• The Korean Journal of Pain
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• v.14 no.1
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• pp.68-75
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• 2001

Background: Thoracotomy is the operation that produces the most postoperative pain, necessitating the highest requirements for postoperative analgesics. The common methods of treating postthoracotomy pain are the use of thoracic epidural analgesia, intemittent or continuous intercostal nerve blocks, intravenous narcotics and cryoanalgesia. We designed to assess the analgesic effect of epidural analgesia, cryoanalgesia and the combined analgesia in thoracic surgery. Methods: A prospective study was carried out in 59 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: C (cryoanalgesia), CE (cryoanalgesia and thoracic epidural analgesia), E (epidural analgesia). All patients had standard anesthesia with endotracheal intubation using a double lumen endotracheal tube, and one-lung ventilation. Subjective pain relief was assessed on a visual analog scale. Analgesic requirements, complications and the degree of satisfaction were evaluated during the 7 days following surgery. Results: Subjective pain relief was significantly better in Group CE and Group E in comparison with Group C (P < 0.05). Cryoanalgesia provided a better pain score on the 6th and 7th POD than the early postoperative periods. Analgesic requirements were higher in Group C than in the Group CE and Group E during the first POD. The incidence of side effects was similar in Group CE and Group E. Conclusions: If we can reduce the concentration of fentanyl and local anesthetics in combined analgesia of epidural and cryoanalgesia, the disadvantages of each method would be overcome and would be a better method of postthoracotomy pain control.

• Archives of Plastic Surgery
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• v.34 no.1
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• pp.93-98
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• 2007

Purpose: Many options are available for the incision and pocket selection in breast augmentation. Each method has its advantages and disadvantages. To leave an invisible operation scar and to achieve easier pocket dissection by the central location of the incision on the breast, we made a transareolar-perinipple incision. To overcome the disadvantages of the transareolar incision, originally advocated by Pitanguy in 1973, we modified the direction of incision line and dissection plane. Methods: To avoid the injury of 4th intercostal nerve responsible for nipple sensation, we made perinipple incision on the medial side of the nipple instead of trans-nipple incision and made the transareolar incision as 11-5 o'clock on the left side and 1-7 o'clock on the right side instead of 3-9 o'clock on both sides. To avoid the possible infection and breast feeding problem caused by the injury to the lactiferous duct, and the possible implant hernia caused by the incisions lying on a same plane of pocket dissection, we made a subcutaneous dissection just above the breast tissue medially down to the bottom of breast tissue and made a subglandular or subfascial pocket, which may avoid the injury of lactiferous duct and create different planes for skin incision and pocket dissection. Other advantages of the transareolar-perinipple incision include easier pocket dissection, less chance of hematoma, and as a result less postoperative pain because of the central location of the approach which allow finger dissection and meticulous bleeding control with direct vision, without any specialized instrument such as an endoscope or long mammary dissectors. As for pocket selection, we made dual pockets. We prefer subglandular or subfascial pocket. Also, we made a subpectoral pocket in the upper 1/4 of the pocket to add more volume on the upper part of the augmented breast, which can make aesthetically more desirable breasts in thin Asian women with small breasts. Possible disadvantages of our method are subclinical infection and scar widening, which could be overcome by meticulous operation techniques, antibiotic therapy, and intradermal tattooing. Results: From September, 2003 to August, 2005, 12 patients underwent breast augmentation using round smooth surface saline implants by our method. During the mean follow-up period of 13 months, there were no complications such as infection, hematoma, capsular contracture, and sensory change of nipple, and results were satisfactory. Conclusion: We suggest breast augmentation via transareolar-perinipple incision and dual pockets(subpectoral-subglandular or subfascial) as a valuable method in thin oriental women with small breasts.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.441-446
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• 2001

Background: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. Methods: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. Results: Tidal volume increased from 143.3$\pm$51.3 ml to 272.3$\pm$87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7$\pm$4.0 mmHg to -10.5$\pm$4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1+2.5 mmHg to 1.2$\pm$4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3$\pm$6.7cmH$_{2}$O to 20.0$\pm$5.3 cmH$_{2}$O. Conclusion: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.920-926
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• 1997

Remarkable effect of pain relief and prevention of the postoperative Complications after thoracotomy has been achieved by continuous intravenous analgesia. This study was carried out with thirty patients who underwent posterolateral thoraco tony. The patients were divided into three groups: Group I(n= 10), the patients with intermittent intramuscular analgesia(piroxicam 20 mg), Group II(n=10), the patients with continuous epidural analgesia(0.5% bupivacaine 30m1 + normal saline 30 ml + morphine 10 mg), and Group III(n= 10) the patients with controlled intravenous infusion of analgesics(fentanyl 2500 mfg +normal saline 10 ml). The results w re as follows; 1) There were no significant changes of vital signs, between groups. 2) Tidal volume and FVC were significantly improved in the group II and III compared with the group I during the first postoperative day. 3) A significant reduction of immediate post-thoracotomy pain was achieved in the group II and III compared with the group I. 4) The limitation of motion in the operative side was less in the group II and III compared with the group I. 5) A signi(icant reduction of the postoperative analgegics consumption was noticed in group II and III. 6) Significant complications were not occured during follow-up period in all groups.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.595-601
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• 2003

Background: It has been known that the most effective treatment method of hyperhidrosis is video-assisted thoracoscopic sympathetic nerve block. Postoperative compensatory hyperhidrosis and anhidrosis are major factors that decrease the postoperative satisfaction. Although sympathetic rami have been selectively blocked to decrease the complications, technical difficulties and excessive bleeding have prevented the universal application. Material and Method: Three pre-fixative cadavers were dissected before clinical application. Bilateral sympathetic chains were exposed in supine position after the whole anterior chest wall was removed. Second and third sympathetic rami were blocked using clips. After the sympathetic chains including ganglia were removed, we evaluated the extents of rami block. Twenty-five patients were subjected to the clinical application. Surgeries were performed in semi-fowlers position under general anesthesia and bilateral ventilation. 2 mm thoracoscopy and 5 mm trocar were intro-duced through third and fourth intercostal space, respectively. Second and third sympathetic rami were blocked using thoracoscopic clips. The postoperative complications, satisfaction, and compensatory hyperhidrosis rate were evaluated retrospectively. Result: Sympathetic rami were completely blocked in cadaver dissection study Hyper-hidrosis symptom was improved in all patients without operative complication. Operative time was shorter than that of traditional ramicotomy. All patients, except four, were satisfied with postoperative palmar hyperhidrosis. Com-pensatory hyperhidrosis was more severely happened in fifteen patients (60%). The remaining six patients had no complaint. Two patients had a minimal degree of gustatory hyperhidrosis. Conclusion: This operative method had shorter operative time and less complication rate, compared with traditional ramicotomy Operative success rate was similar to the traditional syrnpathicotorny; lower extent and occurrence rate of compensatory hyperhidrosis. The thoracic sympathetic rami clipping was suggested as an alternative method for treatment of palmar hyperhidrosis.