• The Korean Journal of Pain
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• v.12 no.2
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• pp.268-271
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• 1999

Intrathecal phenol-glycerin block is a potent tool in stepwise approach to intractable perineal pain. At outpatient clinic, intrathecal phenol-glycerin block have been frequently used to control the cancer pain, as this procedure does not require special equipment. However, undesirable effects may occur with any given intrathecal injection. Although most side effects do not last long, they deserve well to prevent. Recently, we have been controlled the perineal and perianal cancer pain with intrathecal phenol-glycerin block without any specific complications. However, one patient we managed experienced that one patient, with this procedure for chronic non-malignant perineal pain control experience gait disturbance and one-week of voiding and defication difficulties. This research reports these practices, including the review of literature.

• The Korean Journal of Pain
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• v.30 no.2
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• pp.134-141
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• 2017

Background: Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery. Methods: Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels. Results: Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group. Conclusions: Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability.

• The Korean Journal of Pain
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• v.3 no.2
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• pp.172-176
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• 1990

In Incheon Severance Hospital, a secondary delivery hospital, anesthesiologists have treated cancer pain in the operation room when referred from other department. Intrathecal neurolytic block is a valuable means of producing high quality pain relief in any hospital. It is simple to carry out, requires brief hospitalization, can be used in elderly or severely ill patients, can be repeated with the block wears off and its duration is sufficient for the terminal cancer patients. We reviewed the clinical charateristics of the intrathecal alcohol and phenol-glycerine used in two cases of cancer with pain.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.188-191
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• 1988

Recent studies have shown that narcotic drugs produce an intense prolonged analgesic action when injected into the subarachnoidal or extradural space of animals and man. In order to study the effects of intrathecal injection of morphine on postoperative pain relief and segmental block effect, we administered 0.25 mg of morphine sulfate (0.25 mg of morphine/1 ml normal saline) into lumbar subarachnoid space prior to brahial plexus block for upper extremity surgery group The results were as follows: 1) more than 20 hours analgesic effect at least 2) no segemental block effect in analgesia 3) some adverse effect (Nausea, Vomiting, Pruritus, Urinary retention).

• The Korean Journal of Pain
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• v.30 no.3
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• pp.207-213
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• 2017

Background: Surgeon satisfaction and patient analgesia during the procedure of laparoscopic surgery are important issues. The aim of this work was to study if an intrathecal (IT) Bupivacaine combined with Magnesium sulfate may or may not provide good surgeon satisfaction in addition to improvement of intraoperative and postoperative analgesia. Methods: Sixty female patients were enrolled in this prospective, randomized, double-blind controlled clinical trial study. All patients were operated for gynecological laparoscopic surgery under spinal anesthesia. Patients were divided into two groups (Bupivacaine and Magnesium). Group Bupivacaine (30 patients) received intrathecal Bupivacaine 0.5% only (15 mg), while 30 patients in group Magnesium received intrathecal Bupivacaine (15 mg) in addition to intrathecal Magnesium sulfate (50 mg). The sensory block level, the intensity of motor block, the surgeon satisfaction, the intraoperative visual analog scale (VAS) for pain assessment, the postoperative VAS, and side effects were recorded during the intraoperative period and within the first 24 hours after surgery in the post-anesthesia care unit. Results: Surgeon satisfaction, intraoperative shoulder pain, postoperative pain after 2 h, and perioperative analgesic consumption (ketorolac) were significant better in group Magnesium than in group Bupivacaine. (P < 0.05). The onset of motor and sensory blocks was significant longer in group Magnesium than the other one. The incidence of PONV, pruritus and urinary retention was insignificant statistically between both groups. Conclusions: Magnesium sulfate if used intrathecally as an adjuvant to Bupivacaine would provide a better surgeon satisfaction and would improve the analgesic effect of spinal anesthesia used for gynecological laparoscopic surgery.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.47-52
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• 1988

Since 1979 forty-three cancer patients have been given intrathecal block at the pain clinic of Yonsei Medical Center. The male patients numbered 23 and female 20 and most of them were in the 4th and 5th decades of age. In 78.6% of the patients, the diagnosis was rectal cancer in 20 cases, cervix cancer in 7 cases, bladder cancer in 4 cases and colon cancer in 3 cases. Thirty six patients with cancer pain were treated by intrathecal 10% phenol-glycerine block and rest of them had only test block. Fourteen patients whose pain sites were lumbar or lumbar and upper sacral dermatomes were put into the lateral recumbent position on the fluoroscopic table. The spinal puncture was performed as close to the spinal roots to be impregnated as possible. In 22 patients the pain sites were covered by the sacral dermatomes and so the L5-S1 interspace was punctured in the sitting position shifted 15 degree to the affected site. Fifty one blocks were performed and their results are classified into three categories: good, fair antral poor. We achieved good results in 38 patients(77.1%), fair in 6 patients(17.1%) and poor in 2 patient(5.7%). Thus a satisfactory pain relief was achieved in 94.2% of patients. After intrathecal block with phenol glycerine, transient voiding difficulty was noted in 7, defecation difficulty in 1, and transient paresthesia and/or muscle weakness was present in 3 patients. The mean duration of pain relief was 2.5 months and longer than the mean survival time of 2.25 months. When patients are selected carefully and tile block is performed with great caution and good technique, the risk is minimal and a long lasting relief of intractable cancer pain achieves a painless life until death.

• The Korean Journal of Pain
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• v.27 no.3
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• pp.239-245
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• 2014

Background: Neuropathic pain induced by spinal or peripheral nerve injury is very resistant to common pain killers, nerve block, and other pain management approaches. Recently, several studies using stem cells suggested a new way to control the neuropatic pain. In this study, we used the spinal nerve L5 ligation (SNL) model to investigate whether intrathecal rat mesenchymal stem cells (rMSCs) were able to decrease pain behavior, as well as the relationship between rMSCs and reactive oxygen species (ROS). Methods: Neuropathic pain of the left hind paw was induced by unilateral SNL in Sprague-Dawley rats (n = 10 in each group). Mechanical sensitivity was assessed using Von Frey filaments at 3, 7, 10, 12, 14, 17, and 24 days post-ligation. rMSCs ($10{\mu}l$, $1{\times}10^5$) or phosphate buffer saline (PBS, $10{\mu}l$) was injected intrathecally at 7 days post-ligation. Dihydroethidium (DHE), an oxidative fluorescent dye, was used to detect ROS at 24 days post-ligation. Results: Tight ligation of the L5 spinal nerve induced allodynia in the left hind paw after 3 days post-ligation. ROS expression was increased significantly (P < 0.05) in spinal dorsal horn of L5. Intrathecal rMSCs significantly (P < 0.01) alleviated the allodynia at 10 days after intrathecal injection (17 days post-ligation). Intrathecal rMSCs administration significantly (P < 0.05) reduced ROS expression in the spinal dorsal horn. Conclusions: These results suggest that rMSCs may modulate neuropathic pain generation through ROS expression after spinal nerve ligation.

• 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.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.59-63
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• 1999

Background: Contraction of anal sphincter muscle produces severe pain in perianal surgery postoperatively. Recent reports have indicated that effective and prolonged pain relief can be obtained by the injection of small doses of morphine into the subarachnoid space. We attempted to use this technique for perianal surgery and investigated postoperative pain control and its side effects. Methods: Forty five patients scheduled for hemorrhoidectomy and anal fistulectomy were studied to determine the minimal effective dose of intrathecal morphine for postoperative analgesia. In order to control the pain, 7 mg of 0.5% hyperbaric bupivacaine with 0.05 mg (group I), 0.1 mg (group II) and 0.15 mg (group III) of morphine hydrochloride was injected with a 25 gauge spinal needle into the subarachnoid space. We estimated the duration of analgesia until the pain score attained to above 3 in 10 cm VAS (visual analogue scale) and incidence of itching, nausea and vomiting by percentage, headache, backpain and respiratory depression by positive and negative. We also checked the time of self-voiding. Results: The mean time of analgesia was $10.3{\pm}1.54$, $19.7{\pm}2.22$ and $20.3{\pm}2.29$ hours in group I, II and III respectively. Urinary retention of group I, II and III after block persisted for an average of $20.3{\pm}2.31$, $21.2{\pm}2.51$ and $23.3{\pm}3.74$ hours. Nausea and vomiting were observed 33%, 53%, 67% and itching was observed 53%, 67%, 80% in group I, II and III respectively and respiratory depression did not occur in all groups. Conclusions: It is not necessary to use more than 0.1mg of intrathecal morphine in perianal surgery because analgesia is not prolonged and side effects are increased.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.357-362
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• 1995

Percutaneous/intrathecal chemical neurolysis of sacral nerve with 12% phenol was performed on 13 cases of hyperreflexic bladder to augment bladder capacity and to reduce bladder pressure. Urodynamic evaluations were done before and after chemical neurolysis. Mean bladder capacity increased significantly after chemical neurolysis (from 171.4 ml to 375 ml). No significant changes in bowel or injection sites were noted. The result suggests that the chemolysis of sacral nerve was available modality for hyperreflexic bladder patients, who did not respond to anticholinergic medication, before decide the more aggressive alternatives such as augmentation cystoplasty or urinary diversion.