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요추부 수술후 경막외 Morphine Sulfate와 Bupivacaine의 지속적 주입에 의한 통증 조절의 효과
신문수,이병희,최훈규,노재섭,안정용,신승훈,이병희,정봉섭,Shin, Moon Soo,Lee, Byung Hee,Choi, Hun Kyu,Noh, Jae Sub,Ahn, Jung Young,Sheen, Seung Hun,Lee, Byung Hee,Chung, Bong Sub 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5
Objective : The purpose of this non randomized prospective study was to verify the effect of pain control in small doses of epidural morphine and bupivacaine through continuous infusion for 48 hours. Patients and Methods : Thirty-five patients who underwent spine surgery including laminectomy, fusion with fixation were assigned into two groups ; pain control group(n=20) and control group(n=15). Pain score was measured on a visual analogue scale(VAS). A continuous infusor was used to give morphine and bupivacaine continuously via indwelling epidural catheter which was placed before closure of muscles in pain control group. Results : Mean scores(VAS) of pain control group were between 1.3 and 2.1 from the 30 min to the 72 hour, but the lowest mean score in the control group was about 2.6 at the 72 hour. Although a number of extra-analgesics were used in control group, differences of mean scores were statistically significant till 24 hour in pain control group. The patients in pain control group was less painful than the patients in control group from 24 hour till 72 hour, but it was statistically insignificant. There were some side effects such as nausea/vomiting, pruritus, urinary retention which existed transiently, but there was no respiratory depression. Conclusion : It was concluded that the early postoperative pain can be easily and safely controlled with continuous infusion of epidural morphine and bupivacaine in small doses.
박진영,안정용,허륭,최훈규,이병희,신문수,정봉섭,Park, Jin Young,Ahn, Jung Yong,Huh, Ryoong,Choi, Hun Kyu,Lee, Byung Hee,Shin, Moon Soo,Chung, Bong Sub 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11
Objectives : Embolization of intracranial aneurysms by using Guglielmi detachable coils(GDC) is proving to be a safe method of protecting aneurysms from rupture. Occasionally, patients with unruptured intracranial aneurysms present with symptoms related to the aneurysm's mass effect on either the brain parenchyma or cranial nerves. In the present study, the authors conducted a retrospective review to evaluate the response to GDC embolization in a series of 6 patients presenting with cranial nerve dysfunction due to mass effect. Patients and Methods : Aneurysms were classified by size, shape, and amount of intraluminal thrombus. Patients were classified by duration of symptoms prior to GDC treatment(range<1 month to>4 years). Clinical assessment was performed within days of the GDC procedure and at later follow-up appointments(range 5-16 months, mean 9 months). Results : In the immediate post-GDC embolization period, one of the five patients had transient worsening of third nerve palsy, which later improved to better than baseline status. Two patients who presented with third nerve deficit from a internal carotid artery-posterior communicating artery junction aneurysm had complete recovery. One patient who presented with hemiparesis and dysarthria from a giant mid-basilar aneurysm showed improvement of these symptoms. One patient who presented with sixth cranial nerve deficit from a cavernous aneurysm showed no change at the 8-months follow-up examination. Conclusion : The endovascular treatment of intracranial aneurysms by using GDC is suggested as an alternative therapeutic method for improving or alleviating neurological deficits produced by mass effect.
요추부 수술 후 경막외 무통방법과 지속적 정맥 주입에 의한 통증 조절의 효과 비교
오규성,신문수,길현주,허륭,최훈규,안정용,권성오,Oh, Kyu Sung,Shin, Moon Soo,Gil, Hyun Joo,Hur, Ryoong,Choi, Hun Kyu,Ahn, Jung Yong,Kwon, Seong Oh 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12
Objective : The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery. Methods : Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol. Results : In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group. Conclusion : CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.
최훈규 한양대학교 의과대학 2000 한양의대 학술지 Vol.20 No.2
Percutaneous vertebroplasty is an effective new procedure consisting of the percutaneous injection of a biomechanical material, usually methylmethacrylate, into a lesion of a vertebral body. This technique allows marked or complete pain relief and bone strengthening in most cases. The technique was used over a 6 month period in 6 patients with 7 painful osteoporotic vertebral fractures. The technique involves percutaneous puncture of the involved vertebra via a transpedicular approach followed by injection of polymethylmethacrylate(PMMA) into the vertebral body. The procedure was technically succesful in all patients. All patients reported significant pain relief immediately after treatment.
최훈규,김광명,정환영,김남규,오석전,백광흠 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.10
A 3 years old boy had precocious puberty and hypothalamic hamartoma. CT scan and MRI disclosed an interpedunculary tumor. A craniotomy was sucessfully performed and grossly total removal of tumor was done. In the hormon study at postoperative 10 days. s-LH, s-FSH and s-testosterone were decreased. But, sexual precocity was not improved and s-testosterone level was increased over preoperative level.