• Journal of Acupuncture Research
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• 제27권4호
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• pp.9-18
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• 2010

Objectives : This study will broaden understanding of acupotomy therapy through comparison of side effects and complication which can be caused by the mechanism of treatment, surgical methods, and procedure by acupotomy therapy and epidural neuroplasty. Moreover, through an in-depth analysis of headache affected by two procedures, this research is supposed to find prospective cures for headache after acupotomy therapy. Methods : To compare acupotomy therapy with epidural neuroplasty this research was done using a comparative analysis eight theses about acupotomy therapy since 1995, as well as eleven theses about epidural neuroplasty since 2000. Other theses and data were used as references in the process of comparative analysis. Results : Acupotomy therapy and epidural neuroplasty, new treatments of damaged discs in the spine and stenosis made in 1990s, have the mechanism of treatment in common in that adhesion, a node or scar caused by the soft tissue damage is removed by putting catheter or acupuncture into the lesions. Epidural neuroplasty has additional injection into the lesions, which is different from acupotomy therapy in the process of surgical procedure. There are various reports of positive effects about curative effect in these two treatments. The two procedures may cause various complications. Headache may be a complication after surgery. The headache after acupotomy therapy is characterized as being an ache in the body, which is similar to that of post-dural puncture headache in the outbreaks and symptom. Headache after percutaneous epidural neuroplasty appears in general, which is similar to a headache as a result of the increased pressure of the brain spinal cord regardless of posture. Conclusions : Although they are alike in the mechanism of treatment, surgical methods and side effects, and complication after they are carried out as a result of analyzing theses related to acupotomy therapy and percutaneous epidural neuroplasty, there is a difference in aspects and mechanism of headaches experienced after the procedure.

• The Korean Journal of Pain
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• 제8권2호
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• pp.266-271
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• 1995

Recently, continuous epidural infusion of narcotics and local anesthetics have been used for postoperative pain relief. This study was designed to compare the analgesic efficacy and side effects of continuous epidural infusion of narcotics and local anesthetics with those of intramuscular administration of meperidine, for postoperative pain relief after cesarean section. Forty patients were divided into 2 groups of 20 patients each ; Continuous epidural group and control (IM meperidine) group. Before each operation, the epidural group had an epidural catheter placed (L1-2) and following each operation, a bolus of 1%~8ml of lidocaine was injected, followed by continuous infusion of morphine 3 mg/day, fentanyl 300g, 2% mepivacaine 20 ml, 0.5% bupivacaine 20 ml and normal saline 40 ml. The control group received meperidine 50mg IM injection as needed. We evaluated analgesic efficacy with VAS (Visual analogue scale) and side effect at 1, 6, 12, 24, 36 and 48 hour intervals after the operation. The results were as follows: 1) Continuous epidural group was superior to the control group with respect to postoperative analgesia. 2) Side effects (pruritus, nausea & vomiting) were more frequent in the epidural group.

• The Korean Journal of Pain
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• 제27권4호
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• pp.334-338
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• 2014

Background: Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. Methods: Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. Results: There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). Conclusions: A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective.

• The Korean Journal of Pain
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• 제22권1호
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• pp.52-57
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• 2009

Background: Transforaminal epidural injection (TEI) may be useful to treat unilateral pain that has a dermatomal distribution. In this approach, the needle tip can be placed closer to the dorsal root ganglion and ventral aspect of the nerve root. However many studies have reported that serious complications following TEI occurred more frequently when it was conducted at the cervical level. One of the presumptive mechanisms of the complication is intravascular injection. Therefore this study was conducted to identify the incidence of complications in response to intravascular injections at cervical segments. Methods: This study included all patients, who visited our pain clinic and had radicular symptoms or herpes zoster associated pain. All procedures were conducted under fluoroscopic guidance with contrast enhancement by one of the authors. After the ideal needle position was confirmed by biplanar fluoroscopy, the blood aspiration through the needle hub was evaluated, and a 3 ml mixture of nonionic contrast (2 ml) with normal saline (1 ml) was injected at a rate of 0.3-0.5 ml/sec continuously under real time fluoroscopic visualization. We then classified the contrast spreading pattern as neural, simultaneous neural and vascular, or vascular. Results: A total 71 cervical TEIs were performed. In 26 cases (36.6%), the contrast only spread to the nerve sheath. However, 45 cases (63.4%) showed an intravascular spreading pattern, 37 (52.1%) of which showed a neural and vascular pattern and 8 (11.3%) of which showed only a vascular pattern. Conclusions: Approximately two thirds of the cases of cervical TEI were found to lead to intravascular spreading, which is much higher than the incidence reported in previous studies.

• Clinical Pain
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• 제19권2호
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• pp.116-119
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• 2020

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

• The Korean Journal of Pain
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• 제28권2호
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• pp.148-152
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• 2015

The goal of cancer treatment is generally pain reduction and function recovery. However, drug therapy does not treat pain adequately in approximately 43% of patients, and the latter may have to undergo a nerve block or neurolysis. In the case reported here, a 42-year-old female patient with lung cancer (adenocarcinoma) developed paraplegia after receiving T8-10 and $11^{th}$ intercostal nerve neurolysis and T9-10 interlaminar epidural steroid injections. An MRI results revealed extensive swelling of the spinal cord between the T4 spinal cord and conus medullaris, and T5, 7-11, and L1 bone metastasis. Although steroid therapy was administered, the paraplegia did not improve.

• The Korean Journal of Pain
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• 제7권1호
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• pp.106-112
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• 1994

45세 여자 환자에서 요하지통의 치료를 위해 triamcinolone 40 mg과 0.125% bupivacaine 10 ml를 경막외로 주입한후 24시간에 걸쳐 하지마비 및 해리성 감각소설이 발생하였다. 그 원인은 분명하지 않으나 선행절환의 악화, 급성 횡단성 척수염, 전척수동맥증후군, 그리고 신경독성등이 추정된다.

• The Korean Journal of Pain
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• 제14권2호
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• pp.171-175
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• 2001

Background: This purpose of this study is to compare the analgesic efficacy, occurrence of motor block and other side effects of 48 hr continuous postoperative epidural infusions with 0.125% ropivacaine with fentanyl or 0.15% ropivacaine with fentanyl. Methods: Forty patients undergoing Cesarean section were randomly allocated into two groups. Both groups received epidural injection of 2.0% lidocaine 19 ml and 0.75% ropivacaine 2-5 ml with fentanyl $50{\mu}g$ for 20 minutes before surgery. Following surgery, a continuous epidural infusion using a two- day infusor was given for 40 minutes for post-operative pain control. Group 1 (n = 20) then received 0.125% ropivacaine and 6 ug/ml of fentanyl at a rate of 2 ml/h. Group 2 (n = 20) received 0.15% ropivacaine and 6 ug/ml of fentanyl at the same rate. Visual analog scales (VAS) for pain during rest and movement, sensory change and motor blockade were assessed for 48 hr after surgery. Results: There were no significant differences in VAS for pain during rest or movement. The incidence of side effects was similar in both groups. Conclusions: Using 0.125% ropivacaine with fentanyl via an epidural route provided similar pain relief and side effects as 0.15% ropivacaine with fentanyl.

• The Korean Journal of Pain
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• 제10권2호
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• pp.231-234
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• 1997

Background: The aim of this study was to examine the precise spreading pattern of contrast media in small increments in rabbits. Following pentobarbital anesthesia, the epidural puncture was done surgically with a blunt hook. Methods: The tip of epidural catheter was located at the mid-portion of T7 and T12, in the T7 group (n=7) and T12 group (n=8), respectively. Injection of the contrast media was started at 0.1 mL/kg and increased by 0.1 mL/kg up to a maximum of 0.6, mL/kg, under fluoroscopy. Results: In both groups, the extent of spread increased continuously as a Starling resistor with increasing injected volume(T7 group: $y=4.0+41.8x-28.1x^2$, T12 group: $y=0.2+57.7x-43.5x^2$) the total spread of contrast media was similar. The contrast media spread equally, both rostral and caudal, from catheter tip in T7 group; media spread approximately twice as far rostral as compared to caudal in T12 group (P<0.05). Conclusions: In rabbits, the position of epidural catheter tip should be positioned 2~3 segments below the aimed segment in lower thoracic or lumbar region, whereas in mid-thoracic region it should be positioned close to the level of aimed segment. Rabbits have relatively small epidural space therefore, the volume of injectant should be carefully determined with the suggested equations of this study.

• The Korean Journal of Pain
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• 제35권1호
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• pp.97-105
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• 2022

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two non-randomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions: Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.