• The Korean Journal of Pain
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• v.14 no.2
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• pp.249-252
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• 2001

Total spinal anesthesia is a serious life threatening complication of spinal and epidural anesthesia. We report an accidental total spinal anesthesia developed during a thoracic epidural block in a practitioner's pain clinic. A 69-year-old female with post-herpetic neuralgia was treated by a thoracic epidural block. A thoracic tapping for the epidural block was performed in the right lateral position at a level between $T_{5-6}$, using a 23 gauge Tuohy needle. After the epidural space was identified, a mixed solution of 10 ml of 0.3% lidocaine and 20 mg of triamcinolone was injected into the epidural space. After removal of the syringe, fluid was dripping through the needle. The patient subsequently complained of dyspnea and dizziness, and she became unconscious. She was intubated immediately and cardiopulmonary resuscitation was performed because there was no pulse palpable. The patient recovered an hour after transfer to a general hospital and was discharged without any further complication 19 days later.

• The Korean Journal of Pain
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• v.23 no.4
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• pp.247-253
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• 2010

Background: Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain. Methods: In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging. Results: The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery. Conclusions: Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.178-182
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• 2011

Background: We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method. Materials and Methods: From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation. Results: The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation. Conclusion: Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.544-546
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• 2010

Paraplegia following spinal epidural anesthesia is extremely rare. Various lesions for neurologic complications have been documented in the literature. We report a 66-year-old female who developed paraplegia after left knee surgery for osteoarthritis under spinal epidural anesthesia. In the recovery room, paraplegia and numbness below T4 vertebra was checked. A magnetic resonance image (MRI) scan showed a spinal thoracic intradural extramedullary (IDEM) tumor. After extirpation of the tumor, the motor weakness improved to the grade of 3/5. If a neurologic deficit following spinal epidural anesthesia does not resolve, a MRI should be performed without delay to accurately diagnose the cause of the deficit and optimal treatment should be rendered for the causative lesion.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.732-738
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• 1999

Background: Video-assisted thoracoscopic surgery has become a standard therapy for several diseases such as pneumothorax, hyperhidrosis, mediastinal mass, and so on. These methods usually required single-lung ventilation with double-lumen endobronchial tube to collapse the lung under general anesthesia. However, risks of general anesthesia itself and single-lung ventilation must be considered in high-risk patients. Material and method: Between December 1997 and July 1998, eight high-risk patients (6: empyema, 1: intractable pleural effusion, 1: idiopathic pulmonary fibrosis) with underlying pulmonary disease and poor general condition were treated by video-assisted thoracoscopic surgerys under epidural anesthesia and spontaneous breathing. Result: Video-assisted thoracoscopic surgerys were successfully per formed in 7 patients. Conversion to general anesthesia was required in 1 patient because of decrease in spontaneous breathing. But, conversion to open decortication was not required. In two patients with chronic empyema, one patient required thoracoplasty as a second procedure and one patient required re-video-assisted thoracoscopic procedure due to a recurrence. The mean operative time was 31.8$\pm$15.2 minutes. No significant postoperative respiratory com plication was encountered. Conclusion: Video-assisted thoracoscopic surgerys can be per formed safely under epidural anesthesia for the treatment of empyema and diagnosis of pulmonary abnormalities in high-risk patients.

• The Korean Journal of Pain
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• v.31 no.3
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• pp.191-198
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• 2018

Background: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. Methods: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. Results: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. Conclusions: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.678-682
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• 2003

Video-assisted thoracoscopic surgery is good indication of secondary spontaneous pneumothorax. This method usually required general anesthesia and single-lung ventilation with collapse of other lung. But, risks of general anesthesia and single-lung ventilation must be considered in high-risk patients. Material and Method: Between September f999 and August 2001, 15 high-risk patients were treated by video-assisted thoracoscopic surgery under epidural anesthesia. Result: Video assisted thoracoscopic surgery was successfully performed in 15 patients. Duration of postoperative air-leakage was 4.3days, Significance of complication was none, No recurrence of pneumothorax was encountered. Conclusion: Video-assisted thoracoscopic surgery can be performed safely under epidural anesthesia for treatment of secondary spontaneous pneumothorax in high-risk patients.

• The Korean Journal of Pain
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• v.29 no.4
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• pp.255-261
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• 2016

Background: Thoracic epidural anesthesia is frequently used to maintain intraoperative and postoperative analgesia. Frequently, 3 ml of local anesthetic is used as a test dose, or for intermittent epidural injection. We assessed the extent of the spread of 3 ml of contrast medium in the thoracic epidural space and attempted to identify any correlating factors affecting the epidurography. Methods: A total of 70 patients were enrolled in the study, and thoracic epidural catheterizations were performed under fluoroscopic guidance. Using 3 ml of contrast medium, epidurography was evaluated to confirm the number of spinal segments covered by the contrast medium. Correlation analysis was performed between patient characteristics (sex, age, body mass index, weight, height, and location of catheter tip) and the extent of the contrast spread. Results: The mean number of vertebral segments evaluated by contrast medium was $7.9{\pm}2.2$ using 3 ml of contrast medium. The contrast spread in the cranial direction showed more extensive distribution than that in the caudal direction, with statistical significance (P < 0.01). Patient height demonstrated a negative correlation with the extent of distribution of contrast medium (r = -0.311, P < 0.05). Conclusions: Thoracic epidurography using 3 ml of contrast medium results in coverage of a mean of $7.9{\pm}2.2$ spinal segments, with more extensive cranial spread, and patient height showed a weak negative correlation with the distribution of contrast medium.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.598-603
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• 2006

Background: High thoracic epidural anesthesia allows awake coronary artery bypass grafting, avoiding the drawbacks of mechanical ventilation and general anesthesia. Materian and Method: From April, 2005 to September, 2005, 12 patients were underwent awake coronary artery bypass grafting using high thoracic epidural anesthesia. There were 1 female and 11 male patients, with a mean age of $66{\pm}6$ years. Off pump coronary artery. bypass grafting was performed through a median sternotomy using arterial grafts. Result: There were no mortality. Pneumothorax was developed during surgery in 8 patients. Five patients required secondary intubation because of pneumothorax (n=3), bowel herniation (n=1), and hemothorax after chest tube insertion (n=1). Postoperative coronary angiography was performed before discharge in all patients and all the grafts were patent. Conclusion: Our intial experience demonstrated the feasibility of awake off-pump coronary artery bypass grafting. Further study is required to define the indications, advantages and limitations of this strategy.