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"Postoperative pain"

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"Postoperative pain"

Original article

[English]
Effect of ultrasound-guided bilateral rectus sheath block on postoperative pain control after robotic single-site gynecologic surgery: a randomized study
Sunyoung Moon, Sooyoung Cho, Youn Jin Kim, Seunghee Yoo, Jong Wha Lee, Hye-Won Oh, Eunbi Cho
Received May 18, 2026  Accepted June 10, 2026  Published online June 22, 2026  
DOI: https://doi.org/10.12771/emj.2026.01396    [Epub ahead of print]
Purpose
Rectus sheath block (RSB) is a simple abdominal wall block that can be readily applied. This study evaluated the postoperative analgesic efficacy of ultrasound-guided bilateral RSB in robotic single-site gynecologic surgery.
Methods
Sixty patients were randomly assigned to the RSB group (n=30) or the control group (n=30). After induction of general anesthesia, patients in the RSB group received ultrasound-guided bilateral RSB with 30 mL of 0.25% ropivacaine. Pain intensity was assessed using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, and 48 hours postoperatively. Intravenous patient-controlled analgesia was provided to all patients, and fentanyl was administered as rescue analgesia on request.
Results
VNRS scores at 0, 1, and 6 hours were significantly lower in the RSB group than in the control group (all P<0.05). Rescue fentanyl use in the post-anesthesia care unit was also significantly lower in the RSB group than in the control group (19.8±21.0 µg vs. 46.3±27.6 µg, P<0.001). Subgroup analysis showed that RSB was associated with lower VNRS scores in patients undergoing ovarian surgery or myomectomy, whereas no significant difference was observed in patients undergoing hysterectomy.
Conclusion
Ultrasound-guided bilateral RSB reduced early postoperative pain and rescue analgesic requirements after robotic single-site gynecologic surgery.
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Review article

[English]
Two paths, one goal–uniting regional and general anesthesia for optimal surgical care: a narrative review
Min Kyoung Kim, Oh Haeng Lee, Hyun Kang
Ewha Med J 2025;48(4):e61.   Published online September 16, 2025
DOI: https://doi.org/10.12771/emj.2025.00724
The integration of regional anesthesia (RA) with general anesthesia (GA) has become a central component of multimodal strategies to improve perioperative pain management. This approach not only enhances analgesic efficacy but also reduces opioid requirements and mitigates opioid-related adverse effects. By targeting peripheral or neuraxial nociceptive pathways, RA attenuates the surgical stress response and decreases central sensitization, complementing the systemic actions of GA. The combined application of RA and GA has shown substantial benefits across a wide range of surgical procedures, including abdominal, thoracic, orthopedic, and pediatric operations. Reported advantages include improved hemodynamic stability, enhanced pulmonary function, earlier ambulation, faster gastrointestinal recovery, and greater patient satisfaction. Moreover, recent evidence indicates a positive association between effective postoperative pain control and long-term outcomes, such as reduced incidence of persistent postsurgical pain, better functional independence, and even improved immune function and survival following cancer surgery. The development of sustained-release local anesthetic delivery systems, which provide localized and prolonged analgesia, further extends the benefits of RA-GA integration into the postoperative period. This review summarizes the mechanistic rationale, clinical applications, and future directions of RA-GA combinations in modern surgical care, with special emphasis on their role in enhanced recovery after surgery protocols.

Citations

Citations to this article as recorded by  
  • Results and Future Perspectives of the Sustainable Anesthesia Project: A Large-Scale, Real-World Implementation Study at the Largest Spanish Private Healthcare Provider
    Juan Acha-Ganderias, María del Pino Henríquez-de Armas, Luis Enrique Muñoz-Alameda, Ion Cristóbal, Cristina Caramés, Leticia Moral-Iglesias
    Healthcare.2026; 14(3): 300.     CrossRef
  • Effect of transcutaneous electrical nerve stimulation on patients after coronary artery bypass grafting: a systematic review and meta-analysis
    Enyu Zhang, Jihe Kang, Yan Liu, Lulu Wang, Bo Wan, Xiaoling Li
    Frontiers in Cardiovascular Medicine.2026;[Epub]     CrossRef
  • From repair to reconstruction: a holistic perspective in abdominal wall hernia surgery
    Xin-liang Hou, Ting Zeng, Xu Wang, Li-ye Tan
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • Future directions in anesthesia: expanding the role of anesthetic drugs in sedation, analgesia, and recovery
    Min Kyoung Kim, Hyun Kang
    Journal of the Korean Medical Association.2026; 69(4): 294.     CrossRef
  • Letter to the Editor re “Opioid Prescribing Patterns and the Effect of Chronic Kidney Disease in Pediatric Urology Population: A Retrospective Cohort Analysis”
    Yashkumar Kiranbhai Rajvi, Mohit Kumar, Shubham Singh
    Journal of Pediatric Urology.2026; : 105964.     CrossRef
  • 4,264 View
  • 63 Download
  • 4 Web of Science
  • 5 Crossref
Original Article
[English]
The Effects of Intraarticular Morphine, Bupivacaine with or withour Epinephrine after Knee Arthroscopy
Rack Kyung Chung, Jong In Han, Jong Hak Kim, Chi Hyo Kim, Guei Yong Lee, Choon Hi Lee, Yeon Jin Cho
Ihwa Ŭidae chi 1996;19(2):249-255.   Published online July 24, 2015
DOI: https://doi.org/10.12771/emj.1996.19.2.249
Objectives

There are controversies about the analgesic effects of intraaarticular morphine and local anethetics bupivacaine. This study sought to compare the effects of saline with mor-phine, bupivacaine with or without epinephrine, administrated intraarticularly upon pos-toperative pan following arthroscopic knee surgery under general anesthesia.

Methods

In a double-blined, randommized manner, 40 patients received one of saline(20ml, n=10), morphine(1mg in 20ml NaCl, n=10), bupivacaine(0.25%, 20ml, n=10), bu-pivacaine with epinephrine(0.25%, 20ml, 200ug of epinephrine, n=10) intaarticularly at the completion of surgery. The pain scores by VAS were determined after 1,2,3,4 and 24 hours after intraarticular administration.

Results

There were no significant statistical differences between four groups in the pain score. The maximal pain scores were 37.5 in control group, 48.0 in morphine group, 33.6 in bupivacaine group postoperative 1 hour and 32.9 in bupivacaine with epinephrine group pos-toperative 2 hours. The pain scores were decreased as the time went by and were minimin as 21.4 in control group, 17.6 in morphine group, 11.2 in bupivacaine group and 12.3 in bu-pivacaine with epinephrine group 24 hour postoperatively.

Conclusion

Though there were no significant statistical significances with those doses, there were tendencies that the bupivacaine group with or without epinephrine had the postoperative analgesic effect rather than control group, and morphine group had a slow onset of analgesic ef-fect. So, we should study to decide the dose or volume of the drugs and appropriate time to evaluate for the anagesic effects after knee arthroscopy further.

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