• Title/Summary/Keyword: 액와 신경

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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 Axillary Brachial Plexus Block, Performed by Orthopedic Surgeons (정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술)

  • Kim, Cheol-U;Lee, Chul-Hyung;Yoon, Ja-Yeong;Rhee, Seung-Koo
    • Journal of the Korean Orthopaedic Association
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    • v.53 no.6
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    • pp.513-521
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    • 2018
  • Purpose: The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons. Materials and Methods: From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated. Results: The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5-13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5-40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141-540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case. Conclusion: An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.

Anterior Dislocation of the Shoulder with Rotator Cuff tear Over the 5th Decades of Age (40대 이후 발생한 견관절 탈구와 회전근 개 파열)

  • Moon, Young-Lae;Lee, Sang-Hong;Kim, Jeoung-Ho
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.2
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    • pp.131-135
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    • 2002
  • Object : To evaluate the prognostic factors of the rotator cuff tear after anterior dislocation of the shoulder over the 5th decades of age. Methods : We evaluated twelve patients who had rotator cuff tears combined with primary anterior dislocation of the glenohumeral joint between May 1995 and October 1998. Their age were ranged from 42 to 67-years-old. Two of them were initially presumed to have an injury of the axillary nerve and associated with avulsion fracture of the greater tuberosity. Among twelve patients who had rotator cuff tears, 8 cases had massive, 3 cases had medium and one case had a small sized tear. Results : All the tears of the rotator cuff were repaired and the results were obtained by UCLA shoulder rating scale. Ten cases of them revealed more than good results except for 2 cases who had been unhappy triad of the shoulder injury. Conclusions : In the case of anterior dislocation of shoulder, it is necessary to check the injury of rotator cuff and axillary nerve in the middle age group. If these injuries are combined, proper rotator cuff repair and axillary nerve rehabilitation program would be asked for better results.

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Endoscopic transthoracic sympathectomy: An efficient and safe method for the treatment of hyperhidrosis (흉강내시경을 이용한 교감신경절 절제술 -다한증의 치료를 위한 효과적이고 안전한 방법-)

  • 최순호;한재오;양현웅;최종범
    • Journal of Chest Surgery
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    • v.31 no.7
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    • pp.697-702
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    • 1998
  • Hyperhidrosis of the palms, axillae, and the face has a strong negative impact on the quality of life for many people. Existing nonsurgical therapeutic options are far from ideal. A definitive cure can be obtained by upper thoracic sympathectomy. The traditional open surgical technique is a major procedure; few patients and doctors have found that risk-benefit considerations favor surgery. Endoscopic minimal invasive surgical techniques are now available. We investigated whether endoscopic ablation of upper thoracic sympathetic chain(T2-4) is an efficient and safe treatment of hyperhidrosis. We treated 40 patients with bilateral endoscopic transthoracic sympathectomy. There were no mortalities, life-threatening complication, no treatment failures occurred in 40 patients. After a short-term follow-up, 100% of the patients reported satisfactory results. Endoscopic transthoracic sympathectomy is an efficient, safe, and minimally invasive surgical method for the treatment of palmar, axillary hyperhidrosis.

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Effects of Caffeine on Nerve Conduction Velocity (카페인이 신경전도속도에 미치는 영향)

  • Kang, Yun-Jung
    • Journal of Convergence for Information Technology
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    • v.10 no.3
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    • pp.195-199
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    • 2020
  • This study examined the effect of the nervous-system-stimulating caffeine on the nerve conduction velocity. The purpose of this study is to investigate the effect of caffeine that stimulates the nervous system on nerve conduction test. Although both measurement intervals did not show statistically significant differences when comparing the pre- and post-NCV values within the control and individual experimental groups, it was found that the nerve conductivity in the Axilla-Above Elbow section increased significantly after caffeine intake for the experimental group. Caffeine intake, which has increased the nerve conduction velocity (NCV), was determined to play roles in improving motor skills, muscle strength and nerve performance by temporarily increasing the nerve conduction velocity. Through this study, we learned that caffeine has an influence on the peripheral nervous system as it helps to improve the nerve conduction velocity. upon an appropriate amount of caffeine intake. We hope that these results will help develop treatment and diagnostic methods for patients with nerve dysfunction and myofunctional disorders.

The Role of Axillary Artery Cannulation in Surgery for Type A Acute Aortic Dissection (급성 상행대동맥 박리증 수술에서 액와동맥 삽관술의 역할)

  • 유지훈;박계현;박표원;이영탁;김관민;성기익;양희철
    • Journal of Chest Surgery
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    • v.36 no.5
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    • pp.343-347
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    • 2003
  • Background: The femoral artery is the most common site of canuulation for cardiopulmonary bypass in surgery for type A aortic dissection. Recently, many surgeons prefer the axillary artery to the femoral artery as the arterial cannulation site for several benefits. We evaluated the safety and usefulness of axillary artery cannulation in surgery for acute type A aortic dissection. Material and Method: Between Oct. 1995 and Sep. 2001, 71 patients underwent operations for acute type A aortic dissection. The arterial cannula was inserted into the axillary artery in 31 patients (AXILLARY group, mean age=56), and into the femoral artery in 40 patients (FEMORAL group, mean age=57). We retrospectively compared the incidence of mortality, morbidities, and hospital course. Result: The mean duration of cardiopulmonary bypass and circulatory arrest were significantly shorier in the AXILLARY group (207 min and 39min, respectively) than in the FEMORAL group (263min and 49 min, respectively; P<0.05). Postoperative hospital stay was significantly shorter in the AXILLARY group than in the FEMORAL group (mean 15 days vs. 35 days, p<0.05). Although there was no difference in the incidence of new-onset permanent neurological dysfunction (3.2%, in the AXILLARY group, 2.5% in the FEMORAL group), the incidence of transient neurological dysfunction was significantly lower in the AXILLARY group (12.9% vs. 25%, p<0.05). In the FEMORAL group, two patients needed urgent conversion to cannulation site due to arch vessel malperfusion. In the AXILLARY group, there was only one patient who had a complication related to the cannulation, i.e., median nerve injury. Conclusion: Axillary artery cannulation was safe and helpful in decreasing the cerebral ischemic time and incidence of transient neuroligcal dysfunction in surgery for acute type A aortic dissection, It enabled us to approach the patients with aortic arch pathology more aggressively.

Usefulness of Three-phasic Bone Scan in Young Male Patients Suspected of Post-traumatic Reflex Sympathetic Dystrophy Syndrome (외상후 교감신경 이영양증이 의심되는 젊은 남자 환자들에서 삼상 골스캔의 유용성)

  • Lee, Won-Woo;Kim, Tae-Uk;Kim, Tae-Hoon;Jung, Cheoul-Yun;Moon, Jin-Ho
    • The Korean Journal of Nuclear Medicine
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    • v.35 no.1
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    • pp.52-60
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    • 2001
  • Purpose: In young male patients who suffered several kinds of trauma with subsequent suspicious reflex sympathetic dystrophy syndrome, we performed three-phasic bone scan in order to investigate its usefulness. Materials and Methods: Patients with narrow range of age (21-25. mean $22.8{\pm}1.3$, all male) were included with suspicious reflex sympathetic dystrophy syndrome of 12 feet and 5 hands. Only one was bilateral feet case and 16 were ipsilateral (Rt:13, Lt:3). The etiologic traumas were 4 fractures, 4 sprains, 3 blunt trauma, 2 cellulitis, 1 tendon tear, 1 crush injury, 1 overexercise, and 1 unknown. Radiologically 3 showed osteoporotic changes. Three-phasic bone scans were performed $21.2{\pm}7.3wks$ after trauma. Results: According to symptom complex, confirmatory reflex sympathetic dystrophy syndrome 4 cases and suspicious 13 were analyzed. All confirmatory cases (100%) showed increased uptake at delay phase with periarticular accentuation. Of confirmatory 4 cases, 2 showed increased uptake in all three phases (perfusion: P, blood pool: B, and delay: D), and other 2 revealed decreased P but, both increased B and D. Of suspicious 13 cases, 9(69.2%) had increased D (4 periarticular and 5 focal), 2 decreased D, and 2 symmetric D. In 12 foot cases, so-called weight hearing patterns - increased contralateral sole at P and B - were revealed in 7(58.3%). Conclusion: Diffuse periarticular increased uptake at delay phase of three-phasic bone scan was a compatible finding to reflex sympathetic dystrophy syndrome in young male patients whose symptom complex strongly designated post traumatic reflex sympathetic dystrophy syndrome.

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