• Journal of Chest Surgery
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• 제55권6호
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• pp.485-488
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• 2022

Serratus anterior plane block (SAPB) has been used for perioperative pain control during video-assisted thoracoscopic surgery (VATS), and the effects of continuous SAPB have been studied. This procedure is usually performed by the anesthesiologist; however, it could be performed more simply and safely by the thoracic surgeon through the use of meticulous finger dissection to create a space in the deep serratus anterior plane during surgery. We describe 3 cases of surgical catheterization for continuous SAPB in patients with lung cancer during VATS lobectomy, in which postoperative pain was effectively reduced.

• 디지털융복합연구
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• 제10권11호
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• pp.551-558
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• 2012

본 연구는 카이로프랙틱 기법 중 누운 자세에서 시술되어지는 S.O.T category II 골반 블록 중재가 골반의 불안정으로 인한 기울어짐을 회복시킴으로써 이에 따른 어깨통증을 줄이고 복근의 지구력을 향상시킬 수 있는지 알아보고자 한 것이다. 이 실험을 위해 엉치엉덩관절의 불안정을 가지고 있으며 허리의 통증이 있는 총 50명의 참여자가 실험군과 대조군에 각 25명씩 무작위 할당되었다. 실험군은 category II 블록 중재를 받았고, 대조군은 거짓블록 중재를 받았으며, 이들 두 집단을 통해 중재 전, 중재 후, 그리고 중재 2주 후에 복근지구력과 어깨통증을 측정하여 그 결과를 반복측정 이원분산분석법으로 분석하였다. 분석결과 S.O.T category II 골반 블록 중재 후 실험집단에서 복근지구력이 유의한 증가를 보였으며 중재가 끝난 2주 후에도 유지 되었다. 또한 어깨통증의 경우에도 실험집단에서 통증의 감소를 보였으며 역시 중재가 끝난 2주 후에도 유의한 감소를 보였다. 이상의 연구 결과를 종합해 볼 때 S.O.T category II 골반 블록 중재는 골반의 안정성을 유도하여 복근지구력을 증진시키고, 어깨통증을 감소시키며 중재 후에도 지속효과가 있는 것으로 나타남으로, 골반의 불안정성이 원인이 되는 어깨통증이나 복근지구력을 회복시킬 수 있는 중재법으로 활용되어질 수 있을 것으로 사료된다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권4호
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• pp.209-215
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• 2019

Background: Pain is an unpleasant sensation ranging from mild localized discomfort to agony and is one of the most commonly experienced symptoms in oral surgery. Usually, local anesthetic agents and analgesics are used for pain control in oral surgical procedures. Local anesthetic agents including lignocaine and bupivacaine are routinely used in varying concentrations. The present study was designed to evaluate and compare the efficacy of 0.25% and 0.5% bupivacaine for postoperative analgesia in infraorbital nerve block. Methods: Forty-one patients undergoing bilateral maxillary orthodontic extraction received 0.5% bupivacaine (n = 41) on one side and 0.25% bupivacaine (n = 41) on the other side at an interval of 7 d. The parameters evaluated for both the bupivacaine concentrations were onset of action, pain during procedure (visual analog scale score [VAS]), and duration of action. The results were noted, tabulated, and analyzed using the Wilcoxon signed rank test. Results: The onset of action of 0.5% bupivacaine was quicker than that of 0.25% bupivacaine, but the difference was not statistically significant (P = 0.306). No significant difference was found between the solutions for VAS scores (P = 0.221) scores and duration of action (P = 0.662). Conclusion: There was no significant difference between 0.25% bupivacaine and 0.5% bupivacaine in terms of onset of action, pain during procedure, and duration of action. The use of 0.25% bupivacaine is recommended.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.456-462
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• 2001

Objective : Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. Method : Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result : In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. Conclusion : These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

• 한국산학기술학회논문지
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• 제13권9호
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• pp.4065-4072
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• 2012

본 연구는 정맥 천자 전 국소 마취제인 엠라크림을 도포하여 침습적 시술 시 발생하는 통증과 불안에 미치는 영향을 확인하여 엠라크림의 임상적 적용을 확대하기 위한 기초 자료를 마련하고자 하였다. 실험군 40명과 대조군 37명을 대상으로 2011년 10월27일부터 11월13일까지 구조화된 설문지를 통하여 일반적 특성, 기질불안, 상태불안, 주관적 통증, 객관적 통증에 관하여 자료 수집을 하였으며, SPSS 15.0 프로그램을 이용하여 ${\chi}^2$-test, t-test, ANOVA, Correlation analysis로 분석하였다. 연구 결과 엠라크림 도포가 통증과 불안 감소에 효과가 있는 것으로 나타났으며, 엠라크림 도포 후 통증과 불안과의 관계에 대해 살펴본 결과 안면 표정, 음성변화, 객관적 통증은 불안과 상관관계를 보이는 것으로 나타났다. 이러한 결과를 통해 임상에서는 환자들에게 침습적 처치로 인한 통증과 불안을 감소시켜줌으로서 의료의 질을 향상시키고 엠라크림의 임상적 적용 확대를 고려해 보아야 할 것이다.

• The Korean Journal of Pain
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• 제13권2호
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• pp.196-201
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• 2000

Background: Currently, minimally invasive operations are preferred to open surgery whenever possible. Lumbar sympathectomy using RF (radiofrequency) thermocoagulation is both safe and minimally invasive. The problem with the technique is that it cannot be performed successfully in a significant number of cases. If the temperature change in the sole is monitored immediately after the procedure then it can be determined if the procedure needs to be repeated. Methods: A curved tip cannula, 150 mm long with a 10 mm active tip, was used for RF lumbar sympathectomy. The temperature of the soles of both the foot on the affected side and the foot on the control side was monitored immediately before the procedure, immediately after making the L2 lesion, immediately after making the L3 lesion and at 5, 10, and 15 minutes after the procedure. Results: No statistically significant difference was observed in the temperature of the two soles before making the lesions. In the 24 of the 27 patients, there were prominent differences in temperature between the two soles at 10 minutes after the procedures. 11 of the 24 patients showed a significant temperature change after the first trial. But the remaining 13 required a second lesion on L2 and L3. Conclusions: We judged the success of the operation in the operating room by monitoring the temperature difference in the soles of the feet. When no increase in the temperature difference is observed, we can move the electrode and make another lesion. With this procedure, we can drastically increase the success rate of the procedure.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.149-151
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• 2014

The cerebello-pontine angle lipomas causing trigeminal neuralgia or hemifacial spasm are rare. A lipoma causing glossopharyngel neuralgia is also very rare. A 46-year-old woman complained of 2-year history of severe right throat pain, with ipsilateral episodic otalgic pain. The throat pain was described as an episodic lancinating character confined to the throat. Computed tomography and magnetic resonance imaging revealed a suspicious offending posterior inferior cerebellar artery (PICA) compressing lower cranial nerves including glossopharyngeal nerve. At surgery, a soft, yellowish mass ($2{\times}3{\times}3mm$ in size) was found incorporating the lateral aspect of proximal portion of 9th and 10th cranial nerves. Only microvascular decompression of the offending PICA was performed. Additional procedure was not performed. Her severe lancinating pain remained unchanged, immediate postoperatively. The neuralgic pain disappeared over a period of several weeks. In this particular patient with a fatty neurovascular lump causing glossopharyngeal neuralgia, microvascular decompression of offending vessel alone was enough to control the neuralgic pain.

• The Korean Journal of Pain
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• 제31권3호
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• pp.155-173
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• 2018

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.

• The Korean Journal of Pain
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• 제6권2호
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• pp.220-223
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• 1993

Administration of local anesthetics or morphine through epidural space has the effect of curbing postoperative increases in endocrine hormone. Other benefits include improving metabolic reaction and eliminating postoperative pain. However, repeated administration of local anesthetics through epidural space causes tachyphylaxis, and the unstable blockade of sensory nerve resulting in insufficient analgesia. Morphine has excellent postoperative analgesic effect, but complications including: itching, nausea, vomiting, urinary retention and respiratory depression may be associated with its administration. Sixty patients that fall into the category of ASA class I and II were randomly selected for the purpose of the experiment. Thirty patients were give 4 mg of morphine and the rest, 4 mg of morphine plus 80 ml of 0.25% bupivacaine administered through epidural space with the Baxter infuser. Analgesic effect was satisfactory in both groups. On the day of operation, the effect was stronger in group I (P<0.05) and on postoperative second day, group II showed better analgesic effect (P < 0.05). Group II had more patients who complained of itching (P < 0.05). Other complications were statistically insignificant. The findings indicate that administration of morphine through epidural space for postoperative pain management is an effective procedure. Baxter infuser was found to be very instrumental in pain control while reducing the chance of complications.

• 대한물리치료과학회지
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• 제19권3호
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• pp.39-47
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• 2012

Background : Patients with frozen shoulder have pain and limited range of motion (ROM) at the affected shoulder. Shoulder pain of these patients usually decreases with recovery of range of motion. The aim of this study is to identify effects of static stretching and hold-relax on recovering ROM and reducing pain of patients with frozen shoulder. Methods : In this study, 15 patients with frozen shoulder who were only treated with physical therapy were recruited. Patients who received any surgical procedure or hydrotherapy were excluded. The subjects were divided randomly into 3 groups; control(n=5), static stretching(n=5) and hold-relax(n=5) groups. Patients were treated with stretching and the total number of treatments was 12 times. The ROM was measured at baseline, after fourth, eighth and final treatments. Shoulder pain and disability index(SPADI) scores were assessed before and after doing all treatments. Repeated measures ANOVA was used to analyze ROM change within each group. Changes of ROM between groups was analyzed by one way ANOVA followed by post hot analysis(Tukey's HSD). SPADI score within each group analyzed using Wilcoxon signed ranks test. A p-value<0.05 was considered statistically significant. Study Design : Repeated measures design. Result : There were significant differences of ROM in both treatment groups except internal rotation of static stretching group. ROM was significantly increased in treatment groups compared with control group, but the difference of ROM change between two treatment groups did not differ significantly. SPADI scores for treatment groups significantly decreased compared with pre-SPADI score. Conclusion : The result suggests that hold-relax can be more effective than static stretching to recover range of motion and alleviate shoulder pain on patients with frozen shoulder.