BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.
Administration, Intravenous ; Analgesia* ; Anesthesia ; Fentanyl* ; Humans ; Ketorolac* ; Narcotics ; Operating Rooms ; Pain, Postoperative ; Recovery Room ; Respiration

BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.
Administration, Intravenous ; Analgesia* ; Anesthesia ; Fentanyl* ; Humans ; Ketorolac* ; Narcotics ; Operating Rooms ; Pain, Postoperative ; Recovery Room ; Respiration

The transdermal administration of narcotics is one of the alternative ways of providing adequate pain relief for the patients with chronic cancer pain. A Phase 4 trial was conducted to evaluate the efficacy and safety of Fentanyl-TTS in adult patients with cancer-related pain in Korea. METHODS: Patients with histologically confirmed malignancy, who have pain related to the cancer and/or therapy, pain necessitating the use of opoid analgesics, age of 18 yr or older, ability to communicate effectively with study personnel, and signed on informed consent were included. The patients were titrated with a short-acting narcotic to control their cancer pain before they are converted to a fentanyl-transdermal therapeutic system(TTS). Short acting parenteral morphine and MS contin were used as rescue medications. All patients were evaluated initially and were followed up with a pain visual analogue scale(VAS), quality of life(QOL)-VAS. Patients were asked to keep the daily record for 21 days about pain VAS, QOL-VAS, amount of rescue morphine used, and side effects. RESULTS: Twenth two patients were enrolled from January 1996 to October 1997. The dose of fentanyl-TTS required, ranged between 25 and 75 ug/hr (25 microgram/hr in 13, 50 microgram/hr in 4, and 75 microgram/hr in 2). The mean dose of morphine required before the use of the fentanyl-TTS was 135.3 mg (20-285 mg/day), but it was decreased after the use of the fentanyl-TTS. Pain VAS and QOL-VAS were in adquate level during the fentanyl- TTS treatment. Patients favored continuous use of fentanyl after the study was finished. Side effect of fentanyl-TTS was minimal. CONCLUSION: Transdermal fentanyl seems to be a convenient and effective analgesic for the control of cancer related pain in Korean. A controlled trial comparing fentanyl-TTS to morphine needs to be followed.
Administration, Cutaneous ; Adult* ; Analgesics ; Fentanyl ; Humans ; Informed Consent ; Korea ; Morphine ; Narcotics

Background: Intravenous (IV) oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose (ED) and the 95% effective dose (ED) of an IV bolus of oxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone. Methods: Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon's up-and-down method was used to obtain EDdata for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men (step size was 0.01 mg/kg). Next, a dose-response curve from the probit analysis was generated to determine the EDand EDto blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 min before propofol injection. Results: Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED and EDof oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg (95% confidence interval [CI], 0.220-0.328 mg/kg) and 0.357 mg/kg (95% CI, 0.297-2.563 mg/kg), respectively. In men, the ED and EDwere 0.324 mg/kg (95% CI, 0.274-0.381 mg/kg) and 0.454 mg/kg (95% CI, 0.384-2.862 mg/kg), respectively. Men required 28% more oxycodone than women for induction (P < 0.01). The most common adverse events were dizziness (87.3%), vertigo (66.7%), sedation (74.6%), and respiratory depression (66.7%). Conclusions Oxycodone can be used for induction to prevent intubation reactions. Gender affected the EDand EDof oxycodone for blunting the tracheal intubation reaction.
Adult ; Anesthetics, Intravenous ; Female ; Hemodynamics ; drug effects ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; Male ; Middle Aged ; Narcotics ; administration & dosage ; Oxycodone ; administration & dosage

BACKGROUND: Nalbuphine is one of the opioid agonist-antagonists and is used frequently in the anesthetic field. Usage is focused on potent analgesic action and the adjuvant of narcotics because of less complications with preserved analgesia. The most common routes of administration for postoperative pain control are epidural and intravenous, so we compared both pharmacokinetic profiles. METHODS: Twelve patients were randomly divided into two groups. All patients were given a spinal anesthesia with tetracaine hydrochloride. One group (n = 6) received nalbuphine 10 mg via epidural route and another group (n = 6) received the same dose via intravenous route. Venous blood was drawn at 0, 0.25, 0.5, 1, 2, 4, 6 and 8 hours to measure plasma nalbuphine concentrations. Analysis was performed by high performance liquid chromatography with an electrochemical detector. RESULTS: At 0.25 hour, the plasma concentration of nalbuphine was significantly higher in the epidural administration group (49.48 +/- 4.98 ng/ml) than in the intravenous administration group (40.44 +/- 1.64 ng/ml). At 6 and 8 hours, the plasma concentration of nalbuphine was significantly higher in the epidural administration group (5.98 +/- 1.86 ng/ml, 3.85 +/- 0.94 ng/ml) than in the intravenous administration group (3.80 +/- 0.33 ng/ml, 2.43 +/- 0.32 ng/ml). Clearance, elimination half life, volume of distribution and AUC were not significantly different between the two groups. CONCLUSIONS: The plasma concentrations of nalbuphine via epidural route and intravenous route were similar in both groups after 0.25 hour to 6 hours. At 0.25 hour and after 6 hours, the epidural administration group had a higher plasma concentration of nalbuphine than the intravenous administration group.
Administration, Intravenous* ; Analgesia ; Anesthesia, Spinal ; Area Under Curve ; Chromatography, Liquid ; Half-Life ; Humans ; Nalbuphine* ; Narcotics ; Pain, Postoperative ; Plasma* ; Tetracaine

BACKGROUND: Postoperative pain control in children is a difficult problem for management. Fentanyl is one of the most commonly used narcotics in infants and children due to its rapid onset and brief duration. Infants older than 3 months had a lower incidence of apnea than adults given fentanyl; however, the dosage of fentanyl varies a great deal depending on the purpose and plan for the postoperative management. This study is designed to evaluate the effective dose of intraoperative intravenous fentanyl for pain control following inguinal herniorrhaphy in pediatric patients. METHODS: Sixty children for inguinal herniorrhaphy under general anesthesia were divided into four groups. Group I received no analgesics as a control. Group II, III and IV received intravenous fentanyl 0.5 microgram/kg, 1 microgram/kg and 1.5 microgram/kg respectively. Fentanyl was injected intravenously at the beginning of fascia closure. Extubation time and the degree of pain was evaluated. RESULTS: Our result showed that group III and IV had a lower pain score than that of the control group during the first 30 min in the recovery room (p<0.05), but no significant differences were found between the group III and group IV. The time interval from fascia closure to extubation was prolonged in the group II, III and IV compared to the control group (p<0.05). But no significant differences were found between the three groups. CONCLUSION: We suggest that intravenous administration of fentanyl 1 microgram/kg at the closure of fascia would be an easy, simple and effective means for relieving postinguinal herniorrhaphy pain in recovery room.
Administration, Intravenous ; Adult ; Analgesics ; Anesthesia, General ; Apnea ; Child* ; Fascia ; Fentanyl* ; Herniorrhaphy* ; Humans ; Incidence ; Infant ; Narcotics ; Pain, Postoperative ; Recovery Room

Neuroleptanesthesia using Innovar and nitrous oxide-oxygen was administered to 56 surgical patients. The following are the results: 1) Muscle rigidity involving the thorax was observed during the induction phase, which resulterl in marked resistance to passive inflation of the chest. Intravenous administration of succinylcholine chloride provided effective control. 2) Respiratory depression was profound, but was of shorter duration than with other narcotics. 3) Circulatory stability was remarkable during and after operation, being particularly valuable in the elderly and poor risk patients. 4) Analgesia and sedation extended well into the postoperative period, minimizing the need for narcotics. 5) Recovery from anesthesia was rapid and smooth. The anesthetic method facilitated postanesthetic management, and complications were rare. 6) Liver function did not seem to be significantly affected by the agents employed.
Administration, Intravenous ; Aged ; Analgesia ; Anesthesia ; Humans ; Inflation, Economic ; Liver ; Muscle Rigidity ; Narcotics ; Postoperative Period ; Respiratory Insufficiency ; Succinylcholine ; Thorax

INTRODUCTIONParacetamol overdose is the most common drug overdose worldwide. To our knowledge, the maximum number of paracetamol tablets ingested reported in the literature is 45 g.

CLINICAL PICTUREWe describe a 21-year-old patient who acutely ingested 120 tablets, each 500 mg paracetamol (i.e., 60 g equivalent to 1200 mg/kg body weight) in a suicidal attempt. Our patient also drank 2 bottles of codeine-based cough syrup equivalent to 360 mg of codeine. At 6 hours post ingestion, her serum paracetamol level was 207 mg/L. The poor prognostic factors for paracetamol overdose in our patient included massive paracetamol ingestion (confirmed by blood levels), codeine co-ingestion and elevated serum amylase (189 U/L).

TREATMENTShe was treated with a 3-day modified regimen of intravenous N-acetylcysteine.

OUTCOMEThe liver function tests and the prothrombin time remained normal over the second and third day of admission and the patient was discharged without complications on the fifth day.

CONCLUSIONFrom this experience we feel that in very severe paracetamol poisoning, a modified regime of intravenous N- acetylcysteine for 3 days is safe and efficacious.

Acetaminophen ; blood ; poisoning ; Acetylcysteine ; administration & dosage ; Adult ; Amylases ; blood ; Antidotes ; administration & dosage ; Codeine ; poisoning ; Drug Overdose ; Female ; Humans ; Liver Function Tests ; Narcotics ; poisoning ; Suicide, Attempted ; Tablets ; Time Factors

BACKGROUND: This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. METHODS: Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. RESULTS: There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. CONCLUSIONS: The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty.
Adult ; Aged ; Amides/administration & dosage ; Analgesia/*methods ; *Arthroplasty, Replacement, Hip ; Clinical Protocols ; Female ; Humans ; Injections, Intra-Articular ; Length of Stay ; Male ; Methylprednisolone/administration & dosage ; Middle Aged ; Morphine/administration & dosage ; Narcotics/administration & dosage ; Pain/prevention & control ; Pain Measurement ; Pain, Postoperative/prevention & control

BACKGROUND: Clonidine, alpha2-adrenoreceptor agonist, has nonopiate antinociceptive properties, which might be an alternative for postoperative analgesia free of opioid induced side effects. The aim of this study was to evaluate the fentanyl sparing effect of clonidine and reducing side effects with intravenous administration. METHODS: Fourty seven patients undergoing a cesarean section were randomly allocated to two groups to be given the following agents by intravenous administration. Group I, fentanyl 0.2ng/kg/h with clonidine 0.2ng/kg/h for 72 h adding normal saline for a total of 150 cc. Group II, fentanyl 0.4ng/kg/h for 72 h adding normal saline for a total of 150 cc and analgesia was provided intravenously via patient -controlled analgesia (PCA; basal rate = 2 ml, rescure dose = 1 ml, lock-out time = 10 min). Postoperative analgesia was assessed by VAS at 2, 4, 8, and 24 h after extubation. In addition, we also checked the vital sign sedation score. RESULTS: There were no differences of VAS scores, hemodynamic values except systolic pressure (P < 0.05), or side effects between group I and group II. The frequency of nausea was 8.7% in group I and 29% in group II, and dizziness was 4.3% in group I and 8.3% in group II. CONCLUSIONS: Intravenous clonidine with narcotics is a possible approach to postoperative pain management in patients recovering from major surgery, especially spine surgery, and clonidine spares and reduces side effects in narcotics.
Administration, Intravenous ; Analgesia ; Blood Pressure ; Cesarean Section* ; Clonidine* ; Dizziness ; Female ; Fentanyl* ; Hemodynamics ; Humans ; Infusions, Intravenous* ; Narcotics ; Nausea ; Pain, Postoperative ; Pregnancy ; Spine ; Vital Signs