• The Korean Journal of Pain
• /
• v.8 no.2
• /
• pp.298-303
• /
• 1995

We have inserted epidural catheter for single or continuous injection of a drug for epidural analgesia. It is important to localize the tip of epidural catheter in appropriate site to acquire the most effective analgesia. In epidural block, we observed course and location of the tip of epidural catheter. Subject: 70 patients were divided into group I(non-injection of saline group during catheter insertion) and group II(injection group during catheter insertion). Group I included cervical(n=20), thoracic(n=10), and lumbar(n=20) epidural group. Group II, cervical(n=10), and lumbar(n=10) epidural group. Method: 19G FlexTip $Plus^{TM}$ Epidural Catheter ($Arrow^{(R)}$) was inserted 10cm cephaladly in epidural space with(group II) or without(group I) saline flushing. We observed course and location of the tip of epidural catheter by C-arm image intensifier during injection of contrast media ($Omnipaque^{(R)}$). Result: In group I, the number of tips of epidural catheters located within 2 cm from inserted site were: cervical 14/20(70%), thoracic 2/10(20%). lumbar 16/20(80%). In thoracic epidural blocks, tips of epidural catheters were more cephaladly located than with cervical and lumbar epidural blocks. With cervical epidural blocks, the number of tips of epidural catheters located within 2 cm from insertion site were less in group II than group I (20% vs. 70%). But no significant differences were noted between group I and group II with lumbar epidural block(90% vs. 80%). The number of tips of epidural catheters located around a predicted site were: cervical 2/20(10%), thoracic 4/10(40%), lumbar 0/20(0%) in group I, and cervical 2/10(20%), lumbar 1/10(10%) in group II. Conclusion: It was impossible to predict the exact location of tips of epidural catheters by measuring the inserted length without epidurogram. With many cases, tips of epidural catheters were located around the insertion site in lumbar epidural blocks, and in some cases around the predicted site in thoracic epidural blocks. The results suggests that epidural block should be done at a point near the required band of analgesia.

• The Korean Journal of Pain
• /
• v.10 no.2
• /
• pp.285-290
• /
• 1997

Horner's syndrome is a well-recognized complication of regional analgesia of neck and shoulder region, and not often a complication of lumbar or low thoracic epidural block. Recently we experienced right Horner's syndrome accompanying paralysis of right upper extremity following lumbar epidural block in for an obstetric patient. Epidurography and MRI was performed to clarify the cause of unilateral high epidural block and cervical sympathetic block. Radiologic study demonstrated a loop formation of the epidural catheter and tip of catheter was located in right anterior epidural spaced(L1-2). The initial epidurogram revealed unilateral spreading of dye in the cervical region in right epidural space. A second epidurogram, 10 minutes following, showed dye filling in left epidural space, however spread of dye in left side was limited to lumbar and low thoracic region. We concluded the most probable cause of this unilateral high epidural block was due to misplacement of the catheter into the anterior epidural space.

• The Korean Journal of Pain
• /
• v.10 no.1
• /
• pp.131-133
• /
• 1997

Number of elderly patients requiring nerve blocks have been increasing in recent years. We had two elderly patients who suffered stroke one day and three days after lumbar facet joint block and lumbar single epidural block respectively. Both patients due to their advanced age had potential risk factor to suffer one or more of the following; stroke, hypertension, and diabetes mellitus. Due to our experience with these patients, we suggested the following: (1) Nerve blocks should be reconsidered for elderly patient who posesses a potential risk factor to suffer a stroke. (2) Prior to invasive block administration of mild sedatives or analgesics may provide beneficial effects for patients with hypertension. (3) Adequately informed consent must be fully discussed time of consultation with patient scheduled for nerve block especially for elderly and risky patient.

• The Korean Journal of Pain
• /
• v.11 no.2
• /
• pp.230-234
• /
• 1998

Background: Continuous epidural block is widely used for surgical operation and postoperative pain management. The potential infection due to the epidural catheter is a definite harzard of continous epidural block. We investigated the effectiveness of bacterial filter in prevention of infection due to the epidural catheter. Methods: Patients scheduled for transabdominal hysterectomy were assigned to two groups by simple randomization (50 patients per group). All catheters were placed in the 2nd and 3rd lumbar epidural space, using careful sterile technique. Group 1 received injections by the epidural catheter with a bacterial filter and group 2 received injections by the epidural catheter without a bacterial filter. The infection rate in the tips of epidural catheter left for 3 days were compared between the two groups. Results: There was no significant difference in the infection rate between two groups. Conclusions: A bacterial filter of the epidural catheter for surgical anesthesia and postoperative analgesia dose not prevent all kinds of infection in continuous epidural block.

• The Korean Journal of Pain
• /
• v.11 no.2
• /
• pp.314-316
• /
• 1998

Psoas compartment block has been used to provide anesthesia and analgesia of hip joint. This block is advocated for relief of pain of various origins in the thigh, leg and lumbar area. A-40-year-old women complained of pain in the left thigh and lumbar area after operation of the second lumbar vertebral compression fracture. To relieve pain, caudal block was performed. This block reduced in lumbar pain but left thigh pain persisted. So, we were performed psoas compartment block using mepivacaine and dexamethasone, which relieved the pain in the left thigh and lumbar area. We recommend psoas compartment block as useful and simple method for patients with thigh and lumbar area pain, especially when the epidural block is not feasible.

• The Korean Journal of Pain
• /
• v.8 no.1
• /
• pp.156-158
• /
• 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
• /
• v.9 no.1
• /
• pp.114-119
• /
• 1996

Buerger's disease is a nonatherosclerogic occlusive inflammatory disease of medium and small arteries, and veins, of unknown cause. It occurs predominantly in young males who are habitual tabacco users. These patients often complain of painful ulcerations of their digits. The care of this disease is very difficult when the treatment is delayed. Consequently, early treatments are most important to patients with Buerger's disease. This disease can be treated with sympathetic block such as stellate ganglion block for upper extremities and lumbar epidural block, and lumbar sympathetic block for lower extremities. Intravascular regional sympathetic block can be another method of treatment. However, discontinuation of smoking is the most basic and essential treatment for Buerger's disease. We treated 43 Buerger's disease patients with stellate ganglion block and laser therapy. The treatment was not effective for three patients who definitely required amputation.

• Journal of Chest Surgery
• /
• v.26 no.10
• /
• pp.781-786
• /
• 1993

Effrctive analgesia after elective thoracotomy can be provided by continuous extrapleural intercostal nerve block.This study was designed to prove the effectiveness of continuous extrapleural intercostal nerve block. Twenty patients undergoing elective thoracotomy were randomized into two groups. Group I received lumbar epidural block[N=10] and group II received continuous extrapleural intercostal nerve block[N=10]. Postoperative pain relief was assessed on Numeric Rating Scale[NRS] and recovery of pulmonary function was assessed by coparison of preoperatrive and postoperative FVC[Forced Vital Capacity], FEV1[Forced expiratory Volume in 1 second], VC[Vital Capacity]. Arterial blood gas analysis[ABGA], vital signs and amount of additive analgesics were compared also. No significant difference was observed between the groups concerning these parameters mentioned above. Systemic complications, such as urinary retention[2/10] and weakness of lower extremity[2/10], occurred in group I but no complication occurred in group II. We conclude that continuous extrapleural intercostal nerve block is as effective as epidural block in pain relief and restoration of pulmonary mechanics with fewer comlications. Also because of it`s ease and safetiness, this must be considered as a substitute of epidural block in routine use for thoracotomy pain relief.

• The Korean Journal of Pain
• /
• v.8 no.2
• /
• pp.235-243
• /
• 1995

A retrospective study was performed to evaluate the effects, and side effects, of epidural analgesia for postoperative pain relief of 2,381 surgical patients who received general-epidural, or epidural anesthesia only. Anesthesia records, patients charts, and pain control records were reviewed and classified according to: age, sex, body weight, department, operation site, epidural puncture site, degree of pain relief by injection mode & epidural injectate, and side effects(including nausea, vomiting, pruritus, urinary retention and respiratory depression). The results were as follows: 1) From the total of 2,381 patients, there were 1,563(66%) female patients; 1.032(43%) patients were from Obstetrics and Gynecology. 2) Lower abdomen, thorax, lower extremity and upper abdomen in the operation site; and lumbar, upper, lower thoracic in puncture site were order of decreasing frequency. Length of epidural injection for pain relief averaged $1.72{\pm}1.02$ days. 3) Ninety three percent of the patients experienced mild or no pain in the postoperative course. Analgesic quality was not affected by the kind of epidural injectate. 4) Nausea occurred in 3.2% of all patients, vomiting in 1.1%, pruritus 0.9%, urinary retention 0.6%, respiratory depression 0.08%. 5) Frequency of nausea was higher with female patients compared to male patients(p<0.05). 6) Pruritus frequency was higher with male patients than female patients(p<0.05); and more frequent with patients who received epidural injection with morphine than patients who received epidural injection without morphine(p<0.01). 7) Urinary retention was higher in female patients, and more frequent with patients who had received epidural injection with morphine than epidural injection without morphine(p<0.05). 8) There were two cases of respiratory depression. The course of treatment consisted of: cessation of epidural infusion, then administration of oxygen and intravenous naloxone. We conclude that postoperative epidural analgesia with a combination of local anesthetics and opiate is and effective method for postoperative pain relief with low incidence of side effects. However, patients should be carefully evaluated as rare but severe complications of respiratory depression may ensue.

• The Korean Journal of Pain
• /
• v.1 no.1
• /
• pp.53-58
• /
• 1988

We have treated patients who have visited pain clinic and those admitted to the other departments of Pusan National University Hospital from Mar. 1987 to Feb. 1988 with complaints of severe cancer pain on both upper and lower abdomen and extremities by continuous administration of a very small amount of morphine in the lumbar subarachnoid(group I) and epidural(group II) space in 10 cases respectively. The results of analgesia obtained are as follows: 1. The average duration in onset of analgesia was 8 mins. in group I and 23 mins. in group II. 2. The average duration In maintaining analgesia was 12.4 hrs. in group I and 18.4 hrs. in group II. 3. The efficiency of analgesia in group I was excellent in 5, good in 4, and null in 1, and group II was excellent in 5, good in 2, and moderate in 3. 4. The degree of tolerance in group I was rather mild comparable ti that of pain score 4 till the 22nd. day of morphine administration. 5. The complications are: 2 of respiratory distress in group I, 2 of voiding difficulties in both group I and II, 1 of itching sensation in both group I and II, 1 of euphoria with hallucination In group I, and 1 of C.S.F leakage in group II. As results, it is thought that epidural administration is safer than subarachnoid administration in achieving analgesia with morphine among patients with malignant pain if the problem of tolerance is solved.