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내장 신경 차단후 생존 기간과 통증 완화 정도에 관한 추적 조사
이윤우,윤덕미,장원석,오홍근 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2
Background : It is difficult to manage intractable pain from advanced carcinoma of the upper abdomen. One method used to control pain associated with these malignancies is to block the splanchnic nerve. We investigated that VAS (visual analogue scale) difference before and after splanchnic nerve block (SNB) and pain relief day. Also we studied relationship between VAS before SNB and pain relief day. Methods : A rewiew of 70 patients who took splanchnic nerve block (SNB) from September 1994 to February 1998 was carried out to assess age, sex, primary diseases, pain sites, VAS before and after SNB, date of diagnosis, date of SNB, date of death and pain relief day, etc. Results : Of 70 patients, 44 were males and the remaining 26 were females. The causes of pain were stomach cancer 28 (40%), pancreatic cancer 18 (25%), gall bladder cancer 7 (10%), hepatoma 6 (8.6%) respcectively. Average day from diagnosis to SNB was 272 and average day from diagnosis to death was 341. So, patients died on the average 69 days after they took the splanchnic nerve block in pain clinic. VAS average before SNB was 8.01 and VAS average after SNB was 3.64. Patients felt pain relief during 35 days after SNB. Pain relief day of patients who had lower VAS before SNB was longer than that of patients who had higher VAS before SNB. Conclusion : Early application of splanchnic nerve block will make the patients endure the cancer pain more easily. (Korean J Anesthesiol 1999; 36: 273∼278)
제왕절개술 환자에서 Meperidine 정주를 이용한 술후 제통효과
이윤우,이원주,윤덕미,장원석 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.6
Background : Perioperative noxious stimuli and inflammation may induce peripheral and central sensitization. Together, these changes contribute to the state of postinjury pain hypersensitivity found postoperatively. Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurones and may therefore, reduce postoperative pain. We studied whether or not intravenous meperidine infusion before induction could affect postoperative pain and analgesic consumption when compared with intravenous meperidine infusion at peritoneum closure. Methods : Female patients scheduled for cesarean section were randomly assigned to one of two groups for prospective study. Group I(n=10) received intravenous meperidine(0.5 mg/kg) 5 minutes before induction of anesthesia and group II(n=10) received the same treatment at peritoneal closure. Both groups had a continuous infusion of meperidine(5 mg/hr) immediately after intravenous bolus meperidine. Postoperative pain relief was provided with intravenous meperidine from a PCA system(Walkmed , Medex, USA). Postoperative visual analogue pain scores(VAS), meperidine consumption and side effects were examined and compared between the groups for two postoperative days Results : At two hours post surgery VAS at rest were below 3 in both groups and were not statistically significant. VAS on motion were slightly higher than VAS at rest in both groups and were not statistically significant. There was no significant difference in meperidine consumption. There were minor side effects such as nausea, somnolence, dizziness and pruritus, but no patients needed any treatment and all of them were satisfied. Conclusions : Preemptive or postincisional intravenous PCA with meperidine was equally effective for postoperative analgesia after cesarean section, with minor side effects. These results suggested that there was no reason for applying preemptive analgesia for cesarean section patients. Further studies will be needed to evaluate preemptive effects of intravenous meperidine or other analgesics in cesarean section patients. (Korean J Anesthesiol 1998; 34: 1241∼1246)