• Journal of Dental Anesthesia and Pain Medicine
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• 제21권4호
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• pp.337-344
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• 2021

Background: The primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity. This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia. Methods: Fifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20-60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively. Results: The results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group. Conclusion: Ropivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

• 대한정형외과 초음파학회지
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• 제3권2호
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• pp.54-58
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• 2010

목적: 만성적으로 경추 동통을 호소하는 환자의 통증의 근원은 대부분 후관절인데, 증상을 일으키는 관절의 정확한 위치 확인의 어려움과 합병증 및 위약효과의 가능성으로 인해 임상에서의 적용에 의구심을 가지게 된다. 본 연구에서는 만성 경추 동통을 호소하는 환자에서 후관절 동통의 유병율을 평가하고 진단 및 치료적 목적의 초음파를 이용한 후관절 차단술의 유용성에 대해 보고한다. 대상 및 방법: 만성적이면서 비특이적인 경추 동통을 6개월 이상 호소하는 환자를 대상으로 하였다. 방사통을 동반한 추간판 탈출 관련 통증을 호소하는 환자는 그 대상에서 제외되었으며, 물리 치료나 척추 교정 요법, 약물 치료 등의 보존적 치료 요법에 실패한 환자 160명을 대상으로 하였다. 경추 동통에 대한 진단적 후관절 차단술은 1% 리도카인(lidocaine)을 사용하여 시행하였으며, 리도카인에 양성 반응을 보인 환자에 대해서는 2주 뒤 0.25% 부피바카인(bupivacaine)을 사용하였으며, 후관절 차단술 시행 이후 경추 운동시 75% 이상의 통증 감소를 보일 경우를 양성 반응으로 고려하였다. 결과: 만성 경추 동통을 호소하는 환자 160명 가운데 리도카인을 이용한 후관절 차단술에 96명, 60% 양성반응을 보였으며, 리도카인에 음성반응을 보인 환자 64명 가운데 부피바카인에 48명, 75% 양성반응을 보였다. 리도카인에 양성반응을 보였으나 부피바카인에 음성반응을 보인 가양성 환자는 48명, 50%에 해당하였다. 총 160명의 환자들의 시술 전 VAS는 평균 8.5이었으며, 2주 추시시 2.7 (p=0.001), 4주 추시시 3.6 (p=0.001)로 감소하였다. 초기 시술로 증상의 호전이 만족스럽지 않았던 8명과 경과 관찰 도중에 악화되었던 3명은 4주째 후관절 차단술을 추가적으로 실시하여 통증의 완화를 보였다. 결론: 만성 경추 동통을 호소하는 환자에 대해 초음파를 이용한 단일 차단술은 가양성 반응이 높아 진단적 가치가 상대적으로 낮으며, 후관절에 시행한 두 번의 차단술은 만성 경추 동통 환자의 중재적 통증 조절에 유용한 방법으로 사료된다.

• The Korean Journal of Pain
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• 제10권1호
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• pp.121-123
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• 1997

Stellate ganglion block(SGB) is frequently performed to relieve a patient from headache of various. We experienced a rare case of subarachnoid hemorrhage by aneurysmal rupture after SGB. A 46-year-old female patient diagnosed with tension headache, and normal MRI finding consulted our pain clinic. We performed right SGB in combination with greater occipital nerve block. The next day, we performed left SGB with 6 ml of 0.25% bupivacaine. She had no evidence of subarachnoid block or intravascular injection. 15 minutes after injection, she abruptly developed convulsion and loss of consciousness. She was given artificial respiration with oxygen. The diagnosis of ruptured left posterior communicating aneurysm was confirmed by 4-vessels angiography.

• The Korean Journal of Pain
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• 제12권2호
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• pp.250-252
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• 1999

A 77-year-old male patient was admitted to the hospital with acute appendicitis and underwent emergency appendectomy under inhalation anesthesia without any complications. After the operation, the patient was placed on epidural analgesia with the mixture of fentanyl-bupivacaine and scopolamine patch for nausea and vomiting. The patient experienced central anticholinergic syndrome (CAS) with hallucination, confusion, somnolence, dysarthria and delirium at 20 hours after patch placement and recovered from all symptoms of CAS in 24 hours after the removal of the patch. The CAS occurs when central cholinergic sites are occupied by specific drugs and also as a result of an insufficient release of acetylcholine. The diagnosis of CAS is often determined by a process of exclusion and not actually made until a positive therapeutic response to physostigmine, a centrally active anticholiesterase agent, has taken place. Treatment of CAS includes prompt removal of the patch, cleansing of the area, and physostigmine administration. The scopolamine patch should be used with extreme caution in elderly patient.

• The Korean Journal of Pain
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• 제11권1호
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• pp.138-142
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• 1998

Fibromyalgia syndrome is defined as a diffuse, aching musculoskeletal pain associated with multiple and discrete predictable tender points along with stiffness. A primary form associated without any disease is uncommon compared to the secondary diffuse fibrositis. We witnessed a case of a primary fibromyalgia syndrome. A 28-year-old woman was suffering from pain on posterior neck, right shoulder, upper back, left hand and arm for two years. She also complained of morning stiffness, fatigue, and headache. We treated her with stellate ganglion block with 0.25% bupivacaine, medication that included amitriptyline, TENS and superlizer. We also recommended aerobic exercise.

• The Korean Journal of Pain
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• 제5권1호
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• pp.121-125
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• 1992

A 37-year-old male was admitted for left chest pain during a 6 months period and was given an epidural block for pain control. Vancomycin 500 mg/4 ml instead of 0.25% bupivacaine was accidentaly injected into the epidural space. The patient suddenly complained of an unexpected chest tightness and dyspnea after epidural injection. The patient was treated with steroids and local anesthetics via epidural space and recovered without any neurologic sequelae. The patient completely recovered on the 46th postadmission day and went home without any complaints. We report this case and review the accidental injection of substances into the epidural space.

• The Korean Journal of Pain
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• 제5권1호
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• pp.113-116
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• 1992

The psoas compartment block has been advocated as the technique of choice for the surgical correction of the fractured neck of the femur. It is, moreover, widely used as a technique for postoperative analgesia. This block has not been discribed in the treatment of pain in cancer patients unitl 1988. A 54-year-old woman with advanced stomach cancer complained of pain in the right leg. Psoas compartment block using bupivacaine and methylprednisolone; was effective for pain control. Psoas compartment block is a useful procedure and can be of particular use in patients who have not responded to opiates or find the side effects intolerable.

• The Korean Journal of Pain
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• 제9권1호
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• pp.244-247
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• 1996

A 67 year old male with postherpetic neuralgia complained of right anterior chest throbbing pain and also allodynia. We performed thoracic epidural block with 0.25% bupivacaine and 1% lidocaine. Oral carbamazepine and imipramine were also administred concomitantly. One month later, patient complained of fatigue, anorexia, pruritis, jaundice, and dark urine. Liver function test values were significantly elevated then. Therefore we removed the epidural catheter and ceased all medication. Liver function test values decreased rapidly after discontinuation of medication. Hepatitis might have developed as result of drugs administered and could have been prevented if the patient had been monitored with regular clinical laboratory follow up. The purpose of this case report is emphasize the importance of early regular laboratory test to detect any possible side effect that may occur by administration of drugs during treatment of chronic pain.

• The Korean Journal of Pain
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• 제9권1호
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• pp.264-267
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• 1996

Cervical epidural block can be useful in the management of acute and chronic pain of the head, neck, shoulder, and arm, for selected patients. In spite of the widespread use of cervical epidural blocks for pain, there is limited published data on the specific technique and complications regarding the procedure. High levels of epidural block do not appear to be associated with clinically significant circulatory or ventilatory changes unless the concentrations of local anesthetics used are great enough to produce paralysis of intercostal and phrenic nerves. However, high level of epidural block is associated with sympathetic block which may affect responses of circulatory and ventilatory systems. Accordingly, the possibility of major complications of cervical epidural block must be borne in mind. We experienced two cases of respiratory arrest during cervical epidural block with bupivacaine. This is a report regarding complications of cervical epidural block.

• 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.