• The Korean Journal of Pain
• /
• 제23권1호
• /
• pp.65-69
• /
• 2010

Chronic perineal pain is an often encountered problem, which produces a great degree of functional impairment and frustration to the patient and a challenge to the treating physician. The reason for this problem is that the region contains diverse anatomic structures with mixed somatic, visceral and autonomic innervations affecting bladder and bowel control and sexual function. A blockade of nociceptive and sympathetic supply to the perineal region, supplied through the ganglion impar has been shown to benefit patients with chronic perineal pain. Several options to this block have been described that chemical neurolysis, radiofrequency ablation etc. Although the analgesic effect of Botulinum toxin type A (BoNT-A) has long been considered secondary to its action for muscle relaxation, BoNT-A also affects the release of the neurotransmitters that are involved in pain perception. We describe a patient who was successfully given ganglion impar block with BoNT-A.

• Journal of Korean Neurosurgical Society
• /
• 제50권1호
• /
• pp.36-39
• /
• 2011

Objective : To evaluate the efficacy of scalene injection in patients with thoracic outlet syndrome. Methods : We selected 142 patients diagnosed with thoracic outlet syndrome between January 2005 and October 2009. We performed a series of scalene injection with conservative treatment in all cases. Patients rated their pain degrees using a visual analogue scale. We also evaluated the time to return to everyday life and work, and patients' functional capacity. Results : There were no complications or instances of inadvertent somatic or sympathetic ganglionic blockade after scalene injection. Overall, 111 patients (76.5%) experienced improved symptoms after the first set of scalene injection and 128 patients (88.2%) improved after scalene injection followed by conservative treatment. Of the 68 patients who returned to work during the study period, 54 returned within 1 week, and 62 within 2 weeks. Of those who returned to work, 61 reported nearly full functional capacity. We found that scalene injection was more effective in cases of thoracic outlet syndrome related to trauma than in those related to work-related repetitive stress. Conclusion : In patients with thoracic outlet syndrome, scalene injection effectively reduces pain. We recommend scalene injection as an adjunct to conservative treatment.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제23권1호
• /
• pp.45-51
• /
• 2023

Andersen-Tawil syndrome (ATS) is a rare genetic disease characterized by a triad of episodic flaccid muscle weakness, ventricular arrhythmias, and physical anomalies. ATS patients have various cardiac arrhythmias that can cause sudden death. Implantation of an implantable cardioverter-defibrillator (ICD) is required when life-threatening cardiac arrhythmias do not respond to medical treatment. An 11-year-old girl underwent surgery for an ICD implantation. For general anesthesia in ATS patients, anesthesiologists should focus on the potentially difficult airway, serious cardiac arrhythmias, such as ventricular tachycardia (VT), and delayed recovery from neuromuscular blockade. We followed the difficult airway algorithm, avoided drugs that can precipitate QT prolongation and fatal cardiac arrhythmias, and tried to maintain normoxia, normocarbia, normothermia, normoglycemia, and pain control for prevention of sympathetic stimulation. We report the successful application of general anesthesia for ICD implantation in a pediatric patient with ATS and recurrent VT.

• 생명과학회지
• /
• 제28권1호
• /
• pp.116-129
• /
• 2018

생물체는 스트레스에 대처하기 위한 항상성 유지 기작을 가지고 있으나, 만성적이고 반복적인 스트레스는 카테콜아민과 같은 스트레스 호르몬의 과도한 방출로 인해 인체에 해로운 영향을 미친다. 교감신경계와 암과의 관련성을 분석하는 연구는 스트레스가 암을 악화시킬 수 있다는 오랜 가설을 바탕으로 이루어졌다. 다수의 전임상연구와 역학 연구결과는 교감신경계의 주요 신호전달경로인 ${\beta}$-adrenergic signaling을 조절하는 것이 암의 진행을 억제할 수 있음을 보여주고 있다. 교감신경계의 활성화는 암세포의 oncogene과 DNA repair 유전자 조절, 생존과 사멸 조절, EMT 및 전이 조절, 면역계와 혈관신생 조절, 세포외기질과 간엽세포 조절, 지방세포 조절 등을 통해 암세포와 종양미세환경에 광범위하게 영향을 미칠 수 있다. 오늘날 암의 성장과 관련된 분자적 기전을 차단하는 표적항암치료가 각광받고 있으나, 보상경로의 활성화와 항암제 내성 출현 및 여러 부작용으로 말미암아 임상적 실패를 거듭하면서 암의 생병리를 다방면에서 조절하는 전략이 새로운 치료법으로 대두되고 있다. 본 총설에서는 이러한 암의 전신적 조절인자로서 교감신경계가 암의 형성과 발전에 미치는 영향을 요약하고, 향후 새로운 암 치료전략으로서 ${\beta}$-adrenergic signaling을 조절하는 약물의 임상적 활용가능성에 대해 논의하고자 한다.

• 고려인삼학회:학술대회논문집
• /
• 고려인삼학회 2002년도 학술대회지
• /
• pp.392-400
• /
• 2002

We have previously found that the saponins but not other components in the ginseng reduce the secretion of catecholamines (CAs) from bovine adrenal chromaffin cells, a model of sympathetic nerves, evoked by acetylcholine (ACh) due to the blockade of $Na^+$ influx through nicotinic ACh receptor-operated cation channels, and it has been concluded that the inhibitory effect may be associated with the anti-stress action of ginseng. However, the saponins, which showed the great reduction of the CA secretion, were mainly the protopanaxiatriols. The protopanaxadiol and oleanolic acid saponins had a little or little such effect. Recent studies demonstrated that the oligosaccharides connected to the hydroxyl groups of the aglycones of the saponins are in turn hydrolyzed by gastric acid and enzymes in the intestinal bacteria when the ginseng is orally administrated. In this study, the effects of their major 6 kinds of metabolites on the secretion of CAs were investigated. All metabolites (M1, 2, 3 and 5 derived from the protopanaxadiols, and M4 and 11 from the protopanaxiatriols) reduced the ACh-evoked secretion from the cells. In the metabolites, the M4 inhibition was the most potent ($IC_{50}({\mu}M):M4(9)$ < M2 (18) < M3 (19) < M1l (22) < M5 (36) < MI (38)). Although M4 also reduced the CA secretion induced by high $K^+$, a stimulation activating voltage-sensitive $Ca^{2+}$ channels, the inhibitory effect was much less than that on the ACh-evoked secretion. M4 inhibited the ACh-induced $Na^+$ influx into the cells in a concentration-dependent manner similar to that of the inhibition of the ACh-evoked secretion. When the cells were washed by the incubation buffer after the preincubation of the cells with M4 and then incubated without M4 in the presence of ACh, the M4 inhibition was not completely abolished. On the other hand, its inhibition was maintained even by increasing the external ACh concentration. These results indicate that the saponins are metabolized to the more active substances in the digestive tract and the metabolites attenuate the secretion of CAs from bovine adrenal chromaffin cells stimulated by ACh due to the noncompetitive blockade of the ACh-induced $Na^+$ influx into the cells. These findings may further explain the anti-stress action of ginseng.

• Journal of Chest Surgery
• /
• 제32권5호
• /
• pp.465-470
• /
• 1999

배경: 안면부 다한증 환자들은 수장부, 액와부 다한증 환자들 못지 않게 대인관계에 매우 어려움을 보이고 있다. 적절한 치료가 없었으나 최근 교감신경차단술을 시행하여 좋은 결과를 얻고 있다. 안면부 다한증에 대해 흉강경을 이용한 흉부 교감신경절제술은 하부 성상교감신경절을 절제하는 것으로 알려져 있으나 호너증후군과 같은 합병증의 우려 때문에 잘 시행되고 있지 않았다. 본 병원에서는 최근 6년간 수장부, 액와부 다한증 치료 경험에서 안면부 다한증도 제2흉부 교감신경절 절단만으로 충분할 것으로 판단되어 시술을 하였고, 만족할 만한 결과를 얻었다. 대상 및 방법: 서울대학교병원 흉부외과학 교실에서는 1997년 6월부터 1998년 5월까지 연속적으로 38명의 안면부 다한증 환자들에서 2 mm 기구를 이용하여 양측성 제2흉부 교감신경절단술을 시행하였다. 결과: 수술직후 전례에서 안면부 발한이 소실되었다. 합병증으로 수술후 다섯명(13.2%)에서 흉관 삽입이 필요 하였는데, 3명은 불완전한 폐의 재팽창 때문에, 나머지 2명은 심한 폐유착을 박리한후 생긴 혈흉 때문이었다. 예측되는 합병증인 호너증후군, 상완신경총 손상 등은 없었다. 모든 환자가 수술후 평균 1.7$\pm$0.9일에 퇴원하였다. 결론: 안면부 다한증에서 적절한 교감신경 절단 부위는 제2흉부 교감신경절이며, 하부 성상교감신경절을 절단하지 않음으로서 호너 증후군등의 합병증 발생을 예방할 수 있다. 아울러 미세한 2 mm 흉강경 기구를 이용한 수술이 가능하며 결과도 매우 좋다.

• 대한약리학회지
• /
• 제26권2호
• /
• pp.101-111
• /
• 1990

흰쥐, 개, 고양이의 뇌내의 머스커린수용체에 작용함이 알려져 있는 physostigmine(PS)의 동맥혈압에 미치는 효과를 urethane마취토끼에서 조사하였다. 정맥내 (iv) PS $25{\sim}250{\mu}g/kg$은 혈압변동을 일으키지 않았다. 그러나 토끼를 chlorisondamine(CS), hexamethonium, 뇌실내 (icv) clonidine, icv xylazine, icv reserpine으로 처리후 또는 척수이단후에는 승압반응을 일으켰다. CS처리토끼의 iv PS승압반응은 prazosin또는 pirenzepine처리후에는 현저히 약화되었다. Iv PS는 CS처리나 척수이단토끼에서 일어나는 McN-A-343의 승압효과를 억제하였고 또 McN-A-343주입시에는 iv PS는 승압을 일으키지 않았다. DMPP의 승압효과는 iv PS의 영향을 받지 않았다. Icv PS $12{\sim}100{\mu}g/kg$은 승압반응을 일으켰고 이는 CS처리로 강화되었다. 이 승압효과는 완전치는 않으나 prazosin 또는 pirenzepine으로 억제되었다. Angiotensin II 길항약인 $(Sar^{1},\;Ala^{8})-angiotensin$ II와 prazosin또는 pirenzepine으로 토끼를 처리할때는 icv PS승압효과는 거의 볼 수 없었다. 그러나 이 angiotensin II 길항약은 prazosin, pirenzepine의 iv PS승압반응에 대한 억제효과는 항진시키지 않았다. Icv pirenzepine은 icv PS승압반응은 차단하였으나, iv PS승압효과에는 영향을 미치지 않았다. 본실험성적은 CS처리 및 척수이단토끼에서 볼 수 있는 iv PS승압은 교감신경절의 머스커린수용체의 흥분으로 일어나고, icv PS승압은 뇌내의 머스커린수용체의 흥분으로 교감신경계 및 angiotensin계의 활성도가 높아져서 일어남을 가리키고 있다. 또한 토끼에서는 교감신경절니코틴수용체차단, 교감신경절에 미치는 중추 교감신경의 지배력의 감소 또는 척수이단등으로 교감신경절 머스커린수응체의 감수성이 바꾸어지지 않은한 iv PS는 승압반응을 일으키지 못함을 시사하고 있다.

• The Korean Journal of Pain
• /
• 제14권1호
• /
• pp.110-113
• /
• 2001

In controlling chronic intractable pains, the current therapeutic methods used are exercise, over the counter medication, cognitive-behavioral therapy, opioid medication, neural blockade, operation, etc., spinal cord stimulation being the last resort. Spinal cord stimulation was initiated when Shearly and others clinically tested the Gate control theory of Melzack and Wall. This had triggered the advancement of theoretic research on the mechanism and hardware necessary and has resulted in an accumulation of clinical experiences. This is known to be effective for treating sympathetic pain, arachnoiditis, failed back pain syndrome, radiculopathy, peripheral vascular disease, phantom limb syndrome, post-herpetic neuralgia, peripheral neuropathy, and angina pectoris. This report describes our experience in experimental spinal cord stimulation in patients with simultaneous post-herpetic neuralgia and herniated intervertebral disc. There wasn't any improvement in the post-herpetic neuralgia but the symptoms of a herniated intervertebral disc was much ameliorated. This was quite an unexpected result. The patient's back pain returned when the stimulation stopped.

• The Korean Journal of Pain
• /
• 제19권1호
• /
• pp.68-71
• /
• 2006

Background: Stellate ganglion block (SGB) is a selective sympathetic blockade that affects the head, neck and the upper extremities. It is an important method that has been frequently used in pain clinics due to its wide range of indications. But there were some problem with performing SGB at C6 or C7. Thus, various techniques have been recently introduced to successfully perform SGB; among them, there is the oblique approach. This study was performed to evaluate the effectiveness of the oblique approach for performing SGB in C7. Methods: Forty six patients with sudden hearing loss were studied. In group I, the patient underwent C7 oblique SGB with 1% mepivacaine (3 ml) under fluoroscopic guidance. In group II, the patients underwent the C7 classical anterior approach SGB with 1% mepivaine (5 ml) under fluoroscopic guidance. We compared the occurrence of Horner's syndrome, the side effects and the changes of temperature of the skin of the hand. Results: The rate of Horner's syndrome was 81.5% in the group I and 84.2% in the group II. The rate of incurring increased skin temperature (${\geq}34^{\circ}C$) of the fingers was 77.7% and 79.4% in each group, respectively. Conclusions: The C7 oblique approach for SGB showed the same SGB effect compared with the C7 anterior approach for SGB, and there were also fewer complications. We conclude that C7 oblique SGB may be a beneficial method for treating patients with this particular malady.

• The Korean Journal of Pain
• /
• 제35권1호
• /
• pp.106-113
• /
• 2022

Background: Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. Methods: This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. Results: A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. Conclusions: Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.