• The Korean Journal of Pain
• /
• 제36권2호
• /
• pp.184-194
• /
• 2023

Background: Degenerative lumbar spondylolisthesis (DLS) is frequently associated with lumbar spinal stenosis (LSS) and conservative treatments such as epidural steroid injection do not have long-term benefits in LSS patients with DLS. This study evaluated the effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with LSS and DLS. Methods: Patients' sex, age, body mass index, diabetes, hypertension, stenosis grading, pain duration, location, pain intensity, and medications were retrieved from electronic medical records. At 1, 3, and 6 months following the procedure, data on pain severity, medication usage, and physical functional status were analyzed. A generalized estimating equations model was used at the six-month follow-up. Patients were divided into those with DLS (the spondylolisthesis group) and those without DLS (the no spondylolisthesis group) to evaluate whether the effects of percutaneous epidural neuroplasty using a balloon catheter were different. Results: A total of 826 patients were included (spondylolisthesis: 433 patients, 52.4%; no spondylolisthesis: 393 patients, 47.6%). Age, body mass index, hypertension, pain location, and stenosis grading were statistically different between the two groups. The generalized estimating equations analyses with unadjusted and adjusted estimation revealed a significant improvement in the estimated mean numerical rating scale of pain intensities compared to that at baseline in both groups (P < 0.001). Any adverse events that occurred were minor and temporary. Conclusions: Percutaneous epidural neuroplasty using a balloon catheter may be an alternative treatment option for patients with chronic LSS, regardless of accompanying DLS, who have had failed conservative management.

• The Korean Journal of Pain
• /
• 제11권1호
• /
• pp.155-159
• /
• 1998

Epidural neurolysis with phenol has appeared in literature since 1960. Complications due to accidental subdural block is a rare and unexpected sensory and/or motor disturbance, but it does occur. A 74 years old woman had postherpectic neuralgia for 3 weeks and VAS score of 10. She was treated with intercostal nerve block and intravenous infusion of lidocaine for 7 days and VAS score decreased to 6. To proceed further, we decided to perform epidural neurolysis with 4% phenol 1.5 ml. During thoracic epidural catherization, we encountered unexpected subdural catheterization in subdurographic finding, but we could not precisely rule out subdural catheterization. We had to check CT for exact location of catheter tip. We then performed subdural neurolysis with phenol. This procedure reduced VAS score to between 3 and 4, and we removed the catheter. She had no complication.

• The Korean Journal of Pain
• /
• 제11권1호
• /
• pp.160-164
• /
• 1998

We report a case of epidural hematoma occuring after bloody tap during epi-dural catheter for cancer pain control in thrombocytopenic patient. Two hours after epidurl puncture, patient experienced severe back pain and numbness of both legs. Following day, patient complained of motor paralysis and urinary difficulty. Diagnosis utilizing magnetic reasonance imaging, showed epidural hematoma extending from $T_{11}$ to $T_{12}$. Thrombocytopenia prevented surgical intervention. Therefore we restored conservative therapy with packed red cell, platelet concentration, steroid and hemostatic, which provided complete neurologic recovery, spontaneously over several days without surgical intervention.

• Korean Journal of Anesthesiology
• /
• 제71권6호
• /
• pp.430-439
• /
• 2018

In infants and small children, ultrasound (US) guidance provides ample anatomical information to perform neuraxial blocks. We can measure the distance from the skin to the epidural space in the US image and can refer to it during needle insertion. We may also visualize the needle or a catheter during real-time US-guided epidural catheterization. In cases where direct needle or catheter visualization is difficult, US allows predicting successful puncture and catheterization using surrogate markers, such as dura mater displacement, epidural space widening due to drug injection, or mass movement of the drug within the caudal space. Although many experienced anesthesiologists still prefer to use conventional techniques, prospective randomized controlled trials using US guidance are providing increasing evidence of its advantages. The use of US-guided regional block will gradually become widespread in infants and children.

• The Korean Journal of Pain
• /
• 제7권2호
• /
• pp.249-253
• /
• 1994

Postherpetic neuralgia is one of the most troublesome disease in pain clinic. Nine patients who suffered from postherpetic neuralgia for 1.5 to 8 month, has been treated with the epidural block for prognostic or therapeutic purpose. Epidural catheter was inserted as close to the involved neural roots as possible, and tip of epidural catheter was confirmed under fluroscopic guide. Epidural neurolysis was performed out intermittent injection of 1~3 ml of 6% phenol in saline and repeated 2~6 times over one or 7 days interval. Two patients reported satisfactory pain relief and 3 patients reported some pain relief. But 4 patients unchanged after phenol block. The overall duration of pain relief was not studied. Validity and safety of epidural phenol block was not confined. Further study will be necessary before application of epidural phenol block to postherpetic neuralgia.

• The Korean Journal of Pain
• /
• 제18권1호
• /
• pp.19-22
• /
• 2005

Background: Most terminal cancer patients suffered from intractable pain. For the treatment of these patients, opioids, via various routes, are usually administered. Continuous epidural opioid, especially morphine, administration is a good method for the management of intractable cancer pain. Methods: We retrospectively analyzed 347 terminal cancer patients, who had been treated with continuous epidural morphine infusion, between 1999 and 2004. For the epidural infusion, an epidural catheter was inserted, tunneled subcutaneously and exited from the anterior chest or abdomen. Multiday $Infursor^{(R)}$ (Baxter, 0.5 ml/h) was used for the continuous infusion. Results: Of the 347 patients studied, there were 211 males and 136 females. The mean treatment time was 54.7 days, ranging from 5 to 481 days. The mean starting and termination doses of morphine were 32.4 (for 5 days) and 100.0 mg, respectively. The doubling time of the morphine dose was 26.3 days, corresponded to a 3.8 percent increase per day. Incidental catheter removal was the most common side effect, which occurred 130 times in 61 cases. Conclusions: The procedure of epidural catheterization, with subcutaneous tunneling, was simple and inexpensive. Despite the disadvantages, such as incidental catheter removal, it is a useful method for the control of terminal cancer pain.

• The Korean Journal of Pain
• /
• 제10권2호
• /
• pp.214-219
• /
• 1997

Background: Epidural neural blockade with local anesthetics combined with steroids has been in clinical trials for patients with low back pain. But pain treatment of low back pain remains somewhat problematic. Many patients with low back pain have epidural fibrosis and adhesions proved with magnetic resonance imaging(MRI) examination. These findings might play an important role in the origin of back pain. Present study was aims to investigate the effect of epidural adhesiolysis in patients with low back pain. Methods: We investigated 76 patients suspected with epidural fibrosis and adhesion was suspected. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. 17G needle specially designed by Racz was inserted at sacral hiatus and catheter was inserted untill its tip was located at lesion site under fluoroscopic guidance. Injection of contrast dye was achieved and prospected spread of agents. Injection of 0.25% bupivacaine, triamcinolone, and 10% hypertonic saline via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) post-epidural adhesiolysis 3 days, 1 week, and 3 months. We also looked for complication of epidural adhesiolysis. Results: Statistical analysis(Friedman nonparametric repeated measures test and Dune's multiple comparison test) demonstrated NRS was significantly less during 3 months after epidural adhesiolysis(P<0.05). Especially, there is a extremely significance in post-epidural adhesiolysis 3 days (P<0.001). Only four patients reported any complications the most common symptom among three persistent headache but disappeared after a few months without residual sequelae. Conclusion: We conclude epidural adhesiolysis is a safe and effective method of pain therapy for low back pain with proven lumbo-sacral fibrosis and adhesion. A direct visualization by epiduroscopy may be more useful to the resulting functional changes after epidural adhesiolysis.

• The Korean Journal of Pain
• /
• 제13권1호
• /
• pp.74-78
• /
• 2000

Background: Epidural Adhesiolysis is an interventional pain management technique for patients with low back pain. In addition to local anesthetics and corticosteroid, hypertonic saline (NaCl) are used for the technique. Present study was aimed to compare analgesic and adverse effects of two different concentration of hypertonic saline in Epidural Adhesiolysis. Methods: Fifty-three subjects with low back pain with radiculopathy were assigned to one of two epidural adhesiolysis treatment groups: 8% (Group I, n=26) or 10% (Group II, n=27) hypertonic saline. 17 G epidural needle was inserted at sacral hiatus and catheter was advanced untill its tip was located at lesion site under fluoroscopic guidance. Subjects in all treatment groups received epidural corticosteroid and local anesthetic. And then, hypertonic saline injection via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) at post-epidural adhesiolysis 1, 2, 3 days, 1 week, and 1, 3 months. We also looked for complications of epidural adhesiolysis at different concentration of hypertonic saline. Results: Statistical analysis demonstrated that NRS was not significantly different between two groups during 3 months after epidural adhesiolysis. There were no major differences of complications between two groups and disappeard after a few months without residual sequelae. Conclusions: We conclude that epidural adhesiolysis using 8% hypertonic saline is effective for relief of low back pain with proven lumbosacral fibrosis without any residual sequelae compared with 10%.

• The Korean Journal of Pain
• /
• 제9권1호
• /
• pp.275-278
• /
• 1996

The placement of epidural catheter may cause complications such as epidural hematoma, epidural abscess and neural damage. Among the above complications, epidural abscess is a rare but serious complication. This report pertains to a diabetic metlitus patient who developed spinal epidural and subdural abscess after continuous epidural catheterization for management of pain caused by reflex sympathetic dystrophy. The patient experienced urinary incontinence, as a neurologic sign, 8 days after epidural catherization. In was considered that the poor prognosis was due to a combination effects of a delayed visit to the hospital for treatment, rapid progression of abscess and uncontrolled blood sugar level. We therefore recommend aseptic technique and proper control of blood sugar level to prevent infection during and after epidural catheterization for diabetic patients. Early diagnosis of epidural abscess following surgical procedure must be required to avoid sequelae.

• 대한의용생체공학회:의공학회지
• /
• 제24권1호
• /
• pp.9-13
• /
• 2003

경막외마취는 전신마취가 불필요하므로 널리 활용되는 마취술이다. 그러나 경막외마취 시술시 천자침이 경막외강 내에 정확하게 위치하지 않으면 각종 부작용이 발생하므로 시술자의 세심한 주의뿐만 아니라 상당한 수준의 숙달이 필요하다. 본 연구에서는 천자침이 연결된 도관 내의 압력 변화를 범용 압력센서로 연속 계측함으로써 침이 경막외강 내로 진입하는 순간을 자동탐지하는 자동화된 저항소실법을 개발하였다. 17G Tuohy 침을 황인대까지 전진시킨 후 침에 공기도관을 연결하고 공기도관에 연결된 압력센서로 압력신호를 추출하여 적절히 증폭ㆍ필터링한 후 역치감지회로가 경막외강의 진입순간을 감지하도록 전자회로를 설계ㆍ제작함으로써 저항소실법을 자동화할 수 있었다. 소량의 공기 주입으로 도관 내의 압력을 50∼100mmHg까지 녹인 후 짐을 천천히 전진시키며 압력변화신호를 10개의 녹색 발광다이오드로 연속 표시하였고 압력이 20mmHg 이하로 하강하는 순간을 경막외강 진입시점으로 인식하여 시술자를 위해 경보를 울리는 보조기기의 형태로 구현하였다. 자체 시뮤레이션을 거친 후, 경막 외마취 시술이 예정된 환자 ,30명을 대상으로 자동화된 보조기기를 사용하여 시술하였고 수동적인 저항소실법을 병행하는 임상실험을 통하여 경막외 마취시술의 성공여부를 판정하였다. 본 기기의 도움으로 첫 번째 시도에서의 마취성공률은 83%이었고 두 번째 시도에서는 모두(100%) 성공하였으며 시술 중 주입된 공기의 용적은 1ml이내로써 별는 부작용이나 합병증은 없었으므로 본 연구의 유용성이 입증되었다. 본 연구의 자동화된 저항소실법은 공기도관을 사용하였으므로 감염의 가능성도 최소화된다고 볼 수 있었으며, 따라서 편리하고 안전한 경막외마취 시술이 가능할 것으로 판단된다.