• Journal of Korean Neurosurgical Society
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• 제56권6호
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• pp.521-526
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• 2014

The authors report a case of symptomatic epidural gas accumulation 2 weeks after the multi-level lumbar surgery, causing postoperative recurrent radiculopathy. The accumulation of epidural gas compressing the dural sac and nerve root was demonstrated by CT and MRI at the distant two levels, L3-4 and L5-S1, where vacuum in disc space was observed preoperatively and both laminectomy and discectomy had been done. However, postoperative air was not identified at L4-5 level where only laminectomy had been done in same surgical field, which suggested the relationship between postoperative epidural gas and the manipulation of disc structure. Conservative treatment and needle aspiration was performed, but not effective to relieve patient's symptoms. The patient underwent revision surgery to remove the gaseous cyst. Her leg pain was improved after the second operation.

• Journal of Korean Neurosurgical Society
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• 제54권1호
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• pp.65-67
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• 2013

Pneumorrhachis, which involves the entrapment of air or gas within the spinal canal, is a rare clinical entity, and the pathogenesis and etiologies of this uncommon entity are various and can present a diagnostic challenge. Usually, pneumorrhachis represents an asymptomatic epiphenomenon but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of symptomatic epidural pneumorrhachis accompanying pneumothorax. Possible pathogenic mechanisms are discussed and a review of the literature is included.

• The Korean Journal of Pain
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• 제12권1호
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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.

• Journal of Chest Surgery
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• 제26권10호
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• pp.781-786
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• 1993

Effrctive analgesia after elective thoracotomy can be provided by continuous extrapleural intercostal nerve block.This study was designed to prove the effectiveness of continuous extrapleural intercostal nerve block. Twenty patients undergoing elective thoracotomy were randomized into two groups. Group I received lumbar epidural block[N=10] and group II received continuous extrapleural intercostal nerve block[N=10]. Postoperative pain relief was assessed on Numeric Rating Scale[NRS] and recovery of pulmonary function was assessed by coparison of preoperatrive and postoperative FVC[Forced Vital Capacity], FEV1[Forced expiratory Volume in 1 second], VC[Vital Capacity]. Arterial blood gas analysis[ABGA], vital signs and amount of additive analgesics were compared also. No significant difference was observed between the groups concerning these parameters mentioned above. Systemic complications, such as urinary retention[2/10] and weakness of lower extremity[2/10], occurred in group I but no complication occurred in group II. We conclude that continuous extrapleural intercostal nerve block is as effective as epidural block in pain relief and restoration of pulmonary mechanics with fewer comlications. Also because of it`s ease and safetiness, this must be considered as a substitute of epidural block in routine use for thoracotomy pain relief.

• 대한수의학회지
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• 제47권1호
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• pp.103-115
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• 2007

The aim of this study was to compare the reaction of the cardiovascular system, and the anesthetic effect among 3 experimental groups, epidural administration of medetomidine as a single agent, the combination of buprenorphine and medetomidine, and the combination of fentanyl and medetomidine. Twenty one dogs were anesthetized with isoflurane and allowed to breathe spontaneously. Epidural, arterial, and venous catheters were inserted. The tip of epidural catheter was positioned at the level of the space between the sixth and seventh lumbar vertebra. After a stable plane of anesthesia was achieved, these dogs were each administered one of the following treatments epidurally : medetomidine $10{\mu}g/kg$ (Group M), a combination of medetomidine $5{\mu}g/kg$ and buprenorphine $10{\mu}g/kg$ (Group M/B), and a combination of medetomidine $5{\mu}g/kg$ and fentanyl $10{\mu}g/kg$ (Group M/F). Heart rate (HR), Respiratory rate (RR), End-tidal carbon dioxide (EtCO2), and arterial blood pressure were measured before drug administration (base line) and 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min postinjection. Blood gas analysis was performed before injection and 5, 15, 25, 35, 45, 60 min postinjection. Isoflurane was discontinued 80 min postinjection and pain/motor function were evaluated up to 260 min postinjection every 15 min. At the early stage of drug introduction (until 5 min), the HR was decreased significantly in all 3 groups compared with base line. In Group M, HR was significantly decreased compared with the other 2 groups. With time (starting 20 min after drug introduction), the HR was decreased significantly in Group M/B in respect to base line. However, no significant difference was seen number-wise in all 3 groups. During 60 min after drug introduction, the systolic, diastolic and mean arterial pressures were highest in Group M and lowest in Group M/F. Among 3 groups, drug action and motor loss duration were longest in Group M/F. Analgesic effect observed in the M/F group was the most prominent and long-lasting, compared to those seen in the other 2 groups. Given the fact that the recovery of motor function takes place in a short period of time after analgesic effects disappeared, additional use of M/F depending on the patient's condition would be a good way to achieve effective pain management. However, proper care should be taken to ensure the function of cardiovascular system in the patient because the administration of M/F under isoflurane anesthesia results in a significant decline in arterial blood pressure ($65{\pm}10mmHg$).