Background: Butorphanol, a synthetic partial agonist-antagonist narcotic, produces adequate analgesia for postoperative pain. This study was designed to determine the appropriate dosage of butorphanol when administered with ketorolac by intravenous patient controlled analgesia (IV-PCA) after subtotal gastrectomy.Methods: Ninety ASA physical status I or II patients undergoing subtotal gastrectomy were randomly allocated into one of three groups according to type of drug used (n = 30 for each group). The patients were divided into group B6 (butorphanol 6 mg), group B10 (butorphanol 10 mg) and group B14 (butorphanol 14 mg). Drugs for each group were mixed with 300 mg of ketorolac and normal saline (total amount: 100 ml) for infusion. Bolus dose, maintenance dose and lockout interval were 0.5 ml per each press, 1 ml/hr and 15 minutes, respectively. In each group, numerical rating scale (NRS) score, sedation score and incidence of side effect were checked.Results: There were no significant differences in analgesic effects and sedation score among three groups but the NRS score of group B14 is lower than that of group B6 (P ＜ 0.05) 3 hrs after the recovery room.Conclusions: We recommend 6 mg butorphanol, mixed with 300 mg of ketorolac, and normal saline for postoperative pain relief using IV-PCA.

Ganglion impar block is a known useful method of controlling perineal cancer pain. Moreover, this method may be suitable for hyperhidrosis because the visceral cancer pain signal and sweating are transmitted by the same sympathetic chain. We experienced a patients who had suffered from systemic hyperhidrosis especially in the sacral and buttock area. She also had long-standing diabetes mellitus and chronic renal failure. Her excessive sweating occurred during hemodialysis. We treated this patients using a ganglion impar block and achieved a good result.