Remifentanil hyperalgesia was induced by high dose of remifentanil-based anaesthesia during sevoflurane anaesthesia, whereas that was not apparent during propofol anaesthesia. Also, remifentanil hyperalgesia did not occur during low dose of remifentanil-based anaesthesia. Maintenance of propofol during high-dose remifentanil-based anaesthesia provided better postoperative analgesia.

BackgroundThe current study evaluated whether the level of preoperative anxiety assessed by the state-trait anxiety inventory (STAI) affects cardiovascular response during anesthetic induction. Furthermore, we evaluated the utility of the preoperative anxiety scale as a predictive factor for hemodynamic changes.MethodsOne hundred twenty patients who were scheduled to undergo elective surgery under general anesthesia were enrolled in this prospective study. The patients were asked to fill out STAI questionnaires the night before the day of surgery. For 5 minutes after tracheal intubation, changes in vital signs were recorded. The correlation between STAI scores and the percent changes in vital signs during the induction of anesthesia for each subgroup was assessed. In addition, the predictability of the 20% change in vital signs by STAI scores was analyzed using receiver operating characteristics curves.ResultsThe state anxiety scores of patients 45 years of age or older showed a significant correlation with percent changes in mean blood pressure and heart rate, whereas the state anxiety scores in other subgroups showed no significant correlation with changes in vital signs during the induction of anesthesia. Furthermore, the state anxiety scores in patients 45 years of age or older were shown to be useful in predicting a 20% change in vital signs during anesthetic induction.ConclusionsThe state anxiety scores of patients 45 years of age or above could be a useful tool for predicting changes in vital signs during anesthetic induction. Thus, physician should be mindful of preoperative anxiety.

As the treatment of chronic non-cancer pain gradually increases, clinicians have more opportunities to encounter opioid prescription. However, guidelines for prescribing opioids for chronic non-cancer pain have never been published in Korea. The present guidelines were prepared by reviewing various research data. In cases in which the data were insufficient, recommendations were presented following discussion among experts affiliated with the Opioids Research Group in the Korean Pain Society. The present guidelines may need to be continuously revised and amended as more clinical evidence is acquired.

The bolus dose of 0.2 % ropivacaine using US-guided CBPB would provide equivalent analgesic efficacy comparable with the basal infusion and motor weakness comparable with IV-PCA after arthroscopic rotator cuff repair.

BackgroundNefopam is a non-opioid non-steroidal centrally acting analgesic. This study was conducted to assess the analgesic efficacy of intravenous patient-controlled analgesia (IV-PCA) using nefopam alone, compared with a combination of morphine and ketorolac, after laparoscopic gynecologic surgery.MethodsSixty patients undergoing laparoscopic gynecologic surgery received IV-PCA. Group A (n = 30) received IV-PCA with a combination of morphine 60 mg and ketorolac 180 mg, while group B (n = 30) received nefopam 200 mg (basal rate 1 ml/h, bolus 1 ml, and lockout time 15 min for both). The primary outcome evaluated was analgesic efficacy using the visual analogue scale (VAS). Other evaluated outcomes included the incidence rate of postoperative nausea and vomiting (PONV), patient satisfaction of pain control, percentage of patients requiring additional opioids, and incidence rate of postoperative adverse effects.ResultsGroup B was not inferior to group A in relation to the VAS in the post-anesthesia care unit, and at 12, 24, and 48 h after surgery (mean difference [95% confidence interval], 0.50 [–0.43 to 1.43], -0.30 [-1.25 to 0.65], -0.05 [-0.65 to 0.55], and 0.10 [-0.55 to 0.75], respectively). The incidence rate of nausea was lower in group B than in group A at 12 and 24 h after surgery (P = 0.004 and P = 0.017, respectively). There were no significant differences in the other outcomes between groups.ConclusionsIV-PCA using nefopam alone has a non-inferior analgesic efficacy and produces a lower incidence of PONV in comparison with IV-PCA using a combination of morphine and ketorolac after laparoscopic gynecologic surgery.