• The Korean Journal of Pain
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• v.9 no.1
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• pp.260-263
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• 1996

High spinal block is a rare complication during epidural block, but it may result in serious events. 56-year-old man with gall stones was scheduled for cholecystectomy under general anesthesia. After operation, lumbar epidural catheterization was done at $T_{8-9}$ interspace for postoperative pain control. At the recovery room, initial bolus drug (0.1% bupivacaine 10 ml containing fentanyl $100{\mu}g$) was administered via epidural catheter and observed carefully. 15 minutes later, hypotension and bradycardia ouccurred. Hartman' solution was administered rapidly and ephedrine 5 mg was injected. 30 minutes after drug administration, loss of consciousness and respiratory arrest developed. Tracheal intubation was done immediately. Cardiovascular and respiratory functions were monitored continuously. The location of intrathecal catheter was confirmed by cerebrospinal fluid (CSF) seen in syringe after aspiration of catheter. The patient recovered gradually and was placed in the ward 4 hours after drug administration, without any problems. He was discharged 1 week later in good health.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.69-74
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• 1996

Background: Efficacy of spinal opioids for the treatment of intractable cancer pain has been reported by several authors. The epidural route seems to be a more reliable and effective method of pain control as compared to the intrathecal route which can lead to opioids by portal system. Methods: Medical records were reviewed of 18 patients who had been treated with epidural morphine via an implanted port-A-Cath from Mar. 1991 to Sep. 1994. Results: Patients were treated for a mean of 92 days. There were wide variation of dose requirements. The minimum daily dose ranged from 2 to 10mg, and maximum daily dose from 3 to 30 mg. Verbal rating scale were below moderate until 100th days after posrtal implantation. When 3 patients suffered from aggravated pain associated with vertebral metastasis. Five of 11 patients who were administered medication longer than 50 days reguired increased doses ranging from 3 mg to 25 mg which were higher as compared to initial doses. These patients also experienced pain due to vertebral metastasis. There were no report of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockade. Conclusion: Continuous epidural morphine administration via Port-A-Cath is an effective method with minimal complication.

• Biomolecules & Therapeutics
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• v.14 no.2
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• pp.119-124
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• 2006

This study was performed to investigate the influence of the spinal adenosine $A_1$ receptors on the central regulation of blood pressure (BP) and heart rate (HR), and to define whether its mechanism is mediated by cyclic AMP (cAMP), cyclic GMP (cGMP) or potassium channel. Intrathecal (i.t.) administration of drugs at the thoracic level were performed in anesthetized, artificially ventilated male Sprague-Dawley rats. I.t. injection of adenosine $A_1$ receptor agonist, $N^6$-cyclohexyladenosine (CHA; 1, 5 and 10 nmol) produced dose dependent decrease of BP and HR and it was attenuated by pretreatment of 50 nmol of 8-cyclopentyl-1,3-dimethylxanthine, a specific adenosine $A_1$ receptor antagonist. Pretreatment with a cAMP analogue, 8-bromo-cAMP, also attenuated the depressor and bradycardiac effects of CHA (10 nmol), but not with cGMP analogue, 8-bromo-cGMP. Pretreatment with a ATP-sensitive potassium channel blocker, glipizide (20 nmol) also attenuated the depressor and bradycardiac effects of CHA (10 nmol). These results suggest that adenosine $A_1$ receptor in the spinal cord plays an inhibitory role in the central cardiovascular regulation and that this depressor and bradycardiac actions are mediated by cAMP and potassium channel.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.14 no.1
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• pp.29-36
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• 2014

Mucopolysaccharidoses (MPSs) are a group of rare inherited metabolic diseases caused by deficiency of lysosomal enzymes. MPSs are clinically heterogeneous and characterized by progressive deterioration in visceral, skeletal and neurological functions. The aim of this article is to review the treatment of MPSs, the unmet needs of current treatments and vision for the future including recent clinical trials. Until recently, supportive care was the only option available for the management of MPSs. Hematopoietic stem cell transplantation (HSCT), another potentially curative treatment, is not routinely advocated in clinical practice due to its high risk profile and lack of evidence for efficacy. From the early 2000s, enzyme replacement therapy (ERT) was approved and available for the treatment of MPS I, II and VI. ERT is effective for the treatment of many somatic symptoms, particularly walking ability and respiratory function, and remains the mainstay of MPS treatment. However, no benefit was found in the neurological symptoms because the enzymes do not readily cross the blood-brain barrier (BBB). In recent years, intrathecal (IT) ERT, substrate reduction therapy (SRT) and gene therapy have been rapidly gaining greater recognition as potential therapeutic avenues. Although still under investigation, IT ERT, SRT and gene therapy are promising MPS treatments that may prevent the neurodegeneration not improved by ERT.

• The Korean Journal of Pain
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• v.2 no.2
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• pp.203-207
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• 1989

Anesthesiologists are usually responsible for the major works in pain clinics and are often called for many sophisticated nerve blocks in the management of acute or chronic intractable pain. It is, therefore, not uncommon for the anesthesiologists to meet some unexpected and unusual complications during his or her performance. We experienced a case of a pneumothorax following a thoracic intrathecal alcohol block. There was an unusual and yet unexplainable cephalad spread of alcohol following an injection through the 4th sacral foramen, and a shearing off of the catheter by a Tuohy epidural needle following the epidural catheterization. All these three cases are herein presented.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.91-97
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• 1988

Herein is a review of eigthy six surgical cases from March to August, 1986 which recieved tetracaine hydrochloride spinal anesthesia. In an attempt to relieve postoperative pain, 0.5 mg morphine sulfate was administrated into the lumbar subarachnoid space. Pruritus, a side effect of intraspinal morphine, was explored in detail. The results were as follows : 1) The incidence of pruritus was 67.4%, 65.5% in man and 71.0% in woman. 2) The time of onset of pruritus was between 30 and 120 minutes with an average of 79.1 minutes. 3) Pruritus primary occurred on the face(87.9%), especially on the nasal, perinasal and periocular areas. Other sites included the scalp, neck, chest, abdomen, shoulder, hip, thigh, flank, and whole body. 4) The severity of pruritus was classified as mild and moderate, but 4 cases(6.9%) were regarded as severe and were treated with naloxone. 5) The duration of pruritus was from 15 minutes to 19 hours with an average of 4.7 hours. 6) There was no significant difference in the prevention of pruritus between the group recieving diphenhydramine and the one which received normal saline.

• Journal of mucopolysaccharidosis and rare diseases
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• v.3 no.2
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• pp.37-40
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• 2017

Mucopolysaccharidosis (MPS) is caused by accumulation of the glycosaminoglycans in all tissues due to decreased activity of the lysosomal enzyme. Patients exhibit multisystemic signs and symptoms in a chronic and progressive manner, especially with changes in the skeleton, cardiopulmonary system, central nervous system, cornea, skin, liver, and spleen. In the past, treatment of MPS was limited to enzyme replacement therapy (ERT). The outcome for affected patients improved with the introduction of new technologies as hematopoietic stem cell transplantation, relegated to specific situations after ERT became available. Intrathecal ERT may be considered in situations of high neurosurgical risk but still it is experimental in humans. New insights on the pathophysiology of MPS disorders are leading to alternative therapeutic approaches, as gene therapy, inflammatory response modulators and substrate reduction therapy. In this paper, we will highlight the recent novel treatment and clinical trials for MPS and discuss with the goal of fostering an understanding of this field.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.96-104
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• 2015

Background: The present experiment was conducted to identify the cooperative effect of serine histogranin (SHG) and noradrenaline in alleviating peripheral neuropathic pain. Methods: Chronic constriction injury of the right sciatic nerve was used to induce chronic neuropathic pain. For drug delivery, a PE10 tube was inserted into the subarachnoid space. Acetone drops and a $44^{\circ}C$ water bath were used to evaluate the cold and heat allodynia, respectively. Placing and grasping reflexes were used to assess the locomotor system. Results: SHG at 0.5 and $1{\mu}g$significantly (P < 0.05) decreased the thermal allodynia. The cold allodynia was also significantly reduced by intrathecal injections of 0.5 (P < 0.05) and $1{\mu}g$(P < 0.001) of SHG. $1{\mu}g$of noradrenaline, but not $0.5{\mu}g$, significantly alleviated the cold (P < 0.01) and thermal (P < 0.05) allodynia. The ameliorating effect of noradrenaline or SHG disappeared when the two compounds were administrated in equal concentrations. A significant difference (P < 0.01 in the acetone and P < 0.05 in the heat) was observed in the groups under equal doses of the two compounds, with a lower effectiveness of the combination therapy. Conclusions: Our findings suggest that the simultaneous administrations of noradrenaline and SHG do not result in synergistic analgesia, and combination therapy may not be a good approach to the treatment of chronic neuropathic pain syndrome.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.122-128
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• 2015

Background: Caudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle on the success rate of caudal epidural blocks. Methods: A total of 49 adults scheduled to receive caudal epidural injections were randomly divided into 2 groups: Group 1 to receive the caudal injection through a conventional method, i.e., caudal injection after advancement of the needle 1 cm into the sacral canal (n = 25), and Group 2 to receive the injection through a new method, i.e., injection right after penetrating the sacrococcygeal ligament (n = 24). Ultrasound was used to identify the sacral hiatus and to achieve accurate needle placement according to the allocated groups. Contrast dyed fluoroscopy was obtained to evaluate the epidural spread of injected materials and to monitor the possible complications. Results: The success rates of the caudal injections were 68.0% in Group 1 and 95.8% in Group 2 (P = 0.023). The incidences of intravascular injections were 24.0% in Group 1 and 0% in Group 2 (P = 0.022). No intrathecal injection was found in either of the two groups. Conclusions: The new caudal epidural injection technique tested in this study is a reliable alternative, with a higher success rate and lower risk of accidental intravascular injection than the conventional technique.

• The Korean Journal of Physiology and Pharmacology
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• v.8 no.5
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• pp.281-288
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• 2004

The present study was undertaken to confirm whether melittin, a major constituent of whole bee venom (WBV), had the ability to produce the same nociceptive responses as those induced by WBV. In the behavioral experiment, changes in mechanical threshold, flinching behaviors and paw thickness (edema) were measured after intraplantar (i.pl.) injection of WBV (0.1 mg & 0.3 mg/paw) and melittin (0.05 mg & 0.15 mg/paw), and intrathecal (i.t.) injection of melittin $(6{\mu}g)$. Also studied were the effects of i.p. (2 mg & 4 mg/kg), i.t. $(0.2{\mu}g\;&\;0.4{\mu}g)$ or i.pl. (0.3 mg) administration of morphine on melittin-induced pain responses. I.pl. injection of melittin at half the dosage of WBV strongly reduced mechanical threshold, and increased flinchings and paw thickness to a similar extent as those induced by WBV. Melittin- and WBV-induced flinchings and changes in mechanical threshold were dose- dependent and had a rapid onset. Paw thickness increased maximally about 1 hr after melittin and WBV treatment. Time-courses of nociceptive responses induced by melittin and WBV were very similar. Melittin-induced decreases in mechanical threshold and flinchings were suppressed by i.p., i.t. or i.pl. injection of morphine. I.t. administration of melittin $(6{\mu}g)$ reduced mechanical threshold of peripheral receptive field and induced flinching behaviors, but did not cause any increase in paw thickness. In the electrophysiological study, i.pl. injection of melittin increased discharge rates of dorsal horn neurons only with C fiber inputs from the peripheral receptive field, which were almost completely blocked by topical application of lidocaine to the sciatic nerve. These findings suggest that pain behaviors induced by WBV are mediated by melittin-induced activation of C afferent fiber, that the melittin-induced pain model is a very useful model for the study of pain, and that melittin-induced nociceptive responses are sensitive to the widely used analgesics, morphine.