• The Korean Journal of Pain
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• 제10권2호
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• pp.281-284
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• 1997

Continuous epidural blockade is a widely accepted, useful technique for providing anesthesia and analgesia. But there have been several anecdotal reports of complications such as: abnormal position, knotting, shearing of the catheter, etc. We experienced a case of shearing of the end of an epidural catheter which was difficult to remove from epidural space of a 39-year-old patient. Ultrasonogram proved to be very effective to confirm the presence and position of the retained catheter. We surgically removed the retained catheter as it could potentially lead to infection of the epidural space. We advocate the ultrasonogram as an effective procedure to confirm and locate retained epidural catheter.

• Journal of Chest Surgery
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• 제44권2호
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• pp.178-182
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• 2011

Background: We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method. Materials and Methods: From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation. Results: The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation. Conclusion: Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

• The Korean Journal of Pain
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• 제29권3호
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• pp.189-192
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• 2016

Thoracotomy is a surgical technique used to reach the thoracic cavity. Management of pain due to thoracotomy is important in order to protect the operative respiratory reserves and decrease complications. For thoracotomy pain, blocks (such as thoracic epidural, paravertebral, etc.) and pleural catheterization and intravenous drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDs], and opioids, etc., can be used. We performed a serratus anterior plane (SAP) block followed by catheterization for thoracotomy pain. We used 20 ml 0.25% bupivacaine for analgesia in a patient who underwent wedge resection for a lung malignancy. We provided analgesia for a period of close to seven hours for the patient, whose postoperative VAS (visual analog scale) scores were recorded. We believe that an SAP block is effective and efficient for the management of pain after thoracotomy.

• The Korean Journal of Pain
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• 제4권2호
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• pp.122-126
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• 1991

Continuous epidural analgesia with intermittent morphine injection is a good technique for the management of intractabie cancer pain. Since epidural tunnelling was introduced for the first time to our institution in 1988, it has been widely used for the cancer pain management. Recently epidural tunnelling was introduced for the keeping an inserted catheter for a long period of time. Twenty-five patients with terminal cancer had been used an epidural tunnelling at the pain clinic of Dongsan Medical Center during the period of 3 months in 1991. Among the 25 patients, 14 were male and 11 were female, and most of them were at the ages of 6th decade. The causes of pain were from stomach cancer in 12, CBD cancer in 3, hepatoma in 2, pancreatic cancer in 2, uterine cervical cancer in 2, and miscellaneous cancer in 4 cases respectively. The outcome of treatment were excellent results in 14(56%), good in 9(36%), and moderate in 2.patients(8%). Accordingly satisfactory pain relief was achieved in 92% of the patients. It is suggested that this long-term management of intractable cancer pain by epidural bupivacaine and morphine with epidural tunnelling is satisfactory and reliable.

• The Korean Journal of Pain
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• 제13권2호
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• pp.255-258
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• 2000

Epidural morphine is effective in the treatment of postoperative pain, but side effects, such as nausea, vomiting, pruritus and urinary retention commonly occur. Droperidol is frequently used as an antiemetic to prevent intraoperative and postoperative vomiting. But it has been reported to cause acute extrapyramidal effects including dystonia. We report one case of acute dystonia in young adult following the use of epidural droperidol.

• The Korean Journal of Pain
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• 제14권2호
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• pp.207-210
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• 2001

Backgroud: Caudal blocks have been used for pain management in outpatient clinics. It is important to estimate the proper depth and angle in order to increase the success rate of the procedure. Methods: Data was collected from 60 patients who visited our pain clinic. We measured the depth of the needle's penetration and the angle of the needle at the insertion point when a caudal approach was confirmed by air flow method. We recorded age, sex, body weight and height, and calculated the ponderal index. Results: The depth from the skin to the caudal epidural space was a mean 2-4 cm ($3{\pm}0.4\;cm$). The angle at the needle insertion point was a mean 15-50 degree ($34.9{\pm}6.8$ degree). Conclusions: If we use the mean depth and angle as a guide, complications during the caudal epidural procedure can be avoided.

• The Korean Journal of Pain
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• 제8권2호
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• pp.378-382
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• 1995

Continuous epidural blockade has been used widely for providing anesthesia and analgesia. But many kinds of unusual complications have been reported such as: kinking, knotting, shearing, abnormal positions of catheter, etc. We experienced a case of malposition of the catheter which pass out the epidural space through the intervertebral foramen in a 33-year-old cancer patient. We confirmed it by epidurogram.

• The Korean Journal of Pain
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• 제8권2호
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• pp.386-389
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• 1995

Combined infusion of local anesthetics and opioids has been a common method for providing postoperative analgesia. Complications that can occur with this method include pruritus, nausea and vomiting, urinary retention, hypotension, and both early and late respiratory depression. Late respiratory depression is a rare but feared complication to epidural opioid therapy. We experienced a case of respiratory arrest during epidural infusion of bupivacaine and morphine.

• The Korean Journal of Pain
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• 제11권1호
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• pp.105-108
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• 1998

Backgrounds: Cervical epidural nerve block is useful in the management of a variety of acute, chronic and cancer related pain syndromes involving the head, face, neck and upper extrimity. To safely perfom the cervical epidural block, an appreciation of the expected distance from skin to epidural space is important. We studied the distance from skin to cervical epidural space of adults to determine if any relationship exists between patient height, weight and neck circumference and the distance from skin to epidural space. Methods: Patients 170, suffering from neck and upper extremity pain with cervical HIVD(herniated intervertebral dics) were selected. Cervical epidural block was performed at $C_{6\sim7}$ or $C_{7-}T_1$ intervertebral space. Then measured the distance from skin to epidural space and analysed the relationship between age, height, weight and neck circumference and the distance from skin to epidural space. Results: The cervical epidural depth of male $C_{6\sim7}$, male $C_{7-}T_1$, female $C_{6\sim7}$ and female $C_{7-}T_1$ groups were $5.17{\pm}0.63$, $5.47{\pm}0.59$, $4.84{\pm}0.56$ and $5.01{\pm}0.60$ cm respectively. Cervical epidural depth significantly correlated with body weight, ponderal index and neck circumference. Conclusions: The distance from skin to cervical epidural space has significant relationships with weight, ponderal index and neck circumference. Although experience is important, patient's weight and neck circumference are indicating factor, of the cervical epidural depth.

• The Korean Journal of Pain
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• 제10권2호
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• pp.214-219
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• 1997

Background: Epidural neural blockade with local anesthetics combined with steroids has been in clinical trials for patients with low back pain. But pain treatment of low back pain remains somewhat problematic. Many patients with low back pain have epidural fibrosis and adhesions proved with magnetic resonance imaging(MRI) examination. These findings might play an important role in the origin of back pain. Present study was aims to investigate the effect of epidural adhesiolysis in patients with low back pain. Methods: We investigated 76 patients suspected with epidural fibrosis and adhesion was suspected. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. 17G needle specially designed by Racz was inserted at sacral hiatus and catheter was inserted untill its tip was located at lesion site under fluoroscopic guidance. Injection of contrast dye was achieved and prospected spread of agents. Injection of 0.25% bupivacaine, triamcinolone, and 10% hypertonic saline via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) post-epidural adhesiolysis 3 days, 1 week, and 3 months. We also looked for complication of epidural adhesiolysis. Results: Statistical analysis(Friedman nonparametric repeated measures test and Dune's multiple comparison test) demonstrated NRS was significantly less during 3 months after epidural adhesiolysis(P<0.05). Especially, there is a extremely significance in post-epidural adhesiolysis 3 days (P<0.001). Only four patients reported any complications the most common symptom among three persistent headache but disappeared after a few months without residual sequelae. Conclusion: We conclude epidural adhesiolysis is a safe and effective method of pain therapy for low back pain with proven lumbo-sacral fibrosis and adhesion. A direct visualization by epiduroscopy may be more useful to the resulting functional changes after epidural adhesiolysis.