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임상연구 : 견관절 수술 후 지속적 사각근간 상완 신경총 차단의 진통 효과
오세철 ( Sae Cheol Oh ),조현숙 ( Hyun Sook Cho ),지종훈 ( Jong Hun Ji ),송철헌 ( Chul Hun Song ),정규돈 ( Kyu Don Chung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: Pain following shoulder surgery is usually severe and difficult to control using conventional postoperative pain control maneuvers. Therefore, we investigated the pain control efficacy, PONV (postoperative nausea vomiting) and complications by the use of a continuous brachial plexus block in patients who had undergone shoulder surgery. Methods: Thirty three shoulder surgery patients were enrolled in this study. According to the Borgeat`s modified lateral technique, 30 ml of 0.37% ropivacaine were injected into the patients, which was followed by insertion of a continuous brachial plexus catheter into the plexus sheath. The operation was then conducted under general anesthesia, and postoperative pain was evaluated in the recovery room 12, 24, 36, and 48 hr after surgery. In addition, nausea and vomiting was calculated using the visual analogue scale (VAS) and sedation was evaluated using the modified Ramsay score. A total of 400 ml of 0.2% Ropivacaine was administered at a rate of 8 ml/hr to control the postoperative pain for 2 days. In addition, other neurological complications were investigated, and the catheter tips were cultured after they were removed to determine if any infection had occurred. Results: The postoperative pain scores were below 2 on the 10 cm VAS, and the level of nausea and vomiting was also satisfactorily (< 2/10 cm VAS). In addition, the mean sedation score of the patients in the recovery room was 2. There were complications including motor weakness (24%), dyspnea (15%), Hornor`s syndrome (9%), postauricular numbness (9%) and metallic taste (3%), however, there were no patients who complained of neurological symptoms after one month of follow-up, and no signs of infection were found when the results of catheter tip cultures were evaluated. Conclusions: The use of a continuous interscalene brachial plexus block is a feasible method of postoperative pain control for patients who undergo major shoulder surgery. (Korean J Anesthesiol 2007; 53: 733∼9)
Neuropathic Pain의 동물모델에서 유발된 Thermal Hyperalgesia에 대한 Clonidine의 효과
윤석화,오세철,최세진 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2
The effects of intraperitoneal injection(i.p.) of the alpha 2 adrenal receptive agonist, clonidine on the thermal hyperalgesia produced by unilateral patially tight ligation of the sciatic nerve was studied in rats. First in the preoperative and postoperative Mays, paw withdrawal latency of both hind paw(lesioned,unlesioned) with heat stimulant was tested. After that, each groups of rats injected saline, clonidine 10㎍/kg, or clonidine 50㎍/kg. I.p.10㎍/kg and 50㎍/kg clonidine, paw withdrawal latency of lesioned side significantly reduced than saline group. It is suggested systemical clonidine may be useful in treating neuropathic pain in humans.
Neuropathic Pain 동물모형에서 경구 투여한 Baclofen 의 효과
이원형,김혜자,윤석화,최세진,오세철,이중석 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.1
The aim of this study was to compare with the effects of baclofen using an animal model of neuropathic pain. The sciatic nerve of rats was ligated unilaterally about dorsal half-portion in the tight according to the method of Seltzer and his colleague. After surgical operation, the rats showed painful symptoms of the ipsilateral hind paw, suggesting the possibility of spontaneous pain. And then, the paw withdrawal latency to the local heating on the paw through the glass plate and the frequency of paw withdrawal response to innocuous mechanical stimulation with modified von Frey filaments were determined to compare with the effects of pre-and post-medication of baclofen, respectively, at postoperative 3, 7, and 10 days. The results obtained were as follows: 1) The thermal hyperalgesia and mechanical allodynia produced by partially tight ligation of sciatic nerve appeared continously postoperative 3 days later. 2) In the hyperesthetic rats, the thermal hyperalgesia was inhibited from the 3rd posroperative day with orally administered baclofen 0.2mg and 1.0mg. 3) In the hyperesthetic rats, the mechanical allodynia was inhibited with baclofen 0.2mg, but not with baclofen 1.0mg. These results suggest that baclofen have more specific effects on thermal hyperalgesia than mechanical allodynia.
백서 기관평활근에서 Lidocaine 과 상피 세포가 기관 장력에 미치는 영향
이원형,김혜자,이정은,신용섭,최세진,손수창,강평희,오세철 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.1
Background : Lidocaine is often administered intravenously to suppress airway reflexes associated with tracheal intubation or tracheal suction. In addition, lidocaine is known to have airway relaxant effects through a direct relaxant mechanism on the smooth muscle. The presence of airway epithelium has been reported to reduce the sensitivity and maximum contractile response to histamine or acetylcholine(ACh). The purpose of this study was to determine whether the cumulative application of lidocaine may cause a concentration-dependent relaxation of the rat tracheal smooth muscle strips with intact or rubbed epithelium. Methods : Using the rat tracheal smooth muscle strips, the effects of 10 6∼3 10 3M of lidocaine pretreatment on isometric tension induced by 40 mM of K+ or 10 5M of ACh in presence or absence of adherent epithelium, and the influences of 10 6M of propranolol, 10 4M of L-NAME and 10 6M of atropine on relaxing response of lidocaine were studied. Results : The tracheal smooth muscle concentration nduced by K+ and ACh was similar magnitude both in presence or absence of adherent epithelium. The removal of epithelium did not affect the relaxant effect of lidocaine on the K+ and ACh-induced tracheal smooth muscle contraction. Lidocaine pretreatment reduced Ca2+-dependent contraction of the rat tracheal smooth muscle. Following pretreatment of the tracheal smooth muscle preparations respectively with propranolol, L-NAME and atropine the relaxing responses to lidocaine of tracheal smooth muscle were not depressed. Conclusions : These results suggest that the effect of the epithelium on lidocaine-induced relaxation of the tracheal smooth muscle is not significant and lidocaine may directly relax tracheal smooth muscle by the influences on the Ca2+ mobilization. (Korean J Anesthesiol 1997; 32: 1∼12)