• The Korean Journal of Pain
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• 제13권2호
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• pp.247-250
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• 2000

Recently, some authors reported that discogenic low back pain should be regarded as a referred pain in respect of neural pathway. The afferent pathways of discogenic low back pain is transmitted mainly by sympathetic afferent fibres from the sinuvertebral nerves in the second lumbar nerve root. This pain arises from the lumbar intervertebral discs, and it had been transmitted mainly through the sympathetic afferent fibres contained in the second lumbar spinal nerve root. Second lumbar dermatome corresponds to the low back area. We experienced a case of low back pain which could not be controlled by conventional therapy and progressed wax and wane. The CT finding showed bulging disc between $L_4$ and $L_5$ and spinal stenosis in $L_4$ area. And epiduroscopic feature showed severe adhesion in $L_4$, $L_5$ and $S_1$. After we blocked $L_2$ root, pain score decreased 10 to 2. Therefore, the $L_2$ root block may be a useful diagnostic procedure as well as provide therapeutic value.

• Clinical Pain
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• 제18권2호
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• pp.59-64
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• 2019

Objective: This study evaluated the feasibility of ultrasound-guided lumbar nerve root block (LNRB) and S1 nerve root block by identifying spread patterns via fluoroscopy in cadavers. Method: A total of 48 ultrasound-guided injections were performed in 4 fresh cadavers from L1 to S1 roots. The target point of LNRB was the midpoint between the lower border of the transverse process and the facet joint at each level. The target point of S1 nerve root block was the S1 foramen, which can be visualized between the median sacral crest and the posterior superior iliac spine, below the L5-S1 facet joint. The injection was performed via an in-plane approach under real-time axial view ultrasound guidance. Fluoroscopic validation was performed after the injection of 2 cc of contrast agent. Results: The needle placements were correct in all injections. Fluoroscopy confirmed an intra-foraminal contrast spreading pattern following 41 of the 48 injections (85.4%). The other 7 injections (14.6%) yielded typical neurograms, but also resulted in extra-foraminal patterns that occurred evenly in each nerve root, including S1. Conclusion: Ultrasound-guided injection may be an option for the delivery of injectate into the S1 nerve root, as well as lumbar nerve root area.

• The Korean Journal of Pain
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• 제8권1호
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• pp.156-158
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• 1995

Total spinal anesthesia is a well documented serious life threatening complication which results from an attempted spinal or epidural analgesia. We had an accidental total spinal anesthesia associated with a cranial nerve paralysis and an eventual unconsciousness during epidural analgesia. A 45-year-old female with an uterine myoma was scheduled for a total abdominal hysterectomy under the epidural analgesia. A lumbar tapping for the epidural analgesia was performed in a sitting position at a level between $L_{3-4}$, using a 18 gauge Tuohy needle. Using the "Loss of Resistance" technique to identify the epidural space, the first attempt failed; however, the second attempt with the same level and the technique was successful. The epidural space was identified erroneously. However, fluid was dripping very slowly through the needle, which we thought was the fluid from the normal saline which was injected from the outside to identify the space. Then 20 ml of 2% lidocaine was administered into the epidural space. Shortly after the spinal injection of lidocaine, many signs of total spinal anesthesia could be clearly observed, accompanied by the following progressing signs of intracrainal nerve paralysis: phrenic nerve, vagus nerve, glossopharyngeal nerve and trigeminal nerve in that order. Then female was intubated and her respiration was controlled without delay. The scheduled operation was carried out uneventfully for 2 hours and 20 minutes. The patient recovered gradually in th4e reverse order four hours from that time.

• The Korean Journal of Pain
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• 제8권2호
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• pp.304-307
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• 1995

1,666 patients treated by nerve block from September 1994 to August 1995 we statistically analyzed according to sex, age, diseases, and kinds of nerve blocks. Most patients were in the range from 30 to 60 year old, with a distribution of 43.9% male and 56.1% female. Diseases and ailments were as follows: low back pain 30.6%, frozen shoulder 14.0%, facial spasm 10.0%, cervical syndrome 9.7%, headache 7.3%, and hyperhidrosis 7.2%. Most common nerve blocks were stellate ganglion block 30.9%, epidural block 25.6%, trigger point injection 16.1%, and suprascapular nerve block 6.7%. Nerve blocks under fluoroscopic guide were as follows: facet joint block 28.6%, spinal root block 22.9%, thoracic sympathetic ganglion block 21.7%, and lumbar sympathetic ganglion block 15.4%.

• The Korean Journal of Pain
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• 제11권2호
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• pp.307-310
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• 1998

Selective lumbosacral radiculography and nerve root block techniques are very useful in determining the nerve root involved. We have done the lumbar root block to 61-year-old female who had suffered from low back pain radiating to right lower leg which was not relieved by epidural steroid injection two times. $L_5$ root block was performed under the fluoroscopic C-arm guide. When the needle was in correct position, we injected contrast medium (Isovist$^{(R)}$ - 300, Schering, Germany). After we injected 1.5 cc isovist, the S1 root was figured but L5 root was not figured. When we reinjected 1.5 cc isovist, $S_1$ root was enhanced and $L_5$ root was slightly visible due to severe disc bulging and lateral spinal stenosis.

• The Korean Journal of Pain
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• 제11권2호
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• pp.288-293
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• 1998

We had retrospective analysis of 421 patients who were consulted from other departments. From 1994 to 1997, these patients received nerve blocks, intravenous lidocaine infusion, lasers and so on for their pain. From these results, we are gathering information and making some recommandations. The largest percentage of patients were in their fifties with a distribution of 32.8% male and 55.1% female. The most common condition requiring treatment was low back pain 44.6%, followed by cancer pain 19.2%, cervical pain 7.4%, and shoulder pain 4.3%. In case of low back pain, the largest portion was HNP(27%), followed by spinal stenosis(16%), sprain(11%), and postlaminectomy(10%). The most common cacer was colorectal(28.4%) and the next was stomach(19.7%). The most commonly done nerve block was stellate ganglion block 32.3%, followed by lumbar epidural block 24.5% and caudal block 7.2%.

• The Korean Journal of Pain
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• 제12권2호
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• pp.191-194
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• 1999

Background: Millions of patients with chronic sciatica are still treated with epidural corticosteroids. The efficacy of epidural corticosteroids remains questionable, especially in the failed back surgery syndrome (FBSS). We studied to evaluate outcome for 10 patients with failed back surgery syndrome treated with spinal nerve root block using corticosteroids, hyaluronidase, and local anesthetics. Methods: The affected nerve roots are localized with the help of fluoroscopy and contrast dye. Local anesthetic diluted in 1,500 U hyaluronidase and 40 mg methylprednisolone is injected. A small retrospective pilot group of 10 patients with FBSS was treated. The success rate is evaluated using a visual analogue scale at 1 week and 3 month interval after the last injection. Results: Initially, 7 patients experienced good pain relief; 5 patients suspained pain relief for 3 months. No complications were observed. Conclusions: This technique is worthwhile for patients with FBSS and where epidural fibrosis is suspected to be the pain origin.

• 대한정형외과학회지
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• 제55권3호
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• pp.210-221
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• 2020

척추 신경 차단술은 다양한 발전을 거듭하면서 상당부분 수술적 치료의 필요성을 줄일 수 있는 대체 보존적 치료의 한 방법으로 자리매김하고 있다. 이러한 척추 신경 차단술은 통증 완화라는 치료적 측면뿐 아니라, 많은 환자에서 척추 이외의 다른 증상들과 감별을 위한 진단적 목적으로도 유용하게 사용되고 있어 사지 및 척추를 다루는 정형외과의사로서 가장 기본이 되는 술기라 할 수 있다. 하지만 사용하는 기구나 약물이 단순함에도 불구하고 이에 대한 전반적인 이해 및 발생 가능한 부작용 및 합병증에 대한 지식이 없다면 시행 초기에 오히려 환자에게 심각한 해를 끼칠 수 있게 된다. 따라서 척추 신경 차단술에 사용하는 약제들의 종류, 약동학적 특성과 각각 약제의 부작용에 대한 이해가 선행되어야 하며, 요추 전반에 걸친 각 시술의 적응증과 장단점을 파악하고 발생 가능한 합병증을 피하기 위해 노력을 기울여야 한다. 본 종설은 요추 신경 차단술에 필요한 기본적인 지식 및 술기를 접하여 독자 스스로 시행할 수 있게 함을 목적으로 한다.

• The Korean Journal of Pain
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• 제22권1호
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• pp.107-111
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• 2009

Neuroablation should be performed cautiously because neuropathic pain can occur following denervation of a somatic nerve. A 34-year-old man presented with severe penile pain and allodynia following a selective neurectomy of the sensory nerve that innervated the glans penis for treatment of his premature ejaculation. He was treated with various nerve blocks, including continuous epidural infusion, lumbar sympathetic block and sacral selective transforaminal epidural blocks, as well as intravenous ketamine therapy. However, all of the treatments had little effect on the relief of his pain. We performed spinal cord stimulation as the next therapy. After this therapy, the patient has currently been satisfied for 3 months.

• The Korean Journal of Pain
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• 제10권2호
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• pp.301-303
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• 1997

A 35-year-old female patient was referred to our hospital with neurologic symptoms after continuous epidural block performed 2 days earlier. She die not have any prior no previous lumbar surgery or experience trauma, intraspinal hemorrhage, infections or other known causative factors to associate with neurologic symptoms. Continuous epidural block is widely used for postoperative pain control. Complications can occur with this block including postduralpuncture headache, epidural abscess and rare cases of arachnoiditis etc. We experienced such a case of spinal arachnoiditis after continuous epidural block. Neurologic examination revealed painful bilateral hypoesthesia below $S_2$ level dermatomes, urinary and fecal incontinence and various degrees of leg weakness. The following day, the patient was noted to have bilateral sacral radiculopathies and lesion on proximal portion of both tibial nerve. CSF study reported: protein 264 mg/dl, sugar 64 mg/dl, WBC $7/mm^3$. L-spine MyeloCTscan results were unremarkable. She was discharged after a month of hospitalization and has regular checkups but her neurologic symptoms show no signs of improvement.