• The Korean Journal of Pain
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• 제25권3호
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• pp.168-172
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• 2012

Background: The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB). Methods: Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block. Results: The average NRS was decreased from $4.8{\pm}0.6$ to $0.6{\pm}0.5$ after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of $15.1{\pm}2.2$ ($11-19^{\circ}$) and a caudal angle of $15.4{\pm}1.7^{\circ}$ ($12-18^{\circ}$). The average distance from the skin to the scapular notch was $5.8{\pm}0.6$ cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block. Conclusions: SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

• The Korean Journal of Pain
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• 제18권2호
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• pp.218-221
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• 2005

This report describes a case of dizziness in a patient with trigeminal neuralgia that was caused by a vestibular schwannoma. A 60-year-old man with a history of pain on his left cheek, chin, molar and tongue for 5 months was diagnosed as suffering with trigeminal neuralgia of the left mandibular nerve, and this was caused by a left vestibular schwannoma. The diagnosis of the tumor was confirmed with magnetic resonance imaging (MRI), and so gamma knife surgery was performed 1 month later. At that time, the patient had been referred to the pain clinic due to allodynia on the tongue and gingival, and hypesthesia was also present on the left half of the face. Trigeminal nerve block with dehydrogenated alcohol and stellate ganglion block with 1% mepivacaine were performed and oral medication with diphenylhydantoin was started. The symptoms were alleviated after nerve block and oral medication. Dizziness, blurred vision and ataxia then developed from the 13th hospital day. We considered the symptoms as a side effect of diphenylhydantoin and we reduced the dose of diphenylhydantoin. However, the symptoms grew worse. Another brain MRI showed a slight increase of the tumor size and a mass effect with displacement of the adjacent organs, and hydrocephalus was also noted. This case shows the importance of considering the secondary symptoms that are due to brain tumor while treating trigeminal neuralgia. The changes of the brain tumors should also be considered along with the presence of new side effects.

• The Korean Journal of Pain
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• 제19권1호
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• pp.68-71
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• 2006

Background: Stellate ganglion block (SGB) is a selective sympathetic blockade that affects the head, neck and the upper extremities. It is an important method that has been frequently used in pain clinics due to its wide range of indications. But there were some problem with performing SGB at C6 or C7. Thus, various techniques have been recently introduced to successfully perform SGB; among them, there is the oblique approach. This study was performed to evaluate the effectiveness of the oblique approach for performing SGB in C7. Methods: Forty six patients with sudden hearing loss were studied. In group I, the patient underwent C7 oblique SGB with 1% mepivacaine (3 ml) under fluoroscopic guidance. In group II, the patients underwent the C7 classical anterior approach SGB with 1% mepivaine (5 ml) under fluoroscopic guidance. We compared the occurrence of Horner's syndrome, the side effects and the changes of temperature of the skin of the hand. Results: The rate of Horner's syndrome was 81.5% in the group I and 84.2% in the group II. The rate of incurring increased skin temperature (${\geq}34^{\circ}C$) of the fingers was 77.7% and 79.4% in each group, respectively. Conclusions: The C7 oblique approach for SGB showed the same SGB effect compared with the C7 anterior approach for SGB, and there were also fewer complications. We conclude that C7 oblique SGB may be a beneficial method for treating patients with this particular malady.

• The Korean Journal of Pain
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• 제14권1호
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• pp.37-40
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• 2001

Background: It had been reported by authors that linear polarized infrared light radiation (Superizer: SL) near the stellate ganglion had a similar effect on the change of skin temperature of hand compared with the stellate ganglion block (SGB). We hypothesized that this was due to dilatation of vessels and an increased blood flow. The aim of this study was to measure the velocity of blood flow in peripheral vessels after linear polarized infrared light radiation near the stellate ganglion and to compare the effect of SL with that of SGB using local anesthetics. Methods: Forty patients whose clinical criteria were matched for the symptoms of SGB were selected for study. We radiated the stellate ganglion by linear polarized infrared light radiation and measured the blood flow of radial artery using Ultrasound Doppler blood flow meter before and after 10, 20 and 30 minutes post-radiation. After 3 days, SGB was performed using 8 ml of 1% mepivacaine to the same patient, and the radial artery blood flow was measured in the same manner. Results: The blood flow velocity was increased by 40% and 27% at 10 min and 20 min after SL and by 42% and 41% at 10 min and 20 min after SGB. However, there was no statistically significant difference in blood flow velocity between SGL and SGB. Conclusions: We could conclude that linear polarized radiation is a clinically simple and useful noninvasive therapeutic tool in clinical area.

• The Korean Journal of Pain
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• 제11권1호
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• pp.30-35
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• 1998

Background: Idiopathic sudden sensorineural hearing loss(ISSHL) has been generally defined as an abrupt loss of auditory acuity without precipitating factors. Since ISSHL was first described as a disease entity, numerous reports assessing a variety of treatment regimens have been published. But its etiology, pathogenesis, treatment, and prognosis are controversial at the present time. Stellate ganglion block(SGB) has been used for the treatment of ISSHL by vasodilatation and increased blood flow to the inner ear. Methods: We reviewed the records of 152 patients to investigate the efficacy of SGB for ISSHL. The control group was managed with medications such as hypaque, heparin, steroid, nicotinic acid, and vitamins. The SGB group was managed with SGB and the same medications. SGB was performed with 8 ml of 1.0% mepivacaine. The efficacy of treatment was evaluated by pure-tone average following therapy. The recovery of hearing was defined as Siegel's criteria I, II, or III. Results: The recovery rate of the SGB group was higher than that of the control group(61.5 vs. 42.9%, p<0.05). The recovery rate was higher in patients who were treated early, within 7 days from the onset of symptoms, especially in the SGB group(79.7%). And in the case that initial hearing loss was severe (>70dB), the SGB group had a higher recovery rate(64.2%) than the control group(42.5%). Conclusions: SGB is thought to be a useful therapy for ISSHL, especially in the patients who were treated soon after onset or whose initial hearing loss was severe.

• The Korean Journal of Pain
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• 제19권2호
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• pp.202-206
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• 2006

Background: Stellate ganglion block (SGB) might be associated with changes in the blood pressure (BP) and heart rate (HR). The heart rate variability (HRV) shows the balance state between sympathetic and parasympathetic activities of the heart. The changes in these parameters of the HRV were studied to evaluate the possible mechanism of SGB in changing the BP. Methods: SGB was performed on 26 patients, using a paratracheal technique at the C6 level, and 8 ml of 1% mepivacaine injected. The success was confirmed by check the Horner's syndrome. The BP, HR and HRV were measured before and 5, 15, 30, 45 and 60 minutes after the SGB. Results: The increases in the BP from the baseline throughout the study period were statistically, but not clinically significant. The HR and LF/HF (low frequency/high frequency) ratio were increased at 5 and 45 min, respectively, after the administration of the SGB. In a comparison of left and right SGB, no significant differences were found in the BP, HR and HRV. A correlation analysis showed that an increased BP was significantly related with the changes in the LF/HF ratio and LF at 15 and 30 minutes, respectively, after the SGB. Dividing the patients into two groups; an increased BP greater and less than 20% of that at the baseline INC and NOT groups, respectively, hoarseness occurred more often in the INC group (P = 0.02). Conclusions: It was concluded that SGB itself does not clinically increase the BP and HR in normal hemodynamic patients. However, the loss of balance between the sympathetic and parasympathetic nerve system, attenuation of the baroreceptor reflex and hoarseness are minor causes of the increase in the BP following SGB; therefore, further studies will be required.

• The Korean Journal of Pain
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• 제19권2호
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• pp.197-201
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• 2006

Background: There are cases in which shoulder pain persists long after shoulder joint surgery and this pain can not be reduced by intravenous patient controlled analgesia (IVPCA). Our purpose was to evaluate the effect of stellate ganglion block (SGB) on postoperative shoulder pain and also to investigate the effect of preventive SBG on complex regional pain syndrome (CRPS). Methods: Forty patients, who were evaluated to ASA class 1 and 2 and who were scheduled for shoulder joint surgery under general anesthesia, were randomly divided into 2 groups. The experimental group of patients (n = 20) received SGB with 0.5% mepivacaine 8 ml after induction of general anesthesia. The control group of patients (n = 20) received only general anesthesia. Their postoperative pain was assessed using the visual analog scale (VAS) at 30 min, 1, 2, 6, 12, 24 and 48 hours postoperatively. Whenever patients wanted supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for supplemental analgesia was recorded. Results: The experimental group of patients had significantly lower pain scores at 30 min, 1, 2 and 6 hours and also significantly lower analgesic requirement at 1, 2 and 6 hours. Conclusions: We found SGB was effective for controlling postoperative pain after shoulder joint surgery. Also, we could expect that SGB reduced the incidence of CRPS.

• The Korean Journal of Pain
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• 제20권1호
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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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• 제27권2호
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• pp.125-132
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• 2014

Background: To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. Methods: This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of ${\leq}2$-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores < 70 (mild to moderate pain; MM group) and ${\geq}70$ (severe pain; SE group) were compared to the controls receiving NSAIDs. Results: A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of ${\leq}20$. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls. Conclusions: Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction.

• Clinical Pain
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• 제19권2호
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• pp.116-119
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• 2020

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.