• The Korean Journal of Pain
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• v.4 no.1
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• pp.60-63
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• 1991

The neuroleptic malignant syndrome (NMS) is an uncommon but dangerous complication of treatment with neuroleptic drugs. This syndrome is characterized by autonomic dysfunction, extrapyramidal dysfunction, and hyperthermia. NMS seems more frequent with parenteral neuroleptic use. We report a patient in whom suspicious NMS was developed in the ward after epidural administration of 2.5mg of droperidol with morphine for postoperative pain control. Extrapyramidal symptoms and autonomic dysfunction were treated with diazepam, but temperature was spontaneously decreased after 16 hours and 40 minute after receiving epidural droperidol.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.105-110
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• 2000

Central neuropathic pain may occur in 10~20% of the patients after spinal cord injury. The central pain syndrome include spontaneous continuing and intermittent pain as well as evoked pain. The pain is evoked by non-noxious stimulation of the region (allodynia) and repeated stimulation (wind-up phenomenon). Four patients were referred suffering from severe pain, allodynia and hyperaesthesia after spinal cord injury. They had received conventional treatment with non-steroidal anti-inflammatory drugs, steroid, anticonvulsant, antidepressant and rehabilitation which failed to provide pain relief. We administered combination of low doses of morphine and ketamine (10 mg) through the epidural catheter with other conventional therapy. Satisfactory pain relief was achieved in each patient. The reduction of pain was not associated with severe side effects. The most bothersome side effect of ketamine was dizziness in one patient, only caused by bolus injection (ketamine 10 mg with normal saline 10 ml). This suggests synergy from this combination that provides an alternative treatment for central pain.

• The Korean Journal of Pain
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• v.7 no.1
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• pp.113-115
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• 1994

Bacterial meningitis is a rare complication of epidural block. As epidural abscess, subarachnoid infection associated with epidural catheters are related to the treatment of pain in diabetic patient whose immune responses have been impaired. A 51-year-old male with non-insulin dependent diabetes came to the pain clinic with neuropathic gain on right thigh and amputated stump of right leg. Treatment consisted of continuous epidural block and subcutaneous tunnelling and epidural morphine with bupivacaine was given on an outpatient basis. Two months later, the patient noted a diffuse frontal headache, projectile vomiting and stiffness neck. These symptoms became more aggrevated over the following 24 h and temperature went up to $38.4^{\circ}C$. A diagnostic lumbar puncture revealed CSF total protein of 747 mg/dl, glucose of 43 mg/dl, and $4320\;WBC/mm^3$. Cultures of epidural catheter tip grew hemolytic staphylococcus epidermidis. A chest x-ray and brain CT scan were negative. Antibiotic therapy with penicillin G and chloramphenicol was given for 15 days. Recovery was uneventful.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.286-292
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• 1995

Buerger's disease(Thromboangiitis Obliterans) is characterized by peripheral arterial occlusion of the extremities in young smokers, and leading to ischemia of the tissue and gangrene. Most of these patients suffered from severe pain. therapy for Buerger's disease not enable to undergo reconstructive arterial surgery has been discouraging while multiple modes of analgesics have advanced. Eight subjects who had been operated due to Buerger's disease or diagnosed with this disease were evaluated retrospectively. Continuous epidural block was done at L 2~3 or L3~4 intervertebral space and multiday continuous infusor was connected to epidural catheter. The content of the infusor was clonidine-bupivacaine or clonidine-morphine-bupivacaine mixture. The minimum dose of clonidine was 75 ${\mu}g/day$ and the maximum 450 ${\mu}g/day$. The results were as follows: The analgesia produced by clonidine was superior to any other analgesics. 2) The incidence of the side effects produced by clonidine-bupivacaine mixture were less than that of clonidine-morphine-bupivacaine mixture. 3) Minimum dose of clonidine for the pain relief was required more than 225 ${\mu}g$ per day. From the above results, we recommend that clonidine is an effective agent to provide pain relief for the patients with Buerger's disease.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.374-379
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• 1996

Background: Recently, improvements in drug administration technology have intensified interest in the treatment of postoperative pain. this has resulted in increased use of continuous intravenous infusion of opioid and epidural opioid as alternative to traditional intramuscular administration of opioid. The goal of this study, therefore, was to document the effects of pain control and side effects following continuous intravenous infusion of morphine or meperidine and intramuscular meperidine following cesarean section. Methods: The vital signs, pain score, oxygen saturation and side effects were compared in 150 patients receiving continuous intravenous infusion of morphine, 30 ${\mu}g/kg/hr$ (n=50, group 1); continuous intravenous infusion of meperidine, 150 ${\mu}g/kg/hr$ (n=50, group 2); or intramuscular meperidine, 50mg/every 6hrs (n=50, group 3). Results: VAS (Visual Analogue Scale) was significantly decreased after 30 minutes of administration in all three groups and was significantly lower at 1 hour, but higher at 6 hours in group 3 than two other groups. Severe desaturation episode, defined as $SpO_2$<90%, occurred in the group 3(0.2%). Moderate desaturation episodes, defined as $SpO_2$ 91~95%, occurred more in group 3 than in group 1 and 2 (17.4% vs. 10.4%, 8.2%). The incidence of side effects were similar among three groups. Conclusion: The continuous infusion of opioid was more effective and safe method of postoperative pain control than traditional intramuscular injection.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.53-58
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• 1988

We have treated patients who have visited pain clinic and those admitted to the other departments of Pusan National University Hospital from Mar. 1987 to Feb. 1988 with complaints of severe cancer pain on both upper and lower abdomen and extremities by continuous administration of a very small amount of morphine in the lumbar subarachnoid(group I) and epidural(group II) space in 10 cases respectively. The results of analgesia obtained are as follows: 1. The average duration in onset of analgesia was 8 mins. in group I and 23 mins. in group II. 2. The average duration In maintaining analgesia was 12.4 hrs. in group I and 18.4 hrs. in group II. 3. The efficiency of analgesia in group I was excellent in 5, good in 4, and null in 1, and group II was excellent in 5, good in 2, and moderate in 3. 4. The degree of tolerance in group I was rather mild comparable ti that of pain score 4 till the 22nd. day of morphine administration. 5. The complications are: 2 of respiratory distress in group I, 2 of voiding difficulties in both group I and II, 1 of itching sensation in both group I and II, 1 of euphoria with hallucination In group I, and 1 of C.S.F leakage in group II. As results, it is thought that epidural administration is safer than subarachnoid administration in achieving analgesia with morphine among patients with malignant pain if the problem of tolerance is solved.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.37-43
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• 1992

Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxemia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine for control of postoperative pain was reported by Behar and associates. This study was carried out for twenty patients who received posterolateral thoracostomy with bleb resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes under general endotracheal anesthesia. For the relief of post-thoracotomy pain following of the general anesthesia, we selected ten patients as control group which were treated intermittently IM with injection of pethidine(50 mg) according to the conventional method and another ten patients as study group which were managed with thoracic epidural analgesia. The tip of the catheter was inserted to T4-5 epidural space through T12-L1 or L1-2 interspinous region before the induction of the general anesthesia and then the epidural analgesics(0.25% bupivacaine 15 ml+morphine 3 mg) was injected once a day via the catheter until 4 th POD in the study group. The epidural catheters were removed at postoperative 4 th day in study group. Clinical observations were done about vital signs, ABG, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; (1) The values of $V_T$ and FVC were significantly improved in study group(85% and 66%) as compared with control group(76% and 61%) during the postoperative 4 day of the epidural analgesia. (2) After the end of the epidural analgesia(7th POD), the values of FVC were improved invertly rather in control group(98%) than study group(84%). It suggested that the reduction of FVC in study group were caused by the raised pain sensitivity following the end of epidural analgesia. (3) The side effects of epidural analgesia such as transient urinary retention(2 cases), itching sensation(1) and headache(1) were noted.

• The Korean Journal of Pain
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• v.27 no.3
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• pp.200-209
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• 2014

Background: Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. Methods: The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic. Results: Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil. Conclusions: Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.294-298
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• 1998

The feature of neuropathic pain may occur in the absence of any apparent stimulus and be exaggerated in either amplitude or duration. Peripheral nerve injury may produce neuropathic pain and opioids have been shown to be relatively unsatisfactory for the treatment of most cases of neuropathic pain. The NMDA receptor system is involved in transmission and modulation of nociceptive information. We treated patients with severe pain, hyperaesthesia and allodynia with epidural injection of NMDA receptor antagonist, ketamine (10 mg) and morphine (0.5 mg) or other opioid. The combinations provided effective pain management in 23 patients with neuropathic pain.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.127-132
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• 1991

Recently a non-electronic, disposable and portable infusor(Baxter infusor with patient control module, Baxter health care Co., Deerfield IL 60015 USA: BI $\bar{c}$ PCM) has been developed that will deliver both a continuous drug infusion as well as allow the patient to deliver extra doses of medication on a demand basis under predetermined limitation of analgesics. Patients may also not require as high analgesic dose rate to control pain when the acceptable and tolerable level of pain relief can be maintained by this device. From April l99l, we have used a total l93 units of BI $\bar{c}$ PCM. These units consisting of two components which one made by a balloon reservoir(capacity 65 ml, flow rate 0.5 ml/hr) to store medication and to regulate the pump power(490 torr), and another two PCMs to regulate additional analgesic administration by patients demand at intervals of 1S minutes and 60 minutes. The dose administered to the patient can be varied by changing the concentration of the infusate within the balloon reservoir. These devices were utilized for the pain control of 44 patients. These patients were divided into two groups. Twenty seven cases had cancer pain and 17 cases had non-cancer pain. The Touhy needle(No. l8 G.) tip was inserted into the epidural space and was used to guide the catheter to the spinal nerve level corresponding to the most painful area. The device was connected to the opposite site of the catheter tip and was filled with 60 ml of mixture solution such as 0.5% bupivacaine 15 ml, morphine HCl 10 mg, trazodone 10 ml, Tridol 3 ml and normal saline 31 ml were administed as the initial dose. When the initial dose was less effective, the next dose could be varied by increasing the concentration of bupivacaine, by adding more morphine (5~10 mg), and by reducing the volume of normal saline. Using these modules of drug self administration, we experienced the following: 1) Improvement of patient's self titration of analgesic requirement was provided. 2) The patients anxiety with pain recurrence resulting from delays in administering pain control medication was decreased significantly. 3) The working load accompanying with the single bolus injection as the usual method was reduced remarkably. 4) There was urinary retention in 5 cases and pruritus in 4 eases which developed as side effects but respiratory depression and vomiting was not encountered in a single case.