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Background Aconitum sinomontanum Nakai (ASN) has been reported to have analgesic effects. In this study an animal model of pharmacopuncture using ASN (100–500 mg/kg) was examined. Methods Sprague-Dawley (SD) rats (n = 40) were randomly assigned to ASN-Low (1 mg/mL, 1.8 mL, ASN-L), ASN-Intermediate (5 mg/mL, 1.8 mL, ASN-M), ASN-High (10 mg/mL, 1.8 mL, ASN-H), negative control (0.2 mL normal saline), and positive control (0.2 mL 0.5% lidocaine) groups. All experiments were administered to the rats’ left hind leg. The analgesic response was assessed by monitoring the physical (hot plate, and von Frey test) and chemical (formalin) responses to pain. Results All ASN pharmacopuncture groups demonstrated significant differences in pain response to the hot plate test, von Frey test, and formalin test, compared to the control group (p < 0.05). The response of the ASN-M group and ASN-H groups to the hot plate, the formalin, and the von Frey tests were significantly different, compared to the lidocaine group (p < 0.05). Conclusion ASN pharmacopuncture had a significant analgesic effect on SD rats in response to physical and chemical models of pain.

Purpose: This study examined the frequency of early cessation of intravenous patient-controlled analgesia (IV-PCA) after orthopedic surgery, and the difference in frequency according to the surgical site and type to determine the factors affecting the early cessation of IVPCA. Materials and Methods: Based on the medical records of 2,915 patients using PCA after orthopedic surgery from October 2018 to February 2020, sex, age, smoking status, surgical site, operation name, anesthesia method, PCA usage time, satisfaction, side effects, early discontinuation and the reason of early discontinuation were assessed. Orthopedic surgery was classified into major surgery and minor surgery, and the surgical site was classified into the upper limb, lower limb, and spine. The reasons for discontinuation were side effects, patient rejection, and discharge. The factors affecting early discontinuation were identified by univariate analysis, and the degree of each factor affecting early discontinuation was confirmed by logistic regression analysis. Results: The early discontinuation rate of IV-PCA was 6% (upper limb: 8.3%, lower limb: 5.7%). Univariate analysis identified, age, surgical site, surgical classification, anesthesia method, PCA usage time, satisfaction, and side effects as factors affecting early discontinuation. Logistic regression analysis showed that early discontinuation of the upper limb surgery was higher than the lower extremity surgery (p=0.005, odds ratio [OR]=1.78). Moreover, that the early discontinuation of minority surgery was higher than that of major surgery (p=0.002, OR=2.029). The most common reason for early discontinuation in lower extremity surgery is the side effects (71.5%), whereas patient rejection was the major reason in upper limb surgery (41.7%). Conclusion: Early cessation of IV-PCA for postoperative pain control was more frequent in upper extremity surgery than lower extremity surgery. The rate of early discontinuation due to simple rejection or discharge of patients was higher in the upper extremity surgery than lower extremity surgery. Therefore, methods such as neuroaxial anesthesia should be considered for pain control after upper limb surgery rather than IV-PCA. [ABSTRACT FROM AUTHOR]

As the elderly population increases, the incidence of lumbar fusion is increasing, and there has been increasing interest in rapid rehabilitation and functional recovery after surgery. Enhanced recovery after surgery program and multimodal pain control methods can reduce the complications and allow rapid recovery. Various methods have been used to increase the fusion. [ABSTRACT FROM AUTHOR]

Hip fracture is one of the most common traumatic fractures in geriatric patients. With the increase in the geriatric population, physicians are more concerned about anesthetic management of these patients and a lot of articles have been published in relation to geriatric hip fracture. Due to age related comorbidities and physical status, perioperative management of these patients are complex and related to mortality and morbidity. Anesthesia and pain control for these patients are directly related to the postoperative outcome. This article summarizes the most recent opinions about perioperative management of geriatric hip fracture patients at the point of preoperative evaluation, anesthetic managements, and pain control. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is one of the most lethal malignancies. Despite the availability of newer and better antineoplastic combinations, the 5-year survival rate for all stages of pancreatic cancer remains only 6%. Palliative care represents an important aspect of care in patient with pancreatic cancer. Thus, optimal palliation of symptoms to maximize remaining quality of life is of primary importance to most patients. This review discusses highlights the most significant problems faced when caring for patients with advanced pancreatic cancer. Common problems include pain, pancreatic insufficiency, anorexia-cachexia and depression. To provide optimal and meaningful supportive care for patients with advanced pancreatic cancer is complex and requires ongoing close monitoring of the physical and emotional aspects of the patient. Prompt management of the many symptoms and problems associated with pancreatic cancer is essential to minimize distress and improve quality of life for patients with this fatal disease. Recognizing end-of-life concerns and patient preferences during the dying process helps clinicians find ways to alleviate suffering for patients and families. [ABSTRACT FROM AUTHOR]