• The Korean Journal of Pain
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• 제8권2호
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• pp.257-265
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• 1995

Patient-Controlled Analgesia (PCA) has been widely used for postoperative pain relief. Meperidine is useful for PCA and has efficient analgesia, rapid onset, and low incidence of adverse effect. To compare the analgesic effect, total dose and hourly dose, side effect and neonatal status of breast feeding with meperidine via intravenous or epidural PCA for 48 hours after Cesarean Section, 40 parturient women undergoing elective Cesarean Section were randomly divided into two groups. Each respective group of 20 parturient women received meperidine via one of the intravenous PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after epidural block with 2% lidocaine 20ml combined with general anesthesia with only $N_2O$ and $O_2$ (EpiPCA group) when they first complained of pain in recovery room. Following the administration of analgesic initial dose, parturient women of IVPCA group were allowed intravenous meperidine 10 mg every 8 minutes when they felt pain. The EpiPCA group received additional bolus dose of meperidine 2 mg and bupivacaine 0.7 mg were administered every 8 minutes as requested the patients with hourly continuous infusion of meperidine 4 mg and bupivacaine 1.4 mg. Data was collected during the 48 hours observation period including visual analog scale (VAS) pain scores, total meperidine dose, hourly dose during 48 hours and each time interval, incidence of adverse effect, satisfaction, and neonatal status with breast feeding. VAS pain scores of analgesic effect in EpiPCA group was significantly lower than in IVPCA group at 2 hours after the initial pain after Cesarean Section. Total dose and hourly dose of meperidine significantly reduced in EpiPCA group. Hourly dose of meperidine at each time interval significantly reduced during first 6 hours and from 12 hours to 24 hours in EpiPCA group. The side effects in IVPCA group were mainly sedation, nausea, and local irritation of skin. And EpiPCA group experienced numbness and itching. The degree of satisfaction of parturient women was 88.2 % in IVPCA group and 85.7 % in EpiPCA group. We did not observe any sedation, abnormal behavior, or seizure like activity in any neonates of breast feeding. From the above results we conclude that epidural PCA was more efficiently analgesic, less sedative, and consumptional, and safer for neonate than intravenous PCA, and could be an alternative method to intravenous PCA.

• 척추신경추나의학회지
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• 제5권2호
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• pp.113-125
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• 2010

2009년 10월 08일부터 2009년 11월 05일까지 동국대학교 분당한방병원 한방재활의학과에 입원한 요통, 양둔통, 골반통을 호소하며 MRI상 T12-L1의 추간판 탈출증을 진단받은 환자를 대상으로 통증의 특징과 이학적 검사상 등-허리, 허리-영치 이행부위 증후군으로 진단하고 침치료 및 요추 굴곡신연기법을 사용하여 치료한 결과 주소증과 이학적 검사상의 호전을 거두었다. 등-허리, 허리-영치 이행부위는 형태적, 역학적, 구조적, 생리적으로 다른 부위에 비하여 쉽게 손상될 수 있으며, 척추 분절의 이상은 각 분절의 후일차가지가 지배하는 영역의 통증과 이상반응을 일으키는데 등-허리, 허리-영치 이행부위 증후군에서 각 이행부위의 이상은 요부, 둔부, 서혜부, 골반에서 공통의 통증 영역을 가진다. 또한, 등-허리, 허리-영치 이행부위는 서로 구조적,기능적, 신경생리학적으로 밀접한 연관을 가지며, 한 이행 분절의 이상은 다른 이행 분절의 병적상태를 초래할 수 있다는 사실을 알 수 있었다. 더불어, 수기요법 이외에 요부의 혈위를 활용한 척추신경의 후일차가지가 지배하는 영역의 인대와 근육을 목표로 한 침치료 역시 이행부위 증후군의 치료에 있어 효과적이라고 생각된다.

• The Korean Journal of Pain
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• 제20권2호
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• pp.169-173
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• 2007

Background: Although the use of intravenous patient controlled analgesia (IVPCA) has been compared to the use of patient conrolled epidural analgesia (PCEA), there is no optimal administration route of alfentanil for the treatment of postoperative pain. This randomized double-blind study compared the efficacy of the use of IVPCA and PCEA for postoperative pain and the side effects after a total abdominal hysterectomy (TAH). Methods: Sixty patients undergoing a TAH were randomly assigned to receive either IVPCA (Group I) or PCEA (Group E) for the infusion of alfentanil for postoperative pain control. In both groups, a loading dose of $750{\mu}g$ alfentanil was administered. All patients received the same continuous infusion rate (0.3 mg/h), bolus dose (0.15 mg), and lockout time (15 min). The incidence of side effects, the VAS (visual analog scale) of pain, blood pressure, and heart rate were checked for 20 hours after the loading dose injection. Results: The VAS of pain was not significantly different between the two groups of patients. The onset of the analgesic effect was significantly more rapid in the Group I patients than in the Group E patients. There was no difference in side effects for either group. Conclusions: When considering multiple factors such as the onset of analgesia, technical difficulties or infection after the procedure, IVPCA using alfentanil is more useful than PCEA for postoperative pain control after a TAH.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.669-673
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• 2011

Purpose: The authors have conducted a series of anatomic studies on the factors affecting shape of a lower vault in Asian noses. The results of the studies showed that prominence of alar lobule is mainly affected by the volumes of the dilator naris anterior and posterior muscles and the insertions of the dilator naris posterior muscles. However, information on its clinical availability is yet insufficient. The present study was undertaken for clinical purpose to find out the effect of dilator naris muscle resection on the correction of prominent alar lobule. Methods: Six patients who were treated by dilator naris muscle resection with a long-term follow-up of more than 1 year were involved in this study. Rhinoplasties were performed via endonasal approaches with resecting dilator naris anterior and posterior muscles by sharp scissor. The effect of the dilator naris muscle resection on alar prominence was investigated by measuring ratio of the short axis to the long axis of a nostril (SA/LA) pre-and postoperatively. The visual analog scale (VAS) was also used to evaluate satisfaction of patients. An average follow-up time was $15.6{\pm}3.7$ months. Results: Having lost the dilating and lateral pulling effects of the dilator naris muscles, the alar lobule shifted medially and alar lobule shapes improved. SA/LA significantly improved (preoperatively $0.71{\pm}0.11$ and postoperatively $0.58{\pm}0.08$; $p$ <0.05). The VAS score was also increased postoperatively (preoperatively $3.2{\pm}1.8$ and postoperatively $8.7{\pm}1.2$; $p$ <0.05). A mild degree of hyperpigmented scar was noted in one alar lobule. Otherwise, there was no case of postoperative complication. Conclusion: Our results suggest that prominent alar lobule could be modified by resecting the attachment of the dilator naris muscles. This maneuver removes the function of dilator naris muscles, then may produce a more aesthetically acceptable alar lobule shape.

• Korean Journal of Acupuncture
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• 제22권1호
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• pp.33-41
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• 2005

갑작스러운 요통과 양측하지통, 하지의 근력 감소, 대소변 장애 및 운동, 감각장애로 양방병원에서 마미증후군으로 진단받고 추궁판 절제술과 감압술을 시행 후 임상적인 호전을 보이지 않은 환자 1례에 대해 홍화자(紅花子) 약침요법(藥鍼療法)을 중심으로 복합적인 한방치료를 시행한 결과 요통에 대한 VAS와 요통점수표, ODI 항목에서는 각 항목 모두에서 현저한 호전 양상을 나타내었다. 운동기능 및 보행에 있어서 입원 당시에 보행기에 의지하여 보행하였는데 치료 후에는 안독으로 보행이 가능하고 일상적인 가벼운 생활도 가능해지게 되었다. 배뇨기능에 있어서도 자발적인 배뇨가 가능할 정도로 완전회복 되었다. 하지만 배변의 상태는 입원 당시와 치료 후에는 변의가 느껴지는 것 이외에 자발적인 배변은 이루어지지 않았다. 감각 기능의 회복에 있어서도 온통각, 압촉각과 하지 냉감은 호전 양상을 보였으나 안장 감각과 괄약근의 기능은 거의 회복되지 않았다. 본 연구를 기초로 하여 향후 수술이나 양방적인 치료 후에 발생할 수 있는 후유증의 관리에 있어서 홍화자(紅花子) 약침(藥鍼)에 대한 더욱 심도있는 후속 연구가 이루어져야 할 것이다.

• 한국융합학회논문지
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• 제12권4호
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• pp.303-310
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• 2021

본 연구는 원위경비인대결합이 손상된(High Ankle Sprain) 운동선수들의 경·비간 압박테이핑 적용이 통증, 관절가동범위, 근력에 미치는 영향을 규명하는데 있다. High Ankle Sprain 또는 발목 염좌를 진단받은 선수 중 이학적 검사결과 양성인 운동선수 14명을 대상으로 중도 포기 4명을 제와한 10명을 대상으로 진행하였다. 3주간 아급성기재활 전, 중, 후로 경비간 압박테이핑 처치군(TG)과 적용하지 않는 대조군(NTG)으로 나누어 통증, 관절가동범위, 등척성근력을 측정 하였다. 통계는 반복측정에 의한 변량분석을 실시하였으며 사후검증은 t-test를 실시하였다. 연구 결과 통증(VAS)은 유의한 차이가 발생하지 않았으며, 관절가동범위는 두 그룹 모두 내번과 외번 가동범위가 시기간 유의한 증가를 보였고, 등척성근력은 테이핑 처치군 에서만 내번(0°, 7°, 14°)과 외번(0°)에서 시기간 유의한 향상이 나타났다. 결론적으로 원위경비인대결합 손상 운동선수의 경·비간 압박 테이핑 적용이 아급성기 재활프로그램에서 동일한 통증수준에서도 관절가동범위와 근력의 조기 향상에 효과가 있는 것으로 나타났다.

• Asian Spine Journal
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• 제12권6호
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• pp.1106-1116
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• 2018

Study Design: Prospective observational study. Purpose: To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. Overview of Literature: The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI. Methods: In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients. Results: According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach's alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach's alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach's alpha=0.712, p>0.05) and pain (Cronbach's alpha=0.625, p>0.05). Conclusions: A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.594-602
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• 2019

Objective : Although surgical intervention, such as percutaneous vertebroplasty (PVP), is the standard treatment for osteoporotic vertebral compression fractures (OVCFs), its effectiveness and safety are unclear. Therefore, this study compared the safety and efficacy of conservative treatment with that of PVP for acute OVCFs. Methods : Patients with single-level OVCFs who were treated conservatively with a transdermal fentanyl patch (TFP) or with PVP between March 2013 and December 2017 and followed-up for more than 1 year were retrospectively evaluated. Patients with pathologic fractures, fractures of more than two columns, or a history of PVP were excluded. Clinical outcomes (visual analog scale [VAS] scores) and radiographic factors were evaluated, including changes in the compression rate of the corresponding vertebral body at onset and after 12 months, sagittal Cobb angle at onset and after 6 and 12 months, and the incidence of adjacent compression fractures. Results : Of the 131 patients evaluated, 75 were treated conservatively using TFPs and 56 underwent PVP. We divided the patients into TFP and PVP groups. Their baseline characteristics (including sex, level of fracture, and bone mineral density T-scores) were similar, but the TFP group was significantly younger. The overall VAS score for pain showed a greater decrease during the first month (1 week after PVP) in the PVP group but remained similar in the two groups thereafter. The compression rate after 12 months increased in the TFP group but decreased in the PVP group. Five patients in the PVP group, but none in the TFP group, experienced adjacent compression fractures within 12 months. Conclusion : We compared clinical and radiological outcomes between the TFP and PVP groups. The immediate pain reduction effect was superior in the PVP group, but the final clinical outcome was similar. Although the PVP group had a better-preserved compression rate than the TFP group for 1 year, the development of adjacent fractures was significantly higher. Although TFPs seemed to be beneficial in reducing the failure rate of conservative treatment, the possibility of side effects (22.6%, 17 out of 75 patients, in this study) should be carefully monitored.

• 대한한방내과학회지
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• 제40권4호
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• pp.582-596
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• 2019

Objective: The aims of this study were to analyze the deficiency-excess pattern identification (虛實辨證) and compare it to the sputum cytokines of asthma patients. Method: 50 asthma patients who met the inclusion and exclusion criteria were included in this study. They were divided into two groups: deficiency and excess syndrome groups. Sputum examinations were performed including $TNF-{\alpha}$, Interleukin (IL)-4, IL-5, IL-10, and IL-13. The Quality of Life Questionnaire for Adult Korean Asthmatics (QLQAKA), the Visual Analog Scale(VAS), and heart rate variability (HRV) were also measured. We also conducted laboratory tests, including the hematological indexes. Results: Based on the pattern identification, 50 asthma patients can be divided into two categories of groups: the deficiency syndrome group (N=24) and the excess syndrome group (N=26). In the analysis of sputum cytokines, although the $TNF-{\alpha}$, IL-4 and IL-13 were at a higher level in the deficient pattern group than in the excess pattern group, it was insignificantly different. There was a negative correlation in the analysis of QLQAKA and VAS. In the analysis of HRV, although the mean value of VLF, LF, and HF in the deficiency syndrome group was higher than in the excess syndrome group, it was insignificantly different. There was no significant difference in the hematological tests between the deficiency and the excess syndrome group. The mean value of the IgE in the blood tests was five times greater than the reference value. Conclusion: The cytokines of sputum including $TNF-{\alpha}$, IL-4, IL-5, IL-10, and IL-13 were indifferent statistically. Reinforcing the healthy and eliminating the pathogenic factors should be considered.

• Clinics in Shoulder and Elbow
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• 제24권1호
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• pp.21-26
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• 2021

Background: To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear. Methods: Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. Results: There were 402 female patients (79%) with mean age of 55 years (range, 31-87 years). Mean duration of symptoms was 16 months. Mean size of calcific materials was 11.4 mm (range, 0-35 mm). Mean value of VAS and ASES scores were 6.5 (range, 1-10) and 47 (range, 8-95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all p<0.05). Conclusions: This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.