1.Continuous Femoral Nerve Block Guided by Ultrasound Sonography in Metastatic Cancer Patient: A case report.
Dae Hyun JO ; Myoung hee KIM ; Sa hyun PARK ; Hyeonjeong YANG ; Jong yeon LEE ; Min Gu KIM
Korean Journal of Anesthesiology 2008;54(2):232-235
Terminal cancer pain is always a challenge to pain doctors.If the focus of the cancer pain is located in the restricted area, it is easy to control the pain. However, if the focus of cancer pain is widespread, it is very difficult to control the pain and it makes pain doctors embarrassed.Nowadays, the ultrasound-guided nerve block become a popular method. It is easy to find the nerve and helps to insert the catheter around the nerve for the continuous nerve block. We encountered a patient who was 59 years old with a stomach cancer and vertebral metastasis. He complained about the pain in his abdomen, back and left thigh. His abdominal and back pain vanished with the use of continuous lumbar epidural injection. However, the patient still complained about the pain and numbness on the left thigh, because of this, he couldn't get any sleep.We tried a continuous femoral nerve block under the ultrasound guidance, after that his pain was gone.The ultrasound-guided nerve block will be very helpful to control the pain.
Abdomen
;
Back Pain
;
Catheters
;
Femoral Nerve
;
Humans
;
Hypesthesia
;
Injections, Epidural
;
Neoplasm Metastasis
;
Nerve Block
;
Stomach Neoplasms
;
Thigh
2.Comparison of 0.5% ropivacaine with fentanyl and 0.75% ropivacaine used in extension of a preexisting labor epidural for emergency cesarean section: retrospective study.
Yun Sic BANG ; Hyeonjeong YANG ; Su jeong NAM ; Seo Min PARK ; Kum Hee CHUNG ; Su Yeon LEE ; Dong Wook SHIN ; Duk Hee CHUN
Anesthesia and Pain Medicine 2014;9(1):65-69
BACKGROUND: Various regimens have been studied in extension of a preexisting labor epidural for emergency cesarean section. Lumbar epidural analgesia for delivery is safe and efficient. We compared retrospectively 0.5% ropivacaine with fentanyl and 0.75% ropivacaine in extension of a preexisting labor epidural for emergency cesarean section. METHODS: We investigated medical records of 61 parturients in extension of a preexisting labor epidural for emergency cesarean section. There were two regimens which was 0.5% ropivacaine with fentanyl (group 1) and 0.75% ropivacaine (group 2). We recorded demographic data, local anesthetic dose, surgical readiness time, maximum level of sensory block, surgery time, intravenous supplementation, number of hypotension and total dose of ephedrine between two groups. RESULTS: There were no differences between the study groups in demographic data, surgical readiness time, maximum sensory block level, intravenous supplementation, incidence of hypotension and total dose of ephedrine. Local anesthetic volume was larger in group 1 than group 2, but local anesthetic doses were lower in group 1 than group 2. CONCLUSIONS: 0.5% Ropivacaine with fentanyl regimen is as fast and efficacious as 0.75% ropivacaine in extension of a preexisting labor epidural for cesarean section and reduces the requiring total local anesthetic dose.
Analgesia, Epidural
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Cesarean Section*
;
Emergencies*
;
Ephedrine
;
Female
;
Fentanyl*
;
Hypotension
;
Incidence
;
Medical Records
;
Pregnancy
;
Retrospective Studies*
3.Clinical Features and Risk Factors of Adrenal Insufficiency in Patients With Cancer Admitted to the HospitalistManaged Medical Unit
Min Kwan KWON ; Junhwan KIM ; Jonghwa AHN ; Chang-Yun WOO ; Hyeonjeong KIM ; Hye-Seon OH ; Mingee LEE ; Seungha HWANG ; Keun Hoi PARK ; Young Hak LEE ; Jakyung YU ; Sujeung KANG ; Hyo-Ju SON
Journal of Korean Medical Science 2022;37(28):e222-
Background:
The symptoms of adrenal insufficiency (AI) overlap with the common effects of advanced cancer and chemotherapy. Considering that AI may negatively affect the overall prognosis of cancer patients if not diagnosed in a timely manner, we analyzed the incidence, risk factors, and predictive methods of AI in cancer patients.
Methods:
We retrospectively analyzed the medical records of 184 adult patients with malignancy who underwent a rapid adrenocorticotrophic hormone stimulation test in the medical hospitalist units of a tertiary hospital. Their baseline characteristics and clinical features were evaluated, and the risk factors for AI were identified using logistic regression analysis.
Results:
Of the study patients, 65 (35%) were diagnosed with AI, in whom general weakness (63%) was the most common symptom. Multivariate logistic regression showed that eosinophilia (adjusted odds ratio [aOR], 4.28; 95% confidence interval [CI], 1.10–16.63; P = 0.036), history of steroid use (aOR, 2.37; 95% CI, 1.10–5.15; P = 0.028), and history of megestrol acetate use (aOR, 2.71; 95% CI, 1.38–5.33; P = 0.004) were associated with AI. Baseline cortisol levels of 6.2 μg/dL and 12.85 μg/dL showed a specificity of 95.0% and 95.4% for AI diagnosis, respectively.
Conclusion
AI was found in about one-third of patients with cancer who showed general symptoms that may be easily masked by cancer or chemotherapy, suggesting that clinical suspicion of AI is important while treating cancer patients. History of corticosteroids or megestrol acetate were risk factors for AI and eosinophilia was a pre-test predictor of AI.Baseline cortisol level appears to be a useful adjunct marker for AI.
4.Effect of prophylactic abdominal drainage on postoperative pain in laparoscopic hemicolectomy for colon cancer: a single-center observational study in Korea
Sung Seo HWANG ; Heung-Kwon OH ; Hye-Rim SHIN ; Tae-Gyun LEE ; Mi Jeong CHOI ; Min Hyeong JO ; Hong-min AHN ; Hyeonjeong PARK ; Hyun Hee SIM ; Eunjeong JI ; Anuj Naresh SINGHI ; Duck-Woo KIM ; Sung-Bum KANG
Journal of Minimally Invasive Surgery 2024;27(2):76-84
Purpose:
This study aimed to evaluate the effect of prophylactic abdominal drainage (AD) in laparoscopic hemicolectomy, focusing on assessing postoperative pain outcomes.
Methods:
Patients were categorized into two groups: those with and without AD (AD group vs.no-AD group). A numerical rating scale (NRS) was used to assess postoperative pain on each postoperative day (POD). Further, the inverse probability of treatment weighting (IPTW) method was used to reduce intergroup bias.
Results:
In total, 204 patients who underwent laparoscopic hemicolectomies by a single surgeon between June 2013 and September 2022 at a single institution were retrospectively reviewed. After adjusting for IPTW, NRS scores on POD 2 were significantly lower in the no-AD group (3.2 ± 0.8 vs. 3.4 ± 0.8, p = 0.043). Further examination of postoperative outcomes showed no statistically significant differences in complications between the AD (17.3%) and no-AD (12.4%) groups (p = 0.170). The postoperative length of hospital stay was 7.3 ± 2.8 days in the AD group and 6.9 ± 3.0 days in the no-AD group, with no significant difference (p = 0.298). Time to first flatus was 3.0 ± 0.9 days in the AD group and 2.7 ± 0.9 days in the no-AD group, with no significant difference (p = 0.078). Regarding readmission within 1 month, there were four cases each in the AD (2.3%) and no-AD (1.7%) groups, with no significant difference (p = 0.733).
Conclusion
Laparoscopic hemicolectomy without AD resulted in no significant differences in postoperative clinical outcomes, except for postoperative pain. This finding suggests that prophylactic AD may exacerbate postoperative pain.