• Annals of Clinical Neurophysiology
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• 제9권1호
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• pp.36-38
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• 2007

The pathomechanisms involved in both restless legs syndrome (RLS) and complex regional pain syndrome type I (CRPS I) are still controversial whether they are central or peripheral origins. We recently encountered a patient who had an unusual coexistence of both RLS and CRPS I, and both of which showed good responses to sympathetic block. These findings suggest the role of peripheral mechanisms, especially unmyelinated small autonomic fiber, in both RLS and CRPS I.

• The Korean Journal of Pain
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• 제36권2호
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• pp.216-229
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• 2023

Background: The role of the sympathetic nervous system appears to be central in causing pain in complex regional pain syndrome (CRPS). The stellate ganglion block (SGB) using additives with local anesthetics is an established treatment modality. However, literature is sparse in support of selective benefits of different additives for SGB. Hence, the authors aimed to compare the efficacy and safety of clonidine with methylprednisolone as additives to ropivacaine in the SGB for treatment of CRPS. Methods: A prospective randomized single blinded study (the investigator blinded to the study groups) was conducted among patients with CRPS-I of the upper limb, aged 18-70 years with American Society of Anaesthesiologists physical status I-III. Clonidine (15 ㎍) and methylprednisolone (40 mg) were compared as additives to 0.25% ropivacaine (5 mL) for SGB. After medical treatment for two weeks, patients in each of the two groups were given seven ultrasound guided SGBs on alternate days. Results: There was no significant difference between the two groups with respect to visual analogue scale score, edema, or overall patient satisfaction. After 1.5 months follow-up, however, the group that received methylprednisolone had better improvement in range of motion. No significant side effects were seen with either drug. Conclusions: The use of additives, both methylprednisolone and clonidine, is safe and effective for the SGB in CRPS. The significantly better improvement in joint mobility with methylprednisolone suggests that it should be considered promising as an additive to local anaesthetics when joint mobility is the concern.

• The Korean Journal of Pain
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• 제34권2호
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• pp.201-209
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• 2021

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. Methods: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. Results: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. Conclusions: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.

• The Korean Journal of Pain
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• 제19권2호
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• pp.223-227
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• 2006

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, sensory and motor disturbances, and trophic changes of the skin. A 21-year-old man was suffering from pain and swelling in his right hand and forearm. His arm had been in splints for 3 weeks following an extension injury of the right fingers and wrist, with the pain having developed 2 weeks after the splinting. He was treated with various nerve blocks including continuous epidural infusion, thoracic sympathetic block and peripheral nerve blocks, and squeezing his edematous region under general anesthesia as well as intravenous lidocaine and ketamine infusions. However, all of the performed treatments had no effect on the patient's pain or hand swelling. As a next line therapy, spinal cord stimulation should be considered because of intractable severe pain and swelling to almost all other modalities of therapy. We therefore performed an early intervention of spinal cord stimulation for the patient with refractory CRPS type I 5 months after the onset of pain and have got an excellent result.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권2호
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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.

• The Korean Journal of Pain
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• 제3권1호
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• pp.34-39
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• 1990

급성 대상 포진환자 51예를 분석하여 다음과 같은 결과를 얻었다. 1) 발생 빈도는 50대 이상 고령층의 여자에서 높았다. 2) 이환 부위는 흉추부가 가장 많았다. 3) 통증 성격은 매우 다양하였으나 쏜다, 찌른다, 쑤신다가 가장 많았다. 4) 진통제는 aspirin과 phenobarbital을 가장 많이 사용하였다. 5) 스테로이드는 전신적으로 사용한 예가 가장 많았고 전신적 및 경막외로 병용했던 예가 많았다. 6) 신경차단으로 두경부 질환에는 성상 신경절 차단, 그 이하는 경막외 차단이 가장 많았다. 7) 대상 포진후 신경통으로 이행하는 율은 11.8%였다. 이상의 결과는 급성 대상 포진의 치료에 탁월한 효과를 갖는 단독적인 방법이 없다는 것을 의미하며 통계적으로 명확히 증명되지는 않았으나 국소 마취제에 스테로이드를 혼합하여 경막외에 주입하는 것이 확실한 교감신경 차단과 병소 및 전신적인 약물 효과를 얻을수 있다는 점에서 유리할 것으로 사료된다.

• Journal of Chest Surgery
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• 제17권3호
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• pp.522-530
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• 1984

During a 12-month period, 31 patients underwent diagnostic and therapeutic thoracoscopy for previously undiagnosed thoracic diseases. In all patient, the diagnosis had been unobtainable by the usual diagnostic modalities of thoracentesis, closed pleural biopsy, bronchoscopy, or mediastinoscopy. The patients ranged from 4 years to 84 years old. One procedure was performed for mediastinal mass, 8 for parenchymal lesions, 21 for pleural diseases, and 1 for diaphragmatic disease. A correct diagnosis was obtained by thoracoscopy in 31 procedures for a 90% overall accuracy rate. There was no clinically significant morbidity in this series and no procedure-related mortality. Thoracoscopy, performed under intercostal nerve block and regional anesthesia, has proved to be a very attractive method of the diagnosis of thoracic disease.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권3호
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• pp.165-167
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• 2015

It has recently been reported that long-standing post-traumatic open bite can be successfully corrected with botulinum toxin type A (BTX-A) injection into the anterior belly of the digastric muscle (ABDM). The report documented an individual with bilaterally symmetrical and otherwise unremarkable anterior digastric musculature. However, the existence of variant anterior digastric musculature is common and may complicate the management of anterior open bite with BTX-A injection. Screening for variant ABDM can be accomplished via ultrasound, computed tomography, and magnetic resonance imaging. Screening for variant ABDM should be performed prior to BTX-A injection in order to account for musculature that may exert undesired forces, such as inferolateral deviation, on the anterior mandible in patients with anterior open bite.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권1호
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• pp.57-57
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• 2023

• The Korean Journal of Pain
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• 제10권2호
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• pp.225-230
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• 1997

Background: Authors modified the traditional continuous axillary brachial plexus block technique of Selander for purpose of increasing success rate and decreasing complications by use of commercial epidural anesthesia set. Method: Thirty-nine patients scheduled for upper extremity operations were injected with 40 ml of anesthetic solution by axillary perivascular technique, using 23~25G immobile needle at 2 cm from the pectoralis major. Tuohy needle was immediately introduced at 4 cm from the pectoralis major and pierced the expanded neurovascular sheath at an angle of 30 degree to the skin. The "pop" was well noted well. Needle was advanced 0.5 to 3.0 cm and epidural catheter introduced through the needle. After removal of needle, occlusive dressing was done. Tip of catheter and spread of solution were demonstrated by fluoroscopy with contrast dye after completion of procedure. Result: Catheter insertion was successful at first attempt for all case. Total length of insertion was from 6 to 13($10.0{\pm}1.7$) cm. Tip of catheter was placed in infraclavicular space(66.7%), about the humeral head(17.9%) and in upper arm in 3 cases as U-shape(7.9%). Catheters were maintained for $6.7{\pm}2.6$(3-12) days. There were no complications such as: perforation of major vessels, needle trauma to nerve, infection, bleeding or hematoma. Conclusion: This study demonstrated continuous axillary brachial plexus block with epidural anesthesia set is safe, easy and convenient modification of technique of Selander.