• The Korean Journal of Pain
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• 제8권2호
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• pp.244-250
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• 1995

Many clinical and laboratory experiments have been developed to prevent or decrease post-operative pain. One of these methods is pre-operative administration of opioid. Recently there have been differing and debatable results reported of pre-operative treatment for post-operative pain management. It was our study to determine whether pre-operative epidural fentanyl prevented central facilitation or wind up of spinal cord from nociceptive afferent input through c-fibers. We evaluated the effect of epidural fentanyl 50 mcg 10 minutes before operation and 10 minutes before the end of surgery. 28 parturient women for Cesarean Section were randomly allocated to receive the epidural fentanyl either at 10 minutes before operation (Group 1, n=14) or 10 minutes before the end of surgery (Group 2, n=14). All of the 28 parturient women were anesthetized with epidural block using (22 ml of) 2% lidocaine supplemented with light general anesthesia ($N_2O$ 2 L/min-$O_2$, 2 L/min), we controlled post-operative pain with epidural PCA(patient controlled analgesia) infusion of meperidine and 0.07% bupivacaine. The action duration of epidural fentanyl from the end of surgery to the first requirement of analgesics with epidural PCA were not significantly different between the two groups. No significant differences between two groups were observed in VAS pain score at 1, 2, 3, 6, 12, 24, and 48 hours after the operation. The number of self administration of narcotics with PCA during 48 hours after surgery were the same between the two groups. The hourly infusion rates of demerol were the same. Pre-operative administration of fentanyl was not clinically effective compared to administration just before the end of surgery for postoperative pain control.

• The Korean Journal of Pain
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• 제2권1호
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• pp.89-93
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• 1989

We performed the autologous epidural blood patch (AEBP) for the relief of headache and other related symptoms following dural punctures of the lumbar region during 8 years from 1981 to 1988. The total of 37 patients with the patching consisted of 9 cases in 3007 of spinal anesthesia, 12 accidental dural punctures in 4283 cases of lumbar epidural anesthesia, 12 cases in 4747 of epidural analgesia for back pain control, 3 cases of myelography and a case of diagnostic lumbar puncture. The headaches were relieved completely in 35 cases following the first AEBP and the remaining two were also relieved following the second AEBP. We think that the AEBP for postdural-puncture headache is the treatment of choice.

• The Korean Journal of Pain
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• 제25권2호
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• pp.94-98
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• 2012

Background: An intravenous infusion of lidocaine has been used on numerous occasions to produce analgesia in neuropathic pain. In the cases of failed back surgery syndrom, the pain generated as result of abnormal impulse from the dorsal root ganglion and spinal cord, for instance as a result of nerve injury may be particularly sensitive to lidocaine. The aim of the present study was to identify the effects of IV lidocaine on neuropathic pain items of FBSS. Methods: The study was a randomized, prospective, double-blinded, crossover study involving eighteen patients with failed back surgery syndrome. The treatments were: 0.9% normal saline, lidocaine 1 mg/kg in 500 ml normal saline, and lidocaine 5 mg/kg in 500 ml normal saline over 60 minutes. The patients underwent infusions on three different appointments, at least two weeks apart. Thus all patients received all 3 treatments. Pain measurement was taken by visual analogue scale (VAS), and neuropathic pain questionnaire. Results: Both lidocaine (1 mg/kg, 5 mg/kg) and placebo significantly reduced the intense, sharp, hot, dull, cold, sensitivity, itchy, unpleasant, deep and superficial of pain. The amount of change was not significantly different among either of the lidocaine and placebo, or among the lidocaine treatments themselves, for any of the pain responses, except sharp, dull, cold, unpleasant, and deep pain. And VAS was decreased during infusion in all 3 group and there were no difference among groups. Conclusions: This study shows that 1 mg/kg, or 5 mg/kg of IV lidocaine, and palcebo was effective in patients with neuropathic pain attributable to FBSS, but effect of licoaine did not differ from placebo saline.

• Journal of Veterinary Science
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• 제22권1호
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• pp.9.1-9.11
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• 2021

Background: Scalding burn injuries can occur in everyday life but occur more frequently in young children. Therefore, it is important to develop more effective burn treatments. Objectives: This study examined the effects of bee venom (BV) stimulation on scalding burn injury-induced nociception in mice as a new treatment for burn pain. Methods: To develop a burn injury model, the right hind paw was immersed temporarily in hot water (65℃, 3 seconds). Immediately after the burn, BV (0.01, 0.02, or 0.1 mg/kg) was injected subcutaneously into the ipsilateral knee area once daily for 14 days. A von Frey test was performed to assess the nociceptive response, and the altered walking parameters were evaluated using an automated gait analysis system. In addition, the peripheral and central expression changes in substance P (Sub P) were measured in the dorsal root ganglion and spinal cord by immunofluorescence. Results: Repeated BV treatment at the 2 higher doses used in this study (0.02 and 0.1 mg/kg) alleviated the pain responses remarkably and recovered the gait performances to the level of acetaminophen (200 mg/kg, intraperitoneal, once daily), which used as the positive control group. Moreover, BV stimulation had an inhibitory effect on the increased expression of Sub P in the peripheral and central nervous systems by a burn injury. Conclusions: These results suggest that a peripheral BV treatment may have positive potency in treating burn-induced pain.

• Journal of Medicine and Life Science
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• 제18권1호
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• pp.11-15
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• 2021

In elderly patients, the vital parameters tend to fluctuate based on the blood volume status, which may cause sudden hypovolemic shock if the postoperative bleeding continues. Particularly, those who undergo surgery for arthritis needs to pay extra attention because the bleeding may persist over the joints after the surgery. Therefore, appropriate pain control is required to reduce the postoperative blood loss. This retrospective chart review study was conducted to assess the postoperative pain control and reduction of blood loss with a single injection of saphenous nerve block (SNB) in elderly patients with osteoarthritis. We reviewed the electronic medical records of patients who underwent knee total arthroplasty with spinal anesthesia between January and May 2016. A total of 51 patients participated in this study. All patients were treated with intravenous patient-controlled analgesia for the postoperative pain control, and additional analgesic agents were administered at a visual analogue scale above a score of 6. In 25 patients, SNB was performed using ultrasound with the administration of 0.75% ropivacaine (15 mL) after the surgery. Patients who received additional analgesics were significantly low in the nerve block group (P=0.009). Additionally, the volume of blood loss from catheter drainage was significantly low at 2 and 3 days postoperatively (P=0.013 and P=0.041, respectively) in the nerve block group. In patients who underwent total knee arthroplasty with osteoarthritis, only a single injection of saphenous nerve block was sufficient for the postoperative pain control and reduced bleeding.

• 임상간호연구
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• 제26권3호
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• pp.296-304
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• 2020

Purpose: This study was conducted to demonstrate objective stability of postoperative pain management status managed by nurse-based, anesthesiologist-supervised Acute Pain Service (APS). Methods: A retrospective descriptive review was conducted with 5,748 patients who had used intravenous Patient Controlled Analgesia (PCA) from January to December 2017. Data were analyzed using descriptive statics, Frequency analysis, ANOVA, Cross tabulation with χ2test, and Correlation coefficient. Results: As the APS nurse's education date increased, the period of using PCA was statistically significantly longer, and the period of stopping PCA while using it became shorter (p<.001). Statistically significant, the most painful operations were extremities, spine, upper abdomen, and thorax, while the least painful surgery was lower abdomen (p<.001). Lower abdominal surgery used the highest amount of PCA (p<.001), and extremities and spinal surgery, the lowest amount of PCA and frequently stop using it (p<.001). The most common side effects were nausea and vomiting after surgery, with an incidence of 16.0% within 24 hours and 9.8% within 48 hours. The overall error caused by PCA was 1.5%, with 84.3% being caused by human errors. Conclusion: With the pain management effect of APS nurses, patients used PCA more effectively. There were also fewer side effects and error rates compared to prior studies. Therefore, it is suggested that this system is safe and effective for pain management.

• The Korean Journal of Pain
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• 제36권4호
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• pp.425-440
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• 2023

Background: Muscimol's quick onset and GABAergic properties make it a promising candidate for the treatment of pain. This systematic review and meta-analysis of preclinical studies aimed at summarizing the evidence regarding the efficacy of muscimol administration in the amelioration of nerve injury-related neuropathic pain. Methods: Two independent researchers performed the screening process in Medline, Embase, Scopus and Web of Science extracting data were extracted into a checklist designed according to the PRISMA guideline. A standardized mean difference (SMD [95% confidence interval]) was calculated for each. To assess the heterogeneity between studies, ² and chi-square tests were utilized. In the case of heterogeneity, meta-regression and subgroup analyses were performed to identify the potential source. Results: Twenty-two articles met the inclusion criteria. Pooled data analysis showed that the administration of muscimol during the peak effect causes a significant reduction in mechanical allodynia (SMD = 1.78 [1.45-2.11]; P < 0.0001; I² = 72.70%), mechanical hyperalgesia (SMD = 1.62 [1.28-1.96]; P < 0.0001; I² = 40.66%), and thermal hyperalgesia (SMD = 2.59 [1.79-3.39]; P < 0.0001; I² = 80.33%). This significant amendment of pain was observed at a declining rate from 15 minutes to at least 180 minutes post-treatment in mechanical allodynia and mechanical hyperalgesia, and up to 30 minutes in thermal hyperalgesia (P < 0 .0001). Conclusions: Muscimol is effective in the amelioration of mechanical allodynia, mechanical hyperalgesia, and thermal hyperalgesia, exerting its analgesic effects 15 minutes after administration for up to at least 3 hours.

• 대한약리학회지
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• 제30권1호
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• pp.29-37
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• 1994

배외측 뇌교의 전기자극은 척수 수준에서 동통의 역치를 증가시키고, 또한 말초로 부터 오는 유해성 자극에 의해 야기되는 척수후각세포의 흥분성을 억제하여 진통효과를 나타낸다. 이러한 진통효과는 noradrdnergic 원심신경을 매개로 한다고 하였지만, 이직까지 이를 직접적으로 뒷받침하는 신경화학적인 증거는 보고되지 않았다. 따라서 본 실험은 뇌교에 위치한 청반핵(Locus coeruleus)의 전기자극시, 척수 수준에서 일어나는 동통조절효과를 쥐꼬리 회피 반사(Tail Flick Reflex)를 이용해 관찰하고, 이러한 동통조절효과는 어떤 신경전달물질을 매개로해서 일어나며, 또한 생체내에서 직접 유리 되는지 살펴보기 위해 Push Pull technique을 이용해 척수액내 noradrenaline의 농도 변화를 HPLC로 측정하였다. 청반핵자극시의 동통조절기전을 알아보기위해 yohimbine, naloxone 그리고 vehicle의 3group 으로 나누어 각 길항제의 효과를 실험하였다. 청반핵 자극시 TF latency의 증가(>6.Ssec)를 보이는 역치 자극강도가 yohimbine $30{\mu}g$을 척수내로 투여한 후에는 $135\;{\mu}A$로서 안정시의 $55\;{\mu}A$에 비해 147% 증가되어 유의한 변화를 보여주었다(P<0.01, n=5). $Naloxone\;20{/mu}g$을 투여한 실험군 에서도 초기 역치자극강도 $54\;{\mu}A$에서 $120\;{\mu}A$로서 123% 증가되어 역시 유의한 변화를 보여주었다(P<0.01, n=5). 그러나 vehicle group에서는 투여 전, 후 역치자극강도의 변화가 없었다. 청반핵 자극이 없는 안정상태에서의 TF latency 값은 모두 3.1 sec였고 yohimbine과 naloxone투여후에는 각각 2.5 sec,2.6sec로 감소되어, 긴장성 억제가 차단되는 것으로 나타났다(각각 P<0.05,P<0.1,n=5).청반핵의 전기자극$(100\;{\mu}A)$은 척수액내 noradrenaline의 농도를 증가시켰으나(평균 4.18mg/ml에서 7.74 ng/ml로, p<0.05, n=10),dopamine의 농도는 증가되지 않았다. 이상의 결과는 청반핵 자극에 의한 척수내 동통조절효과는 opioid 계외에 부분적으로 noradrdnaline을 매개로 해서 이루어지며, 이에 관여하는 수용체는 ${\alpha}_2$ 임을 보여주었다.

• Journal of Ginseng Research
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• 제24권3호
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• pp.143-147
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• 2000

앞의 연구에서 우리는 진세노사이드 Rc, Rd, Re 및 Rr를 복강내 전 처리할 경우 포르말린으로 유도된 통증을 억제하다는 것을 보고하였다 그러나 이러한 진세노사이드가 어느 위치에서 항통증작용을 발휘하는가에 대하여서는 아직 알려지지 않고 있다. 본 연구에서는 이들 진세노사이드를 뇌실내, 척수강내 혹은 피하내 전처리한 다음 포르밀린에 의하여 유도되는 통증이 어느 위치에서 억제되는가를 연구하였다. 연구 결과 이들 진세노사이드는 척수강내 전처리할 경우 포르말린에 의하여 유도되는 통증을 억제하는 것으로 나타났다. 급성 통증 phase에서 ED$_{50}$는 Rc가 1.0 (0.SS~l.75mg/kg)이었고, Rd가 1.15 (0.6~2.25 mg/kg)이었고, Re가 8.9(3.9~20.5 mg/kg)이었다. 지속성 통증 phase에서 ED$_{50}$는 Rc가0.3 (0.1~0.85 mg/kg)이었고, Rd가 0.6 (0.35~l.1 mg/kg)이었고, Re가 2.45 (1.2s~4.65 mg/kg)이었고, Rf가 1.9(1.5~4.25 mg/kg)인 것으로 나타났다. 또한 뇌실내 전처리할 경우에도 이들 진세노사이드들은 포르말린에 의하여 유도되는 통증을 억제하였다. 급성통증 phase에서 ED$_{50}$는 Rc가 0.9 (0.55~l.4 mg/kg)이었고, Rd가0.9 (0.45~l.7 mg/kg)이었고, Re가 0.93 (0.Sol.75 mg/kg), Rf가1.85 (0.95~3.5 mg/kg)인 것으로 나타났다. 지속성 통증 phase에서는 ED$_{50}$는 Rc가 0.7 (0.45~l.05 mg/kg)이었고, Rd가 1.25(0.7~2.2 mg/kg)이었고, Re가 0.85 (0.45~l.6 mg/kg)이었고, H의 경우에는 0.8 (0.4~l.45 mg/kg) 이었다. 항통증 효능 potency는 두 가지 투여 경로에 있어서 Rc$\geq$Rd>Re>Rf인 것으로 나타났다. 그러나, 피하내 주사는 포르말린에 의하여 유도되는 통증을 억제하지 않은 것으로 나타났다. 이러한 연구 결과는 진세노사이드에 의한 항통증 작용은 척수 수준 및 척수위 수준에서 이루어진다는 것을 보여주고 있다.보여주고 있다.

• The Korean Journal of Pain
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• 제1권1호
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• pp.64-73
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• 1988

Recent studios have shown that narcotic drags produce an unusually intense, prolonged and segmental analgesic action in man whoa injected into the spinal subarachnoid or epidural space (Wang et al, 1979; Behar et al, 1979; Cousins et al, 1979; Magora et a., 1980, Johnston and McCaughey, 1980). Since 1960, many investigators claimed that low molecular weight(LMW) dextran increased the clinical duration of lidocaine(Loder, 1960; Loder, 1962), tetracaine (Chinn and Wirjoatmadja, 1967) and bupivacaine(Kaplan et al, 1975) in man but the mechanism of the action of dextran was unclear. But Curtiss and Scurlock(1979), and Buckled and Fink(1979) claimed that LMW dextran has no effect on the duration of action of bupivacaine in animal studies. The present study was performed to evaluate the clinical efficacy of analgesia by the thoracic epidural injection of morphine and bupivacaine mixture for the relief of pain due to fractured or contused ribs, to evaluate the duration of analgesic effect by the use of the above mixture in a hypertonic solution(dextran 70 or 50% dextrose in water) and to observe the possibility of improvement in the lung function after the pain block. The complications following the pain block were also observed. The 50 single thoracic epidural injections of the mixture were divided into three groups : Group 1(n=15) served as a control group and drags used for the relief of pain were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}1.64\;mg$), 0.5% bupivacaine($3.10{\pm}1.04\;ml$) and 0.9% saline($3.64{\pm}1.11\;ml$). Group 2(n=16) serves as an experimental group and drugs were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}0.72\;mg$), 0.5% bupivacaine($3.06{\pm}0.77\;ml$) and dextran 70($3.75{\pm}1.29\;ml$). Group 3 (n=19) served as an experimental group and drags were as follows(Mean$\pm$S.D.) : morphine($2.42{\pm}0.51\;mg$), 0.5% bupivacaine($3.21{\pm}0.71\;ml$) and 50% dextrose in water($3.58{\pm}1.11\;ml$). The results are were follows: 1) The Dumber of patients who obtained excellent and good analgesic effects following the block were greater in the experimental Croup 2(94%) and Group 3 (90%) than theme of the control Group 1 (80%). 2) The duration of pain relief which lasted more than 3 days after the epidural block was longer in the experimental Group 2 (81%) and Group 3 (75%) than those of the control Croup 1(67%). 3) The pulmonary reserve(FVC%+FEV 1.0%) of 27 cases who were treated by the pain block between 1 and 31 drys following the chest injury was increased to about 13% than those before the block, and that of 13 cases between 32 and 82 days following the chest injury was decreased to about 4% than those before the block. 4) Of the complications following the pain block, there were 5 cased(10%) of nausea within 2 hours following the block, 4 cases(8%) of vomiting after 2 hours following the block, 10 cases(20%) of pruritus after 3~4 hours following the block, 17 cases(34%) of transient urinary retention which tasted 8 to 19 hours, 3 cases(6%) of headache within 2 hoers following the block and 2 cases(4%) of dural puncture. In conclusion, it is suggested that the clinical duration of analgesic effect produced by morphine and bupivacaine mixture can be prolonged by addition of the hypertonic solution to the mixture.