• Journal of Acupuncture Research
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• 제34권1호
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• pp.81-87
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• 2017

Objectives : Chronic post-thoracotomy pain is a refractory condition that responds poorly to existing pain treatments. The aim of this report is to describe favorable symptom changes in a patient with chronic post-thoracotomy pain after major chest trauma who received a series of manual acupuncture treatments over 3 months. Methods : Twelve sessions of manual acupuncture were provided to the patient, once or twice a week. Results : The manual acupuncture sessions were well tolerated. Minor adverse events, including temporary minor bleeding at the needled sites, were intermittently observed. The patient's symptoms, including pain, sleep disturbance, and anxiety gradually resolved and had almost completely disappeared after 12 sessions of acupuncture treatment. Conclusion : This single case report cannot confirm whether the observed positive changes in the patient's symptoms and dysfunctions are associated with the acupuncture treatments. Randomized controlled trials are necessary to explore the role of acupuncture in chronic post-thoracotomy pain in patients with major chest trauma.

• Journal of Chest Surgery
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• 제27권11호
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• pp.942-947
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• 1994

Post-thoracotomy pain is so severe that lead to postoperative pulmonary complications due to the patient`s inability to cough, deep breathing and chest wall motion. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1990, we reported the result that the cryoanalgesia reduce the immediate postoperative pain significantly. We try to compare the effect of cyroanalgesia with the effect of Bupivacain intercostal nerve block for the post-thoracotomy pain control. Ninety patients, who undergoing thoracotomy in Korea University Medical Center Guro Hospital between the January 1993 and September 1993, were evaluated. The patients were divided into three groups : Group A, control, the patients without pain control procedure [N=30], Group B, the patients with Bupivacain intercostal nerve block [N=30], Group C, the patients with cryoanalgesia [N=30]. Postoperative analgesic effects were evaluated by the scoring system which made arbiturary by author. The results were that the Bupivacain intercostal nerve block markedly reduced the immediate postoperative pain compare with two other groups, the cryoanalgesia reduced the immediate postoperative pain significantly compare with control group, the pain reduction effect of the two groups- cryoanalgesia and Bupivacain intercostal nerve block- were not different at postoperative seventh day, probably due to the action time of Bupivacain and the result that there were no significant complications of the procedures.

• The Korean Journal of Pain
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• 제32권2호
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• pp.129-132
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• 2019

Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3-T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient's resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.

• Journal of Chest Surgery
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• 제26권4호
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• pp.303-307
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• 1993

Postoperative pain relief and the side effects of epidurally injected morphine were investigated in 10 patients who received thoracotomy. Epidural morphine injection was given via an epidural catheter after thoracotomy. The pain score[VAS] and repiratory rate were decreased and the SaO2, tidal volume and vital capacity were increased significantly after epidural morphine injection. The analgesia of epidural morphine lasted for 13 hours with average. The side effects of epidural morphine were few and mild, but urinary retention was in 10%[1/10] of total patients.

• Journal of Chest Surgery
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• 제30권2호
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• pp.187-194
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• 1997

개흉술을 시행받은 환자에 있어서 수술후 발생하는 동통은 해결하기 힘든 문제로 다양한 방법들이 시도되어 왔다. 저자들은 침의 효능에 주목하여 개흉술후 동통억제에 침치료가 얼마나 효과가 있는지를 관찰하였다. 1995년 3월부터 9월까지 흉부질환으로 액와 절개술을 이용한 개흉술을 시행받은 20례를 무작위로 2개의 군으로 분류하였다. 동통치료를 위해 통상적으로 사용하는 진통제를 투여한 군을 대조군(n=10)으로 하고 침 치료를 시행한 군을 실험군(n=10)으로 하였다. 수술후 진통효과를 평가하기 위 해 고려대학교 의과대학 흉부외과학교실에서 정한 수술후 통증에 대한 점수체계를 이용하였다. 환자가 느끼는 동통의 정 도와 술측의 팔운동장애의 정도에서 두 군간의 유의한 차이는 없었다. 그러나 진통제의 투여회수는 침 치료를 시행한 군에서 유의하게 감소하였다(P<0.05). 따라서 저자들은 개흉술을 시행받은 환자의 수술후 동통억제시 침술을 이용함으로써 진통제의 투여회 수를 줄일 수 있으며 간기능 저하인 환자나 진통제 주사에 대 해 부작용을 나타내는 환자에게 도움이 될 것으로 생각된다.

• Journal of Chest Surgery
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• 제24권1호
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• pp.54-63
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• 1991

Post-thoracotomy pain is so severe that lead to postoperative complications, such as sputum retention, segmental or lobar atelectasis, pneumonia, hypoxia, respiratory failure due to the patient`s inability to cough, deep breathing and movement. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1974, Nelson and associates introduced the intercostal nerve block using the cryoprobe. The application of cold directly to the nerves causes localized destruction of the axons while preserving the endoneurium and connective tissue, thereby introducing a temporary pain block and able to complete regeneration of intercostal nerves. One hundred and two patients, who undergoing axillary or posterolateral thoracotomy at the Department of Thoracic and Cardiovascular Surgery in Korea University Medical Center between April 1990 and August 1990, were evaluated the effects of cryoanalgesia for the post-thoracotomy pain reduction. The patients were divided into two groups: Group A, control, the patients without the cryoanalgesia[No.=50], Group B, trial, the patients with cryoanalgesia[No.=52]. Before the thorax closed, in the group A, local anesthetics, 2% lidocaine 3cc, were injected to the intercostal nerves[one level with the thoracotomy, one cranial and caudal intercostal level and level of drainage tube insertion]. In the group B, cryoprobe was directly applied for 1 minute at the same level. Postoperative analgesic effects were evaluated by the scoring system which made arbitrary by author: The pain score 0 to 4, The limitation of motion score 0 to 3, The analgesics consumption score 0 to 3, The total score, the sum of above score, 0 to 10. For the evaluation of immediate analgesic effects, the score were evaluated at the operative day, the first postoperative day, the second postoperative day, and the seventh postoperative day. The effects of incision type, and rib cut to the post-thoracotomy pain were also evaluated. The results were as follows; 1. The intercostal block with cryoanalgesia reduced the immediate postoperative pain significantly compare with control group. 2. The intercostal block with cryoanalgesia improved the motion of the operation side significantly compare with control group. 3. The intercostal block with cryoanalgesia reduced the analgesics requirements at the immediate postoperative periods significantly. 4. The intercostal block with cryoanalgesia lowered the total score significantly compare with control group. 5. The intercostal block with cryoanalgesia were more effective to the mid-axillary incision than to the posterolateral incision 6. The intercostal block with cryoanalgesia were more effective to the patients without rib cut than to the patients with rib cut. 7. No specific complication need to be treated were not occurred during follow-up.

• Journal of Acupuncture Research
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• 제35권2호
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• pp.95-100
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• 2018

Background: The aim of this study is to assess the feasibility of acupuncture treatment for the management of subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures. Methods: A total of 30 participants who have undergone thoracotomy after traumatic multiple rib fractures will be recruited. Participants will be invited and equally randomised into acupuncture plus usual care and usual care alone groups. A computer-generated random number sequence will be used and concealed using opaque, sealed, sequentially numbered envelopes. Twelve sessions of manual and electrical acupuncture performed by Korean medicine doctors will be provided over a span of 3 months to participants allocated to the acupuncture group. Participants in the usual care group will continue pain medication, exercise and physical therapy as required. Study feasibility will be measured based on the proportion of patients who complete the measurement of pain at 12 or 24 weeks after baseline. The clinical outcomes will include; the average pain intensity over the recent week at rest, movement and cough, quality of life, patient's global assessment of recovery, respiratory function measured by the pulmonary function test and use of pain medication at 4, 8, 12 and 24 weeks after enrolment. Adverse events will be recorded for all participants. Written informed consent will be obtained from all participants. The local ethics committee has approved the study. This pilot trial will inform further studies investigating the potential role of acupuncture for subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures.

• The Korean Journal of Pain
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• 제9권1호
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• pp.135-139
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• 1996

Intercostal nerve blockade with local anesthetics has been used extensively in the past to provide pain relief following thoracotomy. Its popularity fell, for a period, probably due to increasing use of epidural analgesia. More recently, interest has focused on intercostal nerve block with the introduction of variously sited catheters. Two epidural catheters were placed under direct vision, in the intercostal spaces just above and below the wound by feeding the catheters posteriorly from the wound edges, superficial to the parietal pleura. Bupivacaine 0.25%. Was infused continuously at a rate of 5 ml/hour through each of the two intercostal catheters. Each catheter was primed with 10 ml/hour through each of the two intercostal catheters. Each catheter was primed with 10 ml of 0.25% bupivacaine. Postoperative vital signs resembled preoperation data. Arterial carbon dioxide pressure ($PaCO_2$) was unchanged and arterial oxygen pressure ($PaO_2$) was increased during two days after surgery because oxygen was administered at 21/min. Forced vital capacities (FVC) and forced expiratory volume in 1 second ($FEV_1$) were decreased the day of operation but restored to preoperative value from second operation day. VAS were increased on operation day but decreased from second operation day. Motion range of arms were not impaired. We concluded that continuous intercostal nerve block through catheters placed during thoracotomy in the adjacent intercostal spaces is a simple and effective method for management of the post-thoracotomy pain.

• Journal of Chest Surgery
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• 제26권7호
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• pp.538-542
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• 1993

An approach to the treatment of post-operative pain by the injection of bupivacaine into the pleural space through an intrapleural cathter has been studied. Among 24 thoracotomy patients, bupivacaine was injected only to experimental group[ 12 patients ] when the patient was able to head up for oneself during recovery from anesthesia. The pain and ROM[ range of motion ] scores, respiration rate, PaCO2 level of both experimental and control group were measured at the time of head-up and 30 and 120 minutes thereafter.The scores of pain and ROM of experimental group were significantly[ P value < 0.05 ] decreased in 30 minutes and 120 minutes after bupivacaine injection compared with those of control group but respiration rate and PaCO2 level were not changed significantly. With this result, we can suggest that intrapleural injection of bupivacaine is useful for pain relief following thoracotomy.

• Journal of Chest Surgery
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• 제26권10호
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• pp.781-786
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• 1993

Effrctive analgesia after elective thoracotomy can be provided by continuous extrapleural intercostal nerve block.This study was designed to prove the effectiveness of continuous extrapleural intercostal nerve block. Twenty patients undergoing elective thoracotomy were randomized into two groups. Group I received lumbar epidural block[N=10] and group II received continuous extrapleural intercostal nerve block[N=10]. Postoperative pain relief was assessed on Numeric Rating Scale[NRS] and recovery of pulmonary function was assessed by coparison of preoperatrive and postoperative FVC[Forced Vital Capacity], FEV1[Forced expiratory Volume in 1 second], VC[Vital Capacity]. Arterial blood gas analysis[ABGA], vital signs and amount of additive analgesics were compared also. No significant difference was observed between the groups concerning these parameters mentioned above. Systemic complications, such as urinary retention[2/10] and weakness of lower extremity[2/10], occurred in group I but no complication occurred in group II. We conclude that continuous extrapleural intercostal nerve block is as effective as epidural block in pain relief and restoration of pulmonary mechanics with fewer comlications. Also because of it`s ease and safetiness, this must be considered as a substitute of epidural block in routine use for thoracotomy pain relief.