• The Korean Journal of Pain
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• v.36 no.2
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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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• v.2 no.2
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• pp.198-202
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• 1989

The Tolosa-Hunt syndrome is one of the rare disease with facial, especially peri-orbital pain, and ophthalomoplegia associated mostly with granulomatous lesions in cavernous sinus or superior orbital fissure. In addition to ophthalmoplegia by multiple cranial nerve involvement, the sympathetic nervous system may also be involved leading to Horner's syndrome. A typical Tolosa-Hunt syndrome has a neuro-radiologic finding of an increased density in the involved region, and a laboratory finding of an elevated ESR, as well as a dramatic response to systemic corticosteroid therapy. An unusual case of the Tolosa-Hunt syndrome with normal radiologic and laboratory findings, unresponsive to systemic corticosteroid, and some response of pain relief to a stellate ganglion block, is presented.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.347-349
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• 1995

A 43 year old man who suffered from right facial palsy was treated successfully with the application of both magnetic resonance diagnostic analyser(MRA) and drug therapy. Treatment of facial palsy is generally composed of stellate ganglion block(SGB), drug therapy and operative intervention. Short periods of exposure to appropriate magnetic resonance can beneficially modulate the balance of autonomic nervous system that are responsible for sympathetic overflow. It was concluded that recovery of facial palsy by application of both MRA and drug therapy was effective in patient who refused SGB.

• The Korean Journal of Pain
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• v.19 no.2
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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 Acupuncture Research
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• v.20 no.1
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• pp.177-190
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• 2003

Objective : This study was intended to investigate the analgesic effects of electroacupuncture(EA) on mechanical allodynia according to the frequency and intensity of EA. Also to know if mechanical allodynia and the analgesic effects of EA is related to the sympathetci nervous system and/or the purinergic system. Methods : mechanical allodynia-induced rats were produced by resecting S1-S2 nerve. The zusanli(ST36) was used for acupoint and the rats were divided into 4 groups. Each group was given different stimuli[low frequency low intensity-EA(LFLI-EA), low frequency high intensity-EA(LFHI-EA), high frequency low intensity-EA(LFHI-EA), high frequency high intensity-EA(HFHI-EA)]. Futhermore, to make sympathectomy6-OHDA and phentolamine were administered intraperitonially and the concentration of norepinephrine(NE) were measured. As a ATP blocker, suramin was applied for this study. Results : Comparing to control group, each of the 4 groups(LFLI-EA, LFHI-EA, HFLI-EA, HFHI-EA) showed a significant reduction of response frequency of mechanical allodynia. LFHI-EA was more effective than that of LFLI-EA. The LFHI-EA group also had longer lasting effects from the stimulation than the other groups. Sympathectomy didn't show any reduction of response frequency of mechanical allodynia.(Each n=6, n=4). Nor did both sympathectomy and ATP block. The response frequency wasn't reduced by sympathectomy or by sympathectomy and ATP block, but was significantly reduced with LFHI-EA Conclusions : These results suggest that EA has a significant analgesic effect on mechanical allodynia which has no connection with NE and/or ATP.

• Journal of Life Science
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• v.17 no.11
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• pp.1472-1476
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• 2007

This study was performed to observe changes of the intraocular pressure following cranial cervical ganglion block with the four different concentrations of lidocaine in beagle dogs with the normal intraocular pressure. We performed by the crossover test in ten beagle dogs divided into four groups, which were 2%, 1%, 0.5% and 0.25% lidocaine group. All experimental dogs received each four times cranial cervical ganglion block using 2 ml of lidocaine with the four different concentrations. The blocks were separately done at a week intervals in random order. Horner#s syndrome was observed in all groups. The intraocular pressure in the blocked side was significantly increased to 5 min in the 1% lidocaine group compared to the baseline (p<0.05). The intraocular pressure of 2% and 1% lidocaine groups were decreased between 25 and 45 min following cranial cervical ganglion block, while those of 0.5% and 0.25% lidocaine groups were unchanged. In conclusion, these results suggest that cranial cervical ganglion block affect on the change of intraocular pressure and 0.5% and 0.25% lidocaine are inadequate concentrations for the change of intraocular pressure in the dog with normal intraocular pressure.

• Korean Journal of Biological Psychiatry
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• v.18 no.3
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• pp.163-167
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• 2011

Complex regional pain syndrome (CRPS) is a disease that causes chronic spontaneous pain and hyperesthesia of one or more parts of legs and arms, which is accompanied with problems of the automatic nervous system or the motor nervous system. However, up to date, it is unclear what causes the syndrome and how to diagnose and treat it. Although several treatments including medication and sympathetic nerve block are performed against CRPS, the therapeutic effect of the treatments is limited. The electroconvulsive thera-py (ECT), of which the mechanism is not clarified, is a treatment used for treatment-resistant depression. ECT is also reported to be effective against pain. Therefore, we performed the ECT for a 24-year-old female patient who has been diagnosed as CRPS. Her pain had not been much improved by medications and interventional procedures. At admission to a psychiatric ward for ECT, she com-plained of over 8 points of pain on visual analogue scale and the constrained movement around the painful part. Eight ECTs-three times a week-were performed for three weeks in hospital and then the ECT once a week was performed after her leaving the hospital. During the ECTs, pain had been reduced and the range of movement in the constrained parts had increased. Further systematic re-search is needed to confirm the effect of electroconvulsive therapy against CRPS.

• Journal of Chest Surgery
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• v.33 no.3
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• pp.268-272
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• 2000

Thoracic sympathicotomy has been used safely and successfully to treat essential hyperhidrosis. However, it has been difficult to treat compansatory hyperhidrosis after thoracic sympathicotomy and focal hyperhidrosis. The sweat glands were innervated by post-ganglionic sympathetic fibers with acetylcholic serving as the transmitter. Botulinum A toxin has been reported to block neuro-transmission at the cholinergic autonomic nerve terminals. Prospecting its effect for the sweat gland, we treated 5 patients with focal hyperhidrosis with botulinum A toxin. Three patients received bilateral thoracic sympathectomy (1 case) and sympathicotomy(2 case) via VAT. The hyperhidrosis area was marked with betadine and was subdivided into squares of 2$\times$2 cm(4$\textrm{cm}^2$) each. Botulinum A toxin was injected intracutaneously in a dosage of 2.5U/0.1ml(100U/4ml) /4$\textrm{cm}^2$. A total dose of 100U of Botulinum A toxin was injected into the affected sites. Subjective assessment of sweat production by the patients using a visual analogue scale showed a 20~70% improvement. During the follow-up period, no toxic effects were observed.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.360-366
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• 2008

Purpose: Botulinum toxin type A(BoTA) can block the release of vasoconstriction cotransmitters as well as acetylcholine in nerve terminal. The authors observed that BoTA increases flap survival by preventing sympathetic collapse of peripheral vessels. Methods: 10 Sprague Dawley rats were divided into control(n=5), and BoTA group(n=5). $3{\times}10cm$ sized random pattern cutaneous flaps were elevated on the dorsal side in both groups. In BoTA group, BoTA was injected into the flap via intradermal to subdermal route, 7 days before the flap elevation. Flap survival rates (survival area/total area) were measured 7 days after the elevation. Cutaneous blood flow was measured in proximal, middle and distal compartments of the flap using laser Doppler flowmetry initially, preoperatively, at immediate postoperation, and 7 days after flap elevation, respectively. Histological examination was performed 7 days after the flap elevation. The number and shape of the vessels were evaluated under microscope. Results: Mean flap survival was $53.18{\pm}6.58%$ in control group and $93.79{\pm}6.06%$ in BoTA group, displaying statistically significant difference(p=0.0008, p<0.05). In the control group, blood flow to the middle and distal compartments of the flap decreased significantly immediately after flap elevation. In the BoTA group, blood flow to the middle compartment did not decrease(p=0.002) and slightly decreased in the distal compartment(p=0.001). Cutaneous blood flow was significantly higher in all compartments of the flap in BoTA group than in control group, 7 days after the flap elevation. In histopathologic examination, greater number of vessels were noted in the BoTA group than in the control group. Conclusion: Botulinum toxin A can increase the survival of the random pattern cutaneous flap in rats by preventing the sympathetic collapse of peripheral vessels.

• Journal of Oral Medicine and Pain
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• v.34 no.2
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• pp.197-205
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• 2009

The purpose of this study was to investigate the treatment pattern of patients with neuropathic pain (NeP) in Korea through computerized database of Health Insurance Review and Assessment Service (HIRAS) over three years' period from 2003 to 2005. The results showed that the numbers of treatment visits were the highest for diabetic neuropathy (DN), followed by postherpetic neuralgia (PHN) and trigeminal neuralgia (TN) in order. Top 3 specialties for treatment visits due to NeP conditions were neurology, neurosurgery and anesthesiology. While cost of a treatment visit was higher in anesthesiology and emergency clinics compared to other clinics, there was a tendency to increase costs for visits to clinics of rehabilitation medicine and family medicine over the three years. Cost of dental visits was relatively high for TN, atypical facial pain (AFP) and atypical odontalgia (AO). Surgeries frequently applied to patients with NeP were sympathetic plexus or ganglion block, block of peripheral branch of spinal nerve and cranial nerve or its peripheral branch block. Most common prescribed medication were anticonvulsants, anti-inflammatory analgesics and anti-psychotic drugs while anti-inflammatory analgesics were overwhelmingly frequently prescribed for AO and glossodynia. Based on the results of this study, NeP disorders more relevant to dentists were AO, TN and AFP, TN of which seems to be the most important in terms of patients' number and cost for treatment visits. This indicates that dentists, especially oral medicine specialists should actively participate in management of TN, AO and AFP and share relevant information with patients and community.