Outcome of fast track surgery after intercostal nerve block during thoracoscopic resection of lung bullae: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To analyze the outcome of fast track surgery after intercostal nerve block (INB) during thoracoscopic resection of lung bullae. Methods    We recuited 76 patients who accepted thoracoscopic resection of lung bullae from February 2013 to March 2015. They were randomly divided into two groups: an intercostal nerve block and intravenous patient-controlled analgesia (INB+IPCA) group, in which 38 patients (30 males, 8 females, with a mean age of 23.63±4.10 years) received INB intraoperatively and IPCA postoperatively, and a postoperative intravenous patient-controlled analgesia (IPCA) group, in which 38 patients (33 males, 5 females, with a mean age of 24.93±6.34 years) only received IPCA postoperatively. Their general clinical data and the postoperative pain visual analogue scale (VAS) were recorded. Analgesia-associated side effects, rate of the pulmonary infection were observed. Expenses associated with analgesia during hospital were calculated. Results    The score of VAS, the incidence of nausea and vomiting, fatigue and other side effects, pulmonary atelectasis and the infection rate in the INB+IPCA group were significantly lower than those in the IPCA group. Postoperative use of analgesic drugs was significantly less than that in the IPCA group. Medical expenses did not significantly increase. Conclusion    INB+IPCA is beneficial for fast track surgery after thoracoscopic resection of lung bullae.

Comparison of palonosetron with ondansetron in prevention of postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia after gynecological laparoscopic surgery / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications after anesthesia and surgery. This study was designed to compare the effects of palonosetron and ondansetron in preventing PONV in high-risk patients receiving intravenous opioid-based patient-controlled analgesia (IV-PCA) after gynecological laparoscopic surgery. METHODS: One hundred non-smoking female patients scheduled for gynecological laparoscopic surgery were randomly assigned into the palonosetron group (n = 50) or the ondansetron group (n = 50). Palonosetron 0.075 mg was injected as a bolus in the palonosetron group. Ondansetron 8 mg was injected as a bolus and 16 mg was added to the IV-PCA in the ondansetron group. The incidences of nausea, vomiting and side effects was recorded at 2 h, 24 h, 48 h and 72 h, postoperatively. RESULTS: There were no significant differences between the groups in the incidence of PONV during 72 h after operation. However, the incidence of vomiting was lower in the palonosetron group than in the ondansetron group (18% vs. 4%, P = 0.025). No differences were observed in use of antiemetics and the side effects between the groups. CONCLUSIONS: The effects of palonosetron and ondansetron in preventing PONV were similar in high-risk patients undergoing gynecological laparoscopic surgery and receiving opioid-based IV-PCA.

Gender-related Difference in Intravenous Patient-controlled Analgesia for Postoperative Pain Control in Rotator Cuff Repair / 대한정형외과학회잡지

PURPOSE: This study examined the efficacy and gender-related difference of intravenous patient-controlled anesthesia (IV PCA) for postoperative pain control in patients undergoing rotator cuff repair. MATERIALS AND METHODS: Forty-five patients undergoing rotator cuff repair had their postoperative pain controlled using IV-PCA. There are 21 males and 24 females. The results of the two groups were compared prospectively using a visual analogue scale score (VAS score) measured before and until 5 days after surgery, hospital stay, postoperative rehabilitation, additional analgesics consumption and medication-related adverse effects. RESULTS: There was no difference in age, body mass index, tear size and operative time between the groups. The mean VAS scores measured before and until the 5th postoperative day were 7.6, 8.0, 5.2, 4.0, 4.0, 3.6 and 3.0. There was no statistically significant difference in VAS score on preoperative, immediate postoperative day and until 4th postoperative day. Significant pain relief was noted in the male group on the 5th postoperative day. In medication-related adverse effects encountered were constipation (35.6%), nausea (28.9%), dizziness (22.2%) and vomiting (15.6%). The consumption of additional analgesics was 1.7 and 3.6 times in the male and female group, respectively. Three (14.3%) and 5 (20.0%) patients in the male and female group, respectively, had their IV PCA stopped because of medication-related adverse effects. Although lower in the male group, there were no statistically significant differences in the medication-related adverse effects, additional analgesics consumption and stop IV PCA. CONCLUSION: There were gender-related differences in IV PCA for postoperative pain control in rotator cuff repair, such as a significant decrease in the VAS score on the 5th postoperative day and a shorter hospital stay in the male group.

A comparison of cervical epidural analgesia and intravenous patient-controlled analgesia after mastectomy with immediate latissimus dorsi flap breast reconstruction / 대한마취과학회지

BACKGROUND: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. METHODS: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n = 30), 0.15% ropivacaine + fentanyl 4 microg/ml] or IV-PCA [Group IV-PCA (n = 30) fentanyl 20 microg/kg + ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C)7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. RESULTS: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV- PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. CONCLUSIONS: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction.

Comparison of Morphine and Fentanyl IV-PCA in Gastrectomy Patient

BACKGROUND: Morphine and fentanyl have potent analgesic effects and these agents are widely used for intravenous patient controlled analgesia (IV-PCA); however, these drugs have some side effects. The purpose of this study was to compare the postoperative analgesic effects and side effects of morphine and fentanyl, employing IV-PCA after gastrectomy. METHODS: Fifty patients undergoing gastrectomy were randomized to receive either morphine (M goup, n = 25) or fentanyl (F group, n = 25) via an IV-PCA pump for 48 hours after the end of surgery. The loading dose was administered when a patient first complained of pain, followed by a bolus dose of 2 mg morphine for the M group and 20microg fentanyl for the F group, with a lockout interval of 10 minutes between doses. The VAS pain score, PCA opioid consumption, rescue analgesic requirement, and side effects were assessed at 2, 6, 12, 24 and 48 hours after the end of surgery. RESULTS: No significant differences were observed between the two groups in terms of the VAS pain score, satisfaction score and total and hourly dose for 48 hours. The side effects were similar in both groups except that pruritus and urinary retention were significantly lower in the F group of patients. CONCLUSIONS: We conclude that both morphine and fentanyl have good analgesic effects with few side effects in gastrectomy patients, but the fentanyl group of patients experienced less pruritus and urinary retention than the morphine group of patients.

The effect of femoral nerve block combined with intravenous patient-controlled analgesia after a unilateral total knee replacement / 대한마취과학회지

BACKGROUND: Postoperative pain is a major concern after total knee replacement (TKR). Intravenous patient-controlled analgesia (IV PCA) is very easily controlled method for managing pain, however it is less effective than other methods, especially immediately after TKR. Therefore, we evaluated the effect of the femoral nerve block combined with IV PCA after a unilateral TKR for postoperative pain control. METHODS: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) taken femoral nerve block before extubation followed by IV PCA. We evaluated the effects of the femoral nerve block with 12 ml of 0.25% bupivacaine and epinephrine 1:400,000 on the postoperative cumulative opioid consumption, hourly dose during each time interval, numerical rating pain score, side effects and hemodynamics. RESULTS: Cummulative opioid consumption was decreased in group II. The pain score in group II was lower than that in group I immediately after recovery of awareness and 3, 6 hours postoperatively. The hourly dose in group II was also lower than that in group I until 6 hours postoperatively. But there was no difference in side effects between the groups. CONCLUSIONS: We concluded that femoral nerve block is effective as an easy adjuvant of IV PCA for pain management during early postoperative period after TKR.

The effect of femoral nerve block combined with intravenous patient-controlled analgesia after a unilateral total knee replacement / 대한마취과학회지

BACKGROUND: Postoperative pain is a major concern after total knee replacement (TKR). Intravenous patient-controlled analgesia (IV PCA) is very easily controlled method for managing pain, however it is less effective than other methods, especially immediately after TKR. Therefore, we evaluated the effect of the femoral nerve block combined with IV PCA after a unilateral TKR for postoperative pain control. METHODS: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) taken femoral nerve block before extubation followed by IV PCA. We evaluated the effects of the femoral nerve block with 12 ml of 0.25% bupivacaine and epinephrine 1:400,000 on the postoperative cumulative opioid consumption, hourly dose during each time interval, numerical rating pain score, side effects and hemodynamics. RESULTS: Cummulative opioid consumption was decreased in group II. The pain score in group II was lower than that in group I immediately after recovery of awareness and 3, 6 hours postoperatively. The hourly dose in group II was also lower than that in group I until 6 hours postoperatively. But there was no difference in side effects between the groups. CONCLUSIONS: We concluded that femoral nerve block is effective as an easy adjuvant of IV PCA for pain management during early postoperative period after TKR.

The Effect of Bilateral Femoral Nerve Block Combined with Intravenous Patient-controlled Analgesia after a Bilateral Total Knee Replacement / 대한통증학회지

BACKGROUND: Postoperative pain after bilateral total knee replacement (TKR) is expected to be more severe than unilateral TKR. Intravenous patient-controlled analgesia (IV PCA) is less effective than other methods of pain management especially immediately after an operation even though it is an easily controlled method for managing pain. This study was designed to evaluate the effect of femoral nerve blocks combined with IV PCA after bilateral TKR for postoperative pain control. METHODS: The patients in group I (n = 20) were given only IV PCA with morphine and group II (n = 20) were given bilateral femoral nerve blocks with 12 ml of 0.25% bupivacaine and epinephrine 1: 400,000 before extubation followed by an IV PCA. Main outcome measures included numerical rating pain score, cumulative opioid consumption, hourly dose during each time interval, and side effects. RESULTS: The pain score in group II was significantly lower than that in group I immediately after recovery of awareness and at 3, 6, 12 hours postoperatively. Cumulative opioid consumption was significantly decreased in group II during the first 48 hours postoperatively. The hourly dose in group II was also significantly lower than that in group I until 12 hours postoperatively. There was no difference in side effects between the groups. CONCLUSIONS: We concluded that bilateral femoral nerve blocks improve analgesia and decrease morphine use during IV PCA after bilateral TKR.

The effect of methods of ondansetron administration on nausea and vomiting during intravenous patient-controlled analgesia in pediatric patients undergoing pectus excavatum repair

BACKGROUND: Postoperative nausea and vomiting remain troublesome problems, especially in pediatric patients receiving the opioid analgesics. This study was designed to evaluate the difference between bolus injection and continuous infusion of ondansetron for the prevention of postoperative nausea and vomiting in pediatric patients with intravenous patient-controlled analgesia (IV-PCA). METHODS: Sixty patients undergoing pectus excavatum repair were randomly assigned into three groups, no antiemetic (Group 1, n = 20), intraoperative ondansetron 0.1 mg/kg IV bolus (Group 2, n = 20), ondansetron 0.1 mg/kg mixed with IV-PCA (Group 3, n = 20). The incidence of nausea, vomiting, the need for rescue antiemetics, side effects and pain score were recorded for 48 hr postoperatively. RESULTS: The incidence of nausea in Group 2 (20%) and Group 3 (25%) was significantly lower than Group 1 (60%). There was no significant difference in the incidence of vomiting among the groups (Group 1:60%, Group 2:20%, Group 3:20%). The need for rescue antiemetics was significantly lower in Group 2 and 3 than Group 1. CONCLUSIONS: In pediatric patients undergoing pectus excavatum repair, bolus injection and continuous infusion of ondansetron were effective in preventing postoperative nausea during IV-PCA. And the need for rescue antiemetics was significantly decreased.

Comparison of three parenteral injection methods for early postoperative pain control in patients with intravenous patient-controlled analgesia (IV PCA)

BACKGROUND: This study was performed to compare postoperative pain and sedation among meperidine 50 mg PRN intramuscular injection, meperidine 50 mg routine intramuscular injection and fentanyl 50microg routine intravenous injection at the end of surgery for early postoperative pain control in patients with intravenous patient-controlled analgesia (IV PCA). METHODS: In group P (n = 35), meperidine 50 mg was injected intramuscularly on request of patients. In group M (n = 35) and F (n = 35), meperidine 50 mg was injected intramuscularly or fentanyl 50microg was injected intravenously at the end of surgery, respectively. Pain score was measured with verbal rating scale (VRS; 0?10) at 30 min, 1 hr, and 6 hr, and sedation score was evaluated with Observer's assessment of alertness/sedation scale (OAA/S) at 30 min, and 1 hr after extubation. Additional fentanyl 50 microg was injected intravenously if patient requested pain control in group P and if VRS was higher than 5 point at 30 min after extubation or patients requested pain relief in group M and group F. RESULTS: Sedation scores of group M were higher than group P and group F. Group P had a higher VRS score than group M and group F at 30 min after extubation. Dose of additional fentanyl 50 microg injection was similar among three groups. CONCLUSIONS: Fentanyl 50microg intravenous injection at the end of surgery with additional fentanyl 50microg injection on patient's request may be good method for early pain control for IV-PCA patients.

The Effect of Ondansetron or Dolasetron for the Prevention of Postoperative Nausea and Vomiting in Patients with Intravenous Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing breast surgery or with intravenous patient-controlled analgesia (IV PCA). We evaluated the effect of ondansetron or dolasetron for the prevention of PONV in patients undergoing a mastectomy with IV PCA. METHODS: A total of 126 patients were randomly divided into three groups. The PCA group was a control group. For the PCAO group (IV PCA mixed with ondanseron), 4 mg ondansetron was intravenously injected 30 min before the end of surgery and 8 mg was mixed in IV PCA. For the PCAD group (IV PCA mixed with dolasetron), 10 mg dolasetron and 20 mg was administered as same manner with the PCAO group. The incidence of PONV, the need for rescue antiemetics, adverse events, and the nausea and vomiting severity score were analyzed for 1 hour and 24 hours postoperative periods. RESULTS: During the first 24 hours postoperatively, the incidence of PONV was 76.2% for the PCA group, 70.7% for the PCAO group (P > 0.05 versus the PCA group) and 66.7% for the PCAD group (P > 0.05 versus the PCA group), respectively. The incidence of need for rescue antiemetics was 40.5% for the PCA group, 9.5% for the PCAO group (P < 0.05 versus the PCA group) and 4.8% for the PCAD group (P < 0.05 versus the PCA group), respectively. CONCLUSIONS: In the patients receiving IV PCA after a mastectomy, ondansetron or dolasetron were not effective for the reduction of the incidence of PONV. However, the need for rescue antiemetics was significantly decreased.

The Effect of Preoperative Epidural Analgesia with Intravenous Patient-controlled Analgesia (IV-PCA) for Postoperative Pain Control in Bone Fusion and Pedicle Screw Fixation / 대한마취과학회지

BACKGROUND: Postoperative pain control following bone fusion and pedicle screw fixation is insufficient with IV-PCA alone. Therefore, the effect of preoperative epidural analgesia in addition to IV-PCA was evaluated for postoperative pain control following bone fusion and pedicle screw fixation surgery. METHODS: Eighty patients, scheduled to undergo bone fusion and pedicle screw fixation, were randomly assigned to two groups; the study (n = 40) or control groups (n = 40). After induction, the patient was turned into the prone position, and morphine 2 mg and 10 ml of 0.2% ropivacaine were injected into the L1/2 epidural space, after dye confirmation, under C-arm guidance for the study group, with 10 ml normal saline injected into the L1/2 epidural space for the control group. After induction, IV-PCA was applied in both groups. After the operation, the NRS (numerical rating scale) and side effects were evaluated immediately post-op, and at 24 and 48 hours after the operation. RESULTS: In the study group, the NRS was more reduced for all periods compared with the control group, but the incidences of nausea/vomiting and pruritus were no different from the control group. CONCLUSIONS: It was concluded that preoperative epidural analgesia, in addition to IV-PCA, was a good postoperative pain control method following bone fusion and pedicle screw fixation.

Comparison of Postoperative Pain after Abdominal and Laparoscopic Assisted Vaginal Hysterectomy by using IV-PCA / 대한마취과학회지

BACKGROUND: It is known that laparoscopic surgery is associated with less pain than open surgery in many studies. We wanted to evaluate the postoperative pain by using intravenous patient-controlled analgesia (IV-PCA) in patients undergoing laparoscopic assisted vaginal hysterectomy (LAVH) or abdominal total hysterectomy (ATH). METHODS: Ninety one women with uterine myoma were prospectively assigned to undergo either LAVH (n = 49) or ATH (n = 42). IV-PCA was used for postoperative pain control in both groups. Pain scores were assessed using a visual analogue scale (VAS) and cumulative PCA-drug consumption and incidences of nausea and vomiting were recorded in 1, 2, 4, 24, 48 hours after surgery. RESULTS: There were no differences in terms of patient's age, BMI and total operation time between the both groups. Pain scores and the demand of analgesics of the IV-PCA in 1, 2, 4, 24, and 48 hours after surgery were not significantly different in both groups. Incidences of nausea and vomiting after surgery were more common in LAVH than ATH especially within 4 hours. CONCLUSIONS: The present study demonstrates that LAVH requires adequate postoperative pain control as ATH during the first 48 hours after surgery, and the effective prevention of PONV is required in LAVH compared with ATH.

Intravenous Patient-controlled Analgesia using Remifentanil after Cardiac Surgery / 대한마취과학회지

BACKGOUND: For rapid onset and predictable elimination half life, remifentanil may be suitable for patients undergoing cardiac surgery with unstable vital sign and decreased metabolism. We evaluated the efficacy, safety and proper dosage of intravenous patient-controlled analgesia (IV PCA) using remifentanil in patients undergoing cardiac surgery. METHODS: Forty-nine patients scheduled for cardiac surgery with sternotomy were randomly allocated to three groups. Group F had IV PCA using fentanyl with basal rate of 0.3microgram/kg/h, bolus of 0.5microgram/kg and lockout time of 15 min. Group L had remifentanil IV PCA with basal rate of 4microgram/kg/h, and group S with basal rate of 1microgram/kg/h. Both of group L and group S had setting of bolus of 0.5microgram/kg and lockout time of 5 min. In 12, 24 and 36 hours after surgery, vital sign, arterial blood gas analysis, visual analog pain scale (VAS), sedation score, and incidences of side effects were evaluated. RESULTS: The VAS score of group L was significantly low until 24 hours after surgery compared with other groups (P < 0.001). In group L, sedation score and PaCO2 in 12 hours after surgery were significantly high compared with other groups (P < 0.05), but no treatments were needed. CONCLUSIONS: Remifentanil IV PCA with basal rate of 4microgram/kg/h showed lower VAS score compared with small dosage of remifentanil and fentanyl with basal rate of 0.3microgram/kg/h. In the safety and proper dosage, further evaluations were needed.

The Analgesic Effects of Dose of Butorphanol Administered in Intravenous Patient Controlled Analgesia after Subtotal Gastrectomy / 대한마취과학회지

BACKGROUND: Butorphanol, a synthetic partial agonist-antagonist narcotic, produces adequate analgesia for postoperative pain. This study was designed to determine the appropriate dosage of butorphanol when administered with ketorolac by intravenous patient controlled analgesia (IV-PCA) after subtotal gastrectomy. METHODS: Ninety ASA physical status I or II patients undergoing subtotal gastrectomy were randomly allocated into one of three groups according to type of drug used (n = 30 for each group). The patients were divided into group B6 (butorphanol 6 mg), group B10 (butorphanol 10 mg) and group B14 (butorphanol 14 mg). Drugs for each group were mixed with 300 mg of ketorolac and normal saline (total amount: 100 ml) for infusion. Bolus dose, maintenance dose and lockout interval were 0.5 ml per each press, 1 ml/hr and 15 minutes, respectively. In each group, numerical rating scale (NRS) score, sedation score and incidence of side effect were checked. RESULTS: There were no significant differences in analgesic effects and sedation score among three groups but the NRS score of group B14 is lower than that of group B6 (P < 0.05) 3 hrs after the recovery room. CONCLUSIONS: We recommend 6 mg butorphanol, mixed with 300 mg of ketorolac, and normal saline for postoperative pain relief using IV-PCA.

Effects of Capsicum Plaster at the Korean Hand Acupuncture Point on Pain Management after Knee Replacement / 대한마취과학회지

BACKGROUND: Controlling postoperative pain after knee replacement while reducing opioid-induced adverse effects and improving outcomes remains an important challenge. To assess the effect of combined capsicum plaster at the Korean hand acupuncture point on opioid consumption and outcomes after total knee replacement. METHODS: One hundred and two patients, received total knee replacement, were included in a randomized, double-blinded study: 51 patients were in the placebo group, and 51 patients were in K-M26 group. Capsicum plaster was applied at the K-M26 point in K-M26 group, whereas in the placebo group, an inactive tape was fixed at K-M26 point of both hands. The capsicum plaster was applied before induction of anesthesia for 8 h, and attached during 3 days postoperatively. They received postoperative pain treatment with intravenous patient-controlled analgesia (PCA) during the first postoperative 48 h. Visual analog scale (VAS) scores at rest were used to assess pain. Total PCA volume delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. RESULTS: K-M26 group reported significant lower VAS and supplemental analgesic doses at 3 days postoperatively compared with placebo group. No significant differences were found in delivered doses and requested number of PCA, and satisfaction score between two groups. There was a tendency of decrease in postoperative nausea and vomiting in K-M26 group, but no significant differences. CONCLUSIONS: PCA with capsicum plaster at in K-M26 point is thought to be potent and safe for postoperative pain relief after total knee replacement with the lesser adverse events.

Intravenous Patient-controlled Analgesia for Postoperative Pain Management in Patients with Cerebral Palsy / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of intravenous patient-controlled analgesia (PCA) with fentanyl and ketorolac for postoperative pain management in patients with cerebral palsy. MATERIALS AND METHODS: Sixty patients were categorized based on operation complexity into either a minor operation group or a major operation group, and then subdivided based on the analgesic methods used, i.e., intravenous PCA with fentanyl and ketorolac or intravenous pethidine injection. Pain intensity was assessed using the Wong-Baker's faces pain scale. RESULTS: In the major operation group, patients that received PCA had significantly lower pain scores than those who received intravenous pethidine injection, while no significant differences in pain scores were observed in the minor operation group. Moreover, the side effects of these two analgesic methods did not differ significantly. CONCLUSION: Intravenous PCA with fentanyl and ketorolac is effective and safe for moderate to severe postoperative pain control in pediatric patients with cerebral palsy.

A Study on the Effect of Dosage Increase and Methods of Ondansetron Administration on the Prevention of Postoperative Nausea and Vomiting of Vaginal Total Hysterectomy Patients during IV Patient-Controlled Analgesia / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting are a 'Big Little Problem' during IV-PCA after vaginal total hysterectomy. This study was designed to determine the effect of dosage and the method of ondansetron administration on the incidence of postoperative nausea and vomiting in patients that received intravenous patient-controlled analgesia (IV-PCA). METHODS: Sixty ASA I-II patients that underwent elective total vaginal hysterectomy and received postoperative IV-PCA were randomly divided into three groups according to dosage and the timing of ondansetron administration. These patients were given ondansetron; twice, (4 mg each) after induction and 5 minutes before the end of the operation (group 1); 8 mg 5 minutes before the end of the operation (group 2); and twice, (8 mg each) after induction and 5 minutes before the end of the operation (group 3). The incidences of nausea and vomiting and pain scores by visual analogue scale (VAS) were checked and recorded in recovery rooms and wards at 1, 6, 24, and 48 hours after operation, respectively. RESULTS: The three groups showed no significant differences in terms of the incidences of nausea and vomiting and had similar VAS pain scores. CONCLUSIONS: Our findings suggest that ondansetron dosage and methods of its administration are not effective at reducing the incidence of postoperative nausea and vomiting.

The Effect of Perioperative Analgesic Methods on the Postoperative Changes of White Blood Cells in Patients Undergoing Knee Replacement Surgery / 대한마취과학회지

BACKGROUND: Postoperative pain is a major contributing factor to immune dysfunction related to changes of peripheral neutrophils, lymphocytes and monocytes. The aim of this study is to compare alterations in peripheral white blood cells perioperatively in patients under intravenous patient controlled analgesia (IVPCA) with intra-articular patient controlled analgesia (IAPCA) after general or spinal anesthesia, or epidural patient controlled analgesia (EPCA) after combined spinal epidural anesthesia for knee replacement surgery. METHODS: Thirty-three patients with IVPCA and IAPCA after general anesthesia (group 1), 33 patients with IVPCA and IAPCA after spinal anesthesia (group 2), and 34 patients with EPCA after combined spinal epidural anesthesia (group 3) were reviewed. The number of peripheral neutrophils, lymphocytes and monocytes were counted preoperatively, immediate postoperatively, on the first, third and fifth postoperative day. RESULTS: There were significant increases in neutrophils, decreases in lymphocytes, and increases in monocytes postoperatively in all the groups. However, there were no differences among the groups in three subtypes of white blood cells, except significantly low value of monocytes in the group 1 compared to that of group 2 immediate postoperatively. CONCLUSIONS: The technique of anesthesia and postoperative pain control did not influence to the changes of subtypes of circulating white blood cells in patients underwent knee replacement surgery.

The Effects of the Intravenous Continuous Infusion of Low-dose Ketamine on Postoperative Pain after Total Intravenous Anesthesia / 대한마취과학회지

BACKGROUND: Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, may prevent central sensitization and result in preemptive analgesia when administered before surgically induced trauma. The goal of this study was to determine whether intravenous low dose ketamine would reduce postoperative pain and cumulative analgesic requirements after total intravenous anesthesia (TIVA) with propofol and fentanyl. METHODS: The thirty-four patients undergoing total abdominal hysterectomy were randomly allocated to according to anesthetic agent to a propofol-fentanyl-N2O (60%)-O2 (40%) group (group PFN) or a propofol-fentanyl-ketamine-O2 (40%) group (group PFK); 0.3 mg/kg of ketamine initially during induction followed by a continous infusion at 0.15 mg/kg/h. Propofol and fentanyl were continuously administered using target controlled infusion (TCI). Intravenous patient-controlled analgesia (IV-PCA) using a fentanyl-ketorolac mixture was started in all patients after full recovery in a postanesthetic care unit (PACU). Verbal numerial scale (VNS) pain scores, cumulative total analgesic consumptions, and side effects were recorded immediately before and at 1, 3, 6, 12, 24, and 48 h after IV PCA. RESULTS: No significant intergroup differences were seen in the VNS pain scores and in side effects during entire study period. But, patients in the PFK group had significantly lower total analgesic consumptions at 48 h after IV PCA. No significant differences were observed between the two groups in terms of side effects. CONCLUSIONS: Intravenous low dose ketamine during TIVA with propofol and fentanyl did not reduce postoperative pain scores, but did reduce total analgesic requirement at 48 h after IV PCA.