• Title/Summary/Keyword: 신경 차단술

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Perioperative Pain Management Using Regional Nerve Blockades in Shoulder Surgery: Ultrasound-Guided Intervention (견관절 수술 시 국소신경 차단술을 이용한 통증 관리 - 초음파 유도하 중재술 -)

  • Oh, Joo Han;Lee, Ye Hyun;Park, Hae Bong
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.67-75
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    • 2014
  • There are several kinds of regional nerve blockades, such as interscalene brachial plexus block, C5 root block, suprascapular nerve block, and axillary nerve block, which can be applied for anesthesia and postoperative pain control after shoulder surgeries. These regional nerve blockades have shown good results, but high failure rate and serious complications, such as phrenic nerve palsy, pneumothorax, and nerve injury, still remain. Ultrasound-guided intervention can increase the success rate of nerve blockades and reduce complications. We described the method of ultrasound-guided intervention for the regional nerve blockades around shoulder.

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Ultrasound-Guided Regional Nerve Block in Lower Extremity (하지에서의 초음파 유도 국소 신경 차단술)

  • Kang, Chan
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.5 no.1
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    • pp.50-59
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    • 2012
  • In the domain of orthopaedic surgery, application of regional nerve block for surgery or pain control in upper and lower extremities has been increased. By performing regional block of popliteal (sciatic), femoral, proximal saphenous nerve and ankle block under guidance of ultrasound, not only the safety, but also success rate of the procedure has increased, and amount of local anesthetics could be used less, too. Since the perineural single injection or continuous catheterization of diluted local anesthetics was performed more precisely and easily by the guidance of ultrasound, postoperative pain could be controlled without complications of PCA such as nausea, vomiting, etc. We will discuss about this ultrasound guided regional nerve block.

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Endoscopic Treatment of Latrogenic Chylothorax after Thoracic Symphathicotomy -A Case Report- (교감신경다발 차단술 후 발생한 유미흉의 내시경적 치료 -1례 보고-)

  • 이선훈;김재욱;정재일;윤찬식;윤영철;구본일;이홍섭;김문철
    • Journal of Chest Surgery
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    • v.33 no.12
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    • pp.988-990
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    • 2000
  • 흉강경을 이용한 교감신경다발 차단술은 다한증 치료에 아주 효과적이다. 술 후 유미흉과 같은 합병증은 발생은 적으나 아주 위험할 수 있다. 흉관 근접 부위의 좌측 2번째에서 4번째 흉부 교감신경다발 차단술 후 발생한 유미흉을 흉강경을 이용한 전기 응고법으로 치료하였기에 보고하는 바이다.

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Considerations for Fluoroscopic Guided Intervention in Lumbar Spine (방사선 투시장치를 이용한 요추 중재술 시 고려점)

  • Kim, Dong-Hyun;Song, Kwang-Sup
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.3
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    • pp.210-221
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    • 2020
  • Spinal block procedures are useful methods that reduce the need for surgical treatment. In addition to their therapeutic aspects of pain relief, in many patients, they are also used for diagnostic purposes to distinguish from symptoms originating from extra-spinal areas. Therefore, these procedures are the most basic technique for orthopedic surgeons dealing with diseases from limbs and spine. On the other hand, despite the simplicity of the instruments and drugs used, the overall understanding of them and the lack of knowledge of the possible side effects and complications can cause serious harm to the patient at the beginning of the trial. Therefore, it is necessary to understand the types of drugs used in the spinal block procedures, pharmacokinetic properties, and the side effects of each drug. In addition, efforts should be made to identify their indications, as well as advantages and disadvantages of each procedure to avoid possible complications. The purpose of this review was to provide basic knowledge and skills necessary for lumbar spinal block procedures as well as provide the reader with the ability to perform themselves.

Clincal Results according to the Level and Extent of Sympathicotomy in Axillary Hyperhidrosis (액와부 발한을 동반한 일차성다한증 환자에 있어서 수술방법에 따른 결과 비교)

  • Kim, Byung-Ho;Huh, Dong-Myung
    • Journal of Chest Surgery
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    • v.38 no.8 s.253
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    • pp.570-575
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    • 2005
  • Background: Video-assisted thoracic sympathicotomy plays an important role as an effective method for the treatment of axillary hyperhidrosis. People with axillary hyperhidrosis were not satisfied by the occurrence of the high rate of disabling compensatory hyperhidrosis and axillary resweating. Therefore, by comparing and assessing the clincal results according to the level and extent of sympathicotomy in axillary hyperhidrosis, we aim to determine which method will result in maximal benefits. Material and Method: Among 70 patients suffering from axillary hyperhidrosis having undergone thoracoscopic sympathicotomy from January 2001 through December 2003, 57 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into two groups, Group 1 (n=25): patients having undergone R3, 4, 5 sympathicotomy which consist of blocking the interganglionic neural fiber on the third, fourth, and fifth rib, Group 11 (n=32): patients having undergone R3,4 sympathicotomy which consist of blocking the interganglionic neural fiber on the third and fourth rib. The study parameters were satisfaction rate and degree of compensatory sweating. Result: There was no difference on age and sex, family history, combined hyperhidrosis, and mean follow up month between the two groups. Patients expressing satisfaction were $88.0\%$ in group and $56.3\%$ in groups 11 with statistically significant difference (p=0.02). Moderate to severe compensatory sweating were $52.0\%$ (embrassing 6 patients, disabling 7 patients) in group 1 and $62.5\%$ (embrassing 5 patients, disabling 15 patients) in groups 11 with no significance in the statistical analysis. Conclusion: R3, 4, 5 sympathicotomy was an effective means of treating axillary hyperhidrosis because of higher long term satisfaction rate.

Intermediate Term Follow Up for R3 Sympathicotomy in Palmar Hyperhidrosis (수장부 다한증에서의 제3번 늑골 위 교감 신경(R3) 차단술의 중기 결과)

  • 손국희;김광호;백완기;김정택;김현태;김영삼;윤용한
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.530-535
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    • 2004
  • Background: Thoracoscopic R3 (above the third rib)sympathicotomy has been performed as an effective method in treating palmar hyperhidrosis because it is effective in eliminating the symptoms of hyperhidrosis and has lower degree of compensatory hyperhidrosis than that of sympathectomy. Most of the results published were based on the short-term follow up. So we evaluated the intermediate term follow up results of the R3 sympathicotomy. Material and Method: From April 1999 to August 2001, ninety-four patients with palmar hyperhidrosis had been treated by R3 sympathicotomy at the Inha University Hospital. Follow-up study was completed for 76 patients (male 38, female 38) and average follow-up period were 25$\pm$9.1 (15∼50) months. The sympathetic trunk passing above the upper border of third rib was divided by electric cautery. The patient's satisfaction after surgery was estimated using the analogue scale from score 0 to 100 (100 means perfect satisfaction). Result. The scale of patient's satisfaction immediately after operation was 92.36$\pm$9.93. After 15 months, the scale of satisfaction was decreased to average 71.80$\pm$20.24 and it is statiscally significant. The cause of dissatisfaction were compensatory hyper-hidrosis and recurrence of symptom. The degree of sweating immediately after operation was mean 0 and after 15 months it increased to mean 1.5. The degree of the compensatory hyperhidrosis immediately after operation was mean 1 and it increased to mean 5 after 15 months. Conclusion: R3 sympathicotomy has excellent therapeutic results immediately after operation but therapeutic effectiveness is becoming to decrease 15 months after operation. The common causes of dissatisfaction are compensatory hyperhidrosis and recurrence of hyperhidrosis.

The Effectiveness of Ultrasonography-guided Suprascapular Nerve Block in Patients treated with Arthroscopic Rotator Cuff Repair (관절경하 회전근개 봉합술을 시행한 환자에 대한 초음파 유도하 상견갑 신경차단술의 효과)

  • Moon, Young Lae;Kang, Jeong Hoon;Kim, Hyun Hak
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.2
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    • pp.84-88
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    • 2014
  • Purpose: The purpose of this study was to analyze the effectiveness of suprascapular nerve block using platelet-rich-plasma (PRP) under ultrasonographic guidance in patients treated with arthroscopic rotator cuff repair. Material and Methods: 50 cases of patients, from March 2013 to March 2014, treated with arthroscopic rotator cuff repair were retrospectively analyzed. We performed ultrasonography-guided suprascapular nerve block using platelet-rich-plasma (PRP) to these patients in the outpatient clinics at the 6 weeks follow-up after operation. We evalulated results for visual analogue score (VAS) for pain, range of motion (ROM), Constant Shoulder Score (CSS) for these patients before arthroscopic operation, following 6 weeks and 3 months after operation. Results: There was clinically significant improvement in VAS, ROM, CSS after ultrasonography-guided suprascapular nerve block using platelet-rich-plasma (PRP). Conclusion: Ultrasonography-guided suprascapular nerve block using platelet-rich-plasma (PRP) is an effective treatment method not only for around shoulder pain but also postoperative residual shoulder pain and limitation of shoulder motion.

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Comparison of the Clinical Outcomes of an Ultrasound-Guided and C-Arm Guided Cervical Nerve Root Block (초음파와 방사선 투시장치를 이용한 경추 신경근 차단술의 임상결과 비교)

  • Ha, Dae Ho;Shim, Dae Moo;Kim, Tae Kyun;Oh, Sung Kyun;Lee, Hyun Jun
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.1
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    • pp.78-84
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    • 2020
  • Purpose: This paper compares the clinical outcomes of patients who were treated with a cervical nerve block by ultrasound and C-arm and reports the complication. Materials and Methods: A total of 97 patients were treated with an ultrasound-guided nerve root block from May 1, 2015 to February 8, 2018. On the other hand, 94 patients were treated with a C-arm guided nerve root block. The consequences of the cervical pain and the radiating pain before and after the procedures were reviewed using the verbal numeric rating scale (VNRS). In addition, the complications related to the procedures from the daily notes from the chart were inspected. Results: Sixty-six cases out of 97 cases of ultrasound-guided nerve root block were enrolled in the study. The average age of the patients was 57 years, including 41 males and 25 females. Seventy seven out of 94 cases by a C-arm guided root block were included in the study. The average age of the patients was 55 years, including 40 males and 37 females. Before the nerve root block, the mean numeric rating pain scale (NRS) of the cervical pain in ultrasound-guided block decreased from 5.4 points to 2.7 points at three weeks and 1.4 points at six weeks (p=0.0023, p<0.001), and 3.1 points in the C-arm (p<0.001, p<0.001) at three weeks and 1.5 points at six weeks (p<0.001, p<0.001). In the case of radiating pain, the mean NRS in the ultrasound-guided nerve root block group improved from 6.3 points after the procedure to 2.8 points at three weeks and 1.5 points at six weeks (p<0.001, p<0.001). In the C-arm guided nerve root block group, the NRS improved from 7.4 points after the procedure to 3.3 points at three weeks and 1.9 points at six weeks. In the case of complications, Horner's syndrome and propriospinal myoclonus were observed in one case of C-arm guided block group. Conclusion: The clinical results of the patients who underwent ultrasound-guided cervical nerve root block were not significantly different from those who underwent a C-arm guided cervical nerve root block.