• The Korean Journal of Pain
• /
• v.26 no.3
• /
• pp.270-276
• /
• 2013

Background: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. Methods: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-${\mu}g$ fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. Results: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. Conclusions: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.

• The Korean Journal of Pain
• /
• v.37 no.4
• /
• pp.332-342
• /
• 2024

Background: Pre-operative ilioinguinal-iliohypogastric nerve block (II-IHNB) has a proven role in lessening acute postoperative pain and opioid consumption following hernia repair. However, its role in preventing post-herniorrhaphy groin pain (PHGP) is still unknown. The current study aims to assess pre-operative II-IHNB's impact on PHGP three and six months after open inguinal hernia repair under spinal anesthesia. Methods: Seventy patients posted for inguinal hernia surgery were randomly allocated into group A (received ultrasound-guided II-IHNB with 10 mL of 0.5% ropivacaine and 4 mg [1 mL] dexamethasone) and group B (received ultrasound-guided II-IHNB with 11 mL of 0.9% normal saline). The time to first analgesic request, pain scores, opioid consumption, DN4 score, and PHGP at 3 and 6 months were analyzed using appropriate statistical tests. Results: The numerical pain rating scale at movement in group A was significantly reduced at all the time intervals of 3, 6, 12, and 24 hours compared to group B. Total opioid usage was lower in group A (3.71 mg [3.90]) versus group B (12.14 mg [4.90]) with a mean difference of -8.43 mg (95% CI -10.54, -6.32), P < 0.001. The time required for the first rescue analgesic was significantly longer in group A (360 min [180-360]) versus (180 min [180-360]) in group B (P < 0.001). However, there was no difference in the incidence of PHGP at three and six months between the two groups. Conclusions: Pre-operative ultrasound-guided II-IHNB reduces postoperative analgesic requirement but does not reduce the incidence of chronic PHGP following hernia surgery at 6 months.

• The Korean Journal of Pain
• /
• v.1 no.2
• /
• pp.203-206
• /
• 1988

Evaluation of inadvertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 epidural bloks. (1.6%) Aspiration of CSF was negative in 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decrease in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site may cause subarachnoid injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.

• Journal of Yeungnam Medical Science
• /
• v.24 no.2
• /
• pp.206-215
• /
• 2007

Background : The prone position is often used for operations involving the spine and provides excellent surgical access. The complications associated with the prone position include ocular and auricular injuries, and musculoskeletal injuries. In particular, the prone position during general anesthesia causes hemodynamic changes. To evaluate the cardiovascular effects of the prone position in surgical patients during general anesthesia, we investigated the effects on hemodynamic change of the prone position with the Jackson spinal surgery table. Materials and Methods : Thirty patients undergoing spine surgery in the prone position were randomly selected. After induction of general anesthesia, intra-arterial and central venous pressures (CVP) were monitored and cardiac output was measured by $NICO^{(R)}$. We measured stroke volume, cardiac index, cardiac output, mean arterial pressure, heart rate, CVP and systemic vascular resistance (SVR) before changing the position. The same measurements were performed after changing to the prone position with the patient on the Jackson spinal surgery table. Results : In the prone position, there was a significant reduction in stroke volume, cardiac index and cardiac output. The heart rate, mean arterial pressure and CVP were also decreased in the prone position but not significantly. However, the SVR was increased significantly. Conclusion : The degree of a reduced cardiac index was less on the Jackson spinal surgery table than other conditions of the prone position. The reduced epidural pressure caused by free abdominal movement may decrease intraoperative blood loss. Therefore, the Jackson spinal surgery table provides a convenient and stable method for maintaining patients in the prone position during spinal surgery.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.9
• /
• pp.1209-1214
• /
• 2000

Objectives : The measurement of resistance to cerebrospinal fluid outflow($R_o$) can clearly delineate cerebrospinal fluid dynamics in patients with ventricular dilatation and can help in selecting patients to undergo shunt placement. With regards to type of infusion method, bolus injection is known to be more practical and safer than continuous infusion. The purpose of this study was to obtain $R_o$ of normal adults using lumbar bolus injection method. Material and Methods : Twenty adults aged 25 to 52 years were studied using lumbar bolus injection method. Fifteen patients with hemifacial spasm and five with cerebral concussion underwent $R_o$ measurement under propofol general anesthesia and local anesthesia, respectively. Results : The mean values of $R_o$ determined 1 minute and 2 minutes after bolus injection were $4.8{\pm}1.7$ and $4.4{\pm}1.6mmHg/ml/min$, respectively. There was no significant difference of $R_o$ between propofol general anesthesia group and local anesthesia group. Two patients showed $R_o$ greater than 6mmHg/ml/min. One patient revealed unexpectedly high level of $R_o$ due to severe spinal stenosis. Conclusion : Mean Ro in this study was higher than that of Shapiro's study. Borderline Ro near 6mmHg/ml/min should be regarded with caution and compared with clinical symptoms and results of other studies. Patients with severe spinal stenosis should be evaluated with caution.

• The Korean Journal of Pain
• /
• v.10 no.1
• /
• pp.21-27
• /
• 1997

Background : Previous studies have proven beneficial in labor analgesia to use subarachnoid sufentanil(alone or with adjuvant) on parturients in early first stage of labor. We designed this prospective study to evaluate analgesic efficacy and side effects of subarachnoid sufentanil plus bupivacaine in women with cervical dilatation of 7 cm greater. Methods : This was an open-label, nonrandomized trial of 32 parturients in late first stage labor who requested labor analgesia. After signing the consent form each patient received subarachnoid sufentanil (10 ${\mu}g$) and bupivacaine (2.5 mg). Patients were asked to rate their verbal pain score (0-10 scale) before regional anesthesia and 5 minutes after subarachnoid injection, and every 20 minutes thereafter until delivery or request for additional analgesia. Blood pressure, pruritus, Bromage motor block score, mode of delivery and need for supplemental analgesics were recorded. Results : Thirty women were included in the study. Mean pain scores (mean${\pm}$SD) were $8.7{\pm}1.0$ pre-spinal, $0.7{\pm}1.5$ 5 minutes post-injection, and remained less than 5 for 130 minutes after spinal injection. Of 30 patients, 24 had unassisted vaginal delivery, 4 instrumental vaginal delivery (vacuum), and 2 cesarean delivery. Of 28 patients who delivered vaginally, 19 did not require supplemental analgesics and had a delivery pain score of 5 or lower. Blood pressure decreased in three patients after spinal analgesia (p<0.05), which necessitated treatment. The Bromage motor block score was 0 in 26 patients and 1 in 4 patients. Pruritus was noted in 22 patients. Conclusion : Subarachnoid sufentanil-bupivacaine provides rapid analgesia for an effective duration of approximately 130 minutes in parturients in late first stage of labor.

• Journal of Korean Critical Care Nursing
• /
• v.14 no.1
• /
• pp.28-39
• /
• 2021

Purpose : This study investigated the occurrence of postoperative ileus and its related factors in patients after spinal surgery. Methods : After a retrospective review of data from patients who underwent spinal surgery at a single hospital located in Busan from 2012 through 2016, a total of 253 patients were included. The subjects were divided into non-ileus and ileus groups. We compared patient-, surgery-, and postoperative hematological-related factors. Results : A total of 41 (16.2%) out of 253 patients experienced postoperative ileus. Data analysis revealed significant differences between the two groups in mean age (68.44 vs 60.50 years), occupation (9.8 vs 28.8%), cardiovascular comorbidity (63.4 vs 37.7%), approach of surgery (supine/prone: 29.3/70.7 vs 12.7/87.3%), duration of anesthesia (5.86 vs 4.43 hours), narcotic use (75.6 vs 56.6%), postoperative serum hemoglobin level (3 days: 10.81 vs 11.41 g/dL), postoperative serum protein (immediately/3 days: 5.30/5.43 vs 5.62/5.68 g/dL), postoperative albumin level (3 days: 3.17 vs 3.40 g/dL), postoperative C-reactive protein level (3 days: 11.44 vs 8.36 mg/dL), postoperative bed stabilization period (3.32 vs 2.50 days), and onset of bowel movement (2.59 vs 1.94 days). In multivariate logistic regression, age and time of anesthesia were independent risk factors of postoperative ileus. Conclusion : To detect ileus after spinal surgery early, nurse education is needed with intensive screening on advanced age, surgery-related factors, and postoperative hematological indices.

• The Korean Journal of Pain
• /
• v.10 no.1
• /
• pp.134-137
• /
• 1997

We report a case of cauda equine syndrome following caudal anesthesia possibly caused by metastatic spine tumor. Male, 80-year-old, who had prostatic carcinoma with $L_3$ and $L_4$ spine metastasis was scheduled for bilateral orchiectomy. Twenty two-gauge needle was introduced at sacral hiatus and 15 ml of 2% lidocaine administered. The next morning, patient complained of perineal numbness and urination difficulty. During the next several day patient had episodes of fecal incontinence and motor weakness on both lower extremities. This case reminded us that neuroaxial blocks such as spinal, epidural and caudal anesthesia, should be used with extreme care in patients having neoplasm with high incidence of spine metastasis.

• The Korean Journal of Pain
• /
• v.14 no.2
• /
• pp.253-256
• /
• 2001

One of the most serious complications of regional anesthesia is a neurological deficit. Although such a problem is very rare, obstetric patients may develop paresthesia and motor dysfuntion during the postoperative period in association with number of other factors, including direct nerve trauma, equipment problems, adhesive arachnoiditis, anterior spinal artery syndrome, epidural hematoma or abscess and adverse drug effect. We experienced a case of unilateral paraparesis following epidural anesthesia with 20 ml of 0.75% ropivacaine and $25{\mu}g$ of fentanyl in an obstetric patient.

• Proceedings of the Korean Society of Precision Engineering Conference
• /
• 2005.10a
• /
• pp.135-138
• /
• 2005

Robotic devices have been widely used in many medical applications due to their accuracy and programming ability. One of the applications is a virtual reality medical simulator, which trains medical personnel in a computer generated environment. In this paper, we are going to present an application, an epidural anesthesia trainer. Because performing epidural injections is a delicate task, it demands a high level of skill and precision from the physician. This trainer uses a robotic device and computer controlled solenoid valve to recreate interaction forces between the needle and the various layers of tissues around the spinal cord. The robotic device is responsible for generation of interaction forces in real time and can be used to be haptic guidance that allows the user to follow a previous recorded expert procedure and feel the encountered forces.