• The Korean Journal of Pain
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• 제12권1호
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• pp.144-147
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• 1999

A 72-year-old female patient was presented complaining of unbearable abdominal pain in the upper left quadrant at our hospital. Two weeks earlier she had developed a vesicular eruption on the right C3 dermatome and 1 week earlier she had experienced a vesicular eruption on the left T11 dermatome. Her medical history was unremarkable. She had suffered from severe abdominal pain in the upper left quadrant for 10 days and the mild pain in the right shoulder region for 20 days. The pain in the upper left quadrant had increased and was unresponsive to drugs prescribed by the local clinic. And we performed T11 root block with 0.5% lidocaine 5 ml and dexametasone 5 mg, and thoracic epidural blockade on 1st hospital day under diagnosis of herpes zoster infection. Her VAS were improved from 10 to 2 on 2nd hospital day. We performed thoracic epidural blockade with 0.5% lidocaine 6 ml. Her VAS were changed from 2 to 7 and so then we performed the thoracic epidural blockade with 0.5% lidocaine 5 ml and triamcinolone 40 mg on 3rd hospital day. On 4th hospital day, her VAS were from 7 to 1. After 4 month of our managements she was tolerable without any medications.

• The Korean Journal of Pain
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• 제22권3호
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• pp.245-248
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• 2009

Ossification of the yellow ligament (OYL) is a pathologic condition that causes spinal stenosis, which is a form of ectopic ossification. OYL causes compressive myelopathy and radiculopathy. Although the pathogenesis of OYL is still unclear, diffuse mechanical stresses and degenerative changes caused by extreme ranges of motion may be related to the development of OYL in young sportsmen. Here we report an interesting case of thoracic radiculopathy due to OYL in a 35-year-old male amateur judo player who was successfully treated with continuous thoracic patient controlled epidural analgesia and epidural adhesiolysis.

• 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.

• Journal of Yeungnam Medical Science
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• 제36권2호
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• pp.109-114
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• 2019

Background: Transforaminal epidural block (TFEB) is an effective treatment option for radicular pain. To reduce complications from intravascular injection during TFEB, use of imaging modalities such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA) has been recommended. In this study, we investigated whether DSA improved the detection of intravascular injection during TFEB at the whole spine level compared to RTF. Methods: We prospectively examined 316 patients who underwent TFEB. After confirmation of final needle position using biplanar fluoroscopy, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under RTF; 30 s later, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under DSA. Results: Thirty-six intravascular injections were detected for an overall rate of 11.4% using RTF, with 45 detected for a rate of 14.2% using DSA. The detection rate using DSA was statistically different from that using RTF (p=0.004). DSA detected a significantly higher proportion of intravascular injections at the cervical level than at the thoracic (p=0.009) and lumbar (p=0.011) levels. Conclusion: During TFEB at the whole spine level, DSA was better than RTF for the detection of intravascular injection. Special attention is advised for cervical TFEB, because of a significantly higher intravascular injection rate at this level than at other levels.

• The Korean Journal of Pain
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• 제1권1호
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• pp.64-73
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• 1988

Recent studios have shown that narcotic drags produce an unusually intense, prolonged and segmental analgesic action in man whoa injected into the spinal subarachnoid or epidural space (Wang et al, 1979; Behar et al, 1979; Cousins et al, 1979; Magora et a., 1980, Johnston and McCaughey, 1980). Since 1960, many investigators claimed that low molecular weight(LMW) dextran increased the clinical duration of lidocaine(Loder, 1960; Loder, 1962), tetracaine (Chinn and Wirjoatmadja, 1967) and bupivacaine(Kaplan et al, 1975) in man but the mechanism of the action of dextran was unclear. But Curtiss and Scurlock(1979), and Buckled and Fink(1979) claimed that LMW dextran has no effect on the duration of action of bupivacaine in animal studies. The present study was performed to evaluate the clinical efficacy of analgesia by the thoracic epidural injection of morphine and bupivacaine mixture for the relief of pain due to fractured or contused ribs, to evaluate the duration of analgesic effect by the use of the above mixture in a hypertonic solution(dextran 70 or 50% dextrose in water) and to observe the possibility of improvement in the lung function after the pain block. The complications following the pain block were also observed. The 50 single thoracic epidural injections of the mixture were divided into three groups : Group 1(n=15) served as a control group and drags used for the relief of pain were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}1.64\;mg$), 0.5% bupivacaine($3.10{\pm}1.04\;ml$) and 0.9% saline($3.64{\pm}1.11\;ml$). Group 2(n=16) serves as an experimental group and drugs were as follows(Mean$\pm$S.D.): morphine($2.13{\pm}0.72\;mg$), 0.5% bupivacaine($3.06{\pm}0.77\;ml$) and dextran 70($3.75{\pm}1.29\;ml$). Group 3 (n=19) served as an experimental group and drags were as follows(Mean$\pm$S.D.) : morphine($2.42{\pm}0.51\;mg$), 0.5% bupivacaine($3.21{\pm}0.71\;ml$) and 50% dextrose in water($3.58{\pm}1.11\;ml$). The results are were follows: 1) The Dumber of patients who obtained excellent and good analgesic effects following the block were greater in the experimental Croup 2(94%) and Group 3 (90%) than theme of the control Group 1 (80%). 2) The duration of pain relief which lasted more than 3 days after the epidural block was longer in the experimental Group 2 (81%) and Group 3 (75%) than those of the control Croup 1(67%). 3) The pulmonary reserve(FVC%+FEV 1.0%) of 27 cases who were treated by the pain block between 1 and 31 drys following the chest injury was increased to about 13% than those before the block, and that of 13 cases between 32 and 82 days following the chest injury was decreased to about 4% than those before the block. 4) Of the complications following the pain block, there were 5 cased(10%) of nausea within 2 hours following the block, 4 cases(8%) of vomiting after 2 hours following the block, 10 cases(20%) of pruritus after 3~4 hours following the block, 17 cases(34%) of transient urinary retention which tasted 8 to 19 hours, 3 cases(6%) of headache within 2 hoers following the block and 2 cases(4%) of dural puncture. In conclusion, it is suggested that the clinical duration of analgesic effect produced by morphine and bupivacaine mixture can be prolonged by addition of the hypertonic solution to the mixture.

• Journal of Chest Surgery
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• 제55권2호
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• pp.118-125
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• 2022

Background: A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program. Methods: Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1-3, 4-6, and 7-9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters. Results: In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1-3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4-6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7-9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7-9 months post-ERATS (p=0.06). Conclusion: The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.

• Journal of Chest Surgery
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• 제30권9호
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• pp.920-926
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• 1997

개흉술후 동통으로 발생할 수 있는 술후 합병증을 예방하고 동통을 경감시킬 수 있는 방법중의 하나인 마약성 진통제의 정주요법으로 술후 괄목할만한 진통효과를 보았다. 총 30명의 후측방 개흉술 및 늑골절제를 시행받은 환자를 대상으로 통상적인 진통제의 근주를 시행한 환자 10명을 I 군으로, 경막외 신경차단을 시행한 환자 10명을 II군으로 그리고 환자 자가조절에 의한 지속적 정주 요법을 시행한 환자 10명 III군으로 구분하여 조사하였다. 연구 결과는 혈압, 심박수, 호흡수 및 동맥혈 가스 분석상 세 군간에 유의한 차이는 없었으나 II군과 III 군이 I군보다 기침 및.심호흡을 현저하게 잘하였다. 술후 2시간 후의 일회호흡량(tidal volume)의 회복률은 I군이 58.2$\pm$5.9%, II군이 77.9$\pm$ 11.7%, III군이 84.1 :5.8%로, III군은 II군보다, II군은 I군보다 유의한 차이가 있었다(p<0.05). 술후 2,8시간 후에 실시한 노력성 폐활량(forced vital capacity)의 회복률은 II군 및 III군 은 비슷하였으나, 각각 I군보다는 통계학적으로 유의하게 호전되었다(p< 0.05). 수술후의 통증은 II, III군 이 I군에 비하여 현저하게 감소하였으며, 수술측 부위의 운동도 원할하였고, 진통제 투여량에서도 I군보 다 감소 소견을 보였으며 수술후 회복도 보다 용이 하였다. 결론적으로 마약성 진통제의 지속적 정주요법 은 술후 폐기능 회복과 동통 완화 효과가 우수하였으며, 경막외 신경차단법과 비슷한 결과를 보였으나 수 술직후 2시간째의 폐기능 회복률에 있어서는 마약성 진통제의 정주요법이 경막외 신경차단법 보다 다소 효과가 좋았다..0%로 유의한 차이를 보였다(p<0.05). 조직형별 5년 생존율은 편평상피세포암이 43.1%, 선암이 23.3%, 거대세포암이 30.3%였다(p>0.05).치료법이며 앞으로 장기적인 추적검사가 필요하리라 생각된다.ricuspid valve pouch 19례), 우심실 유출로폐쇄(4례), 아급성심내막염(1례) 및 동반질환을 부가적인 수술적응으로 삼았다. 6. 수술후 관찰결과 사망률은 없었고, 잔존 심실중격결손증도 없었다. 이상의 결과로 경삼첨판륜 절개방법(TATV)은 삼침판맹낭을 가지고 있는 막성주위형 심실중격결손증 (PMVSD) 수술시 좋은 방법이며, 또한 막성주위형 심실중격결손증(PMVSD)에서 수술시 시야를 좋게하고 수술후 삼첨판폐쇄부전에 악영향을 미치지 않는 결과로 안전하고 효과적인 방법으로 사료된다.량치가 뜻하는 의 미는 서로 달랐으며, 암조직내에서 대조조직내보다 CYFRA 21-1 치가 더 낮게 나온 것은 암세포내 에서는 세 포질 성분의 고갈로 인한 것으로 추정되며 암세포의 활동성과는 무관한 것으로 판단된다. EGF-R은 세포벽내에 존재하는 수용체로서 암세포의 증식에 따라 증가하는 양상을 보이며 대조조직보다는 암세포에서 유의한 증가를 보이는 것은 종양 증식과 암표지자로서 의의가 있는 것으로 판단된다.것이 수술 결과를 좋게 하는 방법이라고 사료된다.료의 축적을 통한 신생대동맥근위부 확쏭 진행여부에 주의를 기울여야하겠다.록 mosaic 형태로 외래유전자가 발현되었지만 대조구에서 87.0% (26/30개) 배반포기가 $\beta$-Gal 활력을 보인 반면, G418 처리구에서는 모든 배반포기가 $\beta$-Gal 활력을 보였다 (P<0.05). 그러나 대조구 및 G418 처리구의

• Journal of Chest Surgery
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• 제34권6호
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• pp.472-476
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• 2001

배경: Nuss에 의한 누두흉의 최소 침습적 수술법은 연골 절제나 흉골절개가 없이 누두흉을 교정하는 새로운 수술법이다. 보고자는 Nuss술식의 조기 경험을 보고하는 바이다. 대상 및 방법: 1999년 12월에서 2001년 1월까지 20명의 누두흉 환자에서 Nuss술식을 시행하였다. 수술 대상은 남자 14 명, 여자 6 명으로, 1 세에서 33세까지 평균 10.1$\pm$7.7 세이며 대부분의 환자는(19명) 20세 이하였고, 33세된 성인 여자도 1명이 있었다. 결과: 가슴 함몰의 정도는 CT로 조사하였는데 CT지수는 평균 4.9$\pm$5.7 이었다. 평균 수술시간은 85.8$\pm$23.7 분이었다. 사용된 금속막대의 길이는 8 인치 에서 16인치 가지 평균 11.8$\pm$14.4 인치였다. 술후 조기 합병증은 3례의 환자에서 기흉이 있었고, 1례에서는 장마비, 전례에서 술후 통증조절을 위해 정맥진통제를 사용하였다. 1례의 성인 환자에서 술후 통증 조절을 목적으로 경막외 통증조절을 위한 도관을 삽입하였다. 그러나 전례에서 중대한 합병증은 발생치 않았다. 결론: 보고자가 누두흉 치료에 적용한 Nuss술식의 조기결과는 만족할만 하였지만 널리 이용되기에는 장기적인 관찰이 필요할 것으로 사료된다.