• The Korean Journal of Pain
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• 제4권2호
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• pp.162-167
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• 1991

Epidural steroid therapy has been well-established for the treatment of sciatica and low back pain. Disappointing results following surgical decompression or discectomy pain owing for to nerve root compression have led to trials of corticosteroids injected either systemically or into the intrathecal or epidural space to treat intervertebral disc. Epidural steroid is less effective in the patients with low back pain who have a history of surgical operation, so that the use of epidural morphine and methylprednisolone has been advocated for the amelioration of chronic low back pain in the post-laminectomy pain("failed back") syndrome over the past several years. We treated 47 patients with low back pain who had a history of one or two surgical procedures. We concluded that epidural steroid therapy is less effective in the patients with "failed back" syndrome than in the virgin back furthermore, there is a greater risk of complication such as inadvertent dural puncture and corresponding motor paralysis and headache.

• The Korean Journal of Pain
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• 제10권1호
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• pp.104-108
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• 1997

Spontaneous intracranial hypotension, a syndrome of low CSF pressure, occurs without preceding events such as lumbar puncture, back trauma, operative procedure or medical illness. The most characteristic symptom is an occipital or frontal headache which is aggrevated in the erect position and relieved in the supine position. This syndrome usually resolves spontaneously or with strict bed rest. When the headach persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of spontaneous intracranial hypotension. Epidural blood produces an organized clot which effectively tamponade any dural CSF leak. The rapid relief of headache immediately after the infusion of blood occur by some other mechanism, such as an increase in subarachnoid pressure that is known to occur with infusion of fluid into the lumbar epidural space. We report three cases of spontaneous intracranial hypotension successfully treated with epidural blood patch.

• The Korean Journal of Pain
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• 제11권1호
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• pp.160-164
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• 1998

We report a case of epidural hematoma occuring after bloody tap during epi-dural catheter for cancer pain control in thrombocytopenic patient. Two hours after epidurl puncture, patient experienced severe back pain and numbness of both legs. Following day, patient complained of motor paralysis and urinary difficulty. Diagnosis utilizing magnetic reasonance imaging, showed epidural hematoma extending from $T_{11}$ to $T_{12}$. Thrombocytopenia prevented surgical intervention. Therefore we restored conservative therapy with packed red cell, platelet concentration, steroid and hemostatic, which provided complete neurologic recovery, spontaneously over several days without surgical intervention.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.483-486
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• 2015

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

• The Korean Journal of Pain
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• 제23권1호
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• pp.46-50
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• 2010

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

• The Korean Journal of Pain
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• 제24권3호
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• pp.169-171
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• 2011

Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.

• The Korean Journal of Pain
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• 제12권1호
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• pp.157-161
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• 1999

We report a patient with spontaneous intracranial hypotension. In addition to the cardinal feature of a postural headache and a low CSF pressure, the patient also had subdural hematoma demonstrated by brain MRI. Radionuclide cisternography revealed a CSF leakage in the intracranium. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Methods of treatment are identical to those for post-dural puncture headaches. We experienced a patient with spontaneous intracranial hypotension developed in the intracranium who was successfully managed with a cervical blood patch.

• The Korean Journal of Pain
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• 제22권2호
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• pp.163-166
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• 2009

The superiority of air versus saline for identifying the epidural space remains unestablished. Epidural anesthesia using a loss of resistance technique (LORT) with air is associated with increasing complications of dural puncture-induced headaches and neurological and hemodynamic changes. Here, we described a case of pneumocephalus with a large amount of air that was accompanied by severe headache and nuchal and chest pain occurring after epidural block using LORT with air for combined spinal-epidural anesthesia.

• Journal of Medicine and Life Science
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• 제19권2호
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• pp.70-73
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• 2022

Here, we report a case of ultrasound-assisted subarachnoid block in a patient with severe kyphosis. A 69-year-old man was scheduled for metal removal from hip screws. He had a previous experience with subarachnoid block using the landmark-guided technique, but it was very difficult due to severe kyphosis. However, we could easily determine the correct needle insertion point using ultrasound imaging and performed a successful dural puncture on the first attempt. This case demonstrates the clinical usefulness of ultrasound imaging for subarachnoid blocks in patients with severe kyphosis.

• 디지털융복합연구
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• 제15권3호
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• pp.229-236
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• 2017

척추마취 후 두통완화를 위한 침상안정에 대한 연구에 대한 체계적 문헌고찰을 통해 이들 연구에서 사용된 연구설계, 대상자 및 주요 중재방법과 그 효과에 대해 분석하였다. 연구추출을 위해 1980년부터 2016년까지 총 4234의 문헌중 15편의 연구논문을 분석하였다. 그 결과 5239명의 척추마취를 시행한 대상자가 연구에 참여하였으며, 실험연구가 10편, 비실험연구 5편이 포함되었다. 실험연구 대부분 24시간 침상안정군을 대조군으로 선정하여 다양한 시간의 침상안정에 따른 두통 발현율을 비교하였는데 2편의 논문을 제외한 연구에서 조기이상군의 두통발현율이 낮았다. 개별연구의 연구 질 평가결과를 감안하여 척추마취 후 두통을 완화시키기 위한 적절한 침상안정시간을 산정하기 위해 다양한 연구시도와 기존연구를 이용한 메타분석연구가 필요한 것으로 사료된다.