• The Korean Journal of Pain
• /
• v.19 no.2
• /
• pp.223-227
• /
• 2006

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, sensory and motor disturbances, and trophic changes of the skin. A 21-year-old man was suffering from pain and swelling in his right hand and forearm. His arm had been in splints for 3 weeks following an extension injury of the right fingers and wrist, with the pain having developed 2 weeks after the splinting. He was treated with various nerve blocks including continuous epidural infusion, thoracic sympathetic block and peripheral nerve blocks, and squeezing his edematous region under general anesthesia as well as intravenous lidocaine and ketamine infusions. However, all of the performed treatments had no effect on the patient's pain or hand swelling. As a next line therapy, spinal cord stimulation should be considered because of intractable severe pain and swelling to almost all other modalities of therapy. We therefore performed an early intervention of spinal cord stimulation for the patient with refractory CRPS type I 5 months after the onset of pain and have got an excellent result.

• Journal of radiological science and technology
• /
• v.45 no.2
• /
• pp.171-177
• /
• 2022

The purpose of this study was to investigate the effect of the characteristics of patients who underwent spinal nerve block on the fear of injection and the risk of radiation. Subjects were 137 patients (67 males, 70 females) who visited the Department of Anesthesiology and Pain Medicine in Cheongju. The method was conducted as a research study using a total of 28 questionnaires consisting of patient characteristics, experience characteristics of nerve block surgery, nerve block fear scale, and radiation risk perception scale. The reliability of the questionnaire response was secured with a Cronbach's alpha coefficient of 0.6 or higher. For statistical analysis, correlation was tested by descriptive statistics, frequency analysis, independent sample T-test, and Pearson and Spearman correlation coefficients by measurement scale and factor. As a result, the fear scale of nerve block was significantly higher in women than in men (p<0.05). The fear scale of nerve block injection was significantly higher in the first-visit patients than in the second-visited patients (p<0.05). However, there was no significant difference among all variables in radiation risk perception. In conclusion, patients undergoing spinal nerve block were more aware of the fear of injection than the risk of radiation exposure during the procedure.

• The Korean Journal of Pain
• /
• v.33 no.4
• /
• pp.378-385
• /
• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

• Archives of Plastic Surgery
• /
• v.39 no.3
• /
• pp.257-260
• /
• 2012

This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.3 no.2
• /
• pp.74-78
• /
• 2010

Since the extent of use of musculoskeletal ultrasound in orthopaedic surgery is expanding, popliteal block(sciatic nerve block) and femoral nerve block(saphenous nerve block) are easily and safely performed without complications such as nerve injury or incomplete block. Also, due to the expanding use of ultrasound, orthopaedic surgery of not only foot but also ankle and lower leg could be done without general anesthesia or spinal anesthesia. We describe a detailed technique for ultrasound-guided femorosciatic nerve block based on the experience over 120 cases.

• The Korean Journal of Pain
• /
• v.1 no.1
• /
• pp.20-27
• /
• 1988

Continuous cervical epidural anesthesia with two different concentrations of bupivacaine had been performed in 43 cases for surgery of upper extremity and cervical spine. After the initial dose of 0.33% bupivacaine 15ml to Group I(n=22) and 0.5% bupivacaine 15ml to Group II(n=21) was injected respectively, we observed the circulatory and pulmonary functions to be changed, and evaluated the duration of those analgesic action. The number of spinal segment to be affected and the complications were checked. Statistical significance of changes after the initial dose in both groups was determined by student's t-test. All values are impresed as mean$\pm$1S.D.. The results were as follows: 1) Circulatory functions; Systolic B.P. and Pulse rate were decreased by 10~15torr and 5~6 beats per minute respectively between 10~30 minutes following the initial dose, which were statistically significant in both groups. 2) Pulmonary functions; The diminution of minute volume showed to 20% and a rise of $PaCO_2$ level to 5~6 torr respectively between 30~60 minutes following the initial dose, which were statistically significant in both groups. There were no significant changes in self respiration and respiratory rate in both groups. 3) The duration of analgesic action was $72.3{\pm}25.7$(min) in Group I and $83.5{\pm}28.5$(min) in Group II which was not statistically significant between two groups, and the number of affected spinal segment at ore hour following the Anesthusia was $8.7{\pm}2.0$ in Group I and $10.5{\pm}2.4$ in Group II which was statistically significant between two groups. 4) Complications; a. Hypotension(below 80torr in systolic pressure) was appeared in 5% of all patients. b. Bradycardia(below 60 beats per minutes) was appeared in 25% of all patients. c. Inadvertent dural puncture was developed in only one patient, In conclusion, the 0.33% bupivacaine as well as 0.5% bupivacaine were enough for those analgesic effect in the above mentioned surgery even though the duration of analgesic action was about 10 minutes shorter in Group I than that of Group II. The cardiopulmonary function was clinically rather stable in Group I than that of Group II. Therefore we thought 0.33% bupivacaine was satisfactory for the clinical practicality in the cervical epidural anesthesia.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.12
• /
• pp.1394-1398
• /
• 2001

Objective : The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery. Methods : Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol. Results : In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group. Conclusion : CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.

• The Korean Journal of Pharmacology
• /
• v.29 no.1
• /
• pp.33-41
• /
• 1993

Central analgesic effect of capsaicin was assessed by the tail flick reflex (TFR) test, using male Sprague-Dawley rats under anesthesia with pentobarbital sodium (induction with 40 mg/kg and maintenance with $4{\sim}8\;mg/kg/hr$). Level of norepinephrine in the spinal cord was also measured. Capsaicin, $35{\sim}150\;{\mu}g$, was injected intrathecally, and the TFR latency was measured before, 10, 30, and 60 minutes after the drug administration. TFR latency was increased 100% or more immediately by intrathecal capsaicin, from 2.9 seconds to the maximum of 7.0 seconds at 10 minute after the drug; P<0.01. The increase in TFR latency was maintained during the course of experiment of 2 hours. Concomitant reduction of NE content in the spinal cord was observed; from 16 ng/mg protein to 7 ng/mg protein. On the other hand, subcutaneous injection of capsaicin of 50 mg/kg did not change the TFR latency although the NE content reduced similarly to the case of intrathecal injection. Pretreatment of the animal with 0.5 mg/kg of MK-801 reversed the increase of TFR latency and NE reduction induced by intrathecal capsaicin. These results suggest that capsaicin causes analgesia at the spinal cord level by activating the excitatory amino acid-NE-dorsal horn interneurons axis of the descending inhibitory pain modulation pathway.

• Journal of Korean Academy of Nursing
• /
• v.5 no.2
• /
• pp.23-28
• /
• 1975

One hundred and fifty seven cesarean sectioned patients among 2010 deliveries, were reviewed with the following clinical charts from January, 1973 to December, 1974 at Taegu Presby-terian medical Center. The results are as follows; 1) The section rate was 7.8% 2) In age distribution, the most frequent age was 26~30ys and it~s rate was 37%, and others were as follows : 31~35ys 24.2%, 21~25ys 21%, 36~40ys 10.8%, 41~45ys 7% respective]y- 3) In indication, the cephalopelvic disproportion was the most prevalent and it's rate was 29.3%, and others were as follows : malpresentation 14% previous cesarean section 10.8% uttering dysfunction 9.6%, totemic 4%, elderly primigravida 4%, fetal distress 2.5% post maturity 3.2%, wanted cesarean section 1, 9%, pelvic deformity 1.2% twin 1.9%, abruptio placenta 1.2%, Vaginal stricture 1.2%, and others 2.5%. 4) In type of operation, tower cervical transverse type was 82.1%, classical type 17%, ana cesarean hysterectomy was 0.9% respectively. 5) General Anesthesia was major type and it's rate was 63%, and spinal anesthesia 17.2%, epidermal anesthesia 14% and other combined type was 5.8%. 6) Percental mortality was 11.4%. 7) There was no maternal death. 8) Among the cesarean section complications, wound infection was 8,4%, headache 4.4%, urinary tract infection 1.2% and one case in endometritis. 9) In combined surgery, tubal legation was 31.2%, appenectomy 7.6%, posterior repair 1.2%, salpingoop-horectomy 1.9%, and one case in resection of uttering septum. 10) Cesarean section was performed 61.3% in multipara and 38.2% in primipara. 11) 47 (30%) had received artificial abortions. 12) 28 (17.8%) had previously experienced cesarean section.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.21 no.5
• /
• pp.1285-1290
• /
• 2007

The present study aims to identify and characterize genes that cause differen genes between non-responders and responders to electroacupuncture (EA) on mechanical allodynia following peripheral nerve injury. Under sodium pentobarbital anesthesia, animals were subjected to unilateral transection of the superior caudal trunk at the level between S1 and S2 spinal nerves. EA stimulation (2Hz, 0.3 ms, 0.2-0.3 mA) was delivered to Zusanli (ST36) for 30 min 2 weeks after the surgery. The degree of mechanical allodynia was assessed quantitatively by touching the tail with von Frey hair (2.0 g) at 10 min intervals. The rats, which showed an EA-induced decrease of response frequencies under 10 %, were classified as non-responders and those displaying an EA-induced decrease of response frequencies 20 % or more were classified as responders. Results from oligonucleotide microarray, to which cDNAs from the spinal dorsal horn (DH) were applied, showed that hemoglobin beta chain complex and chondroitin sulfate proteoglycan-5 decreased and limbic system-associated membrane protein increased in the non-responder group, whereas calcium-independent alpha-Iatrotoxin receptor homolog-3 increased in the responder group. These results suggest that The functional abnormality of molecules regulating cell adhesion, intracellular signal transduction and cell differentiation in the spinal DH may be involved in the anti-allodynic effect of EA.