Analgesic Effects of Dexmedetomidine in Vincristine-Evoked Painful Neuropathic Rats

박휴정,김영훈,Hyun Jung Koh,박철수,Seung-hee Kang,최종호,문동언 대한의학회 2012 Journal of Korean medical science Vol.27 No.11

Dexmedetomidine, which is a selective α2-adrenoceptor agonist, was recently introduced into clinical practice for its analgesic properties. The purpose of this study was to evaluate the effects of dexmedetomidine in a vincristine-evoked neuropathic rat models. Sprague-Dawley rats were injected intraperitoneally with vincristine or saline (0.1 mg/kg/day) using a 5-day-on, 2-day-off schedule for 2 weeks. Saline and dexmedetomidine (12.5, 25, 50,and 100 μg/kg) were injected to rats developed allodynia 14 days after vincristine injection,respectively. We evaluated allodynia at before, 15, 30, 60, 90, 120, 180, and 240 min,and 24 hr after intraperitoneal drug (normal saline or dexmedetomidine) injection. Saline treatment did not show any differences for all the allodynia. Maximal paw withdrawal thresholds to mechanical stimuli were 3.0 ± 0.4, 9.1 ± 1.9, 13.0 ± 3.6, 16.6 ± 2.4, and 24.4 ± 1.6 g at saline, 12.5, 25, 50, and 100 μg/kg dexmedetomidine injection,respectively. Minimal withdrawal frequency to cold stimuli were 73.3 ± 4.2, 57.1 ± 6.8,34.3 ± 5.7, 20.0 ± 6.2, and 14.3 ± 9.5 g at saline, 12.5, 25, 50, and 100 μg/kg dexmedetomidine injection, respectively. Dexmedetomidine shows a dose-dependent antiallodynic effect on mechanical and cold stimuli in vincristine-evoked neuropathic rat models (P < 0.05).

노년내과 심포지엄_노인의 흔한 문제 : 만성통증의 관리

박휴정 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.2

Chemotherapy induced peripheral neuropathic pain

박휴정 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.1

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most serious complications associated with anticancer drugs. CIPN leads to a lower quality of life and dysfunction of the sensory, motor, and autonomic systems, and often causes patients to discontinue chemotherapy. It is usually misdiagnosed and undertreated due to a lack of consensus and unclear pathophysiology, for which many mechanisms have been suggested, including mitochondrial dysfunction, various pain mediators, abnormal spontaneous discharge in A and C fibers, and others. To date, no agents have been shown to effectively prevent CIPN, leading to debate as to the standard protocol. Duloxetine has demonstrated a moderate therapeutic effect against CIPN. Although tricyclic antidepressants (such as nortriptyline or desipramine), gabapentin, and a topical gel containing baclofen (10 mg), amitriptyline HCL (40 mg), and ketamine (20 mg) showed inconclusive results in CIPN trials, these agents are currently considered the best options for CIPN treatment. Therefore, further studies on the pathophysiology and treatment of CIPN are needed.

Pharmacologic Management of Chronic Pain

박휴정,문동언 대한통증학회 2010 The Korean Journal of Pain Vol.23 No.2

Chronic pain is a multifactorial condition with both physical and psychological symptoms, and it affects around 20% of the population in the developed world. In spite of outstanding advances in pain management over the past decades, chronic pain remains a significant problem. This article provides a mechanism- and evidence-based approach to improve the outcome for pharmacologic management of chronic pain. The usual approach to treat mild to moderate pain is to start with a nonopioid analgesic. If this is inadequate, and if there is an element of sleep deprivation, then it is reasonable to add an antidepressant with analgesic qualities. If there is a component of neuropathic pain or fibromyalgia, then a trial with one of the gabapentinoids is appropriate. If these steps are inadequate, then an opioid analgesic may be added. For moderate to severe pain, one would initiate an earlier trial of a long term opioid. Skeletal muscle relaxants and topicals may also be appropriate as single agents or in combination. Meanwhile, the steps of pharmacologic treatments for neuropathic pain include (1) certain antidepressants (tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors), calcium channel a2-d ligands (gabapentin and pregabalin) and topical lidocaine, (2) opioid analgesics and tramadol (for first-line use in selected clinical circumstances) and (3) certain other antidepressant and antiepileptic medications (topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists). It is essential to have a thorough understanding about the different pain mechanisms of chronic pain and evidence-based multi-mechanistic treatment. It is also essential to increase the individualization of treatment. (Korean J Pain 2010; 23: 99-108)

Analgesic effects of soluble epoxide hydrolase inhibitor in K/BxN serum transfer arthritis mouse model

박휴정,박정현,조민지,하걸 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.1

Background: Soluble epoxide hydrolase (sEH) is an enzyme that converts epoxyeicosatrienoic acid (EET) into the anti-inflammatory dihydroxyeicosatrienoic acids (DHET). Inhibition of sEH by the potent soluble epoxide hydrolase inhibitor (sEHI) decreases inflammation by increasing EET. The K/BxN serum transfer mouse model of arthritis displays an initial inflammation and an associated tactile allodynia that continues on following the resolution of inflammation. Methods: We undertook the following studies: i) Using the K/BxN mouse model, we examined effects on allodynia during the early inflammatory phase of administration of sEHI 3 mg/kg and/or diclofenac (DFC) 10 mg/kg. ii) In the late inflammatory phase, we administered sEHI (3, 10, or 30 mg/kg); DFC 10 mg/kg; gabapentin 100 mg/kg. iii) Using the conditioned place preference (CPP) we examined the synergism between sEHI and DFC in the K/BxN mouse using the CPP paradigm. The drug was administered intraperitoneally and the allodynia was measured with the von Frey test. Results: In the early phase, both sEHI and DFC displayed an antiallodynic action. In the late phase, sEHI, and gabapentin but not DFC were effective in reversing the allodynia. Comparable results were observed with the CPP. Conclusions: This study demonstrates that sEHI reduces mechanical allodynia in both the early and the late inflammatory K/BxN mouse model of arthritis. The sEHI target thus addresses the hyperalgesia arising from inflammation as well as the post-inflammatory phase that has been said to reflect neuropathic-like states, thus presenting alternatives to the limited efficacy of arthritis drugs in use.

Anti-Allodynic Effects of Levodopa in Neuropathic Rats

박휴정,김영훈,권오경,이재민,김은성,문동언 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.2

Purpose: Levodopa is the most effective anti-Parkinsonian agent. It has also been known to exhibit analgesic properties in laboratory and clinical settings. However, studies evaluating its effects on neuropathic pain are limited. The aim of the present study was to examine the anti-allodynic effects of levodopa in neuropathic rats. Materials and Methods: Sprague-Dawley male rats underwent the surgical procedure for L5 and L6 spinal nerves ligation. Sixty neuropathic rats were randomly divided into 6 groups for the oral administration of distilled water and levodopa at 10, 30, 50, 70, and 100 mg/kg, respectively. We co-administered carbidopa with levodopa to prevent peripheral synthesis of dopamine from levodopa, and observed tactile, cold, and heat allodynia pre-administration, and at 15, 30, 60, 90, 120, 150, 180, and 240 min after drug administration. We also measured locomotor function of neuropathic rats using rotarod test to examine whether levodopa caused side effects or not. Results: Distilled water group didn’t show any difference in all allodynia. For the levodopa groups (10-100 mg/kg), tactile and heat withdrawal thresholds were increased, and cold withdrawal frequency was decreased dose-dependently (p<0.01). In addition, levodopa induced biphasic analgesia. Different dosage of levodopa did not impact on the rotarod time (p>0.05). Conclusion: Levodopa reversed tactile, cold and heat allodynia in neuropathic rat without any side effects.

임상연구 : 혈액가스 분석기와 휴대용 혈당측정기로 측정된 혈당 수치의 평가

박휴정 ( Hue Jung Park ),박철수 ( Chul Soo Park ),박종민 ( Chong Min Park ),유건희 ( Keon Hee Ryu ),장혜원 ( Hae Wone Chang ),조은정 ( Eun Jeong Cho ),이윤기 ( Yoon Ki Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Background: A portable glucometer is commonly used to immediately check the blood glucose level. In the anesthetic field, some blood gas analyzers can also give a rapid indication of the blood sugar level but the accuracy is unknown. Therefore, this study assessed the accuracy of the blood glucose values measured by either a blood gas analyzer or portable glucometer. Methods: Venous blood from diabetic patients was used to measure the glucose level with either a blood gas analyzer or a portable glucometer. The difference and 5% deviation from reference values was analyzed. These values were also assessed using a Bland-Altman plot and clinical significance was examined using a Clarke error grid. Results: The differences from the reference values were smaller using the blood gas analyzer (1.3 ± 7.8 mg/dl) than using the portable glucometer (-5.1 ± 16.7 mg/dl)(P < 0.01). 73.4% of the values measured by the blood gas analyzer and 40.0% of those measured by the portable glucometer were within 5% of the reference value. The 95% limits of agreement in the difference ranged from -14.3 to 16.9 in the blood gas analyzer and -38.5 to 28.2 in the portable glucometer. Error grid analysis showed that 100% of the values measured by the blood gas analyzer were located in zone A. When locating the values measured using the portable glucometer, 95.6% were located in zone A, and the remaining 4.4% are located in zone B. Conclusions: The blood gas analyzer measures the blood glucose more accurately than the portable glucometer. However, the blood glucose values measured by the portable glucometer are clinically acceptable. (Korean J Anesthesiol 2006; 50: 506~10)

기도분비물에 의한 기관내 튜브의 부분폐쇄 : 증례보고 A case report

이윤기,박휴정,권오경 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.3

Ultrasound-guided pararadicular block using a paramedian sagittal oblique approach for managing low back pain in a pregnant woman -A case report-

안슬기,이지수,박휴정,김영훈 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.3

Lumbar radicular pain is conventionally treated with transforaminal epidural injection under the guidance of fluoroscopy or computer tomography. However, fluoroscopic radiation can be hazardous in certain populations, including pregnant women. An adjustment of the amount of local anesthetic is required in this population. An alternative method of lumbar root block using ultrasound (US) guidance has recently been introduced. Here, we present the case of a pregnant woman with worsening lumbar radicular pain during her pregnancy and the management of her pain using US-guided pararadicular block.

Remifentanil이 복강경하 자궁절제술 환자에서 Tumor necrosis factor-α와 Interleukin-6 반응에 미치는 영향

김은성,유건희,박휴정,장혜원 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.1

Background: Cytokines are important mediators of immune response to surgery and pain. The aim of the study was to investigate the effect of remifentanil on serum levels of cytokines,tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), in patients undergoing laparoscopic hysterectomy. Methods: Twenty four patients scheduled for laparoscopic hysterectomy were randomly assigned to control or remifentanil group. Both groups received 1.5−2.5% end tidal concentration of sevoflurane and air in 50% oxygen. Remifentanil group received a bolus of remifentanil 1μg/kg over 1 min and an infusion of remifentanil at a rate of 0.1μg/kg/min. Control group received 10ml saline (placebo) and an infusion of saline at the same rate. Venous blood samples for measurement of serum cytokine concentrations were taken before anesthesia (T1), at 2 h after infusion (T2), and at the 1 hour after surgery (T3). Results: Serum TNF-α concentration did not differ significantly over time in both groups. Serum TNF-α concentration was higher in remifentanil group at T3 (9.76 ± 1.19 pg/ml vs. 8.53 ± 0.71pg/ml) than in control group (P < 0.05). In both groups, serum IL-6concentrations were significantly higher at T3, when compared to those at T1 and T2 (P < 0.05). Conclusions: Remifentanil did not attenuate early postoperative change of serum TNF-α and IL-6 concentrations in patients undergoing laparoscopic hysterectomy. Serum IL-6 level increased at postoperative 1 h, regardless of remifentanil use.