• The Korean Journal of Pain
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• 제6권1호
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• pp.109-116
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• 1993

In March of l992, We performed two intentional total spinal blocks for the relief of pain. This was for 2 cases of post-traumatic cervical syndrome whose various symptoms were chronically unresponsive to the usual conservative treatments. We regularly checked the blood pressure, pulse rate, oxygen saturation and observed clinically the changes of respiration, consciousness, lid and light reflexes during the total spinal block. Pain relief was evaluated by using the Visual Analog Scale which is designed to measure the subjective intensity of pain. The results were as follows; 1) The effectiveness of total spinal block was 60% in case 1, 40% in case 2. 2) We observed two complications from the procedure. Firstly during the block, these were transient periods of hypotension. Following the block, accidental procedures related direct neural trauma resulted in anterior chest wall pain. In conclusion we believe that total spinal block is a satisfactory and reliable method for the treatment of post-traumatic cervical syndrome.

• The Korean Journal of Pain
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• 제9권2호
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• pp.403-406
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• 1996

Total spinal block is used as final choice for chronic intractable pain which doesn't respond to other treatments. A 35 years old male patient was admitted to pain clinic due to severe cramping and throbbing pain of whole body, especially left lateral side since 1980. The result of cervical and lumbar epidural block was not good enough, so we decided to try total spinal block. At first, C7-T1 interspace was punctured and 2% mepivacaine 20 ml was injected, but the result was not satisfied. Next day, L3-4 interspace was punctured and 1.5% mepivacaine 40 ml was injected. The sensory block level was C6 and pain score on Visual Analog Scale, was changed from 9 to 4. In both trials, actually even though they were not complete total spinal block, the effect was good enough. If complete total spinal block had been accomplished, better result might be obtained in this chronic intractable pain.

• The Korean Journal of Pain
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• 제14권2호
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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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• 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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• 제23권1호
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• pp.70-73
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• 2010

Complex regional pain syndrome (CRPS) is a painful and disabling disorder that can affect one or more extremities. Unfortunately, the knowledge concerning its natural history and mechanism is very limited and many current rationales in treatment of CRPS are mainly dependent on efficacy originated in other common conditions of neuropathic pain. Therefore, in this study, we present a case using a total spinal block (TSB) for the refractory pain management of a 16-year-old male CRPS patient, who suffered from constant stabbing and squeezing pain, with severe touch allodynia in the left upper extremity following an operation of chondroblastoma. After the TSB, the patient’s continuous and spontaneous pain became mild and the allodynia disappeared and maintained decreased for 1 month.

• 대한방사선기술학회지:방사선기술과학
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• 제45권2호
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• pp.171-177
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• 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
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• 제19권2호
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• pp.288-291
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• 2006

Epidural analgesia using an epidural catheter is an effective method to relieve the pain during the rehabilitating procedure for postoperative orthopedic patients. Total spinal anesthesia is one of the possible complications of epidural catheterization which can lead to a life-threatening condition. Achondroplasia is the most common form of short-limbed dwarfism resulting from a failure of endochondral bone formation. In patients suffering with short stature syndrome like achondroplasia, the incidence and risk of total spinal anesthesia during epidural anesthesia may increase because of the technical difficulty and structural anomaly of the spine. We report here on a 35-year old female patient with a height of a 115 cm. She was diagnosed as achondroplasia and she had a previous Ilizarov operation; both tibial lengthening and correction of valgus were done. No specific event occurred during epidural catheterization. Immediately after the injection of a test dose via epidural catheter, the patient became hypotensive, drowsy and showed weakness of both her upper and lower extremities. The symptoms were disappeared after 40 minutes. The catheter was removed on the next day. We concluded that the total spinal anesthesia was caused by intrathecal injection of local anesthetics through the epidural catheter, and the anesthesia then migrated into the subarachonoid space.

• The Korean Journal of Pain
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• 제24권3호
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• pp.169-171
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• 2011

Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.

• Clinical and Experimental Pediatrics
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• 제60권12호
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• pp.385-389
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• 2017

Purpose: This study aimed to assess whether different anesthetic techniques and oxytocin use applied during delivery affect transcutaneous bilirubin levels during the first 24 hours in neonates. Methods: A total of 1,044 neonates delivered by either caesarian section (C/S) or normal vaginal delivery (NVD) were included in the study. They were classified into 5 groups as follows: group 1: born by C/S using general anesthesia, group 2: C/S using spinal anaesthesia, group 3: C/S using general anesthesia after failed spinal block, group 4: by NVD without anesthesia, and group 5: oxytocin-induced vaginal delivery without anesthesia. Transcutaneous total bilirubin levels (TBLs) were measured during the first 24 hours and on the fifth and eighth days of life and the levels in different groups were compared. Results: The TBLs were significantly higher in neonates delivered by C/S using general anesthesia rather than spinal anesthesia (P<0.001), and both groups had higher levels than those born by NVD without anesthesia ($P{\leq}0.001$). However, the group receiving general anesthesia after failed spinal block was found to have the highest bilirubin level. Moreover, TBLs were significantly higher with the use of oxytocin ($P{\leq}0.001$). Conclusions: C/S and general anesthesia adversely affect the bilirubin levels in neonates, and the use of oxytocin during vaginal delivery also increases TBLs in neonates.

• The Korean Journal of Pain
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• 제31권4호
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• pp.261-267
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• 2018

Background: To compare the effects of adding two different doses of dexamethasone on the duration and quality of the fascia iliaca block in patients undergoing proximal femoral fracture surgery. Methods: A total of 60 patients (age 18-70 years) undergoing proximal femoral nailing surgery under spinal anesthesia were given fascia iliaca block after random assignment to one of the two groups: Group H received an injection of levobupivacaine (0.5%) 28 ml with 2 ml (8 mg) dexamethasone, and Group L received an injection of levobupivacaine (0.5%) 28 ml with dexamethasone 1 ml (4 mg) with 1 ml normal saline. Assessment of the duration of analgesia and the total tramadol requirement over 48 hours were noted after a successful block. Results: The duration of analgesia was found to be significantly longer in Group H ($17.02{\pm}0.45h$) than in the Group L patients ($14.29{\pm}0.45h$) with a p-value of 0.000. Postoperative analgesic requirement (amount of tramadol in mg) was significantly higher in Group L (Q2: 200.0; IQR: 100.0, 200.0) as compared to Group H (Q2: 100.0; IQR: 100.0, 200.0) with a p-value of 0.034. No patient showed any sign of neurotoxicity. Conclusions: Dexamethasone, in a dose of 8 mg, is superior to 4 mg when used as an adjuvant with levobupivacaine in the FIB. Though both prolonged analgesia and were effective in reducing oral/intravenous analgesics, 8 mg dexamethasone can be recommended as a more efficacious adjuvant to local anesthetics in the FIB.