Nan Sook Kim

Pain after laparoscopic cholecystectomy: the effect and timing of incisional and intraperitoneal bupivacaine.

PurposeTo examine the combined preemptive effects of somatovisceral blockade during laparoscopic cholecystectomy (LC).MethodsOne hundred fifty-seven patients under general anesthesia receiving local infiltration and/or topical peritoneal local anesthesia were studied. Patients were randomized to receive a total of 150 mg (0.25% 60 mL) bupivacaine via periportal (20 mL) and intraperitoneal (40 mL with 1:200,000 epinephrine) administration of each. Group A received preoperative periportal bupivacaine before incision and intraperitoneal bupivacaine immediately after the pneumoperitoneum. Group B received periportal and intraperitoneal bupivacaine at the end of the operation. Group C (preoperative) and Group D (postoperative) received only periportal bupivacaine and Group E (preoperative) and Group F (postoperative) received only intraperitoneal bupivacaine. The control group received no treatment. Pain and nausea were recorded at one, two, three, six, nine, 12, 24, 36, and 48 hr postoperatively.ResultsThroughout the postoperative 48 hr, incisional somatic pain dominated over other pain localizations in the control group (P < 0.05). The incisional pain of groups A, B, C and D was significantly lower than that of the control group in the first and second hours. The incisional pain of groups A and C was significantly lower than that of the control group in the first three hours.ConclusionIncisional pain dominated during the first two postoperative days after LC. Preoperative somato-visceral or somatic local anesthesia reduced incisional pain during the first three postoperative hours. A combination of somato-visceral local anesthetic treatment did not reduce intraabdominal pain, shoulder pain or nausea more than somatic treatment alone. Preoperative incisional infiltration of local anesthetics is recommended.RésuméObjectifVérifier les effets préventifs d’un blocage somato-viscéral combiné, réalisé pendant la cholécystectomie laparoscopique (CL).MéthodeCent cinquante-sept patients sous anesthésie générale ont reçu une infiltration locale et/ou une anesthésie locale péritonéale topique. Les patients, répartis de façon aléatoire, ont reçu au total 150 mg (0,25 % 60 mL) de bupivacaïne administrée par la voie périportale (20 mL) et intrapéritonéale (40 mL avec I: 200 000 d’épinéphrine). Les modalités intergroupes sont les suivantes: dans le groupe A, une dose préopératoire périportale avant l’incision et une dose intrapéritonéale immédiatement après le pneumopéritoine; dans le groupe B, une dose périportale et une intrapéritonéale à la fin de l’opération; dans les groupes C (préopératoire) et D (postopératoire), seulement une périportale et dans les groupes E (préopératoire) et F (postopératoire), seulement intrapéritonéale. Le groupe témoin n’a reçu aucun médicament. La douleur et les nausées ont été notées à une, deux, trois, six, neuf, 12, 24, 36 et 48 h après l’intervention.RésultatsPendant les 48 h d’observation postopératoire, la douleur somatique de l’incision a dominé toute autre douleur chez les patients témoins (P < 0,05). La douleur incisionnelle a été significativement plus faible dans les groupes A, B, C et D que dans le groupe témoin pendant les deux premières heures. Elle a aussi été significativement plus faible dans les groupes AetC que dans le groupe témoin pendant les trois premières heures.ConclusionLa douleur incisionnelle a dominé pendant les deux premiers jours qui ont suivi la CL. L’anesthésie préopératoire somatoviscérale ou somatique locale ont réduit la douleur incisionnelle pendant les trois premières heures postopératoires. Une combinaison d’anesthésiques locaux somatoviscéraux n’a pas réduit la douleur intra-abdominale, la douleur à l’épaule ou les nausées davantage que l’anesthésie somatique employée seule. L’Infiltration préopératoire d’anesthéslque local au site d’Incision est recommandée.

Al2O3 nanotubes and nanorods fabricated by coating and filling of carbon nanotubes with atomic-layer deposition

Aluminum oxide (Al2O3) nanotubes and nanorods were fabricated by coating and filling of multiwalled carbon nanotubes (MWNTs) with atomic-layer deposition (ALD). Al2O3 material was deposited on the MWNTs at a substrate temperature of 300°C using trimethylaluminum and distilled water. Transmission electron microscopy, high resolution transmission electron microscopy, energy-dispersive X-ray spectroscopy, and selected area electron diffraction of the deposited MWNTs revealed that amorphous Al2O3 material coats the MWNTs conformally and that this material fills the inside of the MWNTs. These illustrate that ALD has an excellent capability to coat and fill any three-dimensional shapes of MWNTs conformally without producing any crystallites.

Effects of Different Concentrations and Volumes of Formalin on Pain Response in Rats

BACKGROUND Formalin test is commonly used in animal model to assess injury-produced pain response. If the total amount of formaldehyde is fixed, its concentration and volume can be easily adjusted. We evaluated the effect of two sets of three solutions of formalin (one set of same dose of formaldehyde at different concentration and volume, i.e. 2.5%--100 microL, 5%--50 microL, 10%--25 microL, and another set of same volume but at different concentrations, i.e. 2.5%--100 microL, 5%--100 microL, and 10%--100 microL) on the injury-produced pain response in rat. METHODS Male Sprague-Dawley rats weighing 250-300 g were used. Following injection of formalin (n = 8 in each group) or saline (n = 6, control), the flinching frequencies and time spent in licking or biting the injected hind-paw in the early phase 1 (0-5 min after injection) and the late phase 2 (20-60 min after injection) were recorded. Sham-injection rats (n = 5) underwent subcutaneous insertion of the needle, but no substance was injected. RESULTS Flinching in phase 1 and 2 was more frequent in the 2.5%--100 microL and 5%--50 microL groups than in the control group (P < 0.05). Licking (or biting) time in phase 2 in all these three groups was longer than the control group (P < 0.05). In the groups of another set of three different solutions (2.5%--100 microL, 5%--100 microL, and 10%--100 microL), flinching in phase 1 and phase 2 was also more frequent than the control group (P < 0.05). Regarding lick behavior of another set, it occurred more frequently in 2.5%--100 microL group in phase 1 and in 2.5%--100 microL group as well as 5%--100 microL group in phase 2 than the control group (P < 0.05). CONCLUSIONS The 10%--25 microL formalin produces fewer flinching responses than other concentrations. Flinching was a biphasic behavior which was more spontaneous and active than was licking. The volume of formalin was a more important factor than the concentration of formalin in the generation of the active biphasic flinching response in the rat model.

Sufentanil infusion before extubation suppresses coughing on emergence without delaying extubation time and reduces postoperative analgesic requirement without increasing nausea and vomiting after desflurane anesthesia.

Background Coughing, hypertension, tachycardia, and even laryngospasm can occur due to airway irritation during emergence from anesthesia. We investigated the effect of maintaining a sufentanil infusion during emergence from anesthesia by evaluating the incidence of cough and recovery profiles at extubation. Methods In total, eighty-four patients undergoing an elective laparoscopic hysterectomy were randomly divided into two sufentanil groups and a control group. During emergence, sufentanil was administered in the sufentanil groups at a rate of 0.2 µg/kg/hr (Group S1) or 0.3 µg/kg/hr (Group S2), and saline was administered to the control group. Cough score, hemodynamic changes, and recovery profiles, such as duration from skin closure to a bispectral index of 80, to eye opening at verbal command, to tracheal extubation and the total duration of study solution infusion, were recorded. The pain score, the total volume of administered patient-controlled analgesia (PCA), and the postoperative nausea and vomiting (PONV) score were evaluated 1, 6, and 24 hours after surgery. Results Groups S1 and S2 showed significantly lower cough scores and smaller hemodynamic changes on extubation compared to Group C. Recovery profiles showed no significant differences among the three groups. Pain score, PONV at 1 hour postoperatively, and the total volume of PCA administered at all evaluation times were significantly lower in Groups S1 and S2 than in the control group. However, pain score, and PONV at 6 hours and 24 hours postoperatively showed no significant differences. Conclusions A sufentanil infusion (0.2-0.3 µg/kg/hr) during emergence from desflurane anesthesia may suppress coughing on extubation in patients with body mass indexes (BMI) of 21-26 without delaying extubation time. It may also reduce the postoperative analgesic requirement without increasing PONV.

The analgesic effect of nefopam combined with low dose remifentanil in patients undergoing middle ear surgery under desflurane anesthesia: a randomized controlled trial

Background We investigated the effects of the combined administration of nefopam, a N-methyl-D-aspartate receptor antagonist and low dose remifentanil, on early postoperative pain and analgesic requirement. Methods Fifty patients scheduled to undergo mastoidectomy and tympanoplasty were randomized to be given either nefopam 40 mg mixed with normal saline 100 ml (Group N) or an equal amount of normal saline (Group C) before anesthesia induction. Anesthesia was maintained with 5-6 vol% desflurane and remifentanil 0.05-0.15 µg/kg/min during the surgery. Postoperative pain was controlled by titration of ketorolac in the postanesthesia care unit (PACU) and ward. We evaluated the intraoperative remifentanil dose, recovery profiles, ketorolac demand in the PACU and ward, numeric rating scale (NRS) for pain at time intervals of every 10 min for 1 h in the PACU, 6, 12, 18 and 24 h in a ward, as well as the time to first analgesic requirement in the PACU and ward. Results Ketorolac demand and NRS in the PACU were significantly lower in Group N than Group C (P = 0.002, P = 0.005, respectively). The time to first analgesic requirement in the PACU in Group N were significantly longer than Group C (P = 0.046). There were no significant differences in intraoperative remifentanil dose, ketorolac demand, NRS, and the time to first analgesic requirement in the ward between the groups. Conclusions Nefopam administration combined with low dose remifentanil infusion reduces pain and analgesic consumption during the immediate postoperative period in patients undergoing middle ear surgery under desflurane anesthesia.

Multiple psoas abscess formation after pharmacopuncture -a case report-.

Acupuncture has been widely used in alternative medicine for pain relief but may have many complications due to lack of appropriate cares. Pharmacopuncture is a sort of acupuncture that injects a herbal ingredient through a thin tube for the purpose of combining the effects of the herb and acupuncture and it has many pitfalls. The agents used in pharmacopuncture are not refined for a desired effect and not produced by sterile standard processes under strict medical surveillance. We report a case of a 44-yr-old male patient who had multiple abscesses in the psoas region with fever, right low back and hip pain that began after the pharmacopuncture treatment. This case shows that although pharmacopuncture has been practiced widely, it is important that the appropriate aseptic technique should be used to prevent severe infections and other complications.

Effect of nerve block on t-PA release by venous occlusion

Abstract In order to investigate the influence of neural blockade on tissue plasminogen activator (t-PA) release by venous occlusion, we compared the increase in t-PA and fibrinolytic activity in the euglobulin fraction initiated by cubital venous occlusion (100 mmHg for 10 min), in pre-neural block and post-neural block states, in 7 cases. In all patients, the supra-clavicular approach was used to obtain a brachial plexus block and venous occlusion was achieved at the cubital levels on the ipsilateral arm. The euglobulin fibrinolytic activity before venous occlusion was 100.9±27.5 BAU in the pre-nerve block state and 102.7±29.4 BAU in the post-nerve block state (p>0.5). The t-PA antigen level before venous occlusion was 3.5±1.2ng/ml in the pre-nerve block state and 4.0±1.0 ng/ml in the post-nerve block state (p>0.05). The increase in the euglobulin fibrinolytic activity after venous occlusion was 18.0±16.7 BAU in the pre-nerve block state, and 18.3±15.6 BAU in the post-nerve block state (p>0.5). The increase in the t-PA antigen levels after venous occlusion was 3.0±2.0 ng/ml in the pre-nerve block state and 3.0±2.1ng/ml in the post-nerve block state (p>0.5). These findings suggest that the peripheral nervous system does not exert any influence on t-PA release during venous occlusion.

The effect and optimal dose of sufentanil in reducing injection pain of microemulsion propofol

Background Propofol is used as an induction and maintenance agent for general anesthesia but it can cause adverse reactions like hyperlipidemia, growth of microorganisms, and pulmonary embolisms. Microemulsion propofol was developed to avoid these side effects but incidence and severity of pain on injection is higher than with lipid emulsion propofol. We aimed to compare the effects of sufentanil in analgesic doses for reducing the injection pain of microemulsion propofol. Methods The candidates included eighty patients, 19-60 years old and ASA I-II. They were randomly classified into four groups and pretreated with normal saline, sufentanil 0.1 µg/kg, 0.2 µg/kg or 0.3 µg/kg before injection of microemulsion propofol. Five minutes after receiving pretreatment drug, 2 mg/kg of microemulsion propofol was injected and VAS was recorded. Results There were no significant differences in the incidence of injection pain among the groups. Severity of injection pain was significantly lower in the sufentanil 0.3 µg/kg group than normal saline and sufentanil 0.1 µg/kg group. Significant differences in blood pressure and heart rate were observed in sufentanil groups only after endotracheal intubation. One patient each in sufentanil 0.1 µg/kg and 0.3 µg/kg group experienced mild cough, one from sufentanil 0.3 µg/kg group experienced dizziness and another showed signs of hypoxia. One patient each in normal saline and sufentanil 0.1 µg/kg group showed clinical symptoms of phlebitis in the injection area. Conclusions Pretreatment with sufentanil 0.3 µg/kg reduced the severity of microemulsion propofol injection pain without increasing arterial blood pressure and heart rate after endotracheal intubation.