• The Korean Journal of Pain
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• 제9권1호
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• pp.120-125
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• 1996

It has been reported by some authors that caudal block with local anesthetic and steroid is the most effective therapeutic modality for piriformis syndrome; and the incidence ratio of female to male being 6 to 1. We treated 89 patients with piriformis syndrome in 1995. From those clinical experiences and anatomical studies we heave arrived at several conclusions different from other authors. Our results indicate the following: 1) Piriformis syndrome does not provoke lower back pain. 2) Our rate of incidence showed a very different profile as results showed a female to male ratio of 33:56. 3) Releasing the compressed nerves(gluteal, sciatic) with spasmolytic treatment on the piriformis muscle itself is thought to be the only therapeutic modality for piriformis syndrome.

• The Korean Journal of Pain
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• 제22권1호
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• pp.99-103
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• 2009

We studied the historical changes of intervertebral disc displacement using magnetic resonance imaging. The phenomenon of the spontaneous regression of herniated discs is well known. The case of a 40-years-old male presenting with a large disc herniation at L5-S1, experiencing severe sciatic pain, and having the straight leg raising test positive at 25 degrees is presented. The extruded disc was documented by clinical examination. He was treated conservatively with epidural steroid injection (ESI), medication, physical therapy and self-exercise and reevaluated in 10 weeks later, 30 and 1 year. Large extruded disc can be treated successfully by physical therapy with ESI. However, the degeneration and the dehydration of disc result in decrease of disc height. Consequently, the regression of extruded disc might have been due to the resorption and the dehydration.

• The Korean Journal of Pain
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• 제33권2호
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• pp.166-175
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• 2020

Background: The effect of dexmedetomidine as an adjuvant in the adductor canal block (ACB) and sciatic popliteal block (SPB) on the postoperative tramadol-sparing effect following spinal anesthesia has not been evaluated. Methods: In this randomized, placebo-controlled study, ninety patients undergoing below knee trauma surgery were randomized to either the control group, using ropivacaine in the ACB + SPB; the block Dex group, using dexmedetomidine + ropivacaine in the ACB + SPB; or the systemic Dex group, using ropivacaine in the ACB + SPB + intravenous dexmedetomidine. The primary outcome was a comparison of postoperative cumulative tramadol patient-controlled analgesia (PCA) consumption at 48 hours. Secondary outcomes included time to first PCA bolus, pain score, neurological assessment, sedation score, and adverse effects at 0, 5, 10, 15, and 60 minutes, as well as 4, 6, 12, 18, 24, 30, 36, 42, and 48 hours after the block. Results: The mean ± standard deviation of cumulative tramadol consumption at 48 hours was 64.83 ± 51.17 mg in the control group and 41.33 ± 38.57 mg in the block Dex group (P = 0.008), using Mann-Whitney U-test. Time to first tramadol PCA bolus was earlier in the control group versus the block Dex group (P = 0.04). Other secondary outcomes were comparable. Conclusions: Postoperative tramadol consumption was reduced at 48 hours in patients receiving perineural or systemic dexmedetomidine with ACB and SPB in below knee trauma surgery.

• The Korean Journal of Pain
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• 제28권3호
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• pp.185-192
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• 2015

Background: Neuropathic pain is a global clinical problem; nevertheless, nerve injury treatment methods remain limited. Olanzapine has antinociceptive and anti-nueropathic properties; however, its preventive effects have not been assessed in nerve injury models. Methods: We prepared a partial sciatic nerve ligation (Seltzer model) or sham-operated model in male Sprague-Dawley rats under isoflurane anesthesia. In a pre-treatment study, we administered olanzapine (10 mg/kg) intraperitoneally 1 h before nerve ligation. In post-treatment and dose-dependent studies, we injected 3 different doses of olanzapine intraperitoneally 1 h after nerve ligation. Mechanical allodynia was measured before and 7 days after surgery. Immunohistochemical analysis using anti-Iba-1 antibody was used to assess the effect of olanzapine at the spinal level. Results: In the pre-treatment study, median withdrawal thresholds of the normal saline groups were significantly lower than those of the sham-operated groups; however, those of the olanzapine (10 mg/kg) and sham-operated groups were not different. In the post-treatment and dose-dependent studies, the median withdrawal thresholds of the olanzapine (2.5 mg/kg) and normal saline groups were not different; however, those of the olanzapine (10 and 50 mg/kg) groups were significantly higher than those of the normal saline groups. Olanzapine did not have a significant effect on the density of Iba-1 staining. Conclusions: Olanzapine attenuated mechanical allodynia dose-dependently in the Seltzer model. This anti-allodynic effect of olanzapine was observed even when injected 1 h after nerve ligation. This effect of olanzapine appeared to be unrelated to microglia activation in the ipsilateral dorsal horn of the lumbar spinal cord.

• 대한족부족관절학회지
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• 제18권3호
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• pp.133-136
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• 2014

Skin grafting is often required for diabetic ulcerative foot lesions. In skin grafting, effective regional or local anesthesia into the donor and recipient areas plays a significant role in continuous control of pain. We report on a technique of ultrasound-guided nerve block on the femoral, sciatic, and lateral femoral cutaneous nerves in large split-thickness skin grafting for ulcer of the foot and leg.

• The Korean Journal of Pain
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• 제5권2호
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• pp.213-220
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• 1992

Morphine, meperidine 및 pentazocine을 가토의 좌골신경에 주입한 후 마약제의 신경차단 유무와 약제 주입 후 4시간, 24시간 및 1주에 좌골 신경을 절취하여 신경조직학적 변화를 관찰하였다. 좌골신경에 약제를 주입한 후 신경자극에 의한 반응과 뒷다리 운동을 관찰한 결과, morphine군은 신경차단 효과가 없었고 meperidine군과 pentazocine군은 약제주입 5분 후부터 근육이완이 시작되어 10분 후부터 근육수축이 나타나지 않았으며 뒷다리에 마비증상은 약제주입 60분 후부터 부분적으로 회복되기 시작하여 90분 후에는 정상으로 회복되는 양상의 신경차단 효과가 있었다. 광학 현미경적 소견으로는 모두 4시간부터 1주까지의 표본에 특기할만한 변화가 없었으며, 전자 현미경적 소견에서 morphine군은 1주 후 소견에서 유수신경섬유와 무수신경섬유에 경미한 수포양을 보였다. Meperidine군은 4시간 후 소견으로 유수신경섬유의 축삭돌기에 경미한 수포양이 있었고 무수신경의 마이엘린화되는 소견이 있었으며, 24시간 후 유수신경섬유에 경미한 수포양이 있었고 무수신경섬유가 정상으로 되었으며 1주 후 특기할 만한 변화가 없었다. Pentazocine군은 약제주입 4시간 후 유수신경섬유에 경미한 수포양을 보였으며 24시간 후 유수신경 섬유와 무수신경섬유에 중등도의 수포양이 나타났으며 1주 후 경미한 수포양을 나타내었다. 주입된 약제중 morphine이 가장 수포양이 적었으며 pentazocine이 심한 변화를 나타내었고, 전단계 쥐 실험에서 나타났던 meperidine주입 1주 후의 심한 신경조직 손상은 본 실험에서 나타나지 않았다.

• The Korean Journal of Pain
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• 제12권2호
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• pp.177-182
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• 1999

Background: Clonidine, an ${\alpha}_2$ adrenergic agonist blocks nerve conduction. However, in our previous experiment we found that adrenaline neither blocks nerve conduction by itself nor augment nerve conduction blockade by lidocaine near clinical concentrations. Possible explanations are: 1) there may be antagonism between some of adrenergic receptors, 2) clonidine may block nerve conduction via non-adrenergic mechanism. The purpose of this study is to obtain dose-response curves of several different forms of adrenergic receptor agonist to see the relative potencies of each adrenergic receptors to block nerve conduction. Methods: Recordings of compound action potentials of A-fiber components (A-CAPs) were obtained from isolated sciatic nerves of adult male Sprague-Dawley rats. Nerve sheath of the sciatic nerve was removed and desheathed nerve bundle was mounted on a recording chamber. Single pulse stimuli (0.5 msec, supramaximal stimuli) were repeatedly applied (2Hz) to one end of the nerve and recordings of A-CAPs were made on the other end of the nerve. Dose-response curves of epinephrine, phenylephrine, isoproterenol, clonidine were obtained. Results: $ED_{50}$ of each adrenergic agonist was: $4.51\times10^{-2}$ M for epinephrine; phenylephrine, $7.74\times10^{-2}$ M; isoproterenol, $9.61\times10^{-2}$ M; clonidine, $1.57\times10^{-3}$ M. Conclusion: This study showed that only clonidine, ${\alpha}_2$ adrenergic agonist, showed some nerve blocking action while other adrenergic agonists showed similar poor degree of nerve blockade. This data suggest that non-effectiveness of epinephrine in blocking nerve conduction is not from the antagonism between adrenergic receptors.

• The Korean Journal of Pain
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• 제34권3호
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• pp.250-261
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• 2021

Background: Complex regional pain syndrome type I (CRPS-I) consists of disorders caused by spontaneous pain or induced by some stimulus. The objective was to verify the effects of photobiomodulation (PBM) using 830 nm wavelength light at the affected paw and involved spinal cord segments during the warm or acute phase. Methods: Fifty-six mice were randomized into seven groups. Group (G) 1 was the placebo group; G2 and G3 were treated with PBM on the paw in the warm and acute phase, respectively; G4 and G5 treated with PBM on involved spinal cord segments in the warm and acute phase, respectively; G6 and G7 treated with PBM on paw and involved spinal cord segments in the warm and acute phase, respectively. Edema degree, thermal and mechanical hyperalgesia, skin temperature, and functional quality of gait (Sciatic Static Index [SSI] and Sciatic Functional Index [SFI]) were evaluated. Results: Edema was lower in G3 and G7, and these were the only groups to return to baseline values at the end of treatment. For thermal hyperalgesia only G3 and G5 returned to baseline values. Regarding mechanical hyperalgesia, the groups did not show significant differences. Thermography showed increased temperature in all groups on the seventh day. In SSI and SFI assessment, G3 and G7 showed lower values when compared to G1, respectively. Conclusions: PBM irradiation in the acute phase and in the affected paw showed better results in reducing edema, thermal and mechanical hyperalgesia, and in improving gait quality, demonstrating efficacy in treatment of CRPS-I symptoms.

• The Korean Journal of Pain
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• 제4권1호
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• pp.56-59
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• 1991

Piriformis syndrome is a syndrome of low back and leg pain thought to be due to chronic contracture of the piriformis muscle that causes irritation of the sciatic nerve. We have utilized an alternative approach using cauaal steroid in local anesthetics injection in the treatment of piriformis syndrome. I it was a very effective method without any complications.

• Journal of Yeungnam Medical Science
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• 제37권4호
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• pp.337-340
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• 2020

Ureterosciatic hernia is extremely rare. In ureteral herniation, ureter prolapses occur through either the greater or lesser sciatic foramen. Atrophy of the piriformis muscle, hip joint diseases, and defects in the parietal pelvic fascia are predisposing factors for the development of ureterosciatic hernia. Most symptomatic patients have been treated surgically, with conservative treatment reserved only for asymptomatic patients. To the best of our knowledge, long-term follow-up outcomes after ureterosciatic hernia management are sparse. In this paper, we report the case of a 68-year-old woman who presented with colicky left abdominal pain. After computed tomography (CT) scan and anterograde pyelography, she was diagnosed ureterosciatic hernia with obstructive uropathy. We performed ureteral balloon dilatation and double-J ureteral stent placement. After this minimally invasive procedure, CT scan demonstrated that the left ureter had returned to its normal anatomical position without looping into the sciatic foramen. The patient remained asymptomatic with no adverse events 7 years after the minimally invasive procedures. This brief report describes ureterosciatic hernia successfully managed with minimally invasive procedures with long-term follow-up outcomes.