• The Korean Journal of Pain
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• 제7권2호
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• pp.263-269
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• 1994

Causaliga is a syndrome of sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes. Various treatments of causalgia contain sympathetic blockade, sympathectomy, transcutaneous electrical nerve stimulation, physical therapy, cryotherapy and psychotherapy. Repeated stellate ganglion blocks with 6ml of 0.25% bupivacaine provided good results for 2 patients. We recommand sympathetic blocks for treatment of causalgia.

• The Korean Journal of Pain
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• 제19권2호
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• pp.271-274
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• 2006

Unstable angina is a critical phase of coronary heart disease, with widely variable symptoms and prognoses. Recently, despite the advances in surgical revascularization, catheter-based revascularization and medical treatment, an increasing number of patients with angina pectoris are refractory to medical therapy and; therefore, can not be considered as candidates for coronary artery bypass grafting or interventional angioplasty. These patients are often treated with narcotics for pain relief, and forced to severely reduce their levels of activity and productivity. It has become clear that alleviating the pain caused by myocardial ischemia may be possible by altering the sympathetic afferent nerve fibers. Sympathetic blockade can be produced using high thoracic epidural analgesia. Herein, the case of a patient with intractable angina and poor ventricular function, who received high thoracic epidural analgesia to relieve ischemic chest pain, is reported.

• The Korean Journal of Pain
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• 제8권2호
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• pp.363-366
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• 1995

Blockade of the ganglion impar was performed as an alternertive means of managing intractable neoplastic perineal pain of sympathetic origin. We successively treated a patient who had suffered from excessive perianal sweating with ganglion impar block using pure alcohol. Eight months after block, the patient has no complaint of perianal sweating. Ganglion impar block is an effective method in the treatment of excessive perianal sweating as well as perineal pain of sympathetic origin.

• 약학회지
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• 제22권3호
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• pp.138-147
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• 1978

Bethanidine, which is known as a sympathetic blocking agent, was injected into the vein of a dog in an attempt to investigate the influence on renal funciton. Bethanidine resulted in an increased urine flow and glomerular filtration rate, and it produced an increase of urinary sodium and potassium excretion and a decrease of reabsorption rate of sodium and potassium in renal tubules, whereas renal plasma flow showed no significant changes. After pretreatment of phentolamine, a specific alpha adrenergic blocking agent, bethanidine did not significantly increase glomerular filtration rate and diuresis, significantly increased urinary sodium and potassium excretion although the magnitudes were reduced when compared with that of bethanidine alone. In conclusion, bethanidine-induced diuresis appears to be the result of an inhibited tubuler reabsorpting of electrolytes within the kidney through its sympathetic blockade of renal nerves and of an increased glomerular filtration rate, which was caused by the constriction of vas efferense in the glomeruli.

• The Korean Journal of Pain
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• 제13권2호
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• pp.247-250
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• 2000

Recently, some authors reported that discogenic low back pain should be regarded as a referred pain in respect of neural pathway. The afferent pathways of discogenic low back pain is transmitted mainly by sympathetic afferent fibres from the sinuvertebral nerves in the second lumbar nerve root. This pain arises from the lumbar intervertebral discs, and it had been transmitted mainly through the sympathetic afferent fibres contained in the second lumbar spinal nerve root. Second lumbar dermatome corresponds to the low back area. We experienced a case of low back pain which could not be controlled by conventional therapy and progressed wax and wane. The CT finding showed bulging disc between $L_4$ and $L_5$ and spinal stenosis in $L_4$ area. And epiduroscopic feature showed severe adhesion in $L_4$, $L_5$ and $S_1$. After we blocked $L_2$ root, pain score decreased 10 to 2. Therefore, the $L_2$ root block may be a useful diagnostic procedure as well as provide therapeutic value.

• The Korean Journal of Pain
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• 제12권2호
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• pp.238-241
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• 1999

Intractable pain arising from disorders of the viscera and somatic structures within the pelvis and perineum often poses difficult problems for the pain pratitioner. The reason for this difficulty is that the region contains diverse anatomic structures with mixed somatic, visceral, and autonomic innervation affecting bladder and bowel control and sexual function. Clinically, sympathetic pain in the perineum has a distinctly vague, burning, and poorly localized quality and is frequently associated with the sensation of urgency. Although various approaches have been proposed for the management of intractable perineal pain, their efficacy and applications are limited. Historically, neurolytic blockade in this region has been focused mainly on somatic rather than sympathetic components. The efficacy of neurolytic ganglion impar block has been demonstrated in treating perineal pain without significant somatovisceral dysfunctions for patient with advanced cancer in 1990. The introduction of superior hypogastric plexus block in 1990 demonstrated its effectiveness in patients with cancer related pelvic pain. In our report, five patients had advanced cancer (rectal caner 3; cervix cancer 1; metastases to sacral portion of renal cell cancer 1). Localized perineal pain was present in all cases and was characterized as burning and urgent with 9~10/10 pain intensity. After neurolytic block of ganglion impar, patients experiened incomplete pain reduction (7~8/10), as determined by the VAS (visual analogue scale), and change in pain site. We then treated with superior hypogastric plexus block, which produced satisfactory pain relief (to less than 4/10), without complication.

• 대한약리학회지
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• 제28권1호
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• pp.61-74
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• 1992

마취가토에서 혈압유지에 중요한 역할을 하고 있는 교감신경계, renin-angiotensin계, vasopressin계를 차단하였을때의 혈압자체의 변동과 norepinephrine (NE), angiotensin II (AII) 및 vasopressin (VP)의 승압효과의 변동을 조사하였다. 교감신경계와 renin-angiotensin계의 차단에는 각각 교감신경절 차단약인 chlorisondamine (CS)과 pirenzepine (PZ), angiotensin 변환효소억제약인 enalapril (ENAL)를 사용하였다. VP계의 차단에는 혈장 VP농도를 하강시킴이 알려져 있는 kappa opioid 수용체의 작용약인 bremazocine (BREM)을 사용하였다. CS (0.4mg/kg), ENAL (2mg/kg), BREM (0.25mg/kg)은 각각 비슷한 정도의 저혈압상태를 일으켰다. BREM에 의한 저혈압은 VP와 같은 효과를 가진 합성약인 desmopressin으로 유의하게 길항되었으며 BREM에 의한 저혈압이 적어도 일부 혈장 VP농도의 하강과 관계있음을 시사하였다. CS는 ENAL 또는 BREM으로 하강된 혈압을, ENAL은 CS 또는 BREM으로 하강된 혈압을, BREM은 CS 또는 ENAL로 하강된 혈압을, 더욱 하강시켰다. CS, PZ 그리고 ENAL 또는 CS, PZ 그리고 BREM에 의한 저혈압은 CS이외의 세약물에 의한 저혈압보다 심하였다. CS는 NE에 의한 승압효과 뿐만아니라 AII와 VP의 승압효과도 강화시켰다. AII의 승압효과는 또 ENAL과 BREM으로도 증대되었다. VP의 승압효과는 BREM으로도 강화되었다. ${\alpha}$-수용체의 길항약인 phentolamine과 phenoxybenzamine은 AII와 VP승압효과를 강화시켰다. 3승압계 차단이 혈압자체에 미치는 실험결과는 3계가 모두 혈압조절에 관여하고 그 중에서도 교감신경계가 가장 큰 역할을 하고 있음을 가리키고 있다. 한 승압계의 차단하에서, 그 계의 승압 hormone 뿐만아니라 다른 계의 승압 hormone의 승압효과도 증대됨은 이 3승압계가 긴밀한 상호작용을 하고 있는 증거이다.

• The Korean Journal of Pain
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• 제18권2호
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• pp.240-245
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• 2005

Herein is described the successful treatment of complex regional pain syndrome type II with the combination treatment of spinal cord stimulation and radiofrequency thermocoagulation of the lumbar sympathetic ganglion. A 62 years old male patient, suffering from CRPS type II in his left lower extremity, visited our pain clinic. Medication and nerve blockade produced only slight improvement in his symptoms and signs. Therefore, a linear type spinal cord simulator was inserted into the thoracic epidural space, using a non-surgical percutaneous approach, with the cephalad lead located at the T11 level. Two months later, the repositioning of the electrode to the T12 level for more effective pain control, with radiofrequency thermocoagulation of lumbar sympathetic ganglion also performed at the left L2 and 3 levels for the control of trophic change. These resulted in significant pain relief and decreased trophic change, with no complications, after which the patient was able to resume a normal life.

• The Korean Journal of Physiology and Pharmacology
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• 제18권6호
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• pp.489-495
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• 2014

Protease-activated receptor (PAR)-2 is expressed in endothelial cells and vascular smooth muscle cells. It plays a crucial role in regulating blood pressure via the modulation of peripheral vascular tone. Although some reports have suggested involvement of a neurogenic mechanism in PAR-2-induced hypotension, the accurate mechanism remains to be elucidated. To examine this possibility, we investigated the effect of PAR-2 activation on smooth muscle contraction evoked by electrical field stimulation (EFS) in the superior mesenteric artery. In the present study, PAR-2 agonists suppressed neurogenic contractions evoked by EFS in endothelium-denuded superior mesenteric arterial strips but did not affect contraction elicited by the external application of noradrenaline (NA). However, thrombin, a potent PAR-1 agonist, had no effect on EFS-evoked contraction. Additionally, ${\omega}$-conotoxin GVIA (CgTx), a selective N-type $Ca^{2+}$ channel ($I_{Ca-N}$) blocker, significantly inhibited EFS-evoked contraction, and this blockade almost completely occluded the suppression of EFS-evoked contraction by PAR-2 agonists. Finally, PAR-2 agonists suppressed the EFS-evoked overflow of NA in endothelium-denuded rat superior mesenteric arterial strips and this suppression was nearly completely occluded by ${\omega}$-CgTx. These results suggest that activation of PAR-2 may suppress peripheral sympathetic outflow by modulating activity of $I_{Ca-N}$ which are located in peripheral sympathetic nerve terminals, which results in PAR-2-induced hypotension.

• 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.