• The Korean Journal of Pain
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• 제9권1호
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• pp.283-287
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• 1996

Recently, continuous epidural catheter insertion is usually employed in operation and chronic pain control. Delayed migration of an extradural catheter into subdural space or subarachnoid space is a rare but life threatening complication of continuous epidural catheter insertion, especially with out patients. The symptoms may include lower extremity weakness, hypotension, drowsy and respiratory depression. We experienced two cases of lower extremity paralysis due to delayed migration into subdural or subarachnoid spaces at our pain clinic. The tecnical procedures for continuous epidural catheterization went smoothly without any complications. However, clinical signs of lower extremity paralysis and sensory loss developed gradually, about 2 hours and 30 minutes after the continuous epidural injection. Two cases were confirmed by subdurogram and myelogram.

• The Korean Journal of Pain
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• 제10권2호
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• pp.291-295
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• 1997

Technique of epidural analgesia is generally regarded a safe procedures which is widely applied in postoperative and chronic pain control. Incidence of neurologic complications following epidural analgesia are rare; however, increasing number of published reports describing transient or permanent neurologic complications following such procedures have been appearing more frequently. We report two cases of neurologic complications following epidural analgesia as we believe it is important to draw the attention of other anesthesiologist to the possibility of existence of other complications of significant medicolegal consequences.

• The Korean Journal of Pain
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• 제10권2호
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• pp.241-245
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• 1997

Persistent hiccup is defined as duration lasting longer than 48 hours. Reflex arc of hiccup is divided into three parts : afferent, central, efferent. Afferent portion of the neural pathway of hiccup formation is composed of vagus nerve, phrenic nerve, and sympathetic chain arising from T6 to T12. Efferent limb is phrenic nerve. Hiccup center is located in brain stem, midbrain, reticular system and hypothalamus. Persistent hiccup is very difficult to treat by conventional methods. We performed cervical epidural block of the phrenic nerve root for three patients suffering from persistent hiccup. The therapeutic effect was perfect. The mechanism of the cervical epidural block is not yet defined however it is thought to block the efferent nerve fibers and suppress the reflex arc of hiccup. We conclude cervical epidural block is relatively safe and very effective for treating persistent hiccup.

• Korean Journal of Anesthesiology
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• 제71권6호
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• pp.430-439
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• 2018

In infants and small children, ultrasound (US) guidance provides ample anatomical information to perform neuraxial blocks. We can measure the distance from the skin to the epidural space in the US image and can refer to it during needle insertion. We may also visualize the needle or a catheter during real-time US-guided epidural catheterization. In cases where direct needle or catheter visualization is difficult, US allows predicting successful puncture and catheterization using surrogate markers, such as dura mater displacement, epidural space widening due to drug injection, or mass movement of the drug within the caudal space. Although many experienced anesthesiologists still prefer to use conventional techniques, prospective randomized controlled trials using US guidance are providing increasing evidence of its advantages. The use of US-guided regional block will gradually become widespread in infants and children.

• The Korean Journal of Pain
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• 제11권1호
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• pp.47-53
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• 1998

Background: Epidural coadministration of opioids and local anesthetics has provided excellent analgesia during postoperative period. However, it is usually associated with the occurance of many side effects which were induced by epidural morphine. Low dose of intravenous naloxone has been known to reduce morphine-induced side effects without reversing analgesia, but the effect of epidural naloxone has not been defined in human study. Therefore we evaluated side effects and analgesia when naloxone was administered via epidural route. Methods: Eighty patients having epiduro-general anesthesia for hysterectomy were randomly assigned to one of four study groups. As a mean of postoperative pain control, all received 2 mg of epidural morphine bolusly at 1 hr before the end of surgery and continuous epidural infusion was started by Two-day Infusor containing morphine 4 mg in 0.125% bupivacaine 100 ml with either none of naloxone(Group 1, n=20), 2 ug/kg/day of naloxone(Group 2, n=20), 3 ug/kg/day of naloxone(Group 3, n=20) or 4 ug/kg/day of naloxone(Group 4, n=20). Study endpoints included visual analog scales(VAS) for pain, severity of nausea, itching, somnolence and respiratory depression. They were assessed at 2, 4, 8, 16, 32, and 48 hr postoperatively. Results: VAS for pain showed significant difference in Group 4 compared with Group 1 at all of the evaluation time. Itching score decreased significantly in Group 3 and 4 after 8 hr postoperatively and nausea score decreased significantly in Group 3 after 4 hr postoperatively. Alertness score decreased significantly in Group 3 and 4 especially in early postoperative period. Conclusion: This study suggests that epidural naloxone reduce morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect of epidural morphine.

• The Korean Journal of Pain
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• 제9권1호
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• pp.63-68
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• 1996

Background; Epidural analgesia for controlling labor pain has recently gained world-wide popularity. However, many patients scheduled for continuous epidural analgesia voice concern over harmful effects to their fetus and other possible complications such as hemodynamic changes, back pain and neurologic sequelae etc. The aim of this study was to evaluate the hemodynamic changes with and without epidural block as a measure to determine the safety of epidural analgesia during labor and delivery. Methods: Twenty healthy subjects were divided equally into two groups(Group 1 without epidural block, and Group 2 with epidural block) and serial hemodynamic measurements were taken in all subjects with transcutaneous impedence cardiography. The epidural catheter was inserted at the level of $L_{3,4}$ in Group 2 and analgesia was maintained using 0.25% bupivacaine mixed with fentanyl. Results: Cardiac output increased slightly with cervical dilatation in both groups, but no significant differences were found between the two groups. Similarly, no significant differences were found in blood pressures between the two groups. Stroke volume and end-diastolic volume indices were slightly decreased in group 1 and slightly increased in group 2. However, there were no significant differences between the two groups. The ejection fraction was nearly constant and ranging 56~59%. Conclusion: We concluded epidural analgesia for labor and delivery is a safe technique for the parturients since results indicated no significant differences in hemodynamic changes, as compared to the control group.

• The Korean Journal of Pain
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• 제9권2호
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• pp.363-367
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• 1996

Background: Recently postoperative pain control with continuous epidural analgesia has been increased. This study aimes to evaluate backpain following continuous epidural analgesia by pressure threshold meter (algometer). Methods: After informed consent, 50 ASA physical status I or II patients undergoing elective gynecologic surgery were selected. After placing epidural catheter, patients received morphine 0.05mg/kg with 0.25% bupivacaine 5 ml followed by continuous infusion of 0.125% bupivacaine 100 ml with morphine 4 mg for 48 hours. backpain was measured by pressure algometer over lumbar paraspinalis at the L4 level, 5 and 7 cm from the midline on preoperative, operation day, 1st, 2nd, 3rd, and 4th postoperative days. Results: Postoperative mean pressure thresholds of were higher than preoperative value (p<0.05). Conclusion: The continuous epidural analgesia dose not provide or aggravate postoperative backpain, but it must be evaluated for long term follow-up.

• The Korean Journal of Pain
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• 제11권1호
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• pp.143-145
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• 1998

There are reports on cervical epidural anesthesia for surgery of neck, chest and upper limb. However, there are limited published data on the specific problems with this procedure, including dural puncture, epidural abscess, and vasovagal syncopes. We experienced two cases of vasovagal syncope during cervical epidural anesthesia in the sitting position. These syncopes consisted of sudden hypotention and bradycardia, associated with nausea, dizzness and sweating. The patients were resuscitated successfully and recovered without any adverse effects. Current literature is being reviewed and the possible mechanisms of cardiac arrest under cervical epidural anesthesia in the sitting position are being discussed.

• The Korean Journal of Pain
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• 제10권1호
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• pp.109-112
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• 1997

Spontaneous intracranial hypotension(SIH) is a rare syndrome of spontaneously occurring postural headache associated with low CSF pressure. It usually occur without evidence of any preceeding events such as lumbar puncture, back trauma, operative procedure, or medical illness. This syndrome usually resolves spontaneously or with strict bed rest. When the headache persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of SIH. We experienced a case of SIH with downward displacement of brain in MRI and successfully treated with epidural blood patch.

• The Korean Journal of Pain
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• 제13권1호
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• pp.84-88
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• 2000

Background: An increase in the maximum level of sensory blockade (MLSB) following an epidural top-up in combined spinal epidural anesthesia (CSE) may be achieved by a volume effect as the volume of local anesthetic compresses the dural sac, by a local anesthetic effect, or by a combination of both effects. This study was conducted to investigate the contribution of each of these effects. Methods: Sixty patients scheduled for lower limb surgery under CSE were randomly allocated to one of three groups of twenty patients each. Using the needle-through needle technique, all patients received a subarachnoid dose of 10 mg hyperbaric 0.5% bupivacaine. At 30 min after subarachnoid injection, an epidural top-up with saline 10 ml (group II) or 0.5% bupivacaine 10 ml (group III) was administered; patients in group I received no epidural top-up. The level of sensory blockade was assessed at 5, 10, 15, 20, 25, 30 min after subarachnoid injection and at 5, 10, 15, 20, 25, 30 min after epidural top-up. Results: There was no significant difference in the MLSB and the onset time of MLSB among group I-III. Conclusions: We concluded that the epidural top-up with saline 10 ml or 0.5% bupivacaine 10 ml which injected at 30 min after subarachnoid injection did not significantly increase the level of subarachnoid block in lower extremity surgical patients.