• The Korean Journal of Pain
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• 제8권2호
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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.

• The Korean Journal of Pain
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• 제25권3호
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• pp.191-194
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• 2012

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.

• The Korean Journal of Pain
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• 제20권1호
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• pp.40-45
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• 2007

Background: Caudal block is useful when anesthesia for surgery or treatment for chronic pain is needed, but this procedure has a failure rate of up to 25% even when it performed byan experienced physician. This high failure rate is usually due to improper needle placement. Methods: After gaining approval of the ethics committee, 46 patients received caudal blocks under ultrasound guidance; these were performed after the anatomical structures in the sacral hiatus had been measured with ultrasound. All these procedures were performed by the same anesthesiologist. The position and direction of the needle were identified using fluoroscopy by injecting a radio-opaque contrast through the needle. The time taken from thelidocaine injection to verification of the needle was measured and the planned nerve block was then carried out. Results: All cases of needle insertion into the sacral canal under ultrasound guidance were successful. The average duration of the procedure and the trial count were $134.1{\pm}10.1seconds$ and $1.2{\pm}0.1$, respectively. In 12 of the 46 cases (26%), the needle deviated either left or right in the sacral canal, so the direction of the needle had to be adjusted. The distance between two cornua, the depth of the sacral hiatus and the thickness and length of the sacrococcygeal ligament were $17.1{\pm}0.4$, $3.9{\pm}0.3$, $2.3{\pm}0.1$ and $24.9{\pm}0.9mm$, respectively. Conclusions: Ultrasound guidance can increase the success rate of inserting a needle into the sacral canal. However, even when ultrasound is used, the needle can deviate either left or right in the sacral canal.

• Journal of Korean Neurosurgical Society
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• 제38권5호
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• pp.338-343
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• 2005

Objective : The sacroiliac joint complex is often related with functionally incapacitating pain in old aged people. The purpose of this study is to delineate the investigation strategies and to determine the long-term effect of radiofrequency [RF] neurotomies for pain arising from sacroiliac Joint dysfunction[SIJD]. Methods : Sixteen patients were diagnosed as having chronic pain from SIJD by comparative controlled blocks on L5 dorsal rami, sacroiliac Joints and deep interosseous ligaments. After confirming the positive response [more than 50% of pain relief], sensory stimulation was applied to detect the 'pathological' branches. Subsequently, RF neurotomies were performed on the selected nerve branches. Surgical outcome was graded as successful, moderate improvement, and failure after a 6month follow-up period. Results : Stimulation intensity was 0.45V to elicit pain response in the L5 dorsal rami and lateral sacral branches. The number of RF-lesioned nerve branches was 6per patient. The average number of lesions for each branch was 1.3. Most commonly selected branches were L5 dorsal ramus [88%] and S2-upper division [88%]. Ten patients [63%] reported a successful outcome according to the outcome criteria after 6months of follow-up, and five patients [31%] reported complete relief [100%]. Five patients [31%] showed moderate improvements. One patient reported failure. Conclusion : RF neurotomy of lateral sacral branches is an excellent treatment modality for the pain due to SIJD, provided that comparative controlled block shows a positive response.

• The Korean Journal of Pain
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• 제23권4호
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• pp.242-246
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• 2010

Background: The first sacral nerve root block (S1NRB) is a common procedure in pain clinic for patients complaining of low back pain with radiating pain. It can be performed in the office based setting without C-arm. The previously suggested method of locating the needle entry point begins with identifying the posterior superior iliac spine (PSIS). Then a line is drawn between two points, one of which is 1.5 cm medical to the PSIS, and the other of which is 1.5 cm lateral and cephalad to the ipsilateral cornu. After that, one point on the line, which is 1.5 cm cephalad to the level of the PSIS, is considered as the needle entry point. The purpose of this study was to analyze the location of needle entry point and palpated PSIS in S1NRB. Methods: Fifty patients undergoing C-arm guided S1NRB in the prone position were examined. The surface anatomical relationships between the palpated PSIS and the needle entry point were assessed. Results: The analysis revealed that the transverse and vertical distance between the needle entry point and PSIS were $28.7{\pm}8.8mm$ medially and $3.5{\pm}14.0mm$ caudally, respectively. The transverse distance was $27.8{\pm}8.3mm$ medially for male and $29.5{\pm}9.3mm$ medially for female. The vertical distance was $1.0{\pm}14.1mm$ cranially for male and $8.1{\pm}12.7mm$ caudally for female. Conclusions: The needle entry point in S1NRB is located on the same line or in the caudal direction from the PSIS in a considerable number of cases. Therefore previous recommended methods cannot be applied to many cases.

• Clinical Pain
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• 제18권2호
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• pp.59-64
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• 2019

Objective: This study evaluated the feasibility of ultrasound-guided lumbar nerve root block (LNRB) and S1 nerve root block by identifying spread patterns via fluoroscopy in cadavers. Method: A total of 48 ultrasound-guided injections were performed in 4 fresh cadavers from L1 to S1 roots. The target point of LNRB was the midpoint between the lower border of the transverse process and the facet joint at each level. The target point of S1 nerve root block was the S1 foramen, which can be visualized between the median sacral crest and the posterior superior iliac spine, below the L5-S1 facet joint. The injection was performed via an in-plane approach under real-time axial view ultrasound guidance. Fluoroscopic validation was performed after the injection of 2 cc of contrast agent. Results: The needle placements were correct in all injections. Fluoroscopy confirmed an intra-foraminal contrast spreading pattern following 41 of the 48 injections (85.4%). The other 7 injections (14.6%) yielded typical neurograms, but also resulted in extra-foraminal patterns that occurred evenly in each nerve root, including S1. Conclusion: Ultrasound-guided injection may be an option for the delivery of injectate into the S1 nerve root, as well as lumbar nerve root area.

• The Korean Journal of Pain
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• 제25권1호
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• pp.38-42
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• 2012

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.

• The Korean Journal of Pain
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• 제2권1호
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• pp.85-88
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• 1989

We experienced 3 cases of continuous caudal block. The first case had suffered from severe pain of the external genitalis after urethral injury from a car accident and this was controlled by continuous caudal block. The other 2 cases were a metastaric malignant tumor of the lumbar vertebra from cancer of the cervix and histiocytoma of the breast, and both had suffered from intractable pain of the lower extremity. But lumbar epidural block was impossible because of radiation fibrosis and previous operation scar of the spine. So a continuous caudal block was performed and the pain was controlled effectively. The longest duration was 50 days and there were no problems related catheter indwelling. Pain in the area of the lumbar and sacral nerve distribution can be controlled by continuous caudal block. Here in we reported 3 cases and reviewed the literature.

• 대한척추외과학회지
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• 제25권4호
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• pp.185-195
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• 2018

연구 계획: 문헌 조사 목적: 초음파를 이용한 중재 시술은 임상적으로 흔하게 경험할 수 있는 하요추부 통증이 보존적 치료에 실패한 경우 수술적 치료 이전에 흔하게 시행하게 되는 치료이다. 이 연구의 목적은 요추 및 천추부에 대한 초음파 유도하 중재 시술에 대해 고찰해 보고자 함에 있다. 선행 연구문헌의 요약: 초음파를 이용한 중재 요법은 근육, 인대, 건, 혈관, 신경 등의 연부조직을 직접 관찰할 수 있으며, 환자나 시술자에게 방사선 노출이 없고, 컴퓨터 단층 촬영이나 C형 투시검사 장비처럼 넓은 장소를 필요로 하지 않는 장점들을 가지고 있기 때문에 점차 그 사용이 늘고 있다. 대상 및 방법: 요추부의 정상, 비정상 초음파 소견과 요추 및 천추부에서 시행할 수 있는 초음파 유도하 중재 요법에 대하여 문헌 고찰과 함께 기술을 하였다. 결과: 요천추부의 정확한 초음파 중재 시술을 위해서는 검사 시 환자의 자세 및 해부학과 정상, 비정상 초음파 소견 등에 대한 숙지가 필요하다. 초음파를 이용하면 후방 관절 내 주사 및 내측 분지 차단술, 경막외 차단술, 선택적 신경근 차단술, 천장관절 주사를 효과적으로 시행할 수 있다. 결론: 요추 및 천추부에서 초음파 유도하 중재 요법은 요천추부 통증의 치료에서 효과적으로 사용할 수 있는 술기이다.

• The Korean Journal of Pain
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• 제22권1호
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• pp.107-111
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• 2009

Neuroablation should be performed cautiously because neuropathic pain can occur following denervation of a somatic nerve. A 34-year-old man presented with severe penile pain and allodynia following a selective neurectomy of the sensory nerve that innervated the glans penis for treatment of his premature ejaculation. He was treated with various nerve blocks, including continuous epidural infusion, lumbar sympathetic block and sacral selective transforaminal epidural blocks, as well as intravenous ketamine therapy. However, all of the treatments had little effect on the relief of his pain. We performed spinal cord stimulation as the next therapy. After this therapy, the patient has currently been satisfied for 3 months.