견관절경 수술 후 Ropivacaine, Ropivacaine과 Fentanyl, Ropivacaine, Fentanyl과 Ketorolac의 관절강 내 지속적 주입 시 진통효과에 대한 비교연구

김일석 ( Il Seok Kim ),신근만 ( Keun Man Shin ),강상수 ( Sang Soo Kang ),장지수 ( Ji Su Jang ),홍성준 ( Sung Jun Hong ),윤영준 ( Yeong Joon Yoon ),이희제 ( Hee Je Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3

Background: Arthroscopic shoulder surgery can result in severe postoperative pain. A variety of methods have been used to control pain in postoperative period and the results are variable. The purpose of this study was to compare the relative analgesic efficacies of the postoperative intraarticular infusion of ropivacaine, ropivacaine/fentanyl, and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery. Methods: Thirty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. At the end of surgery, 0.5% ropivacaine 20 ml was infused into the articular space and a continuous infusion catheter was inserted into intraarticular operated site. After surgery, continuous infusion of 0.5% ropivacaine 100 ml (Group 1, n=10), 0.5% ropivacaine 100 ml including fentanyl 10 μg/kg (Group 2, n=10), or 0.5% ropivacaine 100 ml including fentanyl 10 μg/kg and ketorolac 150 mg (Group 3, n=10) was started through catheter at rate of 2 ml/hr with bolus dose of 0.5 ml with a lock out time of 15 minutes for 2 days. The level of pain was assessed using a visual analogue scale (VAS) postoperative 2, 6, 12, 24 and 48 hours and the amounts of supplemental analgesics were recorded. Results: The VAS was significantly lower after 2, 6, 12 hours in Group 2 than in Group 1. In Group 3, the VAS was significantly lower all hours than in the other two groups. Conclusions: The combination of fentanyl and ketorolac with ropivacaine did provide better postoperative analgesia than the other groups after arthroscopic shoulder surgery. (Korean J Anesthesiol 2009; 56: 303∼8)

Risk Factors for Recurrence of Anterior Shoulder Instability after Arthroscopic Surgery with Suture Anchors

Chang-Hyuk Choi,Seok-Jun Kim,Seung-Bum Chae,Jae-Keun Lee,Dong-Young Kim 대한견주관절의학회 2016 대한견주관절학회지 Vol.19 No.2

Background: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. Methods: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. Results: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. Age and the size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. Conclusions: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence were young age and the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.

견관절경 수술 전에 시행한 견갑상신경차단이 수술 후 통증완화에 미치는 영향

박재균,이영복,김순열 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.1

Background: Arthroscopic shoulder surgery results in severe postoperative pain in 45% of patients which requires a large amount of opioids for relief. We hypothesized that a suprascapular nerve block before arthroscopic shoulder surgery would improve the quality of postoperative pain relief thereby allowing patients to require significantly reduced amounts of opioids. Methods: Sixty patients were randomized from a elective arthroscopic shoulder surgery list either into a control group (group 1,n = 30) with only intravenous, patient-controlled analgesia (IV PCA)or an experimental group (group 2, n = 30) involving a suprascapular nerve block before arthroscopic shoulder surgery. The patients had an induction of general endotracheal anesthesia with or without suprascapular nerve block before operation. The IV PCA was connected to the patients 10 minutes after induction. Both groups were analyzed by chi square test and t-test. Results: The postoperative VAS scores for group 2 decreased more than those for group 1. In particular, the VAS scores for group 2 within 12 hours after the operation were significantly higher than those 12 hours postoperative, as compared to group 1. Conclusions: Increased pain relief and less reliance on opioid can be expected through the use of a suprascapular nerve block prior to arthroscopic shoulder surgery.

Effect of short-term prewarming on body temperature in arthroscopic shoulder surgery

신광섭,이귀용,천은희,김윤진,김원중 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.4

Background: Hypothermia (< 36°C) is common during arthroscopic shoulder surgery. It is known that 30 to 60 minutes of prewarming can prevent perioperative hypothermia by decreasing body heat redistribution. However, the effect of short-term prewarming (less than 30 minutes) on body temperature in such surgery has not been reported yet. Therefore, the aim of this prospective study was to investigate the effect of short-term prewarming for less than 30 minutes using forced-air warming device on body temperature during interscalene brachial plexus block (ISBPB) procedure in arthroscopic shoulder surgery before general anesthesia. Methods: We randomly assigned patients scheduled for arthroscopic shoulder surgery to receive either cotton blanket (not pre-warmed, group C, n = 26) or forced-air warming device (pre-warmed, group F, n = 26). Temperature was recorded every 15 minutes from entering the operating room until leaving post-anesthetic care unit (PACU). Shivering and thermal comfort scale were evaluated during their stay in the PACU. Results: There were significant differences in body temperature between group C and group F from 30 minutes after induction of general anesthesia to 30 minutes after arrival in the PACU (P < 0.05). The median duration of prewarming in group F was 14 min (range: 9–23 min). There was no significant difference in thermal comfort scale or shivering between the two groups in PACU. Conclusions: Our results showed that short-term prewarming using a forced-air warming device during ISBPB in arthroscopic shoulder surgery had beneficial effect on perioperative hypothermia.

초음파 유도하 사각근간팔신경얼기 차단술이 견관절경 수술의 수술 후 진통에 미치는 효과: 전신마취와 비교

신영덕,한준성 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.3

Background:Interscalene brachial plexus block (IS-BPB) offers many advantages over general anesthesia for both arthroscopic and open surgeries of the shoulder, including shorter hospital stay, reduced postoperative analgesia requirements, and avoidance of the risks and side effects of general anesthesia. The purpose of this study was to compare the effectiveness of postoperative pain control by IS-BPB to general anesthesia for performing arthroscopic shoulder surgery. Methods:Sixty patients were divided into three groups: general anesthesia (group A, n=20), general anesthesia and suprascapular nerve block (SSNB) (group B, n=20), and only IS-BPB(group C, n=20). All patients received patient-controlled analgesia (PCA), and were instructed to rate their pain using a visual analogue scale (VAS) ranging from 0 to 10. VAS was measured at 1, 4, 8, 12, and 24 hours after surgery. Hospital stays were recorded. Results:VAS decreased significantly with time in group A and B (P < 0.05) (Fig. 1), but not in group C. Group C had less pain at 1, 4, 8, 12, 24, hours postoperatively than the other groups (P < 0.05) (Fig. 1). Group C had shorter hospital stays than the other groups (P < 0.05) (Fig. 2). Conclusions:IS-BPB results in less postoperative pain and a shorter hospital stay than general anesthesia for arthroscopic shoulder surgery (P < 0.05).

임상연구 : 견관절경 수술 후 통증 관리: 견봉하 지속적 자가통증조절 시 Ropivacaine의 효과적인 농도에 관한 연구

박윤정 ( Youn Jung Park ),정미화 ( Mi Hwa Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Background: The aim of this study was to estimate the effective concentration of subacromial ropivacaine for the control of postoperative pain after arthroscopic shoulder surgery. Methods: In a prospective, randomized double-blind trial, 60 patients were divided equally into 3 groups; Groups I, II, and III. At the end of surgery, a bolus dose (0.75% ropivacaine 150 mg, depomedrol 40 mg) was injected via the trocar and a continuous subacromial infusion catheter was inserted into all patients. The drugs were administered for 48 hours after surgery. Group I was given 0.11% ropivacaine in 96 ml of normal saline, which consisted of 0.75% ropivacaine (15 ml), and fentanyl (10μg/kg). Group II received 0.15% ropivacaine in 96 ml saline consisting of 0.75% ropivacaine (20 ml) and fentanyl, (10μg/kg). Group III received 0.23% ropivacaine in saline consisting of 0.75% ropivacaine (30 ml) and fentanyl (10μg/kg). The rate of continuous infusion was, 2 ml/hr. The VAS for pain at rest and the range of motion (ROM) exercise, the amounts of supplemental analgesics and side effects were assessed postoperative 3, 9, 24 and 48 hours. Results: There was no significant difference in the VAS for pain at rest and ROM exercise as well as in the amounts of supplemental analgesics between the three groups. Conclusions: 0.11% ropivacaine with 10μg/kg fentanyl provides effective postoperative analgesia at rest and during ROM exercise after arthroscopic shoulder surgery. (Korean J Anesthesiol 2006; 50: 552~6)

The effect of preemptive intravenous ketamine on postoperative pain in patients undergoing arthroscopic rotator cuff repair with intra articular ropivacaine injection

홍은표,정대희,강희용,최정현,박성욱 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.1

Background: A low dose of ketamine can be an effective preemp- tive analgesic by preventing central sensitization when adminis- tered before surgical trauma. In this study, we assessed the preemptive analgesic effect of low-dose ketamine administered intravenously to patients undergoing arthroscopic rotator cuff repair with intra articular ropivacaine injection. Methods: This randomized, double-blinded study included fifty-six patients scheduled for elective arthroscopic rotator cuff repair. Normal saline (group C) or 0.5 mg/kg of ketamine (group K) was injected intravenously before the skin incision. An intra articular injection using 20 ml of 0.75% ropivacaine was performed in both groups just before wound closure by the surgeon at the end of the surgery. Postoperative pain was assessed by the numeric rating scale (NRS) in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours postoperatively. The total dose of fentanyl con- sumption and side effects were recorded. Results: There were no significant differences between the C and K groups for the NRS of pain in the PACU and at 12, 24, and 48 hours after the surgery. In addition, there was also no significant difference in total fentanyl consumption between the two groups. Conclusions: Preemptive ketamine did not reduce preemptive pain scores and fentanyl consumption in patients who underwent arthroscopic rotator cuff repair with intra articular local anesthetic injection. Therefore, more aggressive and multimodal pain control is required in patients undergoing arthroscopic shoulder surgery regardless of the use of preemptive intravenous ketamine injection.

The hemodynamic changes during the infusion of remifentanil for patients under sevoflurane anesthesia during arthroscopic shoulder surgery

Sang Hun Kim,Keum Young So,Yi Nam Jeong 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5

Background: In spite of its minimal invasiveness, hemodynamic instability frequently happens during arthroscopic procedures. This study was performed to investigate the clinical efficacy of remifentanil for controlling the intra-operative hemodynamics during the performance of arthroscopic shoulder surgery. Methods: Sixty patients (ASA class 1 and 2) who were scheduled for arthroscopic shoulder surgery were recruited for this study. After the induction and maintenance of anesthesia with thiopental sodium, rocuronium bromide, sevoflurane and nitrous oxide, the patients were randomly allocated to receive either saline or three different doses of remifentanil (0.03, 0.05 or 0.07 μg/kg/min) to assess the hemodynamic changes such as the systolic blood pressure, the diastolic blood pressure and the heart rate. Results: The hemodynamics in the remifentanil groups were more stable than those in the saline group (P<0.05), but there were some cardiovascular side effects such as hypertension (remifentanil 0.03 μg/kg/min), hypotension and bradycardia (remifentanil 0.07 μg/kg/min) with using remifentanil. Conclusions: Remifentanil 0.05 μg/kg/min under anesthetic maintenance with sevoflurane showed better hemodynamic stability than the other two remifentanil groups during arthroscopic shoulder surgery. (Korean J Anesthesiol 2009;56:497~501)

어깨 관절경 수술 후 발생한 긴장성 기흉 -증례 보고-

이영민,이경진,정승현,인준용,김경옥,이윤석,조헌 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.4

While arthroscopic shoulder surgery is considered relatively safe, complications have been reported. Though rare, pneumothorax has been reported in patients undergoing arthroscopic shoulder surgery. Tension pneumothorax must be immediately recognized and treated due to its potentially life threatening consequences. The authors present a case of a patient who developed tension pneumothorax after arthroscopic shoulder surgery, and its anesthetic managements.

임상연구 : 견관절경 수술 후 관절강 내 및 정맥 내 자가 통증조절의 효과 비교

임경실 ( Kyung Sil Im ),권용순 ( Yong Soon Kwon ),정현주 ( Hyun Ju Jung ),이재명 ( Jae Myeong Lee ),김종분 ( Jong Bun Kim ),박훈 ( Kuhn Park ),심진철 ( Jin Cheol Sim ),권오수 ( Oh Soo Kwon ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1

Background: The purpose of this study was to compare the postoperative analgesic effects and side effects of an intra-articular PCA infusion of bupivacaine and morphine using an intravenous PCA infusion of morphine following arthroscopic shoulder surgery. Methods: Seventy-one patients, undergoing arthroscopic shoulder surgery under general anesthesia, were randomly assigned to one of two groups. In group 1 (n = 32), morphine and ondansetron, 8 and 4 mg, respectively, were intravenously injected following surgery, with the subsequent infusion of normal saline 100 ml, including morphine and ondansetron, 32 and 12 mg, respectively, through an intra-venous PCA catheter. In group 2 (n = 39), 0.25% bupivacaine, 40 ml, including an intra-articular injection of morphine, 3 mg, followed by an infusion of 0.25% bupivacaine, 100 ml, including morphine, 5 mg, were administered through an intra-articular PCA catheter. In groups 1 and 2, the PCA infusion rate was 2 ml/h, with a bolus dose of 0.5 ml, with a lock out time of 8 min. The VAS for pain at rest, and the range of motion (ROM) exercise and side effects were assessed 0.5, 1, 2, 4, 12, 18 and 24 h postoperatively. Results: The patients in group 2 had significantly lower VAS for pain for the ROM than those in group 1 30 min postoperatively. However, the VAS for pain at rest was significantly lower in group 1 than 2 after 18 and 24 h, but the VAS for pain for the ROM was significantly lower in group 1 than 2 24 h postoperatively. There was no significant difference in the side effects between the two groups, with the exception of dizziness, which was more severe in group 2 at 1, 2 and 4 h postoperatively. Conclusions: An intra-articular PCA infusion of bupivacaine and morphine is no more effective than an intra-venous PCA infusion of morphine and ondansetron with respect to postoperative analgesia and side effects. (Korean J Anesthesiol 2007; 53: 72~8)