was registered on clinicaltrials.gov under the number NCT04143165. Results: There was a significant difference between both groups regarding pain, ODI, spine mobility and ASDAS scores in favor of group I. This effect was at its maximum after 2 weeks. Despite the decline of this effect after 2 months, the difference between the groups remained significant. Higher disease activity, younger age, and shorter disease duration were associated with better outcomes. Conclusions: Epidural injection of lidocaine and triamcinolone is a cost effective and a practical technique for controlling pain, as well as improving the function of the spine and disease activity scores in axial SpA patients with acceptable complications and relatively sustained effect.

• The Korean Journal of Pain
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• 제12권1호
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• pp.43-47
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• 1999

Backgroud: Systemic administration of opioid can prolong the duration of epidural anesthesia. The authors examined the effect of nitrous oxide ($N_2O$) on the level of sensory block induced by epidural lidocaine. Methods: Twenty minutes after epidural injection of 2% lidocaine (below 70 years : 20 ml, 70 years and above : 15 ml), the level of sensory block was assessed (2nd stage). Patients were randomly assigned to receive either medical air (control group, n=15) or 50% $N_2O$ in oxygen ($N_2O$ group, n=15) for 10 minutes, the level of block was reassessed (3rd stage). Pateints were given room air (control group) or 100% oxygen for 5 minutes and room air for 5 minutes ($N_2O$ group), and the level of block was reassessed (4th stage). Results: At the 3rd stage, $N_2O$ group showed 4.3 cm cephalad increase in the level of sensory block (p=0.005), but control group revealed 1.43 cm regression. After discontinuation of gas, the level of block regressed in both group (p=0.000). At the 4th stage, $N_2O$ group revealed 3.5 cm cephalad increase (p=0.048) and control group 1.97 cm regression (p=0.001) as compared with the 2nd stage. Conclusions: The level of sensory block induced by epidural lidocaine was significantly increased cephalad by concommitant use of 50% $N_2O$ for 10 minutes.

• The Korean Journal of Pain
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• 제8권1호
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• pp.156-158
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• 1995

Total spinal anesthesia is a well documented serious life threatening complication which results from an attempted spinal or epidural analgesia. We had an accidental total spinal anesthesia associated with a cranial nerve paralysis and an eventual unconsciousness during epidural analgesia. A 45-year-old female with an uterine myoma was scheduled for a total abdominal hysterectomy under the epidural analgesia. A lumbar tapping for the epidural analgesia was performed in a sitting position at a level between $L_{3-4}$, using a 18 gauge Tuohy needle. Using the "Loss of Resistance" technique to identify the epidural space, the first attempt failed; however, the second attempt with the same level and the technique was successful. The epidural space was identified erroneously. However, fluid was dripping very slowly through the needle, which we thought was the fluid from the normal saline which was injected from the outside to identify the space. Then 20 ml of 2% lidocaine was administered into the epidural space. Shortly after the spinal injection of lidocaine, many signs of total spinal anesthesia could be clearly observed, accompanied by the following progressing signs of intracrainal nerve paralysis: phrenic nerve, vagus nerve, glossopharyngeal nerve and trigeminal nerve in that order. Then female was intubated and her respiration was controlled without delay. The scheduled operation was carried out uneventfully for 2 hours and 20 minutes. The patient recovered gradually in th4e reverse order four hours from that time.

• The Korean Journal of Pain
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• 제14권2호
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• pp.249-252
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• 2001

Total spinal anesthesia is a serious life threatening complication of spinal and epidural anesthesia. We report an accidental total spinal anesthesia developed during a thoracic epidural block in a practitioner's pain clinic. A 69-year-old female with post-herpetic neuralgia was treated by a thoracic epidural block. A thoracic tapping for the epidural block was performed in the right lateral position at a level between $T_{5-6}$, using a 23 gauge Tuohy needle. After the epidural space was identified, a mixed solution of 10 ml of 0.3% lidocaine and 20 mg of triamcinolone was injected into the epidural space. After removal of the syringe, fluid was dripping through the needle. The patient subsequently complained of dyspnea and dizziness, and she became unconscious. She was intubated immediately and cardiopulmonary resuscitation was performed because there was no pulse palpable. The patient recovered an hour after transfer to a general hospital and was discharged without any further complication 19 days later.

• The Korean Journal of Pain
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• 제2권2호
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• pp.194-197
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• 1989

Epidural morphine provides excellent analgesia for the management of postoperative pain, but nausea and vomiting are a commonly reported side effect. Scopolamine, a belladona alkaloid, is an effective antiemetic when nausea is induced by morphine. Transdermal scopolamine patches have the advantage of delivering a constant low dosage of the drug over a prolonged period. To evaluate the efficacy of prophylacitic transdermal scopolamine in reducing nausea or vomiting associated with postoperative epidural morphine analgesia, I studied 60 healthy adult patients. The patients were divided into 3 groups, each group consisting of 20 patients. Group 1; no scopolamine for control Group 2; transdermal scopolamine placebo patch Group 3; transdermal scopolamine patch All patients were anesthetized by epidural injection of 2% lidocaine 15 ml and 0.5% bupivacaine 10 ml with morphine 4 mg. A Comparison with the control group, the placebo group, and Group 3, indicated, that the transdermal scopolamine reduced the incidence of nausea or vomiting associated with postoperative epidural morphine analgesia (group 1; 35%, group 2; 25%, group 3; 10%). However there were no statistically significant differences between groups at a level of p>0.05.

• Journal of Yeungnam Medical Science
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• 제6권2호
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• pp.57-62
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• 1989

지연성 호흡저하의 위험성이 없으며 중추신경계에 작용하는 혈압강하제인 Clonidine을 경막외강으로 주입한 강우의 진통효과를 알아보고자 미추마취를 시행할 항문질환 환자 40명을 대상으로 I군(1.33% Lidocaine 15ml)과 II군(1.33% Lidocaine 15ml+Clonidine $75{\mu}g$.)으로 나누어 수술후 진통효과를 관찰해 보았던 바 다음과 같은 결론을 얻었다. 1. Lidocaine단독 주입한 I군에서는 평균 마취시간이 2.42시간이었다. 2. Clonidine $75{\mu}g$을 혼합 주입한 II군의 경우에는 평균 진통시간이 7.32시간이었다. 3. Clonidine을 혼합 주입한 미추마취경우에 진정제 정주로 환자가 수면상태로 된 후 심한 혈압강하 및 맥박감소가 있었으나 Clonidine의 효과인지 진정효과에 인한 변화인지는 알 수 없었으며 진정제를 투여하지 않은 경우에는 혈압강하 및 맥박 감소가 초래되지 않았다. 4. 수술후 Clonidine과 관련된 특별한 증상은 관찰되지 않았다. 이상의 결과로 보아 항문질환 수술후 특히 외래환자의 차원에서 술후 진통을 위한 방법으로는 지연성 호흡저하 및 뇨정체등의 부작용이 없는 Clonidine의 천골강내 투여방법이 바람직한 것으로 사료된다.

• 한국수정란이식학회지
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• 제12권2호
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• pp.211-218
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• 1997

This experiment was carried out to develop the anesthetic methods for ultrasonography and a new simplified disposable needle guidance device for ovum pick-up(OPU) in cows. Three different anesthetic methods were applied as. 1) epidural analgesia only with 2% lidocaine(20~30 ml), 2) epidural analgesia with 2% under general sedation with xylazine, 3) epidural analgesia with 2% lidocaine under general sedation with detomidine. We evaluated the anesthetic effects with items such as relaxation of anal sphincter, tail movement and rectal wall, retractability of both ovaries, additional anesthesia and possibility of OPU. Through this experiment, the above three anesthetic methods were applicable to OPU, but the epidural anlagesia under general sedation with detomldine was most effective for OPU. We developed a new disposable needle guidance device with stainless steel tube. With this, disposable needles can be easily attatchable to any other intravaginal probes. And also, it was found to he practical, economic and effective for OPU with the recovery rate of 51.2%.

• The Korean Journal of Pain
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• 제2권1호
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• pp.21-25
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• 1989

For the simple operations of the perineal region, caudal, epidural and saddle blocks of analgesia are preferable anesthesia techniques in men. But, if the operations shoud be delayed or the physicians are willing to observe and manipulate the patients for a couple of days, as in the ureteral stone manipulation, continuous epidural analgesia will be a reliable method. The authors have observed 36 male patients of ureteral calculi with continuous lumbar epidural analgesia for the purpose of elimination of an undesirable pain sensation which was associated with the transurethral cystoscopic manipulation. The results were as follows: 1) In most cases, the anesthetics used were 1% lidocaine 20 ml through the $L_{3-4}$ and $L_{4-5}$ interspace with 4~6cm of catheter tip advancement mainly to cephalad. 2) There was no motor weakness or paralysis in the lower extremities except some numbness and paresthesia on the perineal area. 3) Besides the various minor complications, there were no problems in respiration with small doses of morphine extradurally. 4) Among them, four cases of ureteral calculi dropped into the bladder spontaneously due to the epidural technique during transportation of the patients from the pain clinic to the urology out-clinic. One case of calculi was dropped by the aid of instrumentation at the ward, and twelve cases of calculi were removed directly by Dormia stone basket in the scopic room. For the remaining patients, we deduced that their calculi was be evacuated out because there were no complaints were notified after discharge.

• The Korean Journal of Pain
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• 제6권2호
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• pp.265-269
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• 1993

Subdural block is a rare but well recognized complication of epidural anesthesia. The placement of local anesthetics into the subdural space can lead to potentially life-threatening conditions. A healthy 46-year-old women underwent total abdominal hysterectomy under continuous lumber epidural anesthesia. The technical procedure for continuous epidural catheterization went smoothly without a single problem. However, signs of high epidural block such as apnea, cranial nerve paralysis and pupil dilatation developed gradually, about 20 minutes after the epidural injection of 2% lidocaine 20 ml through the epidural catheter. Such extensive segmental block can only be explained as the result of injection into subdural space even if it was not confirmed radiologically.