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하복부 수술에서 경막외 Bupivacaine 과 Fentanyl 에 의한 선행진통법이 술후 통증관리에 미치는 효과
이준학(Jun Hak Lee),김인령(In Ryeong Kim),윤채식(C 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2
N/A Background: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of altered central processing which amplifies postoperative pain. A controversy exists over the effectiveness and clinical value of preemptive analgesia. We studied whether epidural bupivacaine and fentanyl prior to surgery could possibly affect postoperative pain and analgesic demands, as compared to administration of same at end of surgery. Methods: Forty patients scheduled for lower abdominal surgery were randomly assigned to one of two groups and prospectively studied in a double-blind method. Group 1(n 20) received epidural injection of 15 ml bupivacaine 0,25% with fentanyl 100 μg before surgery while group 2(n= 20) received the same injection at the end of their surgery respectively. Postoperative analgesia consisted of basal plus patient-controlled mode of epidural bupivacaine and fentanyl from PCA system. Postoperative visual analog pain scores(VAPS), analgesics consumption, supplementary analgesics requirement and side effects were assessed for 3 postoperative days. Results: There were no significant difference in analgesics requirement and pain scores, at any time, during rest or after movement, in measurement between the groups. Conclusions: We conclude no clinical value of effectiveness in administering epidural bupivacaine- fentanyl before surgery as compared to administration after surgery.
국소마취중 Patient Controlled Sedation 을 위한Propofol 과 Midazolam 의 비교
이기남,박성희,권영은,이준학,김인령,문준일 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.3
Background : Surgical procedures carried out under local anesthesia are associated with patient discomfort and apprehension. The purpose of this study is to compare propofol and midazolam with regard to their suitability for the patient controlled sedation (PCS) technique during local anesthesia. Methods : Forty unpremedicated, ASA physical status I day surgery patients undergoing elective minor surgery were randomly divided into two equal groups of patients who self-administered either propofol or midazolam intraoperatively. All patients initially received 0.5 g.kg-1 fentanyl. The bolus dose was either 20 mg (2 ml over 25 sec) of self-administered propofol or 0.5 mg (2 ml over 25 sec) of midazolam and lock-out period was 1 min. Results : The onset of sedation following propofol was significantly faster than midazolam (p$lt;0.05) and demands of propofol was significantly less than midazolam (p$lt;0.05). There were no significant differences for postoperative recovery, sedation and comfort scale. Conclusions : Propofol was judged the more suitable agent for PCS than midazolam, because of its more rapid onset of sedation and less demands of drug. (Korean J Anesthesiol 1997; 32: 457∼462)