• The Korean Journal of Pain
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• 제2권2호
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• pp.167-173
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• 1989

Inadequate pain relief after upper abdominal surgery increases the incidence of pulmonary complications due to the difficulty in coughing and deep breathing. Kvalheim and Reiestad (1984) introduced intrapleural administration of local anesthetic solutions to produce analgesia following cholecystectomy performed through a subcostal incision, unilateral breast surgery and renal surgery. We studied continuous intrapleural administration of bupivacaine and epinephrine, and its effect in controlling pain after cholecystectomy. In 9 patients, an intermittent dosage technique was used. An intrapleural catheter was inserted and 20 ml of 0.5% bupivacaine and 1:100,000 epinephrine was administered. Results were as following: 1) Mean analgesic duration from the initial intrapleural injection to secondary administration of supplementary bupivacaine was 13.5 hours. 2) No specific changes were noted on vital signs and arterial blood gases. 3) Effective analgesia, produced by intrapleural bupivacaine resulted in significant improvement in tidal volume as measured by spirometry. 4) No signs of systemic toxicity and complications were encountered. 5) Intrapleural administration of a local anesthetics after cholecystectomy provides a satisfactory duration of analgesia.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권1호
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• pp.65-69
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• 2018

Local anesthesia is administered to control pain, but it may induce fear and anxiety. Root planing is a non-surgical periodontal therapy; however, when it is performed in an extensive manner, some tissue removal is inevitable. Notably, this removal may be so painful that local anesthesia is required to be administered to the area scheduled for the treatment. Although patients tend to accept root planing easily, they frequently express a fear of local anesthesia. Intraosseous anesthesia (IA) is an intraosseous injection technique, whereby local anesthetic is injected into the cancellous bone supporting the teeth. A computer-controlled IA system (CIAS) exhibits multiple benefits, such as less painful anesthesia, reduced soft tissue numbness, and the provision of palatal or lingual, as well as buccal, anesthesia via single needle penetration. In this report, we present two cases of root planing that were performed under local anesthesia, using a CIAS.

• 대한기관식도과학회지
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• 제4권1호
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• pp.15-26
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• 1998

The first successful transthoracic esophagectomy and intrathoracic esophago- gastric anastomosis reported in 1938. Stomach, small intestine, and colon as well as free revascularized grafts have been substituted for excised esophagus. During the past 60 years, there have been substantial advances in preoperative assessment, nutritional support, anesthetic and operative techniques, and postoperative care of patients undergoing esophageal resection and reconstruction. However the hospital mortality and morbidity of esophageal resection and reconstruction is still high and disruption of an intrathoracic esophagogastric anastomosis continues to be the most dreaded complication of esophageal surgery, And the choice of the conduit is still controversial. In this paper, I would like to review the current surgical options available to patients who require esophageal resection and reconstruction as well as the advantages and disadvantages of each technique.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권3호
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• pp.125-134
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• 2019

Successful local anesthesia in dental treatment is the most important prerequisite for pain control of patients. However, unlike that in the maxilla, it is difficult to administer local anesthesia in the mandible, and the success rate of conventional inferior alveolar nerve block (IANB) is only 80-85%. It is attributed to various causes such as anatomical variations, extreme anxiety, and technical errors; thus, various alternatives have been devised to improve this. We will analyze the causes of failure in conventional IANB and examine various alternatives that can be applied in these cases.

• Archives of Plastic Surgery
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• 제49권4호
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• pp.531-537
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• 2022

Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.

• Journal of Korean Neurosurgical Society
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• 제40권1호
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• pp.58-62
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• 2006

Objective : Development of diagnostic tools has resulted in early detection of thoracic disc herniations[TDH] even when the herniated disc is soft in consistency. In some of the cases, it is considered better not to opt for surgical treatment due to the unduly high morbidity and potential complications associated with conventional approaches. The authors have applied percutaneous endoscopic thoracic discectomy[PETD] technique to soft TDHs in order to avoid the morbidity associated with conventional approaches. Methods : Eight consecutive patients [range, 31 to 75 years] with soft lateral or central TDH [from T2-3 to T11-12] underwent PETD between May 2001 and June 2004. The patient was positioned in a prone position with intravenous sedation and local anesthetic infiltration. The authors introduced a cannula into the thoracic intervertebral foramen using endoscopic foraminoplasty technique. Discectomy was performed with mechanical tools and a laser under continuous endoscopic visualization and flu oroscopic guidance. Functional status was assessed preoperatively and postoperatively using the Oswestry Disability Index[ODI]. Results : The mean ODI scores improved from 52.8 before the surgery to 25.8 at the final follow-up. In cases of myelopathy, long tract signs showed improvement. The mean operative time was 55 minutes, and no patient required conversion to open surgery. Conclusion : The technique allows a smaller incision and less morbidity. Soft TDH is amenable to this minimally invasive approach in selected patients with myeloradiculopathy.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권2호
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• pp.63-68
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• 2015

Background: Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. Methods: Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. Results: The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was $233{\pm}37min$, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). Conclusions: The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권6호
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• pp.331-341
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• 2022

This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten studies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad's scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needleless jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia. Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltration anesthesia technique.

• Archives of Pharmacal Research
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• 제15권3호
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• pp.196-203
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• 1992

Intramolecular excimer formation of 1, 3-di(1-pyrenyl)propane (Py-3-Py) and fluorescence polarization of 1, 6-diphenyl-1, 3, 5-hexatriene (DPH) were used to investigate the effects of barbiturates on the fluidity of model membranes of phosphatidycholine (SPMVPC), phosphatidylserine (SPMVPS), and phosphatidylinositol (SPMVPI) fractions of synaptosomal plasma membrane vesicles (SPMV) isolated from bovine cerebral cortex. In a dose-dependent manner, barbiturates decreased the excimer to monomer fluorescence intensity ratio (I'/I) of Py-3-Py and increased the anisotropy(r), rotational relaxation time (P), limiting anisotropy $(r_infty)$, and order parameter (S) of DPH in SPMVPC, SPMVPS and SPMVPI. This indicates that barbiturates decreased both the lateral and rotational diffusion of the probes in SPMVPC, SPMVPS and SPMVPI. The relative potencies of barbiturates in ordering the membranes were in the order: pentobarbital > hexobarbital > amobarbital > phenobarbital. This order correlates well with the anesthetic potencies of barbiturates and the potencies for enhancement of $\gamma$-aminobutyric acid-stimulated chloride uptake. Thus, it is strongly suggested that a close relationship might exist between the membrane ordering effects of barbiturates and the chloride fluxes across SPMV.

• 대한소아치과학회지
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• 제24권1호
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• pp.139-147
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• 1997

Argon laser used in this case report, is special in having two wavelength of 488, 514nm blue-green visible light spectrum. Blue light is used for composite resin polymerization and caries detection. Green light is used for soft tissue surgery and coagulation. Maximum absorption of this laser light occurs in red pigmentation such as hemoglobin. The argon laser may be well-suited for selective destruction of blood clots and hemangioma with minimal damage to adjacent tissues. Argon laser light penetrates tissue to the 1 mm depth, so its thermal intensity is lower than $CO_2$ laser light. Also, due to its short wavelength it can be focused in a small spot and even single gene can be excised by this laser and microscopy. After applicating argon laser to 4 patient for surgical procedure and to 1 patient for curing the composite resin, following results were obtained. 1. Improved visibility were gained due to hemostasis and no specific technique were needed according to easy recontouring of the tissue. 2. Ability to use by contact mode, tactile sense was superior but tissue dragability and accumulation of tissue on the tip needed sweeping motion. 3. Additive local anesthetic procedure was needed. 4. No suture and less curing time reduced chair time, this made argon laser available in pediatric dentistry.