• The Korean Journal of Pain
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• 제26권3호
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• pp.277-285
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• 2013

Background: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

• 대한족부족관절학회지
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• 제15권2호
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• pp.97-101
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• 2011

Intravenous Patient Controlled Analgesia (IV PCA0 after general or spinal anesthesia may be a method of postoperative pain control, but side effects such as nausea, vomiting, and sedation occurs in most patients. The following research is based on the ultrasound guided femorosciatic nerve block held on parts below the knee joint operation. Because this anesthesia is held locally on the sciatic nerve with continuous anesthesia performed through perineural catheterization, the complications of nausea, vomiting, and sedation may be reduced while postoperative pain caused by the sciatic nerve is controlled. The following report is held on this experience.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권2호
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• pp.116-124
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• 2020

Objectives: Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. Materials and Methods: A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. Results: The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient's sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. Conclusion: Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.

• The Korean Journal of Pain
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• 제22권2호
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• pp.130-134
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• 2009

Background: The advances in surgical technology, anesthesia and perioperative care have made it possible to perform laparoscopic cholecystectomy on an outpatient basis. This study was conducted to assess the analgesic effect and the adverse events of different dosing methods when using transdermal fentanyl patches (TDFPs) after laparoscopic cholecystectomy. Methods: Sixty patients who were to undergo laparoscopic cholecystectomy under general anesthesia were divided into two groups. Group 1: 2 TDFPs that released $12{\mu}g/h$ were applied after the induction of anesthesia and these 2 patches were removed after 24 hours. Group 2: 2 TDFPs that released $12{\mu}g/h$ were applied after the induction of anesthesia and one patch was removed after 7 hours and the other patch was removed after 24 hours. The intensity of the postoperative pain was assessed by using a visual analogue scale (VAS) and assessing the adverse events, including dizziness, pruritus and nausea/vomiting, were recorded for 48 hours postoperatively. Results: The VAS score of postoperative pain was not significantly different between the two groups at all times. The incidence of dizziness in groups I and II was 10 and 3, respectively, and the incidence of nausea/vomiting in group I and II was 4 and 0, respectively. The incidences of dizziness and nausea/vomiting in group II were significantly lower than those of group I (P<0.05). Conclusions: A dosing method that removes half of the TDFPs ($24{\mu}g/h$) after 7 hours of application caused a lower incidence of dizziness and nausea/vomiting without any significant difference of postoperative analgesic efficacy, as compared to leaving on both the TDFPs (24$\mu$g/h) for 24 hours after laparoscopic cholecystectomy.

• The Korean Journal of Pain
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• 제8권1호
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• pp.43-50
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• 1995

The purpose of this study was to compare postoperative analgesic effect according to intravenous doses of ketorolac. The ninety-eight adult patients, scheduled for elective surgery under general anesthesia, were randomly assigned to receive saline or one of the five doses of ketorolac (10, 15, 30, 45, 60mg). After recoverg from anesthesia, saline or ketorolac was injected intravenously, and the visual analogue score, sedation secore, mean blood pressure, heart rate, and the incidence of nausea and vomiting were measured 30 minutes, 1 hour and 2 hours the injection. Saline or 10 mg of ketorolac had no postanalgesic effect. Above 15 mg of ketorolac had analgesic effect, but this analgesic effect was not increased with increasing doses of ketorolac (30, 45, 60 mg). Any side effects (nausea, vomiting, excessive sedation, cardiopulmonary depression, and renal and hematologic adverse events) was not observed associated with ketorolac administration. These results suggested that 15 mg of ketorolac is the most reliable dose for postoperative anlgesia in intravenous administration.

• Journal of Korean Biological Nursing Science
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• 제20권4호
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• pp.236-243
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• 2018

Purpose: The purpose of this study was to identify the factors associated with the discontinuation of patient controlled analgesia (PCA) after surgery. Methods: The data of 1,092 adult patients that were over 20 years of age and underwent PCA after surgery in the Gachon University Hospital from May 1 to June 30, 2017, were collected through the patients' Electronic Medical Record (EMR). The collected data was analyzed via the use of the Chi-test, t-test and multivariate logistic regression analysis using SPSS 18.0 program. Results: The postoperative PCA discontinuation rate was 26.1%. It was associated with various symptoms, such as those of nausea, dizziness, and headache. The PCA discontinuation was also related with female (odds ratio, OR= 1.75; confidence interval, CI= 1.09-2.82), nausea (OR= 105.27; CI= 61.03-181.58), total intravenous anesthesia (TIVA) of the thyroidectomy (OR= 10.43; CI= 5.01-21.70). Conclusion: It is necessary to provide additional medication and nursing interventions to reduce nausea, which is the symptom associated with PCA discontinuation, especially in the operation of female subjects and thyroidectomy under TIVA. That is, those who are at a high risk for PCA discontinuation should be able to administer additional antiemetics or reduce non medication nursing interventions.

• 대한한방부인과학회지
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• 제22권3호
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• pp.185-196
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• 2009

Purpose: This study aims to estimate the effects of on acustimulation for Gynecological surgery induced nausea and vomiting through reviewing the tendency of the studies. Methods: Literature searches were made through Pubmed, Koreanstudies Information Service System(KISS) and Korean Oriental medical Society database. Data were extracted according to pre-defined criteria. The methodological quality was assessed using Modified Jadad scale. Results: 8 studies were met the condition among the 43 searched studies. They were designed as double blind or observer blind and randomized controlled trial, and were analyzed statistically. 6 studies out of the 8 reported that acupuncture could prevent PONV effectively. Conclusion: The hypothesis that acustimulation may be effective for the prevention of Gynecological surgery induced PONV is supported by the data in recent literatures.

• The Korean Journal of Pain
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• 제11권1호
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• pp.91-95
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• 1998

Background: Quality of postoperative care may be improved by management of postoperative pain. Epidural anesthesia and analgesia have several advantages over general anesthesia and parenteral analgesics in managing the postoperative pain. We retrospectively reviewed records of obstetrical patients who underwent the cesarean sections under epidural anesthesia to evaluate perioperative analgesic use, side effects, and complications. Methods: All patients received epidural anesthesia consisting of 0.25% bupivacaine, 2% lidocaine and 100 ${\mu}g$ fentanyl, followed by epidural analgesia with 0.1% bupivacaine and 12.5 ${\mu}g$/ml fentanyl at rate of 2 ml/hr for 48 hours. Patients' records were reviewed for: medications administered for pain relief, incidence of nausea and vomiting and pruritus, and presence of respiratory or cardiovascular depression. Results: Over 18 months, 1,054 patients' records were reviewed. Average age was 27.8 years (18~43 years). 768 patients (72.9%) received no additional drugs for the pain relief. Intramuscular analgesics, ketoprofens, were one time administered to 247 patients (23.4%), 39 patients (3.7%) received two more dosages. The time of administration was $8.3{\pm}4.3$ hours postoperatively. Antiemetics, for example, low-dose droperidol, were administerd one time for 160 patients (15.2%), 5 patients (0.5%) received two or more administrations. The medication was administered $5.1{\pm}4.2$ hours postoperatively. Drugs for relief of pruritus, low-dose naloxone, were administered one time for 108 patients (10.2%), 10 patients (0.9%) received 2 or more dosages. The time of administration was $6.3{\pm}4.2$ hours postoperatively. None of the patients experienced cardiovascular nor respiratory (<8 breath/min) depression. Conclusions: Postoperative continuous epidural analgesia in combination with bupivacaine and fentanyl is an effective method of providing postoperative analgesia with low incidence of side effects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권2호
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• pp.84-89
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• 2016

Objectives: To compare the efficacy of intravenous ondansetron (4 mg, 2 mL) and granisetron (2 mg, 2 mL) for preventing postoperative nausea and vomiting (PONV) in patients during oral and maxillofacial surgical procedures under general anesthesia. Materials and Methods: A prospective, randomized, and double blind clinical study was carried out with 60 patients undergoing oral and maxillofacial surgical procedures under general anesthesia. Patients were divided into two groups of 30 individuals each. Approximately two minutes before induction of general anesthesia, each patient received either 4 mg (2 mL) ondansetron or 2 mg (2 mL) granisetron intravenously in a double blind manner. Balanced anesthetic technique was used for all patients. Patients were assessed for episodes of nausea, retching, vomiting, and the need for rescue antiemetic at intervals of 0-2, 3, 6, 12, and 24 hours after surgery. Incidence of complete response and adverse effects were assessed at 24 hours postoperatively. Data was tabulated and subjected to statistical analysis using the chi-square test, unpaired t-test, or the Mann-Whitney U-test as appropriate. A P-value less than 0.05 was considered statistically significant. Results: There was no statistically significant difference between the two groups for incidence of PONV or the need for rescue antiemetic. Both study drugs were well tolerated with minimum adverse effects; the most common adverse effect was headache. The overall incidence of complete response in the granisetron group (86.7%) was significantly higher than the ondansetron group (60.0%). Conclusion: Granisetron at an intravenous dose of 2 mg was found to be safe, well tolerated, and more effective by increasing the incidence of complete response compared to 4 mg intravenous ondansetron when used for antiemetic prophylaxis in maxillofacial surgery patients receiving general anesthesia. Benefits of granisetron include high receptor specificity and high potency, which make it a valuable alternative to ondansetron.

• The Korean Journal of Pain
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• 제10권1호
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• pp.48-53
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• 1997

Background : Epidural morphine provides excellent postoperative analgesia but is often associated with side effects such as nausea, vomiting and pruritus. It has been reported that mixed agonist-antagonist, nalbuphine can reverse side effects of epidural morphine without compromising analgesia. This study was designed to compare the efficacy of each intravenous dose of nalbuphine for treatment of side effects following epidural morphine. Methods : All patients received continuous infusion(2 ml/hr) of epidural morphine-local anesthetics mixture(morphine 4 mg, 1% mepivacaine 50 ml and 0.25% bupivacaine 50 ml) following a loading dose (morphine 2 mg with 1% mepivacaine 7 ml). Patients requesting treatment for nausea, vomiting and pruritus randomly received intravenous nalbuphine 0.05 mg/kg(Group 1; n=20), 0.1 mg/kg(Group 2; n=20) or 0.15 mg/kg(Group 3; n=20). The severity of nausea, vomiting, pruritus, degree of pain, sedation and vital sign were assessed prior to and 30 min after each dose. Results : The severity of nausea, vomiting and pruritus decreased significantly in all groups(p<0.01). Pain and sedation scores were unchanged in all groups. One patient received nalbuphine 0.15 mg/kg, complained of dizziness, agitation and palpitation. His blood pressure who had increased to 170/100 after first dose. Conclusions : This study suggests that intravenous nalbuphine is good for treatment of side effects following epidural morphine, and the dose of Group 1, 0.05 mg/kg, may be recommended as an optimal dose.