• The Korean Journal of Pain
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• v.2 no.1
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• pp.85-88
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• 1989

We experienced 3 cases of continuous caudal block. The first case had suffered from severe pain of the external genitalis after urethral injury from a car accident and this was controlled by continuous caudal block. The other 2 cases were a metastaric malignant tumor of the lumbar vertebra from cancer of the cervix and histiocytoma of the breast, and both had suffered from intractable pain of the lower extremity. But lumbar epidural block was impossible because of radiation fibrosis and previous operation scar of the spine. So a continuous caudal block was performed and the pain was controlled effectively. The longest duration was 50 days and there were no problems related catheter indwelling. Pain in the area of the lumbar and sacral nerve distribution can be controlled by continuous caudal block. Here in we reported 3 cases and reviewed the literature.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.344-348
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• 1996

Continuous epidural block can be useful in the management of acute and chronic pain. For the most effective analgesia, it is important to localize the tip of epidural catheter and the spread of radiopaque dye. Epidural catheterization was performed in 12 patients on the sitting position. Catheters were advanced by 10 cm cephalad in the cervical epidural space by median approach and radiopaque dye 3 ml was injected through the catheters. The position of cervical epidural catheters and the spread of dye was confirmed by radiography. The course of epidural catheter were: coiled 3/12 (25%), loop 2/12 (16.7%), straight 2/12 (16.7%). In 8 cases, the tip of epidural catheters were located within one vertebral segment from the level of insertion site. Radiopaque dye spreaded average 3.68 vertebral segment to cranially and 1.67 vertebral segment to caudally from the insertion site.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.63-68
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• 1996

Background; Epidural analgesia for controlling labor pain has recently gained world-wide popularity. However, many patients scheduled for continuous epidural analgesia voice concern over harmful effects to their fetus and other possible complications such as hemodynamic changes, back pain and neurologic sequelae etc. The aim of this study was to evaluate the hemodynamic changes with and without epidural block as a measure to determine the safety of epidural analgesia during labor and delivery. Methods: Twenty healthy subjects were divided equally into two groups(Group 1 without epidural block, and Group 2 with epidural block) and serial hemodynamic measurements were taken in all subjects with transcutaneous impedence cardiography. The epidural catheter was inserted at the level of $L_{3,4}$ in Group 2 and analgesia was maintained using 0.25% bupivacaine mixed with fentanyl. Results: Cardiac output increased slightly with cervical dilatation in both groups, but no significant differences were found between the two groups. Similarly, no significant differences were found in blood pressures between the two groups. Stroke volume and end-diastolic volume indices were slightly decreased in group 1 and slightly increased in group 2. However, there were no significant differences between the two groups. The ejection fraction was nearly constant and ranging 56~59%. Conclusion: We concluded epidural analgesia for labor and delivery is a safe technique for the parturients since results indicated no significant differences in hemodynamic changes, as compared to the control group.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.298-303
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• 1995

We have inserted epidural catheter for single or continuous injection of a drug for epidural analgesia. It is important to localize the tip of epidural catheter in appropriate site to acquire the most effective analgesia. In epidural block, we observed course and location of the tip of epidural catheter. Subject: 70 patients were divided into group I(non-injection of saline group during catheter insertion) and group II(injection group during catheter insertion). Group I included cervical(n=20), thoracic(n=10), and lumbar(n=20) epidural group. Group II, cervical(n=10), and lumbar(n=10) epidural group. Method: 19G FlexTip $Plus^{TM}$ Epidural Catheter ($Arrow^{(R)}$) was inserted 10cm cephaladly in epidural space with(group II) or without(group I) saline flushing. We observed course and location of the tip of epidural catheter by C-arm image intensifier during injection of contrast media ($Omnipaque^{(R)}$). Result: In group I, the number of tips of epidural catheters located within 2 cm from inserted site were: cervical 14/20(70%), thoracic 2/10(20%). lumbar 16/20(80%). In thoracic epidural blocks, tips of epidural catheters were more cephaladly located than with cervical and lumbar epidural blocks. With cervical epidural blocks, the number of tips of epidural catheters located within 2 cm from insertion site were less in group II than group I (20% vs. 70%). But no significant differences were noted between group I and group II with lumbar epidural block(90% vs. 80%). The number of tips of epidural catheters located around a predicted site were: cervical 2/20(10%), thoracic 4/10(40%), lumbar 0/20(0%) in group I, and cervical 2/10(20%), lumbar 1/10(10%) in group II. Conclusion: It was impossible to predict the exact location of tips of epidural catheters by measuring the inserted length without epidurogram. With many cases, tips of epidural catheters were located around the insertion site in lumbar epidural blocks, and in some cases around the predicted site in thoracic epidural blocks. The results suggests that epidural block should be done at a point near the required band of analgesia.

• The Korean Journal of Pain
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• v.34 no.4
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• pp.509-533
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• 2021

Background: Postherpetic neuralgia (PHN) is a refractory complication of herpes zoster (HZ). To prevent PHN, various strategies have been aggressively adopted. However, the efficacy of these strategies remains controversial. Therefore, we aimed to estimate the relative efficacy of various strategies used in clinical practice for preventing PHN using a network meta-analysis (NMA). Methods: We performed a systematic and comprehensive search to identify all randomized controlled trials. The primary outcome was the incidence of PHN at 3 months after acute HZ. We performed both frequentist and Bayesian NMA and used the surface under the cumulative ranking curve (SUCRA) values to rank the interventions evaluated. Results: In total, 39 studies were included in the systematic review and NMA. According to the SUCRA value, the incidence of PHN was lower in the order of continuous epidural block with local anesthetics and steroids (EPI-LSE), antiviral agents with subcutaneous injection of local anesthetics and steroids (AV + sLS), antiviral agents with intracutaenous injection of local anesthetics and steroids (AV + iLS) at 3 months after acute HZ. EPI-LSE, AV + sLS and AV + iLS were also effective in preventing PHN at 1 month after acute HZ. And paravertebral block combined with antiviral and antiepileptic agents was effective in preventing PHN at 1, 3, and 6 months. Conclusions: The continuous epidural block with local anesthetics and steroid, antiviral agents with intracutaneous or subcutaneous injection of local anesthetics and a steroid, and paravertebral block combined with antiviral and antiepileptic agents are effective in preventing PHN.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.186-190
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• 1991

Causalgia is an extremely incapacitating disease often associated with a major peripheral nerve injury, which is characterized by sustained diffuse burning pain, allodynia and hyperpathia. The condition follows traumatic nerve lesions, often combined with vasomotor and sudomotor disturbances and later trophic changes. While sympathectomy has been the classical treatment of causalgia, others nonsurgical therapies such as regional sympathetic block, IV regional sympathetic block, oral adrenolytic drugs, transcutaneous electrical nerve simulation, physical theraphy, cryotheraphy and psychotheraphy have been used. Causalgia is rare in children and early treatment is controversial because of the possibility of many different complications following aggressive treatment. This is a report of a 6-year-old girl with causalgia suffered after a right posterior tibial nerve injury following an intragluteal injection of an antipyretics. We successfully treated this syndrome with continuous epidural block using 0.5% lidocaine and no specific complication was encountered.

• 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.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.1017-1022
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• 1996

Patients with fractured ribs necessarily suffer from severe chest ain, which prevents coughing, deep breathing and bronchial toilette, cause atelectasis and pulmonary shunting. Relief of chest pain is benecial to patients, providing consort and facilitating physiotherapy and effective expectoration. We compared the efficacy of pain relief be!ween continuous epidural analgesia and conventional intramlrscular analgesia in 20 patients with fractured ribs. Among 20 patients, epidural analgesia was done or 10 patients(experimental group) and the remainder ten received intramuscular analgesia(control group). The pain and ROM(range of motion) scores, vital sign, PaO2, forced vital capacity(FVC) and forced expiratory volume for 1 second(FEVI) were checked on immediate admission and 12, 24 hours, third, fifth, and seventh day after starting of continuous epidural block. The pain and ROM scores were decreased and the PaO2, FRC and FEVI were significantly increased in experimental group. The side effects of epidural analgesia were mild and reversible. With th se result, we can suggest that epidural analgesia is more effective for pain relief and restoration of pulmonary mechanics in patients with fractured ribs.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.225-230
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• 1997

Background: Authors modified the traditional continuous axillary brachial plexus block technique of Selander for purpose of increasing success rate and decreasing complications by use of commercial epidural anesthesia set. Method: Thirty-nine patients scheduled for upper extremity operations were injected with 40 ml of anesthetic solution by axillary perivascular technique, using 23~25G immobile needle at 2 cm from the pectoralis major. Tuohy needle was immediately introduced at 4 cm from the pectoralis major and pierced the expanded neurovascular sheath at an angle of 30 degree to the skin. The "pop" was well noted well. Needle was advanced 0.5 to 3.0 cm and epidural catheter introduced through the needle. After removal of needle, occlusive dressing was done. Tip of catheter and spread of solution were demonstrated by fluoroscopy with contrast dye after completion of procedure. Result: Catheter insertion was successful at first attempt for all case. Total length of insertion was from 6 to 13($10.0{\pm}1.7$) cm. Tip of catheter was placed in infraclavicular space(66.7%), about the humeral head(17.9%) and in upper arm in 3 cases as U-shape(7.9%). Catheters were maintained for $6.7{\pm}2.6$(3-12) days. There were no complications such as: perforation of major vessels, needle trauma to nerve, infection, bleeding or hematoma. Conclusion: This study demonstrated continuous axillary brachial plexus block with epidural anesthesia set is safe, easy and convenient modification of technique of Selander.

• The Korean Journal of Pain
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• v.30 no.1
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• pp.3-17
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• 2017

Background: Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods: This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results: Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions: Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.