• The Korean Journal of Pain
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• v.28 no.1
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• pp.11-21
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• 2015

Background: Epidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches. Methods: This manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients). Results: Analysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial. Conclusions: The results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone, or using steroids with long-term follow-up of up to 2 years, in a contemporary interventional pain management setting.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.73-76
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• 1997

Background : Epidural anesthesia is now accepted as a popular technique for pain relief and anesthesia. However, accidental dural puncture may occur during placement of the epidural needle. This study was undertaken to evaluate difference of the epidural depth between parturients and non-parturients. Method : Eighty non-parturients receiving epidural anesthesia were assigned to group I, and eighty parturients whose body weight had not yet increased over 15 kg from pregnancy were assigned to group II. With patients in lateral decubitus position, 18 guage Tuohy needle was punctured by approaching at $L_{3-4}$ interspace. Epidural space was identified using loss-of-resistance to air technique. Result : Epidural depth was 4.18 cm and 4.25 cm in group I and group II respectively. There was no significant statistical difference in body mass index(BMI) and ponderal index(PI) (p<0.05), nor in epidural depth between the two groups. Conclusion : Epidural needle need not be placed deeper in parturients than in nonparturients.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.96-100
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• 1998

Bakground: At our institution, We have controlled pain during vaginal delivery with epidural block since 1986. We designed a questionaire for parturients to analyze the degree of satisfaction of epidural block. Method: The self-questionaire were sent to parturients(N=200), who had epidural block to control labor pain during vaginal delivery. The questionaire covered topics dealing with motivation, fear, satisfaction and complications, of epidural block. Results: Motivation by an experienced person was 72.5%(145 parturients), fear of epidural block was 66%(132 parturients), and satisfactory response was 84%(168 parturients). Parturients who knew the role of anesthesiologist numbered 105(52.5%). Scarcely, 46 parturients displayed confidence for safety of fetus; 111 parturients experienced more than one complications. But special therapy for complications were not necessary. Conclusions: Publicity through mass-media and direct contact will improve the recognition and merit of epidural block by parturients as well as the role of the department of anesthesiology.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.79-83
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• 2000

Background: Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The purpose of this study is to analyze the effect of epidural blood patch in spontaneous intracranial hypotension. Methods: The spontaneous intracranial hypotension patients treated with epidural blood patch were analyzed on the symptoms, radiologic images and methods of epidural blood patch retrospectively by the medical records. Results: Patients had postural headache (15 patients) including nausea/vomiting (10 patients), tinnitus (2 patients), neck stiffness (13 patients), vertigo (3 patients) and occular pain (1 patient). Brain CT and MRI showed diffuse enhancement of the pachymeninges (9 patients) and radionuclide cisternography demonstrated direct evidence of leakage (11 patients). With epidural blood patch, the symptoms were promptly relieved in 11 patients. Conclusions: We concluded that epidural blood patch is a good treatment of method in spontaneous intracranial hypotension patients.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.256-259
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• 1996

Epidural adhesiolysis is a convenient and safe method for the management of back pain. However, we experienced a case where a patient developed sensory change to S2 area after epidural adhesiolysis. Male patient, 43 years old, was admitted to our pain clinic for epidural adhesiolysis for back pain. Patient was experiencing pain radiating to left thigh, and sensory change and motor disturbance to the S1 area. Patient's symptoms and signs were much improved on the first day of epidural adhesiolysis. Patient, however, complained of numbness of perineal and S2 areas after the next day of injections. We postulated the cause of this complication was due to: compression of nerve root by the large volume of injectate and hematoma, and the side effect of local anesthetic, hypertonic saline and steroid.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.279-285
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• 1995

Extradural block is a form of treatment described as early as the beginning of the present centuries. It has since had positive criticism from a number of authors in different countries. Epidural injections of steroids with or without local anesthetic have become an occasional method of conservative treatment in sciatica & lumbago, especially in acute case. We assess the results of continuous epidural block with steroids and local anesthetics in sciatica & lumbago. From July 1994 to June 1995, we treated 46 case of lumbago and sciatica using continuous epidural block with steroids and local anesthetics. After placement of 17-Gauge Tuohy needle in the epidural space by the technique of loss of resistance, 0.25% bupivacaine 5 cc and triamcinolone 40 mg was administered and then epidural catheter was placed and connected to multiday infusor(Paragon) using 1% lidocaine with continuous infusion rate of 1 ml/hour. Usually, the catheter was removed after 1~2 weeks and then treated with the physical therapy. At the time of patient's discharge, 69.5% of all cases showed excellent or good results. Of particular note, 26 of the 46 cases were followed up by telephone. At present, in using Of particular note, 26 of the 46 cases were followed up by telephone. At present, in using continuous epidural block procedure, a relief in symptoms showed in 65.5% of these 26 cases. Continuous epidural block provides shortening of the recovery time from pain, avoidance of long period bed rest and early physical therapy and exercise. Therefore, continuous epidural block is simple and safe in the treatment of lumbago and sciatica, especially in acute phase.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.225-230
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• 1997

Background: Authors modified the traditional continuous axillary brachial plexus block technique of Selander for purpose of increasing success rate and decreasing complications by use of commercial epidural anesthesia set. Method: Thirty-nine patients scheduled for upper extremity operations were injected with 40 ml of anesthetic solution by axillary perivascular technique, using 23~25G immobile needle at 2 cm from the pectoralis major. Tuohy needle was immediately introduced at 4 cm from the pectoralis major and pierced the expanded neurovascular sheath at an angle of 30 degree to the skin. The "pop" was well noted well. Needle was advanced 0.5 to 3.0 cm and epidural catheter introduced through the needle. After removal of needle, occlusive dressing was done. Tip of catheter and spread of solution were demonstrated by fluoroscopy with contrast dye after completion of procedure. Result: Catheter insertion was successful at first attempt for all case. Total length of insertion was from 6 to 13($10.0{\pm}1.7$) cm. Tip of catheter was placed in infraclavicular space(66.7%), about the humeral head(17.9%) and in upper arm in 3 cases as U-shape(7.9%). Catheters were maintained for $6.7{\pm}2.6$(3-12) days. There were no complications such as: perforation of major vessels, needle trauma to nerve, infection, bleeding or hematoma. Conclusion: This study demonstrated continuous axillary brachial plexus block with epidural anesthesia set is safe, easy and convenient modification of technique of Selander.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.114-119
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• 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.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.81-85
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• 1998

Background: Continuous caudal epidural block is a useful method in postoperative pain control after perianal surgery. But caudal epidural block has the potential of developing adverse effects such as urinary retention. The goal of this study is to evaluate the analgesic and adverse effect of bupivacaine with fentanyl through continuous caudal epidural block in relation to the concentration of bupivacaine. Methods: We divided the patients randomly into two groups. For group I(n=25) postoperative pain was controlled by continuous caudal epidural infusion at the rate of 4 ml/hr of 0.0625% bupivacaine with 3 ${\mu}g$/ml fentanyl: group II(n=14), 0.125% bupivacaine with 3 ${\mu}g$/ml fentanyl, respectively, for duration of 48 hours via epidural catheter. We evaluated pain scores with visual analogue scales at 30 mins, 6 hrs, 12 hrs, 24 hrs and 48 hrs after the operation and the incidence of adverse effect, especially urinary retention, for each group. Results: There were no significant differences in the pain score between group I and II. Urinary retention developed in 9 patients(36%) of group I, and 11 patients (78.6%) of group II. Other adverse effects such as pruritus, nausea, vomiting and respiratory depression developed in few patients. Conclusions: While performing continuous caudal epidural block with mixture of bupivacaine and fentanyl after the perianal surgery, we conclude 0.0625% bupivacaine solution is preferable to 0.125% bupivacaine solution because 0.0625% solution resulted in satisfactory analgesia with minimal incidence of adverse effect.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.43-47
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• 1999

Backgroud: Systemic administration of opioid can prolong the duration of epidural anesthesia. The authors examined the effect of nitrous oxide ($N_2O$) on the level of sensory block induced by epidural lidocaine. Methods: Twenty minutes after epidural injection of 2% lidocaine (below 70 years : 20 ml, 70 years and above : 15 ml), the level of sensory block was assessed (2nd stage). Patients were randomly assigned to receive either medical air (control group, n=15) or 50% $N_2O$ in oxygen ($N_2O$ group, n=15) for 10 minutes, the level of block was reassessed (3rd stage). Pateints were given room air (control group) or 100% oxygen for 5 minutes and room air for 5 minutes ($N_2O$ group), and the level of block was reassessed (4th stage). Results: At the 3rd stage, $N_2O$ group showed 4.3 cm cephalad increase in the level of sensory block (p=0.005), but control group revealed 1.43 cm regression. After discontinuation of gas, the level of block regressed in both group (p=0.000). At the 4th stage, $N_2O$ group revealed 3.5 cm cephalad increase (p=0.048) and control group 1.97 cm regression (p=0.001) as compared with the 2nd stage. Conclusions: The level of sensory block induced by epidural lidocaine was significantly increased cephalad by concommitant use of 50% $N_2O$ for 10 minutes.