• The Korean Journal of Pain
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• 제1권1호
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• pp.74-79
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• 1988

Caudal narcotic analgesia was assesses after the injection of 3mg morphine diluted in 30ml (physiologic) saline into the sacral canal in 15 Patients after upper abdominal surgery, in 20 patients after lower abdominal surgery under general anesthesia, and in 20 patients after perianal surgery under caudal block. Pain relief was evaluated by the subsequent need for systemic analgesics. All eases had considerable relief from pain an4 the morphine was effective for 12 or more hours. There were no significant differances between pain relief of the upper abdominal and lower abdominal surgery group, upper abdominal and perianal surgery group, and lower abdominal and perianal surgery group (p>0.05, p>0.05, p>0.05). It is suggested that the morphine, which was administered into the sacral, cannal, reached the subarachnoid space and produced it's effect by direct action on the specific opiate receptors in the substantia gelatinosa of th.8 posterior horn cell of the spinal cord. Consequently, whether analgesia from epidural narcotics appears to be segmental in distribution or not is still in controversy.

• The Korean Journal of Pain
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• 제20권1호
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• pp.40-45
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• 2007

Background: Caudal block is useful when anesthesia for surgery or treatment for chronic pain is needed, but this procedure has a failure rate of up to 25% even when it performed byan experienced physician. This high failure rate is usually due to improper needle placement. Methods: After gaining approval of the ethics committee, 46 patients received caudal blocks under ultrasound guidance; these were performed after the anatomical structures in the sacral hiatus had been measured with ultrasound. All these procedures were performed by the same anesthesiologist. The position and direction of the needle were identified using fluoroscopy by injecting a radio-opaque contrast through the needle. The time taken from thelidocaine injection to verification of the needle was measured and the planned nerve block was then carried out. Results: All cases of needle insertion into the sacral canal under ultrasound guidance were successful. The average duration of the procedure and the trial count were $134.1{\pm}10.1seconds$ and $1.2{\pm}0.1$, respectively. In 12 of the 46 cases (26%), the needle deviated either left or right in the sacral canal, so the direction of the needle had to be adjusted. The distance between two cornua, the depth of the sacral hiatus and the thickness and length of the sacrococcygeal ligament were $17.1{\pm}0.4$, $3.9{\pm}0.3$, $2.3{\pm}0.1$ and $24.9{\pm}0.9mm$, respectively. Conclusions: Ultrasound guidance can increase the success rate of inserting a needle into the sacral canal. However, even when ultrasound is used, the needle can deviate either left or right in the sacral canal.

• The Korean Journal of Pain
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• 제12권2호
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• pp.217-220
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• 1999

Background: Transcutaneous Electrical Nerve Stimulation (TENS) has been widely used for pain relief after surgery instead of opioid analgesics therapy. This study was designed to study the effectiveness of TENS on perianal pain after anal surgery. Methods: Forty-eight patients who underwent anal surgery were evaluated in this suudy. Caudal anesthesia with 1.5% lidocaine 30 ml mixture 1：200,000 epinephrine was performed. TENS was done at 100 Hz for 25 min. duration, postoperatively at 4 hrs and 24 hrs. Pain was also measured at the 4 hrs and 24 hrs postoperatively by visual analogue scale (VAS). VAS value were compared before and after TENS application. Results: Values of VAS after TENS were significantly lower compared to those before TENS. Conclusions: From these results, we concluded, TENS may be effective for postoperative perianal pain relief after anal surgery.

• The Korean Journal of Pain
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• 제10권2호
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• pp.231-234
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• 1997

Background: The aim of this study was to examine the precise spreading pattern of contrast media in small increments in rabbits. Following pentobarbital anesthesia, the epidural puncture was done surgically with a blunt hook. Methods: The tip of epidural catheter was located at the mid-portion of T7 and T12, in the T7 group (n=7) and T12 group (n=8), respectively. Injection of the contrast media was started at 0.1 mL/kg and increased by 0.1 mL/kg up to a maximum of 0.6, mL/kg, under fluoroscopy. Results: In both groups, the extent of spread increased continuously as a Starling resistor with increasing injected volume(T7 group: $y=4.0+41.8x-28.1x^2$, T12 group: $y=0.2+57.7x-43.5x^2$) the total spread of contrast media was similar. The contrast media spread equally, both rostral and caudal, from catheter tip in T7 group; media spread approximately twice as far rostral as compared to caudal in T12 group (P<0.05). Conclusions: In rabbits, the position of epidural catheter tip should be positioned 2~3 segments below the aimed segment in lower thoracic or lumbar region, whereas in mid-thoracic region it should be positioned close to the level of aimed segment. Rabbits have relatively small epidural space therefore, the volume of injectant should be carefully determined with the suggested equations of this study.

• The Korean Journal of Pain
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• 제27권3호
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• pp.253-259
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• 2014

Background: Caudal block is a common technique in children for reducing postoperative pain, and there have been several reports on the variations of the sacral canal in children. However, previous studies have mainly focused on the needle trajectory for caudal block, and there is limited information on the structural variations of the sacrum in children. The purpose of this study was to analyze the anatomic variations of sacral canals in children. Methods: Three-dimensional computed tomographic images were analyzed. The data from the images included (1) fusion of the sacral vertebral laminae and the sacral intervertebral space (2) existence of the sacral cornua and (3) the types of sacral hiatus. The types of sacral hiatus were classified into 3 groups: group I (fusion of S3 or S4 vertebral laminae), group II (unfused vertebral arch with the distance of the S3 and S4 vertebral laminae < 50% of the distance between the cornua), and group III (unfused vertebral arch with the distance of the S3 or S4 vertebral laminae ${\geq}50%$ of the distance between the cornua). Results: A total of 143 children were included in this study. All of the sacral vertebral arches were not fused in 22 children (15.4%). Cornua were not identified bilaterally in 5 (3.5%) and unilaterally in 6 (4.2%) children. In the sacral hiatus, group II and group III were identified in 22 (15.4%) and 31 (21.7%) children, respectively. Conclusions: The sacral canal has various anatomical variations in children. Careful attention must be paid to identify the correct anatomic landmark.

• The Korean Journal of Pain
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• 제34권3호
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• pp.339-345
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• 2021

Background: Ultrasound-guided caudal epidural injection (CEI) is limited in that it cannot confirm drug distribution at the target site without fluoroscopy. We hypothesized that visualization of solution flow through the inter-laminar space of the lumbosacral spine using color Doppler ultrasound alone would allow for confirmation of drug distribution. Therefore, we aimed to prospectively evaluate the usefulness of this method by comparing the color Doppler image in the paramedian sagittal oblique view of the lumbosacral spine (LS-PSOV) with the distribution of the contrast medium observed during fluoroscopy. Methods: Sixty-five patients received a 10-mL CEI of solution containing contrast medium under ultrasound guidance. During injection, flow was observed in the LSPSOV using color Doppler ultrasonography, following which it was confirmed using fluoroscopy. The presence of contrast image at L5-S1 on fluoroscopy was defined as "successful CEI." We then calculated prediction accuracy for successful CEI using color Doppler ultrasonography in the LS-PSOV. We also investigated the correlation between the distribution levels measured via color Doppler and fluoroscopy. Results: Prediction accuracy with color Doppler ultrasonography was 96.9%. The sensitivity, specificity, positive predictive value, and negative predictive value were 96.7%, 100%, 100%, and 60.0%, respectively. In 52 of 65 patients (80%), the highest level at which contrast image was observed was the same for both color Doppler ultrasonography and fluoroscopy. Conclusions: Our findings demonstrate that color Doppler ultrasonography in the LS-PSOV is a new method for determining whether a drug solution reaches the lumbosacral region (i.e., the main target level) without the need for fluoroscopy.

• The Korean Journal of Pain
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• 제11권2호
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• pp.314-316
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• 1998

Psoas compartment block has been used to provide anesthesia and analgesia of hip joint. This block is advocated for relief of pain of various origins in the thigh, leg and lumbar area. A-40-year-old women complained of pain in the left thigh and lumbar area after operation of the second lumbar vertebral compression fracture. To relieve pain, caudal block was performed. This block reduced in lumbar pain but left thigh pain persisted. So, we were performed psoas compartment block using mepivacaine and dexamethasone, which relieved the pain in the left thigh and lumbar area. We recommend psoas compartment block as useful and simple method for patients with thigh and lumbar area pain, especially when the epidural block is not feasible.

• 한국임상수의학회지
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• 제23권2호
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• pp.129-132
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• 2006

The purpose of this paper was to compare the clinical efficacy of iopamidol and iopromide, iohexol nonionic contrast media in terms of their image quality in Beagle dogs with hepatic CT angiography and their application in veterinary clinics. With 9 Beagle dogs, contrast media of iopamidol (pamiray-$300^(R)$) and iopromide (ultravist-$300^(R)$, iohexol (omnipaque-$300^(R)$) were induced intravenously (600 mg I/kg, BW) and CT angiography was done under general anesthesia. CT scan included scout, pre-contrast and cine examinations. During CT angiography, peak HU (Hounsfield unit) and peak time were examined on each site (ROI; region of interest) of the aorta, caudal vena cava, potral vein and liver parenchyma. Any side effects were also examined. After experiments, it was found that there were no significant changes of HU and maximal enhancing time of each ROIs of aorta, caudal vena cava, portal vein and liver parenchyma between these contrast media. And any side effects were not noted. So it is concluded that iopamidol has similiar contrast enhancement like as iopromide and iohexol in hepatic angiography and and it is thought to be useful for evaluation of the abdominal organs by CT scan in veterinary clinics.

• The Korean Journal of Pain
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• 제29권4호
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• pp.255-261
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• 2016

Background: Thoracic epidural anesthesia is frequently used to maintain intraoperative and postoperative analgesia. Frequently, 3 ml of local anesthetic is used as a test dose, or for intermittent epidural injection. We assessed the extent of the spread of 3 ml of contrast medium in the thoracic epidural space and attempted to identify any correlating factors affecting the epidurography. Methods: A total of 70 patients were enrolled in the study, and thoracic epidural catheterizations were performed under fluoroscopic guidance. Using 3 ml of contrast medium, epidurography was evaluated to confirm the number of spinal segments covered by the contrast medium. Correlation analysis was performed between patient characteristics (sex, age, body mass index, weight, height, and location of catheter tip) and the extent of the contrast spread. Results: The mean number of vertebral segments evaluated by contrast medium was $7.9{\pm}2.2$ using 3 ml of contrast medium. The contrast spread in the cranial direction showed more extensive distribution than that in the caudal direction, with statistical significance (P < 0.01). Patient height demonstrated a negative correlation with the extent of distribution of contrast medium (r = -0.311, P < 0.05). Conclusions: Thoracic epidurography using 3 ml of contrast medium results in coverage of a mean of $7.9{\pm}2.2$ spinal segments, with more extensive cranial spread, and patient height showed a weak negative correlation with the distribution of contrast medium.

• Advances in pediatric surgery
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• 제15권1호
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• pp.44-51
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• 2009

This study is a retrospective analysis of 1244 cases of the inguinal hernia in children under the age of fifteen years who were operated at the department of pediatric surgery, Inje University Busan Paik Hospital from March, 1997 to February, 2007. The ratio of male to female was 3.6:1. The type of hernia was indirect in all of the cases. The hernia was on the right side in 656 cases (53.9 %), left side in 467 cases (37.5 %), and bilateral in 121 cases (9.7 %). The hernia presented most frequently in infants under age 12 months; 364 cases (29.2 %). Fifty-nine cases (21.7 %) were in female and 305 cases (31.3 %) in male. There were 428 cases (33.6 %) in 1-3 years age group, 295 cases (23.7 %) in 4-6 years, 112 cases (9.0 %) in 7-9 years, 39 cases (3.1 %) in 10-12 years and 16 (1.2 %) in 13-15 years. The content of hernia sac was small bowel (59 %), omentum (31 %) in males and the ovary and tube (54 %) and small bowel (26 %) in female. The incidence of combined operation at the time was 3.2 %, and consisting of orchiopexy (67.5 %), frenulotomy (12.5 %), appendectomy (10 %), circumcision (5 %), and fistulotomy (5%). The incidence of combined disease was 2.8 % and consisting of undescended testis, Hirschsprung's disease, idiopathic hypertrophic pyloric stenosis, imperforate anus, and congenital heart disease. After unilateral inguinal hernia repairs, contralateral hernias developed in 34 patients. The laterality of the primary site of hernias were left in 19 cases (55.8 %), and right 15 cases (44.1 %). The 936 cases (75.2 %) were operated under general anesthesia; Mask bagging 663 cases (53.2 %), endotrachea intubation 257 cases (20.6 %), and laryngeal mask 16 cases (1.2 %). The remainder 308 cases (24.7 %) were operated under regional caudal anesthesia.