• The Korean Journal of Pain
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• v.14 no.1
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• pp.61-67
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• 2001

Background: Usually, lumbar epidural block is performed on the $L_{3-4}$ interspace. This study was designed to evaluate the analgesic efficacy and shortening of labor duration comparing the $L_{1-2}$ and $L_{3-4}$ interspace epidural blocks in nulliparous normal vaginal deliveries and then investigates side effects following the blocks. Methods: Eighty healthy nulliparous women were divided into two groups, $L_{1-2}$ (n = 40) and $L_{3-4}$ (n = 40). Epidural blocks, lumbar epidural block were performed at the $L_{1-2}$ and $L_{3-4}$ interspace with a catheter advancing 3 cm cephalad. The initial dose of 12 ml (0.167% bupivacaine, fentanyl $50{\mu}g$ and clonidine $75{\mu}g$) was injected epidurally at 4 cm dilatation of cervix and severe pain of labor. If a visual analogue scale (VAS) score was more than 4 points, an additional dose was administered epidurally using the same volume as the above mentioned, but with the exception that the bupivacaine was diluted to 0.1 percentage. The maternal blood pressure, pulse rate, respiration rate and fetal heart rate were measured at 10 min intervals for the first 30 min, at 15 min interval for the next 30 min and at 30 min interval for the last one hour following the blocks. The duration of the first (active) and second stages of labor was counted and the neonatal Apgar score was recorded at one and five min after delivery. The degree of motor block, pruritus, nausea and vomiting were also noted. Results: The patients in group $L_{1-2}$ had lower pain scores than group $L_{3-4}$ at 5, 20, 30, 60 mins. The duration of 1st and 2nd labor stage in the $L_{3-4}$ epidural block were $272{\pm}33.5$ min, $49.2{\pm}27.4$ min respectively but those in the $L_{1-2}$ epidural block were $253.5{\pm}32.5$ min, $37.3{\pm}22.3$ min, respectively. Conclusions: We concluded the analgesic efficacy and shortening of labor duration in $L_{1-2}$ epidural block was better than those in $L_{3-4}$ epidural block. Maternal hemodynamic change, motor block. pruritus, nausea, vomiting and Apgar score showed no significant differences between the two groups.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.54-59
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• 2007

Background: Selective transforaminal epidural block (STEB) has showen effectiveness as a diagnostic and therapeutic option for the management of patients with low back pain or sciatica. This study was carried out in order to determine the short-term effects and prognostic factors associated with STEB in patients with low back pain or sciatica. Methods: Ninety-seven patients were selectedfor participation in this study. Their diagnosis were based werewason the clinical symptoms and MRI findings. We performed STEB under fluoroscopic guidance and injected 3 ml of radio opaque dye in order to confirm the technical success of the procedure. We then injected 20 mg of triamcinolone mixed into 3 ml of 0.5% mepivacaine. One month later, we classified the patient outcomes as excellent, good, moderate or poor, according to the degree of reduction in VAS score from baseline. The independent variables assessed included symptom duration, block level, number of blocks, primary diagnosis, prior caudal block, anterior epidural space filling of dye, medication history, demographic data, radiating pain, back surgery and spondylolisthesis. Results: At a mean follow-up period of 1 month after STEB, excellent results were noted in the patients diagnosed with herniated lumbar disc (70%), non-specific spondylosis (54%), spinal stenosis (44%), and failed back syndrome (28%). The patients with epidural adhesion and combined spondylolisthesis were associated with poorer outcomes. Combined caudal block, symptom duration and the extent of epidural spread of the drug were not related to the effectiveness of the treatment. Conclusions: Selective transforaminal epidural block is effective in treating patients with radiculopathy, such as herniated lumbar disc, but it isrelatively ineffective in treating patients with structural deformities, such as failed back syndrome and spondylolisthesis.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.260-263
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• 1996

High spinal block is a rare complication during epidural block, but it may result in serious events. 56-year-old man with gall stones was scheduled for cholecystectomy under general anesthesia. After operation, lumbar epidural catheterization was done at $T_{8-9}$ interspace for postoperative pain control. At the recovery room, initial bolus drug (0.1% bupivacaine 10 ml containing fentanyl $100{\mu}g$) was administered via epidural catheter and observed carefully. 15 minutes later, hypotension and bradycardia ouccurred. Hartman' solution was administered rapidly and ephedrine 5 mg was injected. 30 minutes after drug administration, loss of consciousness and respiratory arrest developed. Tracheal intubation was done immediately. Cardiovascular and respiratory functions were monitored continuously. The location of intrathecal catheter was confirmed by cerebrospinal fluid (CSF) seen in syringe after aspiration of catheter. The patient recovered gradually and was placed in the ward 4 hours after drug administration, without any problems. He was discharged 1 week later in good health.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.8
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• pp.317-323
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• 2017

This study was conducted to investigate the differences in magnetic resonance imaging (MRI) findings after lumbar epidural nerve block using the transforaminal approach and the interlaminar approach in patients with low back pain. This study was an observational analysis study of abnormal findings of MRI after epidural nerve block. This study included 78 patients who underwent MRI at approximately 24 h after lumbar epidural nerve block at a pain clinic of a university hospital between January 2007 and December 2016. Among patients who received epidural nerve block, 36 used the interlaminar approach and 42 used the transforaminal approach. The incidence of patients with abnormal changes in MRI findings was higher among patients using the interlaminar approach (53%) than those using the transforaminal approach (7%). Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes, with epidural air being the most frequent abnormal finding (72%). We recommend use of the transforaminal approach to reduce the possibility of misreading or difficulty in interpretation of images of patients who underwent MRI at approximately 24 h after lumbar epidural nerve block. Practitioners should consider the possibility of abnormal findings such as epidural air on MRI in cases of epidural nerve block using the interlaminar approach.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.43-47
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• 1999

Backgroud: Systemic administration of opioid can prolong the duration of epidural anesthesia. The authors examined the effect of nitrous oxide ($N_2O$) on the level of sensory block induced by epidural lidocaine. Methods: Twenty minutes after epidural injection of 2% lidocaine (below 70 years : 20 ml, 70 years and above : 15 ml), the level of sensory block was assessed (2nd stage). Patients were randomly assigned to receive either medical air (control group, n=15) or 50% $N_2O$ in oxygen ($N_2O$ group, n=15) for 10 minutes, the level of block was reassessed (3rd stage). Pateints were given room air (control group) or 100% oxygen for 5 minutes and room air for 5 minutes ($N_2O$ group), and the level of block was reassessed (4th stage). Results: At the 3rd stage, $N_2O$ group showed 4.3 cm cephalad increase in the level of sensory block (p=0.005), but control group revealed 1.43 cm regression. After discontinuation of gas, the level of block regressed in both group (p=0.000). At the 4th stage, $N_2O$ group revealed 3.5 cm cephalad increase (p=0.048) and control group 1.97 cm regression (p=0.001) as compared with the 2nd stage. Conclusions: The level of sensory block induced by epidural lidocaine was significantly increased cephalad by concommitant use of 50% $N_2O$ for 10 minutes.

• The Korean Journal of Pain
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• v.34 no.3
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• pp.271-287
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• 2021

Background: Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions. Methods: We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Conclusions: Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

• The Korean Journal of Pain
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• v.11 no.1
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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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• v.9 no.1
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• pp.279-282
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• 1996

A 45-year-old male received cervical continuous epidural block for posterior neck pain radiating to right upper extremity secondary to cervical herniated nucleus pulposus. Three days after epidural catheterization, fever, radicular pain and weakness of both upper extremities were developed. On admission, his temperature was $38.3^{\circ}C$ and showed progressive weakness and numbness in both upper and lower extremities. Cervical epidural abscess was suspected; MRI showed an epidural abscess from C4 to C7 level. Within 24 hours of admission, surgical decompression and drainage was effected. Culture of pus obtained at the lesion yielded Staphylococcus aureus. He was treated with intravenous antibiotics for 7 weeks resulting marked improvement of neurologic signs and symptoms.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.21-26
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• 1999

Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of central nervous system (CNS) and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative low dose epidural bupivacaine and morphine could affect postoperative pain, changes plasma cortisol, and serum glucose. Methods: Thirty patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. General anesthesia was induced in all patients and after that, epidural blocks were done except the control group (n=10) patients. Preoperative block group (n=10) received 0.5% bupivacaine 50 mg and morphine 2 mg epidurally as a bolus before operation and followed by 0.1% bupivacaine $5\;mghr^{-1}$ and morphine $0.2\;mghr^{-1}$ for 10 hours. Postoperative block group (n=10) received the same doses of bupivacaine and morphine under the same method postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative pain by visual analogue scores (VAS), analgesic requirement (first requirement time, total amounts used), side effects, plasma cortisol level and serum glucose level were compared. Results: Until postoperative 6 hrs, VAS of control group was higher than those of the epidural groups. No difference was observed in VAS between the two epidural groups. First analgesics requirement time and total amounts of used analgesics were not different between the two epidural groups, but first analgesic requirement time of preoperative block group was significantly prolonged compared with control group. Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Low dose preoperative epidural bupivacaine and morphine could not reduce postoperative pain, plasma cortisol level and serum glucose level compared with postoperative block group.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.176-180
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• 2005

Background: Epidural steroid injections benefit certain patients with radicular pain, and often have only a limited duration. We compared the efficacy of hyaluronidase and triamcinolone and triamcinolone alone in patients with lumbar herniated disc disease treated with transforaminal epidural block. Methods: Forty patients who had undergone a transforaminal epidural injection were retrospectively reviewed. The T group received triamcinolone and local anesthetics; whereas, the HT group received hyaluronidase, triamcinolone and local anesthetics. We evaluated the improvement as being good, moderate, mild or no improvement, and in those where the improvement was good or moderate, also evaluated the duration of pain relief. Data were collected from the medical records of patients or via phone calls, which were analyzed using Student t- and chi-squared tests. A value of P < 0.05 was considered significant. Results: There were no significant differences in the degree of pain improvement or duration of pain relief between the two groups. Conclusions: A hyaluronidase and triamcinolone injection during transforaminal epidural block has on benefit with respect to the degree of pain improvement or its duration compared to a triamcinolone only injection.