Acute and Critical Care

Randomized Controlled Trial

Post-thoracotomy Analgesia & ICU Length of Stay: Comparison of Thoracic Epidrual Morphine Infusion and Lumbar Epidural Plus Intravenous Morphine Infusion: Seok Hwa Yoon, Jung Hyun Lee, Hee Suk Yoon, Yoon Hee Kim, Myung Hoon Na, Seung Pyung Lim; Korean J Crit Care Med. 2007;22(2):77-82.

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Abstract PDF: BACKGROUND
Length of stay in ICU after thoracotomy is related to postoperative pulmonary function and complication which are affected by postoperative pain. For the post-thoracotomy pain control, epidural morphine is commonly used. Although total dose-requirement for analgesia of lumbar epidural morphine is more than the thoracic, lumbar epidural morphine could be substituted the thoracic. Our study compared the effect of patient controlled analgesia using thoracic epidural morphine (TEA group) and lumbar epidural analgesia with patient controlled intravenous analgesia using morphine (LEA+IV group).
METHODS
Sixty patients were randomly assigned into one of the two groups. The epidural taps were done before the induction. In all the patients morphine 0.2 mg/ml was administered via the epidural catheter at the end of surgery. In TEA group, basal infusion rate was 0.1 mg/hr and bolus dose was 0.02 mg. In LEA+IV group, basal infusion rate of epidural morphine was 0.1 mg/hr, patient controlled intravenous analgesia with morphine started when patients arrived at ICU, and basal infusion rate of intravenous morphine was 1.0 mg/hr and bolus dose was 0.8 mg. Pain score, side effect, postoperative length of stay in ICU and hospital were observed.
RESULTS
There were no significant differences between two groups in pain score, side effects, length of stay in ICU and hospital.
CONCLUSIONS
Lumbar epidural analgesia with patient controlled intravenous analgesia using morphine showed similar postoperative analgesia and length of stay in ICU and hospital compared to thoracic epidural analgesia with morphine, so that can substitute the thoracic epidural analgesia.

Original Article

The Effectiveness of Foot -Reflexo- Massage on the Postoperative Pain of Gastrectomy Patients: Houng Hwa Han, Young Ju Lee, Yun Jeong Chae, Jong Sin Eun, Hyun Ho Lee, Jee Won Park; Korean J Crit Care Med. 2005;20(2):136-143.

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Abstract PDF: BACKGROUND
The objects of this study were to determine the effects of foot reflexo massage on the postoperative pain of the subtotal gastrectomy patients according to quasi-experimental research design, and to provide demonstrative data for using the foot reflexo massage as an intervention for pain nursing. METHODS: The foot reflexo massages were performed on 34 subtotal gastrectomy patients after informed consent was obtained. They were divided into two groups, i.e. control group (n=17) and experimental group (n=17). After 6 hours and 12 hours from the subtotal gastrectomy, the massage was carried out on each foot for 10 minutes twice. Visual analogue scale (VAS) was employed as the measurement tools of pain, and the degree of postoperative pain was measured through frequency of prn (pro re nata) analgesia in chart review. RESULTS: The experimental group with foot reflexo massage 6 hours after the operation have significantly less score of postoperative pain than the control group (5.76+/-0.83, 4.35+/-1.0, p=.000). The experimental group with foot reflexo massage 12 hours after the operation have significantly less score of postoperative pain than the control group (5.12+/-0.53, 3.00+/-1.17, p=.000). The experimental group with foot reflexo massage have significantly less frequency of prn analgesics than the control group from six hours to twelve hours after the operation (p=.004). CONCLUSIONS: It is considered foot reflexo massage is effective for reducing postoperative pain of subtotal gastrectomy patients, as well as useful for an immediate nursing intervention.

Case Report

Labor Analgesia with Epidural Blockade in Parturient with Peripartum Cardiomyopathy: A Case Report: Tae Ha Ryu, Jae Hoon Jeong, Dong Gun Lim, Si Oh Kim; Korean J Crit Care Med. 2004;19(2):143-147.

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Abstract PDF: Peripartum cardiomyopathy (PPCM) is an unusual and uncommon causes of antepartum and postpartum heart failure, which may result in severe cardiac failure and death. PPCM is often unrecognized as symptoms of normal pregnancy commonly mimic those of mild heart failure but can rapidly progress to cardiac failure. We presented a case of elective labor induction in a patient with peripartum cardiomyopathy. A epidural analgesia technique was performed without difficulty for labor analgesia in parturient with peripartum cardiomyopathy. Her post-delivery course was uncomplicated but her baby has died due to respiratory failure. We suggest that vaginal delivery with careful incremental epidural alnalgesia in patient with PPCM is acceptable methods and close peripartum monitoring is essential in the management of PPCM.

Original Article

Effect of Continuous Epidural Block on the Duration of Intensive Care after Cardiac Surgery: Choon Soo Lee, Jung Uk Han, Tae Jung Kim, Chong Kweon Chung, Hyun Kyung Lim, Young Deog Cha, Hey Ran Shin; Korean J Crit Care Med. 2000;15(1):41-46.

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Abstract PDF: BACKGROUND
Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery.
METHODS
30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups.
RESULTS
Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1.
CONCLUSIONS
Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.

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