• The Korean Journal of Pain
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• 제29권3호
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• pp.189-192
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• 2016

Thoracotomy is a surgical technique used to reach the thoracic cavity. Management of pain due to thoracotomy is important in order to protect the operative respiratory reserves and decrease complications. For thoracotomy pain, blocks (such as thoracic epidural, paravertebral, etc.) and pleural catheterization and intravenous drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDs], and opioids, etc., can be used. We performed a serratus anterior plane (SAP) block followed by catheterization for thoracotomy pain. We used 20 ml 0.25% bupivacaine for analgesia in a patient who underwent wedge resection for a lung malignancy. We provided analgesia for a period of close to seven hours for the patient, whose postoperative VAS (visual analog scale) scores were recorded. We believe that an SAP block is effective and efficient for the management of pain after thoracotomy.

• The Korean Journal of Pain
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• 제2권1호
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• The Korean Journal of Pain
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• 제4권1호
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• pp.31-36
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• 1991

Intraspinal alcohol or phenol administration has been used for the treatment of intractable pain due to terminal cancer. It has been alleged to produce good pain relief with minimal complication if performed carefully. We analysed 35 patients who received epidural or subarachnoid neurolytic block out of 83 patients with malignancy who were referrecl to our pain clinic. Most of the patients needed additional treatment modalities including epidural catheterization or systemic narcotic administration. The incidence of complication was high, especially when the neurolytic agents were administered in the lumbar region. This suggest that intraspinal neurolytic block is unreliable and unsafe, although it may temporarily reduce the analgesic requirement.

• The Korean Journal of Pain
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• 제5권2호
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• pp.269-272
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• 1992

대상포진후 신경통은 통증 치료실에서 흔히 만나는 질환이지만 가장 치료하기 힘든 질환 중의 하나이다. 따라서 통증 치료를 담당하는 의사는 자기가 알고 모든 지식을 동원하여 환자를 치료하지만, 그 결과는 대개 만족스럽지 못하고, 또 뜻하지 않은 합병증을 당하여 당황하는 수도 있었다. 저자들은 폐 결핵등의 과거력을 가진 대상포진후 신경통 환자의 치료 도중에 반복적인 늑간신경 차단이 기여했으라라고 생각되는 흉막삼출액 발생을 경험하였기에 보고하는 바이다.

• The Korean Journal of Pain
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• 제19권1호
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• pp.101-103
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• 2006

Oral prostaglandin E1 (PGE1) is a medicine that is clinically applied during a treatment of patients suffering with vascular disease with chronic arterial obstruction because it has vasodilation and anti-platelet effects. The mechanisms of lumbosacral symptoms associated with spinal stenosis probably include vascular insufficiency with hypoxic injury to the cauda equina and the nerve roots. Thus, increasing the blood supply would be beneficial to improve the pathophysiologic condition. Several studies on the improvement of clinical symptoms of spinal stenosis by PGE1 treatment have been reported on. In this case, 47-year old female underwent posterior compression and posterolateral fusion with a cage at L2-4 due to L3 compression fracture, and she did not show improvement of the radiating pain of her right leg after the operation. Therefore, she received repetitive epidural catheterization and adhesiolysis, epidural block and physical therapy, but her symptoms deteriorated after temporary improvement. Finally, she was given PGE1 and the radiculopathy was completely improved, although some muscle weakness still remained.

• The Korean Journal of Pain
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• 제2권2호
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• pp.203-207
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• 1989

통증치료의 분야에서 뿐 만 아니라 환자를 진단하고 치료하는 의학의 전반에 걸쳐 예기치 못한 합병증의 발생은 어쩌면 피할 수 없는 것인지도 모른다. 따라서 환자를 진료하는 의사는 합병증의 발생에 대한 잠재적 가능성을 언제고 염두에 두어야하고, 일단 합병증이 발생하였더라도 임기응변으로 적절히 대처할 수 있는 지식과 기술을 폭넓게 갖추고 있어야 한다고 생각된다. 저자들은 통증치료목적으로 지주막하 alcohol차단, 경천추차단, 경막외 catheter 거치중 폐기종, 약물의 이상확산, catheter 절단을 각각 경험하였으므로 이에 관하여 고찰하였다.

• The Korean Journal of Pain
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• 제34권3호
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• pp.346-368
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• 2021

Background: Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management. Methods: An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months). Results: This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence. Conclusions: Based on the present systematic review, with one RCT and 5 non-randomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.

• The Korean Journal of Pain
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• 제10권2호
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• pp.225-230
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• 1997

Background: Authors modified the traditional continuous axillary brachial plexus block technique of Selander for purpose of increasing success rate and decreasing complications by use of commercial epidural anesthesia set. Method: Thirty-nine patients scheduled for upper extremity operations were injected with 40 ml of anesthetic solution by axillary perivascular technique, using 23~25G immobile needle at 2 cm from the pectoralis major. Tuohy needle was immediately introduced at 4 cm from the pectoralis major and pierced the expanded neurovascular sheath at an angle of 30 degree to the skin. The "pop" was well noted well. Needle was advanced 0.5 to 3.0 cm and epidural catheter introduced through the needle. After removal of needle, occlusive dressing was done. Tip of catheter and spread of solution were demonstrated by fluoroscopy with contrast dye after completion of procedure. Result: Catheter insertion was successful at first attempt for all case. Total length of insertion was from 6 to 13($10.0{\pm}1.7$) cm. Tip of catheter was placed in infraclavicular space(66.7%), about the humeral head(17.9%) and in upper arm in 3 cases as U-shape(7.9%). Catheters were maintained for $6.7{\pm}2.6$(3-12) days. There were no complications such as: perforation of major vessels, needle trauma to nerve, infection, bleeding or hematoma. Conclusion: This study demonstrated continuous axillary brachial plexus block with epidural anesthesia set is safe, easy and convenient modification of technique of Selander.

• The Korean Journal of Pain
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• 제11권1호
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• pp.36-40
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• 1998

Background: Recently, it has been demonstrated that endothelin(ET) and endothelin related peptides are present in the blood and plasma ET levels are increased after operation. But the causes of increasing plasma ET levels are not clearly understood. This current study was to investigate the relationship between postoperative pain and endothelin. Methods: Thirty adult patients, scheduled for upper abdominal operation under general anesthesia, were included. After operation, epidural catheterization was done for postoperative analgesia. Before induction, on complained of pain and 1 hour after analgesics administration, blood samples were obtained to measure plasma ET levels. Plasma ET concentration was determined by radioimmunoassay. Pain score was measured by visual analogue score(VAS). Mean arterial pressure(MAP) and heart rate(HR) were also recorded every sampling time. Results: There were no significant changes in plasma ET levels at the time before induction versus at the time of the pain complaints and at 1 hour after analgesic administration. Pain score was significantly reduced after epidural analgesia. There was no significant correlations between pain score and plasma ET levels. There were no significant correlation between plasma ET levels and either MAP or HR. Conclusions: These results indicate that there is lack of relationship between postoperative pain and endothelin.

• 해부∙생물인류학
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• 제29권4호
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• pp.145-154
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• 2016

이 연구에서는 경막바깥신경성형술 시행에 있어서 중요한 엉치뼈틈새에서 경막주머니종말부 및 척수원뿔 사이의 거리를 자기공명영상에서 계측하여 한국인의 생체 연구에 대한 기초 자료를 제공하고자 한다. 허리통증으로 자기공명영상을 촬영한 환자 중 척추압박골절이나 척추전방전위증 그리고 기형 등이 없는 환자 200명(남자 88명, 여자 112명)을 대상으로 하였으며, 평균 연령은 54.3세(20~84세), 평균 신장은 161.3 cm(135~187 cm)이었다. T2강조 자기공명영상을 이용하여 엉치뼈틈새에서 경막주머니종말부 그리고 척수원뿔 사이 거리를 계측하여 성별 및 신장에 따른 상관관계를 분석하였다. 엉치뼈틈새꼭지에서 경막주머니종말부까지 거리는 $62.8{\pm}9.4mm$, 엉치뼈틈새꼭지에서 척수원뿔까지 거리는 $232.2{\pm}21.8mm$, 엉치뼈틈새꼭지에서 경막주머니종말부 사이 최소 거리는 34.8 mm, 최대 거리는 93.9 mm, 엉치뼈틈새꼭지에서 척수원뿔 사이 최소 거리는 155.0 mm, 최대 거리는 284.0 mm이었다. 엉치뼈틈새꼭지에서 경막주머니종말부까지, 그리고 엉치뼈틈새꼭지에서 척수원뿔까지 거리는 모두 여성이 남성보다 짧게 나타났고(p<0.05), 엉치뼈틈새꼭지에서 경막 종말부 및 척수원뿔 사이 거리는 신장에 대해 유의한 상관관계를 보였다(p<0.01). 이 연구의 결과는 한국 성인의 엉치뼈틈새에서 경막주머니종말부 및 척수원뿔 사이 거리에 대한 생체 계측 자료를 제공하며, 경막바깥공간에 대한 임상적 시술의 안전성 확보와 한국인의 체형에 맞는 카테터 개발에 도움이 될 것이라 생각한다.