Masui. The Japanese journal of anesthesiology
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Treatment of intractable chronic pain employs, nerve block, peripheral nerve stimulation, phototherapy, and drug therapy such as opioid and analgesia adjuvant. We also employ multi disciplinary approach with internal medicine, psychiatry and other related fields. In addition, in a portion of intractable chronic back pain, the pain relief is obtained by interventional approaches such as adhesionlysis and the neuroplasty with epiduroscopy as well as spinal cord stimulation therapy.
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Randomized Controlled Trial Comparative Study
[Effects of propofol or sevoflurane on cerebral regional oxygen saturation (rSO2) during one-lung ventilation].
The present study was designed to evaluate the alteration of cerebral regional oxygen saturation (rSO2) associated with propofol or sevoflurane during one-lung ventilation (OLV). ⋯ We conclude OLV leads to the decrease of rSO2, but there is no difference in the alteration of rSO2 between propofol and sevoflurane group. To maintain adequate rSO2, we should consider together in combination with respiratory, circulatory or metabolic index and depth of anesthesia.
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Patient controlled epidural analgesia (PCEA) is a useful method in alleviation of postoperative pain; however, PCEA sometimes provided inadequate pain relief in the elderly. Therefore, we investigated optimal doses of fentanyl by PCEA in management of postoperative pain after gynecological surgery in the elderly. ⋯ We found that fentanyl 0.172 microg x kg(-1) x 1 hr(-1) by PCEA was the most appropriate dose for alleviation of postoperative pain after gynecological surgery in the elderly.
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Review
[Indication and usage of opioids except morphine for chronic non-malignant intractable pain].
Indication and usage of opioids except morphine for chronic non-malignant intractable pain were reviewed. In Japan, other than morphine, we can use only two opioids, codeine phosphate (codeine), and dihydrocodeine phosphate (dihydrocodeine) for non-malignant pain management according to medical insurance system. But in western countries sustained-release opioids such as MS contine, transdermal fentanyl, oxycontin were used for the management of non-malignant chronic pain. ⋯ Dihydrocodeine has twice analgesic efficacy compared to codeine. The initial dose is the same as codeine. We hope that sustained release opioids such as transdermal fentanyl, oxycontin, tramadol etc will be used in Japan for management of non-malignant chronic pain in the near future.