• The Korean Journal of Pain
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• v.36 no.2
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• pp.149-162
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• 2023

Chronic postsurgical pain (CPSP) is a multifactorial condition that affects a significant proportion of patients undergoing surgery. The prevention and management of CPSP require the identification of preoperative risk factors to screen high-risk patients and establish appropriate perioperative pain management plans to prevent its development. Active postoperative pain management should be provided to prevent CPSP in patients with severe pain following surgery. These tasks have become important for perioperative team members in the management of CPSP. This review article provides a comprehensive overview of the latest research on the role of perioperative team members in preventing and managing CPSP. Additionally, it highlights practical strategies that can be employed in clinical practice, covering the definition and risk factors for CPSP, including preoperative, intraoperative, and postoperative factors, as well as a risk prediction model. The article also explores various treatments for CPSP, as well as preventive measures, including preemptive analgesia, regional anesthesia, pharmacological interventions, psychoeducational support, and surgical technique modification. This article emphasizes the importance of a comprehensive perioperative pain management plan that includes multidisciplinary interventions, using the transitional pain service as an example. By adopting a multidisciplinary and collaborative approach, perioperative team members can improve patient outcomes, enhance patient satisfaction, and reduce healthcare costs. However, further research is necessary to establish targeted interventions to effectively prevent and manage CPSP.

• Journal of Yeungnam Medical Science
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• v.5 no.1
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• pp.23-32
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• 1988

Finger injuries are becoming more common with the increasing use of mechanical industrial and household appliances. Among the hand injuries, amputation is the serious disaster to the patient. Recently, application of microsurgical technique to the reattachment of ampuatated digits has been common clinical procedures. We performed microsurgical replantation to the 75 patients with 102 digits from march in 1986 to february in 1988. The following results were obtained. 1. The most common age distribution was third decade and male to female ratio was about 5:1. 2. The ratio of right to left hand was about 1:1 but the dominant to non-dominant hand was about 2:1. 3. The index finger was most commonly injured and the next was middle finger. 4. The most common type of the injuries was the crushing injury and the most common vector was a kind of pressor. 5. The anesthesia was performed in equal ratio between the general and regional anesthesia. 6. The survival rate of microreplantation to the injuries of the zone II was 77.8% and zone III was 80%. 7. The functional result after replantation at zone II was better than zone III. 8. Microreplantation was performed in any case of the type of the injury, the severity of crushing and the ischemic time, and the patients requirement was an important factor.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.647-652
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• 2007

Purpose: Single hair transplantation for eyebrow loss has been considered as a good method of achieving natural appearance of eyebrow. To date, however, no study has reported the survival rate following single hair transplantation for cicatricial eyebrow alopecia. Methods: We performed single hair transplantation using Choi hair transplanter for 49 cases of scarring eyebrow loss from March 2003 to March 2006. Of these cases, 33 could be under a follow-up postoperatively for more than seven months. These 33 cases comprised 20 men and 13 women. Mean follow-up period was 12 months (7-36 months). In 17 patients(51.5%), 100 to 200 hairs were unilaterally transplanted. Results: Following initial hair transplantation, the surgical outcome was excellent in 11 cases(33.3%), good in 12 cases(36.4%), fair or poor in the remaining ten cases(30.3%). All procedures were done under intravenous sedation and local or regional block anesthesia. It took about one and a half hours for us to transplant 200 hairs. The shape of eyebrow was aesthetically acceptable with a good direction and an ideal inclination of hairs. No patients developed notable complications, while 30 percent had a low survival rate. Conclusion: Single hair transplantation using Choi hair transplanter is a safe, effective surgical method for scarring eyebrow loss.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1451-1455
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• 2000

Objective : The goal of this study is to present whether endoscopic release(ER) is superior to open release(OR) for the treatment of carpal tunnel syndrome(CTS). Method and Material : Fifty-nine wrists in 43 patients who had clnical signs and symptoms consistent with CTS, not responded to non-operative management, were entered into the study. Authors retrospectively compared 27 wrists treated with ER(February 1999-June 1999) with 32 wrists treated with OR(October 1997-March 1999). We performed conventional open surgery in 25 patients(mean age ; 46 years) and Brown's two-portal technique in 18 patients(mean age ; 53 years) under intravenous regional block or general anesthesia. Results : Sixteen patients had CTS on both hands and left hands were affected more frequently than right hand, 34 and 25 respectively. Successful and poor results of ER were similar to those of OR. For patients in OR group, mean duration of symptoms was 5 years(range 1 month-30 years), and postoperative outcome was good in 27(84.4%) of wrists and poor in 5(15.6%). For patients in ER group, mean duration of symptoms was 7 months (range 2 months-25 years), outcome was good in 23(85.2%) of wrists and poor in 4(14.8%). The average time for complete relief of pain was 1.3 weeks and 7.6 weeks, respectively for OR and ER groups. No complication was noted in either group. Conclusion : This preliminary analysis suggests that faster relief of pain was achieved when the endoscopic method was used, although there were no significant differences in their efficacies regarding the improvement of symptoms.

• Journal of Chest Surgery
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• v.28 no.8
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• pp.766-771
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• 1995

The trachea is defined as the airway from the inferior border of the cricoid cartilage to the top of the carinal spur. This paper would confirm the normal tracheal length of Korean adults through the actual measurement using the fiberoptic bronchoscopy. The subjects of this study were 25 patients, 13 males and 12 females between the age of 20 to 69 without abnormality on the neck, trachea, mediastinum and lung pharenchyme on the preoperative chest X-ray, who received the operations from the period of July to September, 1994. For those patients who had heart diseases, the cardiothoracic ratio was below 50%. The measurement was performed on the patients with endotracheal intubation under the general anesthesia in supine and neutral position. The tracheal length was calculated by the difference between the length from the tip of the endotracheal tube [E-tube to carina and to the needle which was inserted into the E-tube at the lower border of the palpated cricoid cartilage, by inserting the broncoscopy through the E-tube. The result was as follow : 1 The measured tracheal length for men was 11.8 0.2 cm[mean standard deviation and women was 10.5 0.3 cm, and that was longer than this [p<0.01 . The average was 11.2 1.0 cm and the standard error was 0.20 cm. 2 According to the correlation between the tracheal length to weight, height[Ht , age, and body surface area[BSA respectively, the Ht [p=0.003 , age [p=0.055 , and the BSA[p=0.017 were significant, while weight was not [p=0.314 . 3 From the regression analysis of the tracheal length[T.L. to the Ht, Age, and the BSA which were significant, the following equation was derived.i Ht : T.L.= -1.29 + 0.076 x Ht [P=0.003 ii Age: T.L.= 10.04 + 0.028 x Age [P=0.055 iii BSA : T.L.= 5.60 + 3.48 x BSA [P=0.017 iv In multi-regression : T.L. = -4.15 + 0.034 x Age + 0.085 x Ht [P=0.0002]

• The Korean Journal of Pain
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• v.29 no.3
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• pp.179-184
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• 2016

Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively. Conclusions: Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety.

• Journal of Yeungnam Medical Science
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• v.17 no.1
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• pp.12-20
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• 2000

The memory of pain can be more damaging than its initial experience. Several factors arc related the directions of pain memory: current pain intensity, emotion, expectation of pain, and peak intensity of previous pain. The possible mechanisms behind the memory of pain are neuroplastic changes of nervous system via peripheral and central sensitization. Peripheral sensitization is induced by neurohumoral alterations at the site of injury and nearby. Biochemicals such as K+, prostaglandins, bradykinin, substance P, histamine and serotonin, increase transduction and produce continuous nociceptive input. Central sensitization takes place within the dorsal horn of spinal cord and amplifies the nociceptive input from the periphery. The mechanisms of central sensitization involve a variety of transmitters and postsynaptic mechanisms resulting from the activations of NMDA receptors by glutamate. and activation of NK-1 tachykinnin receptors by substance-P and neurokinnin. The clinical result of peripheral and central sensitization is hyperalgesia, allodynia, spontaneous pain, referred pain, or sympathetically maintained pain. These persistent sensory responses to noxious stimuli arc a form of memory. The hypothesis of preemptive analgesia is that analgesia administered before the painful stimulus will prevent or reduce subsequent pain and analgesic requirements in comparison to the identical analgesic intervention administered after the painful stimulus, by preventing or reducing the memory of pain in the nervous system. Conventionally, pain management was initiated following noxious stimuli such as surgery. More recently, however many have endorsed preemptive analgesia initiated before surgery. Treatments to control postsurgical pain are often best started before injury activates peripheral nociceptors and triggers central sensitization. Such preemption is not achieved solely by regional anesthesia and drug therapy but also requires behavioral interventions to decrease anxiety or stress. Although the benefit of preemptive analgesia may not be obvious in every circumstance, and in many cases may not sufficient to abolish central sensitization, it is an appropriate and human goal of clinical practice.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.2
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• pp.105-110
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• 2018

Background: A stellate ganglion block (SGB) causes increased blood flow in the maxillofacial region, exhibiting the potential for regenerative effects in damaged tissue. The focus of this study was to understand the efficacy of SGB for regenerative effects against nerve damage. A rat model of the superior cervical ganglion block (SCGB) was created instead of SGB, and facial blood flow, as well as sympathetic nervous system function, were measured. Methods: A vertical incision was made on the left side of the neck of a Wistar rat, and a 5-mm resection of the superior cervical ganglion was performed at the back of the bifurcation of the internal and external branches of the left common carotid artery. Blood flow in the skin at the mandibular angle and mean facial temperature were measured using a laser-Doppler blood flow meter and a thermographic camera, respectively, over a 5-week period after the block. In addition, the degree of ptosis and miosis were assessed over a period of 6 months. Results: The SCGB rat showed significantly higher blood flow at the mandibular angle on the block side (P < 0.05) for 3 weeks, and significantly higher skin temperature (P < 0.05) for 1 week after the block. In the SCGB rat, ptosis and miosis occurred immediately after the block, and persisted even 6 months later. Conclusions: SCGB in rats can cause an increase in the blood flow that persists over 3 weeks.

• Journal of Veterinary Clinics
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• v.9 no.1
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• pp.283-299
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• 1992

Since successive operations under the acupuncture analgesia have been reported In China 1971, veterinary acupuncture was brought to the attention over the world and then its research and clinical use have markedly developed. Veterinary acupuncture and moxibustion was originated in China and Korea, but the research activities on them were not very significantly advanced. In this study, status of veterinarians on veterinary acupuncture and moxibustion, acupunctures which has been practiced by civil acupuncturist, therapeutic effects of acupuncture for the animal diseases in the field, and effects of electric acupuncture on the lumen motility in ruminants, etc. were Investigated. One-fifty of veterinarians of private clinics in Korea was interested in acupuncture and moxibustion in veterinary medicine. A lot of veterinarians required the scientific, systemic technique and knowledge or acupuncture. Civil acupuncturists who have been practiced acupuncture and moxibustion were 20 persons, and most of them were very old. They used chiefly three edged needles which were made by themselves and utilized old traditional technique in which the acupoints were stimulated and bled. Treatment with acupuncture for the digestive, muscular locomotive and febrile diseases was very effective. Until nowadays, the research on veterinary acupuncture in Korea has not much progressed. However, the Korean Societh of Veterinary Acupuncture and Moxibustion was organized in 1990. Valuable development for acupuncture through the society are expected. Electroacupuncture regional analgesia on the combinations of Yao-Pang 1, 2 and 4 acupoints was very effective for abdominal operations in cattle. But a lot of experiences and studies on the acupuncture anesthesia were required for clinical use in the future. Therapeutic effects of about 80% were obtained from electroacupuncture on the combinations of Tian Ping-Bai Hui-Shi Zhang, and Guan Yuan Yu acupoints in cattle with luminal atony and tympany In the field. Electroacupuncture on the combination of Tian Ping-Bai Hui-Qi Men, and Tian Ping-Bai Bui-Wei Gen for the treatment of downer cow was not so effective. The effects of stimulation and bleeding from acupoint by three edged needle was excellent for febrile diseases. The luminal contractile movement was accentuated by electroacupuncture on Tian Ping-Bai Hui-Shi Zhang combination and Guan Yuan Yu acupoint. It was concluded that veterinary acupuncture and moxibustion should be utilized for veterinary practice, and the advanced scientific research and clinical experiences must be followed.

• The Korean Journal of Pain
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• v.30 no.4
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• pp.287-295
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• 2017

Background: Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. Methods: We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. Results: Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05). Conclusions: Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management.