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BACKGROUND Propofol is a commonly used intravenous drug during anesthetic induction because of its rapid onset and short duration. However, the injection pain that patients experience is so severe that they recall the induction of anesthesia as the most painful part of the perioperative period. Therefore, the objective of this study was to determine the effect of heated carrier fluids (40℃) in decreasing propofol injection pain. METHODS A randomized, controlled clinical trial was conducted in 90 patients aged 18 to 65 who were scheduled for either elective or urgent surgery under general anesthesia classified as American Society of Anesthesiologists physical status I or II. Patients were allocated into the following 3 groups: 1) Group W (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to propofol injection; 2) Group L (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to 0.5 mg/kg 1%lidocaine 1 minute before propofol injection; 3) Group C (control group, n = 30) who received 200 ml of room temperature fluids prior to propofol injection. Pain was evaluated using verbal pain score (VPS). RESULTS Group W and Group L showed significant reduction (P = 0.001) in the incidence and severity of injection pain compared to Group C. VPS scores were significantly lower in Group W and Group L compared to those of Group C. Incidence of propofol injection pain was statistically different between Group W (P = 0.005) and Group L (P = 0.037) compared to Group C, but not statistically different between Group W and Group L (P = 0.432). CONCLUSIONS Both sole injection of heated carrier fluids and the combination of 0.5 mg/kg 1%lidocaine pretreatment effectively reduced propofol injection pain.

Background Perioperative lidocaine infusion improves postoperative outcomes, mostly after abdominal and urologic surgeries. Knowledge of the effect of lidocaine on peripheral surgeries is limited. Presently, we investigated whether intraoperative lidocaine infusion reduced anesthetic consumption, duration of ileus, pain intensity, analgesic consumption and hospital stay after breast plastic surgeries. Methods Sixty female patients, aged 20-60 years, enrolled in this prospective study were randomly and equally divided to two groups. One group (n = 30) received a 1.5 mg/kg bolus of lidocaine approximately 30 min before incision followed by continuous infusion of lidocaine (1.5 mg/kg/h) until skin closure (lidocaine group). The other group (n = 30) was untreated (control group). Balanced inhalation (sevoflurane) anesthesia and multimodal postoperative analgesia were standardized. End tidal sevoflurane concentration during surgery, time to the first flatus and defecation, visual analog pain scale (0-10), analgesic consumption and associated side effects at 24, 48, and 72 h after surgery, hospital stay, and patient's general satisfaction were assessed. Results Compared to the control group, intraoperative lidocaine infusion reduced by 5% the amount of sevoflurane required at similar bispectral index (P = 0.014). However, there were no significant effects of lidocaine regarding the return of bowel function, postoperative pain intensity, analgesic sparing and side effects at all time points, hospital stay, and level of patient's satisfaction for pain control. Conclusions Low dose intraoperative lidocaine infusion offered no beneficial effects on return of bowel function, opioid sparing, pain intensity and hospital stay after various breast plastic surgeries.

Background: Sevoflurane anesthesia is associated with emergence agitation in children. In this study, we compared the emergence and recovery profiles of children who received sevoflurane with fentanyl or alfentanil for inguinal herniorrhaphy. Methods: Forty-five children receiving sevoflurane anesthesia for inguinal herniorraphy were assigned to three groups. Saline 0.1 ml/kg (group S), alfentanil 10/kg (group A) or fentanyl 1/kg (group F) was administered intravenously at the beginning of fascia closure. Duration of operation and anesthesia and emergence time were evaluated at the operating room. Agitation score, a degree of pain, the time of stay in PACU (postanesthetic care unit) and postoperative side effects were evaluated by a blinded observer at the PACU. Results: The emergence time was prolonged in the group F compared to the other groups. The time of stay in PACU was prolonged in the group F compared to the group S. Group A and F had lower agitation score and pain score in comparison with that of the group S at the 0, 5, 10, 15 min in the PACU. Agitation score was also significantly lower in the group F compared to the group A at 30 min. Conclusions: We suggest that intravenous administration of alfentanil 10/kg or fentanyl 1/kg at the closure of fascia could effectively reduce the agitation score. Alfentanil also does not delay from emergence and the time of stay in the PACU.

Background: Prolotherapy is an effective treatment for pain due to ligament or tendon laxity. The purpose of this study was to determine the effects of prolotherapy on the relief of shoulder pain. Methods: Twenty-nine patients who complained of shoulder pain were investigated using a pain score system. Prolotherapy was performed using 15% dextrose to regions according to Hemwall's pattern. We recorded numeric rating scale (NRS) pain scores just before prolotherapy and 1, 2, 4 and 8 weeks later. Results: For the 29 patients, prolotherapy proved to be effective and satisfactory in 83% (NRS; 7.2 0.8 before, 2.0 1.3 after prolotherapy). Conclusions: Prolotherapy with 15% dextrose resulted in a clinically significant improvement of shoulder pain due to ligamentopathy.

Background: Postoperative pain control in children is an important problem for management but it was treated negligently. In the past, the pain was undertreated in children, even more in infant. In recent years, the importance of the pain control in children was emphasized but not enough, yet. This study was designed to evaluate the propriety of intraoperative intravenous medication technique and effectiveness of the fentanyl, ketorolac and ketamine for pain control following inguinal herniorrhaphy in pediatric patients. Methods: Eighty 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 were received intravenous fentanyl 1/kg, ketorolac 1 mg/kg and ketamine 1 mg/kg respectively. Fentanyl and ketolorac were injected intravenously during the induction of anesthesia and ketamine was injected at the entrance of operating room. Emergence time and the degree of pain was evaluated. Results: Our result showed that group II and group III had a lower pain score than that of the control group at the 5 min, 10 min, 20 min and 30 min in the recovery room (P /kg and ketorolac 1 mg/kg during induction would be an easy, simple and effective means for relieving postinguinal herniorrhaphy pain in recovery room.

Background: We wondered what type of pain scores is more available and rliable during the immediate postoperative period. In this study, we compared a numerical rating scale (NRS) with a visual analog scale (VAS) pain scores to assess postoperative pain. Methods: Fifty patients were educated as to how to describe pain intensity using the NRS (11-point) and VAS (10 cm) scores during the evening before elective laparoscopic cholecystectomy. Following their operation, patents checked their pain intensity using NRS and VAS at postoperative 1 hour in the recovery room with the assistance of an anesthesiologist, and 3, 6, 12, 18 and 24 h by themselves. The absolute values of the NRS and VAS scores were analyzed for inter-individual variability and for correlations between the two. Results: Forty-eight patients finished this study. The absolute value of the mean NRS score was slightly higher than that of the mean VAS score at each time point. However, the mean difference was only 0.4. Overall, the two parameters correlated well at each of the six measurement times. The correlation coefficients between the absolute values of the NRS and VAS pain scores for all measurement times were over 0.95. Conclusions: This data suggests that NRS and VAS pain scores are well correlated, and that they are equally useful at assessing immediate postoperative pain. (Korean J Anesthesiol 2003; 45: 238- 243)

Background: Intravenous injection of rocuronium produces intense discomfort at the site of injection in conscious patients. We compared the efficacy of normal saline, and of lidocaine 10 mg, 20 mg, 30 mg, and 40 mg pretreatment at preventing pain caused by injecting rocuronium. Methods: 250 ASA physical status Iand II patients, aged 18 to 70 years, were randomized into 5 groups of 50 patients in a double blinded prospective study. After tourniquet application on the forearm, the control group received 2 ml of normal saline as a pretreatment. The other 4 groups received lidocaine 10 mg (Lido10 group), lidocaine 20 mg (Lido20 group), lidocaine 30 mg (Lido30 group), or lidocaine 40 mg (Lido40 group) as a pretreatment in a 2 ml solution. The tourniquet was released after 20 seconds and rocuronium was injected over 10 seconds. The patients were then observed and asked if they had pain in, and responses were assessed. Local signs (i.e. erythema, venous sequelae) on the arm where the rocuronium had been injected were recorded immediately after the injection and 12 h later, after recovery from anesthesia. Results: 44 patients (88%) in the control group, 35 (70%) in the Lido10 group, 32 (64%) in the Lido20 group, 23 (46%) in the Lido30 group, and 16 (32%) in the Lido40 group reported pain. The medial pain score was 1.92 1.04 in the control group, 1.12 0.96 in the Lido10 group, 0.92 0.85 in the Lido20 group, 0.52 0.61 in the Lido30 group, and 0.34 0.48 in the Lido40 group. Moderate to severe pain was observed in 33 patients (66%) in the control group, 16 (32%) in the Lido10 group, 12 (24%) in the Lido20 group, 3 (6%) in the Lido30 group, and none (0%) in the Lido40 group. No local signs were observed. Conclusions: Pretreating with lidocaine at 10, 20, 30 or 40 mg reduced the incidence and severity of pain on injecting rocuronium, and the higher dose was more effective.

Background: Pretreatment or addition of lidocaine or ketamine have been reported to reduce pain on injection. However, the stability of propofol following the addition of lidocaine or ketamine is not yet known. Therefore, we checked compatibility and stability of propofol-lidocaine or propofol-ketamine mixtures. Methods: After mixing 9 ml of 1% propofol and 0, 5, 10, 15, or 20 mg of 2% lidocaine or 10, 20 mg of ketamine, the samples (0.9 ml) were divided into 10 glass vials and stored at room temperature. Macroscopic and microscopic changes, and propofol concentrations were measured at 0, 1/4, 1/2, 1, 2, 3, 4, 5, 6, and 24 hours after mixing. Premedicated 100 ASA classification Ⅰ or Ⅱ patients scheduled for elective surgery were randomly allocated into one of three groups(Group 1: propofol only, Group 2: propofol + lidociane 20 mg, Group 3: propofol + ketamine 10 mg). Intensity and frequency of injection pain was checked during induction (150 ml/hr). Intensity of injection pain was evaluated with a pain score (1: no pain, 2: mild, 3: moderate 4: severe). Results: Macroscopic and microscopic changes were only seen in propofol-lidocaine mixtures (more than 15 mg after 1 hour) in a time-dependent manner. In the mixtures with lidocaine 15 or 20 mg, the propofol concentration decreased linearly and significantly compared to the control (time 0) in a time-dependent manner from 1 hour to 24 hours. However, the propofol concentration was not changed in the propofol-ketamine mixtures. The pain score at 20 mg of lidocaine or 10 mg of ketamine were significantly lower than propofol only group and there was no difference in pain score between group 2 and group 3. Conclusions: Lidocaine (more than 15 mg), but not ketamine, added to 90 mg of propofol reduced the propofol concentration linearly in a time-dependent manner and showed microscopic changes from l hour after mixing. Therefore, this mixture seems to be inappropriate for long-standing storage and thus propofol-ketamine mixtures are more appropriate for this purpose.

Background: Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, is known to have analgesic properties in subanesthetic doses and has been used as an analgesic in the postoperative period by variable routes. The effect of adding ketamine to analgesia using intravenous PCA morphine was evaluated in 90 women after cesarean section. Methods: Ninety parturients were randomly allocated to three groups and each group had 30 women. The parturients in group 1 were given analgesics of morphine only, group 2 were given analgesics of the 2:1 mixture of morphine and ketamine, and group 3 were given analgesics of the 1:1 mixture of morphine and ketamine. We evaluated the analgesic requirement, numerical rating pain score, side effects and patient's satisfaction. Results: The morphine requirement in group 3 was significantly lower than that in groups 1 and 2 at 3, 6, 12, 24 and 48 hours postoperatively. The pain score in group 2 was lower than that in group 1 at 3 and 6 hours and the pain score in group 3 was lowest of all groups at 3 and 6 hours. The incidence of dizziness was higher in group 3 than in groups 1 or 2. Conclusions: We concluded that adding ketamine with morphine in using an intravenous PCA can decrease analgesic requirements and improve analgesic property. (Korean J Anesthesiol 2001; 40: 509∼ 514) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ