• Journal of Korean Neurosurgical Society
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• 제29권3호
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• pp.420-425
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• 2000

Epidural steroid injection(ESI) has been a commonly applied conservative therapy for the management of chronic low back pain and sciatica. However, there are many reports concerning various local, systemic and neurological complications related to ESI. We report two cases with fatal complications after ESI for low back pain and sciatica. In both patients, ventriculitis and meningitis were causative factors to be fatal. Aseptic procedures and careful post-procedure assessment are essential to avoid serious complications following ESI.

• The Korean Journal of Pain
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• 제10권1호
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• pp.77-81
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• 1997

Background : We studied the effects of lumbar spinal root block (RB) prospectively in 21 patients who had suffered from low back pain with radiating pain even treated epidural steroid injection three times. Method : RB was performed under the fluoroscopic C-arm guide. When the needle was in correct position, we confirmed the needle placement and expected drug spreading by injection of contrast medium ($Isovist^{(R)}$-300, Sobering, Germany). Next 2% mepivacaine 1 ml mixed to 40 mg of Depomedrol was injected. Pain assessment was carried out 7 days after RB by numeric pain score regarding the pain just before RB was 10. Remained pain after RB was graded as excellent; 0-2, good; 3-5, bad; 6-8 and poor 9-10. Results : Mean age of the patients was 52.3 years. 38.1% and 47.6% of the patients showed excellent and goo dresults after RB, respectively. Conclusion : We concluded that RB is easy and safe procedure to perfirm and effective for the treatment of remnant pain following epidural steroid injection, especially in the patients who had spinal stenosis.

• The Korean Journal of Pain
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• 제1권2호
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• pp.203-206
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• 1988

1) 통증치료 목적으로 실시한 308경막외 천자 중 원치 않는 경막천자를 일으킨 경우가 5회(1.6%)있었다. 2) 경막천자를 일으킨 5예 중 2예에서는 뇌척수액이 흡입되어 천자당시 알 수 있었으나 나머지 3예에서는 국소마취제 주사 후에 나타나는 척추마취 증상으로 경막천자를 추축할 수 있었다. 3) 뇌척수액이 흡입되지 않은 3예 중 1예에서는 추궁절제술 후 주위조직의 유착으로 인한 경막외강의 신축성 소실 또는 잠재공간의 감소를 일으켜 경막외 주사시의 압력에 의해 경막손상을 입었으리라는 추측이 가능하였고 1예에서는 조직편에 의한 주사침의 폐쇄로 실질적인 경막천자후 뇌척수액 흡입이 음성이었던 것으로 추출되었다. 나머지 1예에서는 경막천자를 의심할만한 이유가 없었으나 나타나는 증상에 의해 경막천자를 의심하였다. 이상의 결과로 보아 경막외 차단 중에는 숙련된 술자에 의해서도 원치않는 경막차단이 일어날 수 있고 특히 뇌척수액의 흡입이 음성인 경우에도 경막천자가 가능하므로 술자에게는 고위 및 전척추마취에 대한 충분한 예비지식 및 응급소생술을 포함한 대처방안이 미리 마련되어 있어야 하고 환자에게 시술전 그 가능성을 인지시켜야 하며 외래 환자의 경우 보호자와 동반 하지 않은 경우는 시술을 될 수록 피하는 것이 좋을 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.134-138
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• 2011

The authors report a case of epidural and extraforaminal calcification caused by repetitive triamcinolone acetonide injections. A 66-year-old woman was admitted presenting with lower extremity weakness and radiating pain in her left leg. Ten months before admission, the patient was diagnosed as having an L4-5 spinal stenosis and underwent anterior lumbar interbody fusion followed by posterior fixation. Her symptoms had been sustained and she did not respond to transforaminal steroid injections. Repetitive injections (10 times) had been performed on the L4-5 level for six months. She had been taking bisphosphonate as an antiresorptive agent for ten months after surgery. Calcification in the ventral epidural and extraforaminal space was detected. The gritty particles were removed during decompressive surgery and these were proven to be a dystrophic calcification. The patient recovered from weakness and radiating leg pain. Repetitive triamcinolone acetonide injections after discectomy may be the cause of dystrophic calcification not only in the degenerated residual disc, but also in the posterior longitudinal ligament. Possible mechanisms may include the toxicity of preservatives and the insolubility of triamcinolone acetonide. We should consider that repetitive triamcinolone injections in the postdisectomy state may cause intraspinal ossification and calcification.

• Journal of Acupuncture Research
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• 제40권1호
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• pp.78-89
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• 2023

This paper presents the clinical outcome of an 82-year-old female who experienced sudden back pain combined with lower limb paresthesia and weakness after epidural steroid injection. The magnetic resonance imaging of the thoracolumbar spine showed a spinal epidural hematoma (SEH) extending from T8 to L4. She was treated non-operatively in the traditional Korean medicine (TKM) hospital. The patient's progress was assessed using the Numerical Rating Scale (NRS), American Spinal Injury Association (ASIS), Spinal Cord Independence Measure version III (SCIM III), and self-reported symptoms. During the 22-day hospitalization period,the NRS score decreased from 7 to 2 points, the motor score on the ASIS scale increased from 65 to 95 points. The subjective sense of lower extremities was felt by 1 increased to 8. The SCIM III score increased from 32 to 69 points. These results suggest that TKM could effectively reduce pain and aid the rehabilitation of patients with SEH.

• The Korean Journal of Pain
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• 제10권2호
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• pp.203-207
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• 1997

Background: To date, there are no controlled studies assessing the effect of metoclopramide administered epidurally to prevent nausea and vomiting associated with epidural morphine for postoperative analgesia. This study was undertaken to determine the effectiveness of continuous epidural infusion of metoclopramide, combined with epidural morphine, in reducing nausea or vomiting associated with epidural morphine and minimizing the side effects of metoclopramide. Methods: Sixty patients undergoing elective gynecologic surgery were randomly assigned to one of two study groups. Patients received continuous epidural morphine infusion (6.0 mg/day) following a bolus loading dose of 3.0 mg (Group A), or epidural mixture of morphine (6.0 mg/day) plus metoclopramide (20 mg/day) following a bolus loading dose (morphine 3.0 mg, metoclopramide 10 mg)(Group B). For the first 24 postoperative hours, incidence of nausea or vomiting, need for antiemetic therapy, level of sedation, degree of pain and pruritus, and adverse effects associated with metoclopramide were evaluated. Result: Incidence of nausea or vomiting and number of patients who required antiemetic therapy were significantly less in Group B, than in Group A (P<0.05). There were no significant differences between groups with regard to adverse effects associated with metoclopramide such as sedation, extrapyramidal reaction and other side effects (P=NS). Conclusion: We conclude simultaneous titration of morphine and metoclopramide via epidural continuous infusion following epidural bolus injection of the mixture reduces nausea or vomiting associated with epidural morphine while preventing side effects of metoclopramide.

• The Korean Journal of Pain
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• 제19권1호
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• pp.87-90
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• 2006

Background: There are many ways to provide superior analgesia for postoperative pain after abdominal surgery of which epidural analgesics with opioids and local analgesics are the most useful. In an effort to maximize the level of analgesia and to minimize the side effects, ketamine, midazolam, clonidine, and adrenalin can be co-administrated as an adjuvant. This study examined the analgesic effect and side effects of midazolam compared with those given an epidural injection of bupivacaine, fentanyl and ketamine. Methods: In a double blind randomized controlled trial, 50 patients received either fentanyl $0.3{\mu}g/kg/h$ and ketamine 0.1 mg/kg/h (Group FK) or fentanyl $0.3{\mu}g/kg/h$, ketamine 0.1 mg/kg/h and midazolam 0.4 mg/h (Group FKM), added to 0.125% of bupivacaine at a rate of as much as 2 ml/h, for patient controlled epidural analgesia (PCEA) after low abdominal surgery. Ten minutes before surgery, the patients received either 10 ml of 0.125% bupivacaine with 0.5 mg/kg of ketamine or 10 ml of 0.125% bupivacaine with the same amount of normal saline, added to fentanyl $50{\mu}g$. The pain score and the side effects were recorded at 1, 3, 6, and 24 hours after surgery. Results: There was no difference in the pain score except for the VAS on coughing 1 hour after surgery. FKM group had fewer side effects. Conclusions: There was a better analgesic effect and fewer side effects with the addition of epidural midazolam to bupivacaine and fentanyl with ketamine formula. However, more study on the dose and route of administration will be needed.

• The Korean Journal of Pain
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• 제14권2호
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• pp.176-180
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• 2001

Background: The aim of our study was to evaluate the antiemetic effects of intravenous dexamethasone in preventing continuously infused epidural morphine-related nausea and vomiting. Methods: Twenty-seven patients requiring general anesthesia for gastrectomy were enrolled in a randomized, double-blinded, and placebo-controlled study. At the end of surgery, all patients received epidural morphine 3 mg and were connected to an epidural morphine infusion pump for 2 days in order to relieve postoperative pain. Before the morphine injection, the dexamethasone group (n = 12) received IV dexamethasone 10 mg, whereas the saline group (n = 15) received IV saline. The incidence of nausea & vomiting, pruritus, back pain and VAS scores were assessed in the recovery room, and at 24 h and 48 h postoperatively. Results: There was no significant difference in the total incidence of nausea and vomiting, pruritus, back pain or in the VAS scores. However, there was no vomiting and no back pain in the dexamethasone group. Conclusions: Intravenous dexamethasone did not significantly decrease the total incidence of nausea or vomiting in patients receiving continuous epidural morphine for postoperative pain control. However, IV dexamethasone appears to decrease the severity of nausea, vomiting and back pain.

• The Korean Journal of Pain
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• 제31권4호
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• pp.277-288
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• 2018

Background: Neck and back pain are leading sources of disability placing substantial burden on health care systems. Surgical interventions in managing chronic neck pain secondary to various disorders continue to increase. Even though surgical interventions are effective, a significant proportion of patients continue to have symptomatology and develop cervical post-surgery syndrome. This study was performed to know the effectiveness of cervical interlaminar epidural injections with or without steroids. Methods: The effectiveness of fluoroscopic cervical interlaminar epidural injections in post-surgery syndrome was evaluated in a randomized, active controlled trial. The study population included 116 patients assigned to 2 groups. Group 1 received cervical interlaminar epidural injections with local anesthetic alone and Group 2 received injection with local anesthetic and steroids. The main outcomes were defined as significant improvement (greater than 50%) of pain relief using the numeric rating scale and/or functional status improvement using the Neck Disability Index (NDI). Results: Both groups had similar results with significant improvement (${\geq}50%$ pain relief and functional status improvement) in 69% of the patients in Group I, whereas, in Group II, 71% of the patients showed significant improvement at the end of 2 years. During a 2-year period, the average number of procedures was 5 to 6, with an average of approximately 12 weeks of significant improvement per procedure. Conclusions: Fluoroscopic cervical interlaminar epidural injections administered in cervical post-surgery syndrome using local anesthetic, regardless of the use of steroids, may be effective in approximately 70% of the patients at 2-year follow-up.

• The Korean Journal of Pain
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• 제12권1호
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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.