According to the International Association for the Study of Pain (IASP), pain is un unpleasant sensory and emotional experience signaling the presence of actual or potential tissue damage, or described in terms of such damage. Clinically, however, pain without proven evidence for its origin, should also be considered and treated nonetheless. Pain is classified as acute and chronic, or nociceptive and neuropathic pain. Acute pain is an adaptive, beneficial response which is necessary for the preservation of tissue integrity. When it becomes a chronic pain, which is a pain that has outlived its usefulness, it may be a timeless, endless, and meaningless perception, bringing the subject a sense of isolation and despair. Therefore, adequate management of pain is absolutely mandatory using whatever modalities. Nociceptive pain is initiated by noxious stimuli, whereas the neuropathic pain is induced by injury to either peripheral or central nervous system. If the pain is not treated or undertreated, noxious stimuli evoke long-term and persistent changes in the dorsal horn neurons in the spinal cord. These changes engrave the memory of the stimuli and sensitize the dorsal horn neurons. Subsequent pain stimuli evoke a even greater response, which results in a centrally mediated secondary hyperalgesia, and is mediated through glutamate acting on the N-methyl-diaspartate (NMDA) receptors. Mechanisms and pathophysiology of each pain are described briefly.
Acute Pain ; Central Nervous System ; Chronic Pain ; Glutamic Acid ; Hyperalgesia ; Memory ; Neuralgia ; Nociceptive Pain ; Posterior Horn Cells ; Spinal Cord ; United Nations

No abstract available.
Animals ; Interleukin-2* ; Interleukin-6* ; Mice* ; Pseudomonas aeruginosa* ; Pseudomonas*

Celiac plexus block with neurolytic agents is widely recommended for the management of intraabdominal pain due to malignant disease as a simple, asafe and effective method. We performed neurolytic celia: plexus block with 60% ethanol in lidocaine in 8 patients: with gastric cancer(4), hepatoma(2), pancreatic cancer(1), and chronic pancreatitis(1). Good to excellent pain relief was obtained in the 2 hepatoma cases, 1 pancreatic cancer, and a gastric cancer patient. In one patient with gastirc cancer, analgesia lasted for about 3 months but the second block was entirely unsatisfactory. The result was uncertain in one patient with chronic pancreatitis because the pain was non-specific and responded even to saline solution(placebo). In the remaing 2 patients, the result was entirely negative and eventually, epidural morphine was given periodically through an indwelling catheter.
Analgesia ; Carcinoma, Hepatocellular ; Catheters, Indwelling ; Celiac Plexus* ; Ethanol ; Humans ; Lidocaine ; Morphine ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Stomach Neoplasms

The micelle solution of Triton X-100 has been used as one of the experimental analogues of biological membrane in the study of the mechanism of anesthesia. It is well known that the cloud point(Tc) of micelle solution is increased by the unionized species of local anesthetics which can penetrate and move into the micelle, and decreased by the ionized form of local anes- thetics which can not penetrate the membrane. Barbiturates(HA) ionize to H+ and A- . The degree of ionization of any drug depends on its own pKa and pH of the solution. The effect of thiobarbiturates on the Tc of micelle solution was studied to see if an unionized form is necessary for the drug to penetrate cell membrane as in local anesthetics. Thiobarbiturates decreased the Tc at low pH and increased at high pH. From the data obtained at pH around 4, the decrease in Tc(dT1) was regarded to be proportional to the concentration of [HA] in micelle, and the data obtained at pH around 10, the increase in Tc(dT2) was regarded to be proportional to the concen- tration of [A-] in aqueous phase. Assuming that the observed changes in Tc(dTc) at pH ranging from 4 to 10 were the summation of dT1 and dT, dTc was expressed as theoretical equation. The experimental data showed a perfect fit to the curve derived from the equation. This confirmed that thiobarbiturates, as local anesthetics, penetrate the micelle(membrane) in an unionized form.
Anesthesia ; Anesthetics, Local ; Cell Membrane ; Hydrogen-Ion Concentration ; Membranes ; Octoxynol ; Thiobarbiturates*

Rabbits injected with ketamine, 2-8mg/kg, i.v. were subjected to positional manipulation. Rotation of the head to a unilateral direction (from the neutral to the right or left) and returning towards the neutral produced nystagmic responses in the bilateral eyeballs. The patterns of the nystagmus observed by ketamine were compared with those by alcohol(1-2 gm /kg). The following results were obtained. 1) Intravenous injection of ketamine did not cause spontaneous nystagmus when the animal was left in the neutral position. 2) Following the ketamine injection, positional manipulation such as lateral rotation of the head elicited nystagmus in the bilateral eyeballs. The directions of the nystagmus appeared to be specific to the direction of the rotation. 3) Returning of the head from the laterally rotated position to the neutral also caused nystagmus with specific directions. 4) The patterns of the positional nystagmus caused by ketamine were quite similar to those of "positional nystagmus" caused by alcohol; nystagmic patterns were almost identical between the animals injected with ketamine and alcohol when the direction of the head rotation was the same. 5) Destruction or removal of the bilateral vestibular systems abolished the nystagmic responses to the positional manipulation. These experimental results indicate that the ketamine does elicit positional nystagmus as alcohol, which has been known as a unique agent causing positional nystagmus in man and animals, and the vestibular system is basically related to the genesis of the positional nystagmus caused by ketamine.
Animals ; Head ; Injections, Intravenous ; Ketamine* ; Nystagmus, Physiologic* ; Rabbits*

This study was undertaken to investigate the effects of Thalamonal and enflurane on the blood glucose level. Anesthesia was maintained with Thalamonal (0.5~1ml/10kg), N2O(41/min), and pancuronium(0.1mg/kg) in group l patients and with enflurane(1.5~2.5vol%), N2O(41/min), pancuronium(0.1mg/kg) in group ll patients. Blood glucose levels were measured at ward, just before induction, 15 min after induction, 5 min and 40 min after skin incision and at recovery room respectively. The following results were obtained. 1) Blood plucose levels in both groups were not significantly changed during a period of fasting(p<0.05). 2) Blood glucose levels in both groups were more significantly increased during anesthesia and surgery than those measured at ward(p<0.01). 3) In group l patients, blood glucose levels measured at recovery room were more significantly increased than those measured at 40 min after skin incision(p<0.01), while in group ll patients blood glucose levels at recovery room were more significantly decreased than those measured at 40 min after skin incision(p<0.05). 4) Changes in blood glucose levels during anesthesia and operation were not significantly different in both groups. 5) Both groups did not show hypoglycemia or hyperglycemia beyond the clinically acceptable range. From above results, it is suggested that both Thalamonal and enflurane are safe anesthetic agents in the patients with diabetes mellitus as well as in the normal patients.
Anesthesia ; Anesthetics* ; Blood Glucose* ; Diabetes Mellitus ; Enflurane ; Humans ; Hyperglycemia ; Hypoglycemia ; Recovery Room ; Skin

Safety for both mother and infant is an imperative element in anesthesia for cesarean section, and ketamine has been widely used in obstetrical anesthesia especially for analgesis for normal vagianl delivery. Small doses of ketamins(0.2~0.5mg/kg) provides satisfactory analgesia during delivery without significant marternal and fetal complications. We added nitrous oxide to the small dose of ketamine and applied it to the induction of anesthesia for cesarean section and the results were compared with those of thiopental. A small dose of ketamine with nitrous oxide may be superior to an ordinary dose of thiopental, in the effects on the maternal cardiovascular system and the Apgar score of the fetus although the Apgar score only is not sufficient to evaluate neonatal condition.
Analgesia ; Anesthesia* ; Anesthesia, Obstetrical ; Apgar Score ; Cardiovascular System ; Cesarean Section* ; Female ; Fetus ; Humans ; Infant ; Ketamine* ; Mothers ; Nitrous Oxide ; Pregnancy ; Thiopental

Several methods for the management of intractable pain for various conditions including malignant disorders, herpes zoster, and low back pain and/or sciatica in 80 patients were described and analyzed. Neurolytric blocks of celiac plexus were given to the patients suffering from intra-abdominal pain from malignant origin or chronic pancreatitis. Herpes zoster was treated mainly by chemical sympathectomy via paravertebral route and occassionaly corticosteroid was administered epidurally with the local anesthetic, bupivacaine. All the patients with low back pain and/or sciatica were given epidural corticosteroid one to three times. Other peripheral were blocks and regional corticosteroid therpy were given to the rest of the patients. Fair to excellent result was obtained in 71% of the patients but the response was poor in the remaining 28% of the patients. It seems that the earlier the patients were referred to the pain clinic, the better the results were.
Bupivacaine ; Celiac Plexus ; Herpes Zoster ; Humans ; Low Back Pain ; Pain Clinics ; Pain, Intractable ; Pancreatitis, Chronic ; Sciatica ; Sympathectomy, Chemical

Effects of ketamine on the cardiovascular system of tortoises was observed in this study. Ketamine elevated blood pressure and increased contractile performance and heart rate of the tortoise's auricle. The hypertensive effect of ketamine was abolished by treatment with hexametbonium or Regitine, while increment of heart rate due to ketamine was not affected by treatment of hexamethonjum, Inderal, or Regitine. In vitro experiments, ketamine increased contractile performance and heart rate of the auricle. These effects of ketamine were not affected by Regitine, Inderal,cocaine, or reserpine pretreatment. Synergism of ketamine and norepinephrine was also observed. Low bath temperature did not influence the effects of ketamine but high bath temperature inhibited the effects of the drug. In the electrically stimulated preparations, field stimulation did not affect the chronotropic and inotropic effects of ketamir, but direct stimulation abolished these effects of the drug. From the above results, it is possible to say that ketamine probably has dual actions on the cardiovascular system of tortoises, i, e., hypertensive action due to stimulation of sympathetic nervous system, and chronotropic and inotropic actions due to direct stimulation of cardiac muscle.
Baths ; Blood Pressure ; Cardiovascular System* ; Heart Rate ; In Vitro Techniques ; Ketamine* ; Myocardium ; Norepinephrine ; Phentolamine ; Propranolol ; Reserpine ; Sympathetic Nervous System

IIn a randomized double-blind study, postoperative pain was assessed in 60 patients undergoing gynecologic surgery with three types of anesthesia; inhalation anesthesia only (enflurane-N2O-O2-vecuronium)(G); inhalation anesthesia with local infiltration (infiltration of the abdominal wall with 40 ml 0.25% bupivacaine along the line of the proposed incision)(GI); and inhalation anesthesia with epidural analgesia (morphine 2 mg mixed with 10 ml 0.125% bupivacaine)(GE). The severity of constant incisional pain, movement-associated incisional pain, and pain upon pressure applied to the surgical wound using 5 pounds of weight was assessed with a visual analogue scale at 2, 6, 12, 24, and 48 hours after surgery. The duration of analgesia (time from the end of the surgery to the first request for analgesic) was 7.9+/-3.1 hours in group G, 22.8+/-4.8 hours in group GI, and 33.1+/-3.9 hours in group GE, with statistically significant differences between group G and other two groups. Forced vital capacity (FVC), peak expiratory flow, and forced expiratory volume in 1 second (FEV1) were measured with the patients in a semisitting position. In all groups, there were no differences in above parameters, These results indicate that postoperative pain after lower aMominal surgery would be managed satisfactorily with infiltration of local anesthetic as well as epidural analgesia.
Abdominal Wall ; Analgesia ; Analgesia, Epidural ; Anesthesia ; Anesthesia, Inhalation ; Bupivacaine* ; Double-Blind Method ; Female ; Forced Expiratory Volume ; Gynecologic Surgical Procedures ; Humans ; Morphine* ; Pain, Postoperative ; Vital Capacity ; Wounds and Injuries