Plasma Concentrations of Morphine during Postoperative Pain Control

Park, Hahck-Soo,Kim, Jong-Hak,Kim, Yi-Jeong,Kim, Dong-Yeon The Korean Pain Society 2011 The Korean Journal of Pain Vol.24 No.3

Background: Morphine has been commonly used for postoperative pain control. We measured plasma concentrations of morphine and compared the efficacy and safety of continuous epidural analgesia (CEA) using morphinebupivacaine with intravenous patient controlled analgesia (IV-PCA) with morphine for 48 hrs after the end of the operation. Methods: Nineteen patients undergoing Mile's operation were assigned to receive a morphine loading dose of 5 mg followed by IV-PCA with 0.1% morphine (IV-PCA group, n = 9) or a morphine loading dose of 2 mg and 0.125% bupivacaine 10 ml, followed by CEA with 0.004% morphine and 0.075% bupivacaine at a rate of 5 ml/hr (CEA group, n = 10). The plasma concentrations of morphine were measured and visual analog scales (VAS) for pain were recorded at 1, 6, 12, 24, and 48 hr postoperatively and the effects on respiration and any other side effects were noted. Results: The mean maximal and minimal levels of plasma morphine were $40.2{\pm}21.2\;ng/ml$ and $23.4{\pm}9.7\;ng/ml$ for the IV-PCA group and $11.8{\pm}3.5\;ng/ml$ and $8.2{\pm}1.9\;ng/ml$ for the CEA group, respectively. Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group. There were no significant differences for the effects on respiration and for any side effects between the two groups. Conclusions: We evaluated plasma concentrations of morphine with CEA using morphine-bupivacaine and IV-PCA using morphine for the postoperative pain control. The CEA group had better postoperative analgesia than that of the IV-PCA group and the incidence of side effects were not significantly different between the two groups.

Plasma Concentrations of Morphine during Postoperative Pain Control

( Hahck Soo Park ),( Jong Hak Kim ),( Yi Jeong Kim ),( Dong Yeon Kim ) 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.3

Background: Morphine has been commonly used for postoperative pain control. We measured plasma concentrations of morphine and compared the efficacy and safety of continuous epidural analgesia (CEA) using morphine- bupivacaine with intravenous patient controlled analgesia (IV-PCA) with morphine for 48 hrs after the end of the operation. Methods: Nineteen patients undergoing Mile`s operation were assigned to receive a morphine loading dose of 5 mg followed by IV-PCA with 0.1% morphine (IV-PCA group, n = 9) or a morphine loading dose of 2 mg and 0.125% bupivacaine 10 ml, followed by CEA with 0.004% morphine and 0.075% bupivacaine at a rate of 5 ml/hr (CEA group, n = 10). The plasma concentrations of morphine were measured and visual analog scales (VAS) for pain were recorded at 1, 6, 12, 24, and 48 hr postoperatively and the effects on respiration and any other side effects were noted. Results: The mean maximal and minimal levels of plasma morphine were 40.2 ± 21.2 ng/ml and 23.4 ± 9.7 ng/ml for the IV-PCA group and 11.8 ± 3.5 ng/ml and 8.2 ± 1.9 ng/ml for the CEA group, respectively. Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group. There were no significant differences for the effects on respiration and for any side effects between the two groups. Conclusions: We evaluated plasma concentrations of morphine with CEA using morphine-bupivacaine and IV-PCA using morphine for the postoperative pain control. The CEA group had better postoperative analgesia than that of the IV-PCA group and the incidence of side effects were not significantly different between the two groups. (Korean J Pain 2011; 24: 146-153)

The effect of head rotation on efficiency of ventilation and cuff pressure using the PLMA in pediatric patients

Hahck Soo Park,한종인,김윤진 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.3

Background: This study examined whether changing the head position from neutral to side can affect expiratory tidal volume (TV) and cuff pressure when the appropriate sizes of a ProsealTM Laryngeal Mask Airway (PLMA) -depending on the body weight -are used in pediatric patients during pressure controlled ventilation (PCV). Methods: Seventy-seven children (5-30 kg) were divided into three groups according to their body weight,PLMA#1.5 (group I, n = 24), #2 (group II, n = 26), and #2.5 (group III, n = 27). After anesthesia induction, a PLMA was placed with a cuff-pressure of 60 cmH2O. The TV and existence of leakage at the peak inspiratory pressure (PIP) of 20cmH2O, and the appropriate PIP for TV 10 ml/kg were examined. Upon head rotation to the left side, the TV, PIP, cuff pressure changes, and the appropriate PIP to achieve a TV 10 ml/kg were evaluated. Results: Head rotation of 45 degrees to the left side during PCV caused a significant increase in cuff pressure and a decrease in TV, and there was no definite leakage. Changes in PIP and TV were similar in the three groups. The cuff pressure increased but there was no significant difference between the three groups. Conclusions: Although cuff pressure and TV of the PLMA were changed significantly after turning the head from the neutral position to the side, a re-adjustment of the cuff pressure and PIP to maintain a TV of 10 ml/kg can make the placed PLMA useful and successful in pediatric patients under general anesthesia.

실험연구 : 토끼에서 사염화 탄소에 의한 간경화 시 Rocuronium의 약력학적 변화

박학수 ( Hahck Soo Park ),손형민 ( Hyung Min Son ),김동원 ( Dong Won Kim ),김교상 ( Kyo Sang Kim ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.3

Piriformis Muscle: Clinical Anatomy with Computed Tomography in Korean Population

Park, Chan-Hong,Lee, Sang-Ho,Lee, Sang-Chul,Park, Hahck-Soo The Korean Pain Society 2011 The Korean Journal of Pain Vol.24 No.2

Backgroud: The objective was to evaluate the distance from the skin and the diameter of the piriformis muscle and their relationship to the body mass index (BMI). Methods: The study was a prospective study involving 60 patients. Patients were prepared on a radiological table in the prone position. Several images were obtained of each. In this view, the distance between the subcutaneous tissue and the piriformis muscle, and the diameter of the piriformis, were measured at three points (medially to laterally). Results: The distance to the piriformis from the skin was $6.6{\pm}0.9\;cm$, $6.3{\pm}0.8\;cm$, and $5.2{\pm}0.9\;cm$ in terms of the lateral, center, and medial measurement, respectively. The center of the piriformis had a greater diameter with $1.7{\pm}0.4\;cm$ (0.9-2.5) cm. The distance to the piriformis increased with BMI. Conclusions: This study shows that the lateral of the piriformis muscle has a relatively greater distance from the skin. The center of the piriformis showed a greater diameter than other two portions. We found that the distance of the piriformis from subcutaneous tissues was correlated with BMI, but the diameter of the piriformis was not affected by BMI. These measurements can be used as a reference for determining the piriformis injection site in patients with piriformis syndrome.

산모에서 체위 변화에 따른 경막외 카테터의 이동

박학수,임영진 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.4

Piriformis Muscle: Clinical Anatomy with Computed Tomography in Korean Population

( Chan Hong Park ),( Sang Ho Lee ),( Sang Chul Lee ),( Hahck Soo Park ) 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.2

Backgroud: The objective was to evaluate the distance from the skin and the diameter of the piriformis muscle and their relationship to the body mass index (BMI). Methods: The study was a prospective study involving 60 patients. Patients were prepared on a radiological table in the prone position. Several images were obtained of each. In this view, the distance between the subcutaneous tissue and the piriformis muscle, and the diameter of the piriformis, were measured at three points (medially to laterally). Results: The distance to the piriformis from the skin was 6.6±0.9 cm, 6.3±0.8 cm, and 5.2±0.9 cm in terms of the lateral, center, and medial measurement, respectively. The center of the piriformis had a greater diameter with 1.7±0.4 (0.9-2.5) cm. The distance to the piriformis increased with BMI. Conclusions: This study shows that the lateral of the piriformis muscle has a relatively greater distance from the skin. The center of the piriformis showed a greater diameter than other two portions. We found that the distance of the piriformis from subcutaneous tissues was correlated with BMI, but the diameter of the piriformis was not affected by BMI. These measurements can be used as a reference for determining the piriformis injection site in patients with piriformis syndrome. (Korean J Pain 2011; 24: 87-92)

Brief Report : The Effect of Stellate Ganglion Block on Intractable Lymphedema after Breast Cancer Surgery

( Jin Kim ),( Hahck Soo Park ),( Soo Young Cho ),( Hee Jung Baik ),( Jong Hak Kim ) 대한통증학회 2015 The Korean Journal of Pain Vol.28 No.1

Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema. (Korean J Pain 2015; 28: 61-63)

The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study

Byun, Jong Min,Park, Hahck Soo,Woo, Jae Hee,Kim, Jin The Korean Pain Society 2014 The Korean Journal of Pain Vol.27 No.4

Background: Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. Methods: Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. Results: There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). Conclusions: A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective.

A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop

Chun, Eun Hee,Park, Hahck Soo The Korean Pain Society 2016 The Korean Journal of Pain Vol.29 No.1

Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy.