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소아환자의 수술후 P.R.N 근주와 PCA의 제통효과의 비교
이강창(Kang Chang Lee) 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1
N/A Background: The postoperative pain in children and adolescents is most commonly managed by intramuscular injections of NSAIDs or opioids. This approach may result in fluctuating plasma drug levels and cycles of pain, comfort, and sedation. Patient-controlled analgesia(PCA) is a method of analgesia administration that consists of a computer- driven pump with a button that the patient may press to administer a small dose of analgesic drug. Materials & Methods: Forty ASA physical status 1 or 2 children and adolescents were divided into two groups. In the PRN group, patients received intramuscularly diclofenac(Valentac®) on a p.r.n. basis. The PCA group patients received a mixture of nalbuphine and ketorolac by WalkMed®PCA infusor. Analgesic efficacy was evaluated with NRS(numerical rating scale) and Faces Pain Rating Scale. The side effects were evaluated. Results: The patients of PCA group had less pain than those of PRN group. Complications were similar in both group. Conclusions: PCA with nalbuphine and ketorolac is a safe and effecfive methods of pain relief in children and adolescents after surgery, and is better accepted than intramuscular injections.
술후 동통 관리에 있어서 Epinephrine 첨가 0.5% Bupivacaine의 늑막강내 투여 효과
이강창(Kang Chang Lee) 대한통증학회 1990 The Korean Journal of Pain Vol.3 No.2
N/A Reiestad and Stromskag recently introduced the interpleuralinstallation of local aneethetic solu- tions as a technique for the management of postoperative pain in patients undergoing cholecystecto- my, renal surgery, and breast surgery. This study was done to manage postoperative pain in the patients undergoing unilateral upper- abdominal surgery and thoracotomy. Twenty patients received 0.5% bupivacaine 20 ml with epine- phrine (Children, received 10 ml). Results were as follows: 1) Analgesic effects appeared in 15.56 minutes; mean analgesic duration from the initial intrapleur- al injection was 10.5 hours. 2) Blood pressure increased more after the operation than before the operation. Blood preasure before injection of bupivacaine was highest (p<0.01). Heart rate was increased before injection and 10 minutes after injection of 0.5% bupivacaine (p<0.05). 3) The values of PaCO2, were improved from 41.7±2.02 mmHg (PaCO2), 85.22,41 mmHg (PaO2) to 37.8X2.41mmHg (PaCO2), 107.0X7.86 mmHg (PaO2) respectively (p<0.01). 4) Complication such as pneumothorax, atelectasis and CNS toxicity did not appear. 5) Intrapleural administration of local anesthetics after unilateral upper-abdominal and thoracic surgery provided a satisfactory pain control.
백서의 신경병증성 통증모델의 척수감각신경세포에 대한 NMDA 수용체 길항제 및 NOS 억제제의 영향
이강창(Kang Chang Lee),최유선(Yu Sun Choi),이환봉(Hwan Bong Lee),박승택(Seung Taeck Park) 대한통증학회 2002 The Korean Journal of Pain Vol.15 No.1
N/A Background: In order to evaluate the effect of N-methyl-D-aspartate (NMDA) receptor antagonist D-2-amino-5-phosphonovaleric acid (APV), nitric oxide synthase (NOS) inhibitor, and aminoguanidine (AGH) on rat spinal sensory neurons from the neuropathic pain animal model. Methods: Cell viability, amount of neurofilament by immunocytochemistry, and rate of protein synthesis were measured after spinal motor neurons of rats were incubated with various concentrations of APV or AGH for 48 hours. Results: Cell viability of spinal sensory neurons from the neuropathic pain model was remarkably decreased compared with the control. Regarding their protective effect, both APV and AGH significantly increased cell viability, amount of neurofilament and rate of protein synthesis, compared to experimental groups with untreated APV or AGH in spinal sensory neurons. Conclusions: The present study suggests that NMDA receptor, reactive nitrogen species (RNS), and No are involved in neuropathic pain.
The Effects of Systemic Morphine to Analgesic Level in Spinal Anesthesia
이강창,김태요,윤재승,이의상,Lee, Kang-Chang,Kim, Tai-Yo,Yun, Jae-Seung,Lee, Eui-Sang The Korean Journal of Pain 1995 The Korean Journal of Pain Vol.8 No.1
척추마취는 국소마취제를 지주막하강에 주입하여 척수신경 전근과 후근을 차단하는 방법으로 하복부나 하지 수술 뿐 아니라 만성 통증과 암성 통증의 치료에도 이용되고 있는데 마취시간이나 제통시간의 연장 및 적절한 피부분절의 마취나 진통의 달성은 척추마취에서 중요한 사항이다. 본 연구에서는 morphine정주가 척추마취에 어떤 영향을 주는지 알아보기 위해 척추마취하에서 하지 수술을 받은 40명의 환자를 대상으로 척추마취를 시행한 80분에 척추마취 레벨, 수축기 및 이완기 혈압, 맥박 그리고 호흡수를 조사한후 morphine 10 mg을 정맥내로 주사후 20분후에 척추마취 레벨과 혈압, 맥박, 호흡수를 조사하여 다음과 같은 결과를 얻었다. 1) 척추마취 레벨은 morphine 투여진 $T_{7.5{\pm}0.32}$에 비해 morphine 투여 20분후에 $T_{6.0{\pm}0.31}$로 의의있게 상승하였다 (p<0.005). 2) 수축기 및 이완기 혈압과 맥박수는 morphine투여전과 투여후에 의의있는 변화가 없었다. 3) 호흡수는 morphine 투여전에 비해 투여후 감소가 있었다(p<0.005). 이상의 결과로 척추마취하에서 수술을 시행할 때나 통증치료시 전신적으로 morphne을 투여하여 마취와 진통부위를 넓일 수 있을 것으로 사료된다.
이건목,이강창,황유진,Lee, geon-mok,Lee, kang-chang,Hwang, yoo-jin 대한침구의학회 2000 대한침구의학회지 Vol.17 No.2
Herniated lumbar intervertebral disc(HIVD) is the most common reason causing low back pain and leg radiating pain. The purpose of this study is to see the good of Oriental-Western medicine on HIVD. In order to this syudy, HIVD patients divided into two groups: Group with Oriental medicine(GOM) and Group with Oriental-Westem medicine(GOWM). The results of treatments were summarized as follows. 1. If We investigate a state of patients, GrIII type is 17 cases in GOM and is 16 cases in GOWM. In the GOM, Gr II shows better than the others and in the GOWM, GrI, III shows better than the others. 2. The results of treatments in GOM and GOWM is the good in a general way. It shows excellent type at 10 cases in the GOM, and shows excellent type at 14 cases in GOWM. 3. In Acute stage(in one month), subacute stage(one month~six months) and chronic stage(over six months), the therapic point of GOM and GOWM is 2.9~3.5 on the average. 4. If we notice the effect point of HIVD, in GOM, the point of bulging type is 3, protruded type is 3.5 extruded type is 3. But in GOWM, the point of bulging type is 3.7, protruded type is 3.5 extruded type is 2.7.
부자(附子)의 경구투여(經口投與)가 RAT의 척수손상(脊髓損傷)에 미치는 영향(影響) 및 비교(比較)
이건목,김경식,이강창,Lee Geon-Mok,Kim Kyung-Sik,Lee Kang-Chang 대한침구의학회 1998 대한침구의학회지 Vol.15 No.2
Purpose In this study, We observed the recovery process in the ability to move in the hind limbs of the rats whose spinal cord injuries were treated by Radix acouniti(RA). The purpose of this study is to see the effects of Radix acouniti(RA) water extract on the contraction of rat's spinal cord injury. Procedure First, the rats were subjected to hemisectional spinal cord injuries by a scalpel blade. Those rats, then, were divided into three groups: Sham operated rats group and the experimental group, which received the Radix acouniti(RA) water extract, and the control group, which had no treatment. Their recovery in the ability to walk was observed by the Open Field Test (OFT) for 14 days after the injuries. Method The OFT was applied at four points: the hip, knee, ankle joint, and the tail. Each joint was given a movement rating of from 0 to 3, depending on the amount of movement. A movement rating of 0 designates no movement, a 1 designates slight movement, a 2 designates increased movement, and a 3 designates active movement. Slight movement is defined as a joint displaying less than or equal to 30% of that joint range, increased movement is displaying less than or equal to 60% of that joint's range, and active movement is greater than or equal to 90% of that joint's range. Tail movement is also graded on a scale of 0 to 3. A rating of 0 indicates that the tail is down 100% of the time, one of 1 indicates that the tail is down more than 10%, one of 2 shows that the tail is down less than 50% but more than 10% of the time, and one of 3 shows that the tail is down less than 10% of the time. All four ratings were added together and then averaged to arrive at a single score. Results The sham group which did not go through spinal cord injuries showed near normal results on all 3 joints and tail from right after the operation, which one would expect. The RA oral application group showed more effective recovery of movememt function than the control group around 4 days after the spinal cord injuries. However, after 14 days, both groups displayed almost the same degree of movement recovery. The results of this study are summarized as follows: 1. After 14days the spinal cord injuries, movement was recovered in sham operated group, control group, and experimented group in the hip, the knee, the tail and then the ankle of rats, in that order. 2. Around 7 days after the spinal cord injuries, the experimental group proved the effectiveness of the therapy in terms of movement recovery. 3. The level of ALT, ALP, AST in RA treated group was slightly increased. 4. The level of BUN and creatinine in RA treated group was slightly increased. The above results indicate that RA therapy at an early stage can bring about better movement recovery in patients with spinal cord injuries from traffic accidents or industrial disasters. But there is apparent side effect of RA on clinical, therefore the study on this should be continued.