• The Korean Journal of Pain
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• 제23권1호
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• pp.60-64
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• 2010

Despite recent methodological advancement of the practical pain medicine, many cases of the chronic anorectal pain have been intractable. A 54-year-old female patient who had a month history of a constant severe anorectal pain was referred to our clinic for further management. No organic or functional pathology was found. In spite of several modalities of management, such as medications and nerve blocks had been applied, the efficacy of such treatments was not long-lasting. Eventually, she underwent temporary then subsequent permanent sacral nerve stimulation. Her sequential numerical rating scale for pain and pain disability index were markedly improved. We report a successful management of the chronic intractable anorectal pain via permanent sacral nerve stimulation. But further controlled studies may be needed.

• 대한암한의학회지
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• 제28권1호
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• pp.1-9
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• 2023

Objectives: To demonstrate an improvement of neuropathic pain after surgical site infection in a patient with anorectal cancer by administration of Soshihotang (SSHT). Methods: A 65-year-old female patient diagnosed with anorectal cancer was administered SSHT to relieve her neuropathic pain induced by surgical site infection. SSHT was administered from 4/22 to 5/2. Clinical outcomes were assessed using a numeric rating scale (NRS), and opioids administered to relieve her pain was calculated. Results: During 10 days of treatment, the NRS scale of neuropathic pain was improved and the dosage of opioids administered reduced to less than half. Conclusions: This case suggests that SSHT could be effective for the management of neuropathic pain induced by surgical site infection.

• 대한한의학회지
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• 제38권2호
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• pp.73-77
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• 2017

Objectives: To inform a clinical case of a refractory levator ani syndrome, that was improved by treatments of traditional Korean medicine (TKM). Methods: A 55-years old female had complained severe anorectal pain which didn't respond to Western medicine therapeutics during 5 months including 45-day hospitalization. Whereas the symptom was rapidly resolved by the treatment in a Korean medicine hospital, and the clinical outcome was monitored. Result: There was no abnormality explaining the anorectal pain from blood tests, gastrointestinal endoscopy, sonogram and computed tomography for abdomen and pelvis. The patient was diagnosed with a levator ani syndrome. Based on the typical feature of tenderness of lower abdomen as well as beating sign around belly, an herbal drug, Shihogayonggolmoryo-tang (柴胡加龍骨牡蠣湯) was prescribed. In addition, the warm acupuncture at BL 31 to BL 33 and moxibustion on lower abdomen were given to the patient. The anorectal pain was radically reduced from treatment 7-day, and it almost disappeared within treatment 25-day. Conclusion: This case report would provide information for the potential of TKM therapies focused on the refractory levator ani syndrome which no satisfactory therapy exist.

• The Korean Journal of Pain
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• 제23권3호
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• pp.190-197
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• 2010

Background: Conventional spinal saddle block is performed with the patient in a sitting position, keeping the patient sitting for between 3 to 10 min after injection of a drug. This amount of time, however, is long enough to cause prolonged postoperative urinary retention. The trend in this block is to lower the dose of local anesthetics, providing a selective segmental block; however, an optimal dose and method are needed for adequate anesthesia in variable situations. Therefore, in this study, we evaluated the question of whether only 1 min of sitting after drug injection would be sufficient and safe for minor anorectal surgery. Methods: Two hundred and sixteen patients undergoing minor anorectal surgery under spinal anesthesia remained sitting for 1 min after completion of subarachnoid administration of 1 ml of a 0.5% hyperbaric bupivacaine solution (5 mg). They were then placed in the jack-knife position. After surgery, analgesia levels were assessed using loss of cold sensation in the supine position. The next day, urination and 11-point numeric rating scale (NRS) for postoperative pain were assessed. Results: None of the patients required additional analgesics during surgical manipulation. Postoperative sensory levels were T10 [T8-T12] in patients, and no significant differences were observed between sex (P = 0.857), height (P = 0.065), obesity (P = 0.873), or age (P = 0.138). Urinary retention developed in only 7 patients (3.2%). In this group, NRS was $5.0{\pm}2.4$ (P = 0.014). Conclusions: The one-minute sitting position for spinal saddle block before the jack-knife position is a safe method for use with minor anorectal surgery and can reduce development of postoperative urinary retention.

• 대한한방내과학회지
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• 제45권1호
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• pp.111-118
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• 2024

목적: 본 연구는 임상에서 종종 마주치는 만성적이고 낫지 않는 항문거근증후군 환자의 한의학적 치료 유용성을 공유하고자 한다. 방법: 14년 전에 치질수술 후에 발생한 항문통증이 개선되지 않고 지속되어 고통스러웠던 47세 남자 환자의 병력과 한의학적 치료 후의 임상적 개선과정을 자세히 제시하였다. 결과: 환자는 평소 건강하였는데, 치질수술 후에 대변을 보면 시작되는 항문통이 발생하였으며, 경우에 따라서는 오전 내내 불편함이 지속되었다. 14년 동안 종종 줄어들기도 하였지만 점진적으로 심해지는 경과를 보였고, 특히 1년 전부터는 더욱 심해졌으나 다양한 치료에도 호전이 없었다. 외국에 거주하는 이유로 한국에 방문하는 기회에 본원에서 한의학적 변증 하에 한약치료 및 약침을 포함하는 침치료와 뜸 치료 후 빠르게 호전되었다. 8주 정도의 치료 후에 NRS 2로 개선되어 만족한 상태로 출국하였다. 결론: 본 증례는 특별한 치료법이 부재하는 만성적이거나 혹은 난치성 항문거근증후군에 대하여 한의학적 치료법이 하나의 훌륭한 치료법일 수 있음을 보여주는 임상 예로서 의미가 있다고 하겠다.

• The Korean Journal of Pain
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• 제10권2호
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• pp.254-257
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• 1997

Ganglion impar lies immediately anterior to the sacrococcygeal junction and blockade of the ganglion is used to treat anorectal and perineal pain. Although the technique introduced by Plancarte et at is widely practised, the bent needle is sometimes difficult to position precisely and patients find the procedure painful. We modified this approach of block of ganglion impar by positioning the needle into the sacrococcygeal junction and using the loss of resistance technique. With the patient in the lateral position, a skin wheal was raised at 1-1.5cm below the sacral hiatus. Twenty-three gauge short needle was directly placed into the sacrococcygeal junction with aid of fluoroscopic guidance. From 1 cm behind the anterior margin of the vertebral body in lateral view, we used the loss of resistance technique to confirm the retroperitoneal space. We found this modified approach easier to perform during six blocks for three patients with anorectal or perineal pain. Our modified approach through the sacrococcygeal junction may provide opportunity for wider administration of this procedure because of its simple technique, reduced pain during procedure and decreased risk of infection.

• The Korean Journal of Pain
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• 제25권2호
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• pp.89-93
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• 2012

Background: Hemorrhoid is one of the most common surgical diseases occurring in the anorectal region. In this study, we evaluated the effect of ischiorectal fossa block on alleviating post hemorrhoidectomy pain. Methods: In this study, 90 patients suffering from hemorrhoids were evaluated. They were randomly divided into 3 groups. The first group had no block, the second group an ischiorectal block with placebo (normal saline), and the third group a preemptive ischiorectal block with bupivacaine. Postoperative variables such as pain intensity, pethidine consumption, nausea, and vomiting were compared between the groups. Results: The postoperative pain score in group 1 was $8.5{\pm}1.3$ and $8.1{\pm}0.9$ (P=NS) in group 2. The post operative analgesic demand was $3.1{\pm}1.5$ and $3.3{\pm}1.8$ hours in groups 1 and 2, respectively (P=NS). The post operative pain score and analgesic demand were $4.2{\pm}2.1$ and $9.3{\pm}2.7$ hours, respectively, in group 3 (P < 0.0001). Conclusions: Preemptive ischiorectal block reduces the posthemorrhoidectomy pain and opioid demand.

• The Korean Journal of Pain
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• 제11권2호
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• pp.214-219
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• 1998

Pain is one of the most frequent and disturbing symptom of cancer patients. And almost of cancer patients are afraid of a attacks of pain related to cancer. Caring for the cancer patient can be divided into two phases. The phase of "active treatment" involves various interventions-surgical, chemical or radiological- that are designed to prolong the patient's life. "Terminal care" is the period from the end of active treatment until the patient's death. But in the majority of clinical settings, cancer pain is not being managed adequately results from a lack of education about how to treat the cancer pain management in the safest and most effective way during terminal phase. Althought organic factors represent the most important cause of their pain, it is also important to deal with the patient's psychological reactions and to take account of his or her social and family environment if treatment for chronic cancer pain is to prove adequate. Thus we try to evaluate a kinds of cancer related to pain, degree of pain, effectiveness of drugs, and patient's responses to management. In regard to the satisfaction for pain relief in pain clinics at Pusan National University Hospital(PNUH) are about 70% in patients and 90% in family. Average life expectancy in cancer patients are about 140 days (3 days- 5.7 years). Cancer patients are complained of several discomfortness (above 30 kinds) such as, pain associated with cancer (75%), nausea and vomitting (38%), sleeping disorder (38%), anorexia (38%), dyspnea (32%), constipation (31%), etc. Distributions of cancer associated with pain are stomach cancer (21%), lung cancer (16%), cervix cancer (10%), anorectal and colon cancer (8.6%), hepatoma (8%), pancreatic cancer (3%). About 1/3 of patients are suffer from incident pain in 3~5 times in a day especially in moving, coughing, and exercise. Methods for drug delivering system before death are transdermal fentanyl patch (42%), intravenous PCA (21%), oral intake of opioid (17%), epidural PCA (14%), etc.

• Advances in pediatric surgery
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• 제6권1호
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• pp.27-31
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• 2000

Fecal incontinence is not rare in children who have been operated upon for anorectal malformation, Hirschsprung's disease, and meningomyelocele. Incontinence can negatively impact on the emotional and social development of these children. Antegrade continence enema (ACE) was utilized in 9 patients with meningomyelocele from January 1998 to June 1999. Cleanliness and post-operative complications were evaluated. Three operative techniques were employed; reversed appendicocecostomy, in situ appendicostomy and neoappendicostomy with cecal flap. All of the patients achieved complete fecal cleanliness. Four patients had post-operative complications; two with stoma leakage, one with abdominal pain on irrigation and one with stoma stenosis. The leakage was minimal and the pain on irrigation improved spontaneously. The stoma stenosis required revision 6th month postoperatively. The ACE has been shown to be safe and highly effective.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권1호
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• pp.72-75
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• 2018

Colorectal carcinoma is a well-known malignancy in adults. However, it is rare in children. Besides, it also has different behaviour in paediatric age-group and usually presents with non-specific symptoms like abdominal pain, weight loss, and anaemia. This usually leads to delay in diagnosis. Adenocarcinoma in children has unfavourable tumour histology (mucinous subtype) and advanced disease stage at presentation which lead to poorer prognosis in children. Family history, genetic typing and sibling screening are essential components of management as this malignancy is frequently seen associated with hereditary syndromes. We describe a case of unusual presentation of rectal carcinoma in a 12-year-old girl.