• The Korean Journal of Pain
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• v.22 no.3
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• pp.245-248
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• 2009

Ossification of the yellow ligament (OYL) is a pathologic condition that causes spinal stenosis, which is a form of ectopic ossification. OYL causes compressive myelopathy and radiculopathy. Although the pathogenesis of OYL is still unclear, diffuse mechanical stresses and degenerative changes caused by extreme ranges of motion may be related to the development of OYL in young sportsmen. Here we report an interesting case of thoracic radiculopathy due to OYL in a 35-year-old male amateur judo player who was successfully treated with continuous thoracic patient controlled epidural analgesia and epidural adhesiolysis.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• The Korean Journal of Physiology
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• v.19 no.2
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• pp.227-232
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• 1985

Previously, we had reported that the electrical stimulation of peripheral nerve with stimlatory parameters of 20 V strength and 2 Hz frequency for 60 min resulted in reducing the pain reaction. The present study was performed to evaluate if the pain reaction was affected by the peripheral nerve stimulation with different stimulatory parameters in the decerebrated cat. The flexion reflex was used as an index of the pain reaction. The reflex was elicited by stimulating the sural nerve (stimulus strength of 20 $V\;\times\;0.5$msec) and recorded as a compound action potential from the motor nerve innervated to the posterior biceps femoris muscle. The common perneal nerve was selected as a peripheral nerve on which the electrical stimulation of various intensities and frequencies was applied. The results are summarized as follows : 1) The peripheral nerve stimulation with 100 mV strength, regardless of frequencies, did not affect the pain reaction induced by the sural nerve stimulation. 2) When the stimulus of 1V intensity and slow frequency (2 Hz) was applied to the peripheral nerve for 30 min or 60 min, the pain reaction was significantly reduced comparing to the control. However, this reduced pain reaction by the peripheral nerve stimulation was not reversed by the injection of naloxone (0.02 mg/kg) 3) High frequency stimulus (60 Hz) of 1V intensity for 30 or 60 min did not show any effects of affecting the pain reaction. These results suggest that the stimulus of relatively high intensity (at least 1V) and low frequency (2 Hz) is needed to elicite the analgesic effect by the peripheral nerve stimulation. By the 1V stimulus, $A\delta$ nerve fiber is activated. Therefore, an $A\delta$ or smaller nerve fibers must be activated for showing analgesia by the peripheral nerve stimulation. However, the mechanism of analgesia by the $A\delta$ nerve activation alone was not related to the endogeneous morphine system since the reduced pain reaction by the $A\delta$ fiber activation alone was not reversed by the treatment of naloxone.

• Women's Health Nursing
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• v.29 no.2
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• pp.137-145
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• 2023

Purpose: This non-randomized study was performed to evaluate the effects of music therapy on labor pain, the childbirth experience, and self-esteem in women during vaginal delivery. Methods: In total, 136 primiparous women over 37 weeks of gestation receiving epidural analgesia during vaginal delivery were recruited via convenience sampling. To minimize diffusion effects, data from the control group (n=71) were collected first (April 2020 to March 2021), followed by data from the music group (n=65; April 2021 to May 2022). Participants in the music group listened to classical music during labor, while the control group was offered usual care (no music). Labor pain was measured using a numeric rating scale (NRS), and self-esteem and childbirth experience were collected using self-report questionnaires. Data were analyzed using the independent t-test, chi-square test and Cronbach's α coefficients. Results: The overall pain level (NRS) at baseline was 0 in both groups. Mothers in the music therapy group had lower levels of latent pain (t=1.95, p=.005), active pain (t=3.69, p<.001) and transition-phase pain (t=7.07, p<.001) than the control group. A significant difference was observed between the two groups, and the music therapy group expressed more positive perceptions of the childbirth experience (t=-1.36, p=.018). For self-esteem, the experimental group's score was slightly higher, but without a statistically significant difference from the control group. Conclusion: Using music therapy during labor decreased labor pain and improved the childbirth experience. Music therapy can be clinically recommended as a non-pharmacological, safe, and easy method for nursing care in labor.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.11-15
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• 1997

Background : There are several treatment of trigeminal neuralgia including Gasserian Ganglion Block. This paper retrospectively analyze the efficacy of Gasserian Ganglion Block as main treatment of trigeminal neuralgia. Methods : We studied 55 patients for followings; sex, age, duration from onset to visit, consulted mediator, causes, characteristics of pain, affected area, types of block, kinds and volume of used neurolytic agents, duration from first block to repeat block, types of repeat block, complications, if surgery was necessary after block. Results : Characteristic items of trigeminal neuralgia are similar with other studies. Mean duration of pain relief was 23 months. The duration was shortened in the repeat block. There were no significant complication. Conclusion : Considering Gasserian Ganglion Block as main treatment of trigeminal neuralgia is an effective and safe method. Therefore we would like to recommend the need to increase public awareness of trigeminal neuralgia and its possible treatment in pain clinics through mass commanication.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.183-187
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• 1999

Background: The efficacy of nerve block on the progression of herpes zoster still remains controversy. The purpose of this study was to evaluate the efficacy of epidural blockade on the pain course of acute herpes zoster. Methods: Among 75 patients admitted with acute herpes zoster, 40 patients were treated with acyclovir and epidural block (epidural group), 35 patients were treated with acyclovir only (no block group). Follow up with patients was done for up to 3 months, either at the outpatient department or by telephone. The days required for pain relief were compared. We also investigated the factors associated with outcome. Results: Though statistically insignificant, patients in the epidural group tended to have faster pain relief. Patients with shorter symptom duration experienced significantly faster pain relief. But other factors such as sex, age, involved dermatome and other coexisting diseases (cancer, diabetes mellitus) were not associated with the outcome in this study. Conclusions: Though patients with epidural block leaded to have taster pair relief, more studies with larger patient population may be needed to confirm the efficacy of epidural block on herpes zoster.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.210-213
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• 2005

Acute viral meningitis and myositis are rare complications of varicella-zoster virus (VZV) reactivation. A 71-years-old immunocompetent man, who presented with lower back pain radiating to the left lower extremities, developed vesicles on the L5 dermatomal area. The next day, he had complained of aberrant vesicles on the trunk, face and scalp, with generalized myalgia, headache and dizziness. He was confirmed with VZV meningitis and myositis, as demonstrated by the presence of VZV DNA in the blood and cerebral spinal fluid using a polymerase chain reaction (PCR) amplification. PCR has been used in patients with a VZV infection associated neurological symptoms, and provides a useful tool for the early diagnosis of VZV-associated neurological disease. The patient was treated with bed rest, with intravenous acyclovir for the VZV infection, and intravenous Patient-controlled Analgesia for pain management and the prevention of postherpetic neuralgia. When he visited the outpatient department 3 months later, the skin lesion, leg pain, headache and myalgia had all improved, without sequelae. Here, this case is reported, with a discussion of the relevant literature on its diagnosis and management.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.299-301
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• 1998

Stellate ganglion block is frequently effective on the pain of head and upper extremities. However, if the degree and duration of pain relief does not increase with repeated blocks, we may consider the neurolytic procedure on the stellate ganglion. A patient sufferring from the pain in the region of ophthalmic branch of left trigeminal nerve and left eyeball region had been treated with stellate ganglion block. In spite of repeated blocks, the degree and duration of pain relief did not increase. We performed the radiofrequency thermocoagulation of stellate ganglion at the operation room under fluoroscopy. Patient got pain relief immediately after the procedure without any remarkable complication except a mild ptosis, which was shown before the procedure. We may give priority to radiofrequency thermocoagulation for stellate ganglion neurolysis due to its simplicity and safty.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.171-175
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• 2001

Background: This purpose of this study is to compare the analgesic efficacy, occurrence of motor block and other side effects of 48 hr continuous postoperative epidural infusions with 0.125% ropivacaine with fentanyl or 0.15% ropivacaine with fentanyl. Methods: Forty patients undergoing Cesarean section were randomly allocated into two groups. Both groups received epidural injection of 2.0% lidocaine 19 ml and 0.75% ropivacaine 2-5 ml with fentanyl $50{\mu}g$ for 20 minutes before surgery. Following surgery, a continuous epidural infusion using a two- day infusor was given for 40 minutes for post-operative pain control. Group 1 (n = 20) then received 0.125% ropivacaine and 6 ug/ml of fentanyl at a rate of 2 ml/h. Group 2 (n = 20) received 0.15% ropivacaine and 6 ug/ml of fentanyl at the same rate. Visual analog scales (VAS) for pain during rest and movement, sensory change and motor blockade were assessed for 48 hr after surgery. Results: There were no significant differences in VAS for pain during rest or movement. The incidence of side effects was similar in both groups. Conclusions: Using 0.125% ropivacaine with fentanyl via an epidural route provided similar pain relief and side effects as 0.15% ropivacaine with fentanyl.

• The Korean Journal of Pain
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• v.28 no.4
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• pp.280-283
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• 2015

Caudal epidural injection is a common intervention in patients with low back pain and sciatica. Even though the complications of fluoroscopically directed epidural injections are less frequent than in blind epidural injections, complications due to contrast media can occur. We report a case of anaphylactic shock immediately after injection of an intravenous nonionic contrast medium (iohexol) during the caudal epidural injection for low back pain and sciatica in a patient without a previous allergic history to ionic contrast media (ioxitalamate). Five minutes after the dye was injected, the patient began to experience dizziness, and the systolic blood pressure dropped to 60 mmHg. Subsequently, the patient exhibited a mild drowsy mental state. About 30 minutes after the subcutaneous injection of 0.2 mg epinephrine, the systolic blood pressure increased to 90 mmHg. The patient recovered without any sequela. Life-threatening complications after injection of intravenous contrast medium require immediate treatment.