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전이성 전립성 암의 골성 통증에 대한 Dexamethasone 의 진통 효과
한태형,신백효,이수련 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2
Background : Steroid therapy has been considered as co-analgesic for palliative treatment of metastatic bone pain in terminal cancer. We designed prospective study to observe analgesic efficacy of dexamethasone, to evaluate different analgesic assessment methods and its correlation to actual improvement of quality of life. Methods : Thirty seven men with symptomatic bone pain of prostate cancer were treated with dexamethasone infusions (10mg twice a day) for 2 weeks. Response to treatment was assessed by daily analgesic intake, by the McGill-Melzack pain questionnaire(MPQ), and by a series of 17 linear analog self-assessment scales(LASA) relating to pain and to various aspects of quality of life. Biochemical and radiological markers were measured. Results : Fourteen patients (38%) had improvement in indices used to assess pain at 2 weeks after starting dexamethasone. Reduction in pain indices was associated with improvement in other dimensions of quality of life and in the scale for overall well-being. Even though radiological and biochemical markers showed no correlation, symptomatic relief of pain was associated with a decrease in serum concentration of adrenal androgens. Conclusion : We conclude that 1) dexamethasone treatment may cause useful relief of pain in some of patients with bone pain of prostate cancer; 2) this relief of pain is associated with suppression of adrenal androgens; 3) measures of pain and quality of life can be used to assess benefits of systemic therapy with dexamethasone; and 4) this effects of dexamethasone should be further investigated in bone pain of other metastatic cancer. (Korean J Anesthesiol 1998; 34: 394∼402)
암성통증관리에서 정주된 케토롤락의 모르핀 절감 및 장폐색 치유효과
한태형,권민아 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.1
Background : Pain management in the terminal stage of advanced cancer is often complicated by opioid-related bowel syndrome and other problems. This study was conducted to investigate the safety and efficacy of ketorolac as an adjunctive analgesic in cancer pain management. Methods : 10 acutely ill cancer patients suffering from pain, complications of advanced disease, and opioid side effects were included. Except one acute leukemia, all of the patients had metastatic solid tumors. Pain complaints consisted of visceral, somatic and opioid bowel syndrome. They were treated with intravenous morphine patient-controlled analgesia infused with a repeated ketorolac bolus dosing. Demographic data, cancer diagnosis, change of pre- and post-treatment morphine infusion rates, and days until pain control or relief of opioid bowel syndrome were evaluated. Results : Excellent pain relief with improvement of opioid bowel syndrome was achieved in a majority of cases. Ketoralac showed good morphine sparing effects. None of the patients reported gastrointestinal side effects. Conclusion: Ketorolac appeared to be well-tolerated in the clinical dose range and for short-term use in acutely-ill terminal cancer pain patients. It also seems to be very effective in relieving opioid- related bowel synclmmes. (Korean J Anesthesiol 2000; 39: 98~103)
개흉술후 통증관리 방법이 수술의 결과 및 환자의 회복에 미치는 영향
한태형,이수련,강현만 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4
Backgroud : Due to severe pain after open thoracotmy, the postoperative pain control is essential to decrease pulmonary complications, and improve a patient's recovery. This study compared the surgical outcome of patients who had undergone open thoracotomy, and been managed with two different analgesic methods. Methods : A retrospective chart review was carried out regarding 81 patients who had undergone open thoracotomy due to lung cancer. 41 of these patients has received continuous thoracic epidural analgesia with 0.1% bupivacaine and 0.3 mg/ml morphine at a rate of 2 ml/hr for postthoracotomy pain control (CTEA group). The remaining 40 patients has received intravenous patient-controlled analgesia with 1% meperidine (IV-PCA group). We compared the effects of the postoperative pain control in the two groups and the outcomes, including the pulmonary complications and durations of hospital stay. Results : There were no significant differences in demographic data between the two groups. Supplemental analgesic requirements and postoperative pulmonary complications were significantly lower in the CTEA group than in the IV-PCA group. There were no significant statistical differences between the two groups in the durations of their hospital stay. Conclusions : We conclude that the continuous thoracic epidural infusion provided better postthoracotomy analgesia and surgical outcomes than intravenous patient controlled analgesia. (Korean J Anesthesiol 1999; 37: 668∼674)
만성 퇴행성관절염에 있어서 선택적 COX-2 억제제 멜록시캄의 임상적 효과
한태형,여진석,성덕현 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6
Background: Nonsteroidal anti-inflammatory agents are associated with a high incidence of gastrointe-stinal side effects due to nonspecific inhibition of cyclo-oxygenase (COX) enzymes, COX-1 and 2. Selec-tive inhibition of COX-2 would minimize the potential for gastrointestinal toxicity without compromising efficacy. This study was conducted to investigate 1) the clinical efficacy and 2) the safety of meloxicam, a preferential inhibitor of COX-2, compared with piroxicam in chronic osteoarthritis patients. Methods: This was designed as a randomized, open labeled, multi-clinic prospective trial. Patients received either meloxicam 7.5 mg or piroxicam 10 mg twice daily for two weeks. Parameters measured were demographic data, disease characteristics, static and dynamic visual analog scale scores (VAS score: 0 = no pain, 10 = extremely severe pain), side effects and their incidences, weekly drop out rates, global efficacy assessed by patients and physicians (1 = extremely satisfactory, 2 = satisfactory, 3 = unsatis-factory, 4 = extremely unsatisfactory), and the changes of disease status assessed by the patients (1 = remarkably improved, 2 = improved, 3 = no change, 4 = worse). Results: There were no significant differences between the two groups in respect to demographic data and disease status. VAS scores at one week showed significant decrease from the baseline, but had no further improvement when compared with those at two weeks. These trends were similar in both groups. At the first week the meloxicam group had lower incidences of side effects, but at the end of the study, these numbers were compatible between the two groups. Global efficacy evaluated by patients and physicians were highly satisfactory. The changes of disease status assessed by patients also revealed good improvements in both groups. Conclusion: Meloxicam had an analgesic effect for chronic osteoarthritis comparable to piroxicam. It appeared to have a better safety profile for short term therapy. but not in long term. (Korean J Anesthesiol 2000; 39: 842 ~848)
사각근간 차단 후에 발생한 좌측 어깨의 감각 이상과 운동 장애
한태형,신백효,이정진 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6
Nerve injury can arise as a complication of peripheral nerve block Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.