수술후 통증조절을 위한 지주막하강내 몰핀투여시 Epinephrine 첨가효과

송민엽,송경준,정종달,소금영,김용일 朝鮮大學校 附設 醫學硏究所 1996 The Medical Journal of Chosun University Vol.21 No.2

To investigate whether the addition of epinephrine would enhance postoperative pain relief by intrathecal morphine, we studied 30 patients scheduled to have spinal anesthesia for low extremities surgery, Patients were randomly allocated to one of two groups: the first group received 0.5% bupivacaine and morphine 0.15㎎ intrathecally: the second group received 0,5% bupivacaine. morphine 0.15㎎ and epinephrine 0.15㎎ intrathecally. There were differences among groups in the incidence of nausea and pruritus and no evidence of respiratory depression. The addition of epinephrine enhances intra-and postoperative analgesia by intrathecal morphine without increasing the incidence of adverse effects as compared with intrathecal morphine alone.

엽산과 시아노코발라민 투여로 회복된 경막내 화학요법과 연관된 척수병증

박수연,박혜리,김지은,성정준 대한신경과학회 2011 대한신경과학회지 Vol.29 No.3

Intrathecal chemotherapy with methotrexate and cytarabine arabinoside is used for the treatment and prophylaxis of malignancies, but can induce myelopathy. We report the case of a 50-year-old woman with stomach cancer who developed myelopathy after administration of intrathecal cytarabine arabinoside and methotrexate. The patient’s neurologic status improved rapidly after the administration of folinate (15 mg) four times daily and cyanocobalamin (100 μg) once daily. The folate metabolites may be effective in the management of intrathecal-chemotherapy-induced myelopathy.

The effect of adjuvant midazolam compared with fentanyl on the duration of spinal anesthesia with 0.5% bupivacaine in opium abusers

Farhad Safari,Ali Dabbagh,Mansour Sharifnia 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.6

Background: There are a number of adjuvants to be used for local anesthetics in spinal block. The aim of this study was to demonstrate the possible effect of intrathecal midazolam compared with bupivacaine as adjuvants in spinal anesthesia with bupivacaine in chronic opium abuses. Methods: In a double blind, randomized clinical trial, 90 opium abuser patients undergoing lower limb orthopedic surgery were selected and randomly assigned into 3 groups (30 cases each). The patients received 15 mg plain bupivacaine, or 15 mg bupivacaine plus 25 mcg fentanyl or 15 mg bupivacaine plus 1 mg midazolam, intrathecally. Results: The duration of anesthesia was much longer in the bupivacaine-midazolam group than the bupivacaine-fentanyl group; both were longer than the plain bupivacaine group (P < 0.05). Conclusions: Subarachnoid injection of adjuvant midazolam or fentanyl with plain 0.5% bupivacaine in opium abusers in lower limb orthopedic surgery increases the duration of sensory block. Therefore midazolam is more effective than fentanyl in such cases. Background: There are a number of adjuvants to be used for local anesthetics in spinal block. The aim of this study was to demonstrate the possible effect of intrathecal midazolam compared with bupivacaine as adjuvants in spinal anesthesia with bupivacaine in chronic opium abuses. Methods: In a double blind, randomized clinical trial, 90 opium abuser patients undergoing lower limb orthopedic surgery were selected and randomly assigned into 3 groups (30 cases each). The patients received 15 mg plain bupivacaine, or 15 mg bupivacaine plus 25 mcg fentanyl or 15 mg bupivacaine plus 1 mg midazolam, intrathecally. Results: The duration of anesthesia was much longer in the bupivacaine-midazolam group than the bupivacaine-fentanyl group; both were longer than the plain bupivacaine group (P < 0.05). Conclusions: Subarachnoid injection of adjuvant midazolam or fentanyl with plain 0.5% bupivacaine in opium abusers in lower limb orthopedic surgery increases the duration of sensory block. Therefore midazolam is more effective than fentanyl in such cases.

Analgesic Effect of Intrathecal Gabapentin in a Rat Model of Persistent Muscle Pain

강태욱,손민균,박노경,고상형,조경진,범재원,강상국 대한재활의학회 2014 Annals of Rehabilitation Medicine Vol.38 No.5

Objective To evaluate the analgesic effect of intrathecal gabapentin therapy on secondary hyperalgesia in a rat model of persistent muscle pain.Methods Intrathecal catheters were implanted into rats. Mechanical secondary hyperalgesia was induced by repeated intramuscular injections of acidic solution into the gastrocnemius muscle. Gabapentin was administrated intrathecally. Rats were allocated to control and experimental (gabapentin 30, 100, 300, and 1,000 mg) group. After gabapentin administration, mechanical withdrawal threshold was measured every 15 minutes and the motor function was measured 30 minutes later.Results Mechanical hyperalgesia was evoked after the second acidic buffer injection. There was a significant improvement on the mechanical threshold after administration of 100, 300, and 1,000 mg gabapentin compared to pre-injection and the control group. The analgesic effect continued for 105, 135, and 210 minutes, respectively. To discern side effects, motor function was measured. Motor function was preserved in both groups after gabapentin administration, except for rats who received 1,000 mg gabapentin.Conclusion Intrathecal gabapentin administration produces dose-dependent improvements in mechanical hyperalgesia in a persistent muscle pain rat model. This implicates the central nervous system as having a strong influence on the development of persistent mechanical hyperalgesia. These results are helpful in understanding the pathophysiology of secondary hyperalgesia and in the treatment of patients with chronic muscle pain.

수술후 통증조절을 위한 지주막하강내 모르핀 투여시 Epinephrine 첨가효과

송민엽,송경준,정종달,소금영,김용일 조선의대 1996 The Medical Journal of Chosun University Vol.21 No.2

경막내로 투여한 신경전달물질이 통증성 배뇨반사에 미치는 영향

박재식,김덕윤,안동국 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.8

Antagonism of Morphine Analgesia by the Pretreatment Sites with Ginseng Total Saponin

Kim, Hack-Seang,Oh, Ki-Wan,Oh, Sei-Kwan,Ryu, Hang-Mook,Seong, Yeon-Hee The Korean Society of Ginseng 1991 Journal of Ginseng Research Vol.15 No.1

The analgesic effect of morphine was antagonized in mice pretreated with ginseng total saponin intraperitoneally, intracerebrally and intrathecally. The antagonized effects of morphine analgesia were reversed predominantly by treatment with L-3, 4-dihydroxyphenylalanine in the tail pinch test and 5-hydroxytryptophan in the tail flick test respectively. These indicate that the antagonistic action of ginseng total saponin might be due to their inhibitions of the activation of descending ihibitory systems at the cerebral site as well as spinal. In addition, any appreciable changes of brain biogenic monoamine levels were not observed in mice pretreated with ginseng total saponin at various time intervals. These results obtained suggest that a newly equilibrated state of neurologic function could be found in mice pretreated with ginseng total saponin, and modification of neurologic function in the mechanism for the antagonism of morphine analgesia by ginseng total saponin was more important than the changes of brain biogenic monoamine levels.

Continuous Intrathecal Morphine Administration for Cancer Pain Management Using an Intrathecal Catheter Connected to a Subcutaneous Injection Port: A Retrospective Analysis of 22 Terminal Cancer Patients in Korean Population

김종해,정진용,조민수 대한통증학회 2013 The Korean Journal of Pain Vol.26 No.1

Background:Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods:Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the 1st, 3rd, 7th and 30th postoperative days were determined from medical records. Results:Intrathecal morphine administration for 46.0 ± 61.3 days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the 7th and 30th postoperative days compared to the 1st postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions:Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.

Continuous Intrathecal Morphine Administration for Cancer Pain Management Using an Intrathecal Catheter Connected to a Subcutaneous Injection Port: A Retrospective Analysis of 22 Terminal Cancer Patients in Korean Population

Kim, Jong Hae,Jung, Jin Yong,Cho, Min Soo The Korean Pain Society 2013 The Korean Journal of Pain Vol.26 No.1

Background: Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods: Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the $1^{st}$, $3^{rd}$, $7^{th}$ and $30^{th}$ postoperative days were determined from medical records. Results: Intrathecal morphine administration for $46.0{\pm}61.3$ days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the $7^{th}$ and $30^{th}$ postoperative days compared to the $1^{st}$ postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions: Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.

Continuous Intrathecal Morphine Administration for Cancer Pain Management Using an Intrathecal Catheter Connected to a Subcutaneous Injection Port: A Retrospective Analysis of 22 Terminal Cancer Patients in Korean Population

( Jong Hae Kim ),( Jin Yong Jung ),( Min Soo Cho ) 대한통증학회 2013 The Korean Journal of Pain Vol.26 No.1

Background: Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods: Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the 1st, 3rd, 7th and 30th postoperative days were determined from medical records. Results: Intrathecal morphine administration for 46.0 ± 61.3 days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the 7th and 30th postoperative days compared to the 1st postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions: Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients. (Korean J Pain 2013; 26: 32-38)