• The Korean Journal of Pain
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• 제8권1호
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• pp.159-163
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• 1995

Accidental high epidural block is a rare but serious complication. It can result from many factors, which include the volume and concentration of drug, posture, puncture site, age, pregnancy or intra-abdominal mass, and patients' height and weight. We had a case of accidental high epidural block recently. This is a case report which was confirmed by an epiduragram. A healthy 50-year-old woman with a huge uterine myoma was scheduled for a total abdominal hysterectomy under continous epidural analgesia. Epidural catheterization was carried out smoothly. However, an unexpected hypotension was noticed after an epidural injection of 2% lidocaine 25 ml. Thereafter, the patient was intubated and her respiration was controlled during the operation. Using the 5mg of ephedrine, her blood pressure and pulse were well maintained. The scheduled operation was carried out for one hour uneventfully, but after the operation, she felt paresthesia on her hands in the recovery room. To differentiate between the high epidural and the subdural blocks. We injected 5 ml of a water soluble Niopam 300 through the catheter postoperatively. It was observed on the epiduragram that the catheter was placed in the epidural space. It was suggested that the high epidural block was induced from the widespread diffusion through the narrowed epidural space due to the engorgement of the epidural venous plexus by the patient's huge uterine myoma.

• The Korean Journal of Pain
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• 제11권1호
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• pp.65-68
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• 1998

Background: Epidural steroid injection(ESI) is often adminstered to treat lower back pain, but its effect iveness on postepidural backache have not yet been determined. Methods: Sixty patients scheduled for cesarean section under epidural anesthesia were randomly assigned to receive, 1 ml of normal saline(Group 1), or 5 mg of dexamethasone (Group 2), epidurally via indwelling catheter after delivery. Results: The incidences of postepidural backache occured significantly more often in Group 1(56.7%) than in Group 2(26.7%)(P<0.05). There was a significant association between postepidural backache and multiple attempts at epidural needle placement. Conclusion: Epidural dexamethasone has a preventive effect on postepidural backache.

• The Korean Journal of Pain
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• 제34권1호
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• pp.114-123
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• 2021

Background: Evaluation of the effectiveness of caudal epidural injection on pain, spine mobility, disease activity, and activity of daily living in axial spondyloarthritis (SpA) patients. Methods: A total sample of 47 patients were registered in this study. They were randomly assigned into 2 groups; Group I received caudal epidural injections, ultrasound-guided, with 1% lidocaine hydrochloride mixed with triamcinolone, whereas Group II did not receive any injections. All participants fulfilled the ASAS criteria for axial SpA. Outcome measures were as follows: visual analogue scale, Oswestry disability index (ODI), modified Schober test, lateral lumbar flexion, and Ankylosing Spondylitis Disease Activity Score (ASDAS) with assessment at baseline, 2 weeks, and 8 weeks post-treatment. This clinical trial was registered on clinicaltrials.gov under the number NCT04143165. Results: There was a significant difference between both groups regarding pain, ODI, spine mobility and ASDAS scores in favor of group I. This effect was at its maximum after 2 weeks. Despite the decline of this effect after 2 months, the difference between the groups remained significant. Higher disease activity, younger age, and shorter disease duration were associated with better outcomes. Conclusions: Epidural injection of lidocaine and triamcinolone is a cost effective and a practical technique for controlling pain, as well as improving the function of the spine and disease activity scores in axial SpA patients with acceptable complications and relatively sustained effect.

• The Korean Journal of Pain
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• 제12권1호
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• pp.95-100
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• 1999

Background: About 75% of terminal cancer patients have severe pain. For the treatment of these patients, physicians usually use potent opioid analgesics. But many of the cancer patients were not controlled by IV or IM injection of opioids. In spite of the untreatable nature of the patient's illness, they should be hospitalized only for pain control. In that case, epidural opioid injection is one of the most effective methods in pain management. Methods: We retrospectively analyzed 126 terminal cancer patients who were treated with epidural morphine for pain management from 1993-97. In the routine procedure, an epidural catheter was inserted into the epidural space and tunnelled subcutaneously, exiting out from the anterior chest or abdomen. Morphine was used as the main analgesic and Multiday Infusor$^{(R)}$ (Baxter, 0.5 ml/h) as a continuous infusion system. Results: 1. Mean treatment time was 55 days (range; 3~373). 2. Mean daily epidural start mg dose of morphine was 8 mg (range; 2~20). 3. Mean daily dose at termination was 19 mg (range; 4~60) 4. 94 patients were controlled with continuous infusion but 32 patients needed additional bolus doses of morphine. 5. heter-associated subcutaneous infection occurred in 2 patients (1.6%). Conclusion: Terminal cancer pain management administered by a tunnelled epidural catheter is a simple, inexpensive method with a very small rate of infection.

• The Korean Journal of Pain
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• 제24권4호
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• pp.221-225
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• 2011

Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.

• The Korean Journal of Pain
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• 제20권1호
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• pp.26-30
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• 2007

Background: Epidural steroid injections (ESI) are a common treatment for spinal disorders. Previous research has shown that aspiration of the syringe is not a sensitive test for placement of an intravascular needle. Serious complications have been reported from injection of steroids and local anesthetics into the vascular space. In addition to safety concerns, the efficacy may decline with partial injection outside the desired epidural location. We hypothesized that incidence of vascular problems is increased in patients who undergo spine surgery compared with the patients who don't undergo spine surgery. We investigated the incidence of vascular problems during lumbosacral transforaminal ESI and we compared the difference of vascular problems between the patients who undergo spinal surgery and those patients who don't undergo spinal surgery. Methods: Two hundreds and three patients were consecutively recruited and they received 299 fluoroscopically guided lumbosacral transforaminal ESIs. Injection of contrast was performed under live dynamic fluoroscopy with using digital substraction analysis. The observed uptake pattern was classified into one of three categories: flashback, aspirated, and positive contrast with negative flashback and aspiration. Results: The vascular incidence rate was 20.4%. Transforaminal ESIs performed at S1 had avascular incidence rate of 27.8% compared with 17.7% for all the other lumbar injection sites. The sensitivity of spontaneous observation of blood in the needle hub or blood aspirate for predicting an intravascular injection in lumbar transforaminal ESIs was 70.4%. Conclusions: There is a high incidence of intravascular problems when performing transforaminal ESIs, and this is significantly increased in patients with previous spine surgery. Using a flash or blood aspiration to predict an intravascular injection is not sensitive therefore; a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are prone to instill medications intravascularly. This finding confirms the need for not only fluoroscopic guidance, but also for contrast injection instillation when performing lumbosacral transforaminal ESIs, and especially for patients with previous spine surgery.

• The Korean Journal of Pain
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• 제27권2호
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• pp.168-173
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• 2014

Background: Recently, there have been several case reports and retrospective studies about the incidence of intradiscal (ID) injection during transforaminal epidural steroid injection (TFESI). Inadvertent ID injection is not a rare complication, and it carries the risk of developing diskitis, although there has been no report of diskitis after TFESI. We prospectively evaluated the incidence of inadvertent ID injection during lumbar TFESI and analyzed the contributing factors. Methods: Ten patients received 2-level TFESI, and the remaining 229 patients received 1-level TFESI. When successful TFESI was performed, 2 ml of contrast dye was injected under real-time fluoroscopy to check for any inadvertent ID spread. A musculoskeletal radiologist analyzed all magnetic resonance images (MRIs) of patients who demonstrated inadvertent ID injection. When reviewing MRIs, the intervertebral foramen level where ID injection occurred was carefully examined, and any anatomical structure which narrowing the foramen was identified. Results: Among the 249 TFESI, we identified 6 ID injections; thus, there was an incidence of 2.4%. Four patients had isthmic spondylolisthesis, and the level of spondylolisthesis coincided with the level of ID injection. We further examined the right or left foramen of the spondylolisthesis level and identified the upward migrated disc material that was narrowing the foramen. Conclusions: Inadvertent ID injection during TFESI is not infrequent, and pain physicians must pay close attention to the type and location of disc herniation.

• The Korean Journal of Pain
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• 제11권1호
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• pp.41-46
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• 1998

Background: Preoperative analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and therefore may preempt postoperative pain. Although preemptive analgesia has shown to decrease postinjury pain in animals, studies in human are not consistent. We studied whether epidural morphine injection before surgical incision could affect postoperative pain and analgesic demands, compared with injection after removal of specimen. Methods: Forty patients scheduled for radical subtotal gastrectomy were randomly assigned to one of two groups for prospective study in a double-blind manner. Group 1 received an epidural injection of 3 mg of morphine in 8 ml of 0.9% saline before surgical incision, and Group 2 after removal of specimen. Postoperative pain relief was provided with I.V. patient controlled analgesia (PCA) system. Numerical rating scales for pain and mood, Prince Henry Hospital scores for pain, cumulative PCA analgesic consumptions, and incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. Results: Cumulative PCA analgesic consumption in group 1 was significantly less than in group 2 at 2, 6 hours after surgery. Pain scores and the incidence of side effects were similar in both groups. Conclusions: Preoperative analgesia with epidural morphine showed little difference in patient controlled analgesic consumption after upper abdominal surgery compaired to intraoperative morphine.

• Journal of Yeungnam Medical Science
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• 제2권1호
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• pp.39-44
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• 1985

상복부 수술후 진통을 위하여 경막외 narcotics 주입시 임상에서 경막외강 천자가 가장 많이 시술되고 있는 부위 안 요부 경막외강에 morphine과 demerol을 각각 주입하여 진통 효과를 관찰하였다. 전신 마취하에서 상복부 수술을 받은 환자 20명을 대상으로 하여서 morphine 1 mg을 주입한 10명의 I군, demerol 10mg을 주입한 10명의 II군에서의 진통 효과를 관찰하였던 바 다음과 같은 결론을 얻었다. 1. Morphine 을 주입한 I군에서는 평균 진통 시간이 29.4시간이었다. 2. Demerol을 주입한 II군에서는 평균 진통 시간이 4.0시간이었다. 3. Morphine을 주입한 I군이 Demerol을 주입한 II군보다 진통 시간이 훨씬 길었으며 통계학적으로 유의하였다. (P<0.05) 이상의 결과로 보아 상복부 수술후 진통 목적으로 마약제를 경막외강에 투여시 시술이 안전한 요부 경막외강내로 투여하여도 우수한 진통효과를 얻을 수 있으며 마약제로는 morphine의 투여가 demerol의 투여보다 더욱 진통 효과가 우수한 것으로 사료된다.

• Journal of Chest Surgery
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• 제30권8호
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• pp.809-814
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• 1997

마약성 진통제와 국소마취제에 의한 지속적 경막외마취는 개흉술후 통증감소를 위한 방법으로 널리 사용되고 있다. 본 연구에서는 지난 1994년 1월부터 1995년 7월까지 본원 흉부외과에서 츠방 혹은 후측방 개흉술을 받은 환자 38명을 대상으로 19명씩 실험군과 대조군으로 구분하여 실험군에 경막외마취를 시행하여 그 효과를 조사하였다. 먼저 lidocaine과 norphine을 섞어 경막서 지속적 외도관을 통해 주사하고 그후 bupivacaine과 morphine을 섞어 술후 5∼6일간 지속투여를 하였다. 대조군에 비해 실험군에서 환자의 통증수치와 상지거상능력과 호흡수는 주사추 30분부터 통계적으로 의미 있게 변화되어 술후 통증이 경감되고 있음을 알 수 있었고, 말초동맥혈 이산화탄소분압은 2시간 후부터 통계적으로 의미 있게 줄어들어 환자가 효과적인 호흡을 하고 있음을 알 수 있었다. 술후 재원기간도 의미 있게 줄어들었다. 경막외마취의 주요한 합병증으로는 뇨정체가 있었으나 심각하지는 않았다. 이상의 결과로 우리는 개흉술후 경막외마취가 우수한 통증완화 효과가 있어 술후 폐합병증을 예방하고 술후 빠른 회복에도 좋은 영향을 미치는 것으로 생각한다.