• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.210-221
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• 2020

Spinal block procedures are useful methods that reduce the need for surgical treatment. In addition to their therapeutic aspects of pain relief, in many patients, they are also used for diagnostic purposes to distinguish from symptoms originating from extra-spinal areas. Therefore, these procedures are the most basic technique for orthopedic surgeons dealing with diseases from limbs and spine. On the other hand, despite the simplicity of the instruments and drugs used, the overall understanding of them and the lack of knowledge of the possible side effects and complications can cause serious harm to the patient at the beginning of the trial. Therefore, it is necessary to understand the types of drugs used in the spinal block procedures, pharmacokinetic properties, and the side effects of each drug. In addition, efforts should be made to identify their indications, as well as advantages and disadvantages of each procedure to avoid possible complications. The purpose of this review was to provide basic knowledge and skills necessary for lumbar spinal block procedures as well as provide the reader with the ability to perform themselves.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.2
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• pp.74-78
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• 2010

Since the extent of use of musculoskeletal ultrasound in orthopaedic surgery is expanding, popliteal block(sciatic nerve block) and femoral nerve block(saphenous nerve block) are easily and safely performed without complications such as nerve injury or incomplete block. Also, due to the expanding use of ultrasound, orthopaedic surgery of not only foot but also ankle and lower leg could be done without general anesthesia or spinal anesthesia. We describe a detailed technique for ultrasound-guided femorosciatic nerve block based on the experience over 120 cases.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.113-119
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• 2014

Purpose: This study was to evaluate effect and efficiency of S1 selective nerve root block using ultrasonography-guided compared with fluoroscopy-guided for lumbar disc herniation or spinal stenosis patients. Materials and Methods: Between February 2012 and December 2013, 38 patients who were with lower leg radiating pain for more than 1months and underwent S1 selective spinal nerve root block in our institution, were reviewed. They divided into two groups: Group A included 18 patients with ultrasonography-guided and Group B included 20 patients with fluoroscopy-guided. Treatment effectiveness was assessed using a visual analogue scale (VAS) and the Korea Modified Oswestry Disability Index (K-MODI). They were evaluated its preoperatively, postoperatively and 1 month later. We were recorded whole procedure time. Results: VAS was improved from 7.4 to 4.7 at 1 month in group A and from 7.39 to 4.36 at 1month in group B. K-MODI was improved from 72.8 to 43.3 at 1month in group A and from 73.8 to 44.1 at 1month in group B. Whole procedure time were $477.53{\pm}115.02s$, $492.47{\pm}144.38s$ in group A, group B, respectively. But there was no significant difference in VAS and K-MODI between two groups. Conclusion: Ultrasonography-guided sacral nerve root block is effective and accurate method in sacral radiating pain.

• Journal of radiological science and technology
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• v.45 no.2
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• pp.171-177
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• 2022

The purpose of this study was to investigate the effect of the characteristics of patients who underwent spinal nerve block on the fear of injection and the risk of radiation. Subjects were 137 patients (67 males, 70 females) who visited the Department of Anesthesiology and Pain Medicine in Cheongju. The method was conducted as a research study using a total of 28 questionnaires consisting of patient characteristics, experience characteristics of nerve block surgery, nerve block fear scale, and radiation risk perception scale. The reliability of the questionnaire response was secured with a Cronbach's alpha coefficient of 0.6 or higher. For statistical analysis, correlation was tested by descriptive statistics, frequency analysis, independent sample T-test, and Pearson and Spearman correlation coefficients by measurement scale and factor. As a result, the fear scale of nerve block was significantly higher in women than in men (p<0.05). The fear scale of nerve block injection was significantly higher in the first-visit patients than in the second-visited patients (p<0.05). However, there was no significant difference among all variables in radiation risk perception. In conclusion, patients undergoing spinal nerve block were more aware of the fear of injection than the risk of radiation exposure during the procedure.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.120-126
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• 2019

Purpose: The efficacy of periarticular multimodal drug injection and adductor canal block after a medial opening-wedge high tibial osteotomy was compared in terms of the postoperative pain level. Materials and Methods: From November 2016 to March 2017, 60 patients underwent a medial opening-wedge high tibial osteotomy under spinal anesthesia. Preemptive analgesic medication, intravenous patient controlled anesthesia were used for pain control in all patients. Thirty patients received a periarticular multimodal drug injection (group I), and 30 patients received an adductor canal block (group II). These two groups were compared regarding the postoperative pain level, frequency of additional tramadol injections, total amount of patient-controlled analgesia, and number of times that the patients pushed the patient-controlled analgesia button at each time interval. Results: The visual analogue scale scores over the two-week postoperative period showed no statistical significance. The frequency of additional tramadol hydrochloride injections was similar in the two groups over time. The mean number of times that patients pushed the patient-controlled analgesia button was similar in two groups over time. The total amount of patient-controlled analgesia was similar in the two groups over time. Conclusion: This study shows that intraoperative periarticular multimodal drug injections and adductor canal block may have a similar effect on postoperative pain control in patients who have undergone a medial opening-wedge high tibial osteotomy for unicompartmental osteoarthritis of the knee.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.185-195
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• 2018

Study Design: Literature review. Objective: Ultrasound-guided injections are a common clinical treatment for lower lumbosacral pain that are usually performed before surgical treatment if conservative treatment fails. The aim of this article was to review ultrasound-guided injections in the lumbar and sacral spine. Summary of Literature Review: Ultrasound-guided injections, unlike conventional interventions using computed tomography or C-arm fluoroscopy, can be performed under simultaneous observation of muscles, ligaments, vessels, and nerves. Additionally, they have no radiation exposure and do not require a large space for the installation of equipment, so they are increasingly selected as an alternative method. Materials and Methods: We searched for and reviewed studies related to the use of ultrasound-guided injections in the lumbar and sacral spine. Results: In order to perform accurate ultrasound-guided injections, it is necessary to understand the patient's posture during the intervention, the relevant anatomy, and normal and abnormal ultrasonographic findings. Facet joint intra-articular injections, medial branch block, epidural block, selective nerve root block, and sacroiliac joint injections can be effectively performed under ultrasound guidance. Conclusions: Ultrasound-guided injections in the lumbar and sacral spine are an efficient method for treating lumbosacral pain.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.272-277
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• 2001

Objective : Polymethylmethacrylate(PMMA) is often used to reconstruct the spine after total corpectomy, but the exothermic curing of liquid PMMA poses a risk of thermal injury to the spinal cord. The purposes of this study are to analyze the heat blocking effect of pre-polymerized PMMA sheet in the corpectomy model and to establish the minimal thickness of PMMA sheet to protect the spinal cord from the thermal injury during PMMA cementation of vertebral body. Materials & Methods : An experimental fixture was fabricated with dimensions similar to those of a T12 corpectomy defect. Sixty milliliters of liquid PMMA were poured into the fixture, and temperature recordings were obtained at the center of the curing PMMA mass and on the undersurface(representing the spinal cord surface) of a prepolymerized PMMA sheet of variable thickness(group 1 : 0mm, group 2 : 5mm, or group 3 : 8mm). Six replicates were tested for each barrier thickness group. Results : Consistent temperatures($106.8{\pm}3.9^{\circ}C$) at center of the curing PMMA mass in eighteen experiments confirmed the reproducibility of the experimental fixture. Peak temperatures on the spinal cord surface were $47.3^{\circ}C$ in group 2, and $43.3^{\circ}C$ in group 3, compared with $60.0^{\circ}C$ in group 1(p<0.00005). So pre-polymerized PMMA provided statistically significant protection from heat transfer. The difference of peak temperature between theoretical and experimental value was less than 1%, while the predicted time was within 35% of experimental values. The data from the theoretical model indicate that a 10mm barrier of PMMA should protect the spinal cord from temperatures greater than $39^{\circ}C$(the threshold for thermal injury in the spinal cord). Conclusion : These results suggest that pre-polymerized PMMA sheet of 10mm thickness may protect the spinal cord from the thermal injury during PMMA reconstruction of vertebral body.

• Journal of Korea Entertainment Industry Association
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• v.13 no.4
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• pp.311-320
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• 2019

Discogenic pain which develops during the degenerative process of intervertebral disc is an intractable disease of musculoskeletal system. Unlike other diseases in modern medical science, it is not clinically confirmed through objective imaging and clinicopathologic index. Moreover, current technology has been facing difficulties finding fundamental treatment. This study examined through reviewing literature whether the therapeutic rationales of interventional procedures for the discogenic pain, such as nerve block, intradiscal electrothermal therapy and nucleoplasty, are valid and whether safety reviews such as preclinical tests are carried out faithfully during the technology development process. As a result, it is presumed that there is not yet an interventional treatment for discogenic pain, whose therapeutic rationale has been objectively verified. And there are some cases of interventional treatment that have not been adequately equipped with the preclinical test steps necessary to review the safety of the procedure during the technology development process. In conclusion, since there is still no interventional treatment for discogenic pain which has clear therapeutic rationale, it is necessary to recognize that a more careful approach is needed to judge whether the procedure is performed in clinical settings. And medical ethical issues may arise for some interventional treatment that are deemed to have been carried out without a thorough review of safety.

• Korean Journal of Acupuncture
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• v.32 no.3
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• pp.99-107
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• 2015

Objectives : This study was designed to obtain basic data for a further large-scale trial as evaluating the efficacy and safety of Geochangmanryeung-dan(GMD) and acupuncture on patient with spinal stenosis treated by epidural steroid injection. Methods: The study is a randomized controlled pilot clinical trial, conducted over 8 weeks. Twenty participants will be recruited and randomly allocated to 2 groups: an experimental(GMD and acupuncture with epidural steroid injection) group and a control(only epidural steroid injection) group. The epidural steroid injection will be administered once per 2 weeks for 6 weeks(3 times in total). GMD will be administered as a dose of 5 pills, 3 times per day, for 6 weeks. Acupuncture will be performed 2 times per week for 6 weeks(12 times in total). The primary outcome will be measured by visual analogue scale and self-rated walking distance. The secondary outcome will be measured by PainVision, short-form McGill Pain Questionnaire, and Oswestry Disability Index. Both primary and secondary outcomes will be measured at baseline, 2, 4, 6, and 8 weeks. The last assessment(at 8 weeks) will be performed 2 weeks after treatment cessation. Conclusions : This clinical trial, as the pilot study for a future large-scale trial, will provide clinical information for evaluating the efficacy and safety of GMD and acupuncture treatment in combination with epidural steroid injection for the treatment of spinal stenosis.