• The Korean Journal of Pain
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• v.11 no.2
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• pp.299-301
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• 1998

Stellate ganglion block is frequently effective on the pain of head and upper extremities. However, if the degree and duration of pain relief does not increase with repeated blocks, we may consider the neurolytic procedure on the stellate ganglion. A patient sufferring from the pain in the region of ophthalmic branch of left trigeminal nerve and left eyeball region had been treated with stellate ganglion block. In spite of repeated blocks, the degree and duration of pain relief did not increase. We performed the radiofrequency thermocoagulation of stellate ganglion at the operation room under fluoroscopy. Patient got pain relief immediately after the procedure without any remarkable complication except a mild ptosis, which was shown before the procedure. We may give priority to radiofrequency thermocoagulation for stellate ganglion neurolysis due to its simplicity and safty.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.28-33
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• 1988

Neurolysis of the celiac plexus has been performed to relieve intractable pain caused by carcinoma of the pancreas, liver, gall bladder or stomach. It is also occasionally effective in controlling the pain of chronic pancreatitis. In practice, however celiac plexus block is not a simple procedure to the beginner. The results and complications are variable. In order to correctly inject neurolytic agents into or near the celiac plexus and to reduce the time consumed to perform celiac plexus block, we used CT scanner for 7 cases of alcohol celiac plexus block. The effects will be described. The purpose of this article is to improve the technical aspect of celiac plexus block to the beginner.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.61-65
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• 1989

Chloroma is a localized myeloblastic tumor which may develop during the course of myelogenous leukemia or as a presenting sign of the disease. A 47-year-old female diagnosed as chronic myelogenous leukemia in her hematologic remission period complained of left lower leg pain. The lumbar-spine series showed multiple osteolytic changes in the left lateral border of the lumbar spine. An inhomogenous soft tissue mass involving left lateral aspects of lumbar vertebrae was identified by CT-scanning. At the first pain attack, lumbar epidural steroid and local anesthetic injection could abolish her pain and the patient could go a few days without pain. The following radiation therapy could also improve the symptom and retain the pain free interval. One month later, a second pain attack occurred and lumbar and caudal epidural steroid and local anesthetic injections could result only in an incidental relief of pain. Radiation and chemotherapy were started but failed to relieve pain. A neurolytic block was considered but the patient's general condition was aggravated and even verbal communication with her became impossible.

• The Korean Journal of Pain
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• v.25 no.1
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• pp.38-42
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• 2012

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.100-104
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• 1993

Malignant tumors of the paranasal sinuses are quite rare entity, with maxillary neoplasms accounting for less than 1 percent of all head and neck malignancies. When considering the paranasal sinuses alone, 77 percent of cancers arise in the maxillary sinuses. There is no situation more frustrating than the management of the patients with chronic facial pain due to cancer. The initial step in managing patients with cancer pain is the use of oncologic therapy in the form of radiotherapy, surgery, chemotherapy, alone or combined, either to effect a cure or decrease the size of the tumor and thus decrease or eliminate the pain. When oncologic therapy is ineffective in providing relief, the pain must be treated by one or more of the followings: Systemic analgesics and adjuvant drugs, psychologic techniques of analgesia, neurostimulating techniques, neuroablative surgical procedures, regional analgesia with local anesthetics or neurolytic blocks. An 82-year old patient had severe pain of the orbital and infraorbital region due to squamous cell carcinoma of the maxillary sinus. We successfully treated this patient with the percutaneous retrogasserian ethanol gangliolysis by a H$\ddot{a}$rtel approach, and the analgesia lasts until the death of the patient.

• The Korean Journal of Pain
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• v.26 no.2
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• pp.164-168
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• 2013

It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.86-88
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• 1997

Regional sympathetic blockade is the most effective treatment for reflex sympathetic dystrophy (RSD). Radiofrequency thermocoagulation provides longer duration of pain relief than local anesthetics and less complication than chemical neurolytic agents for lumbar sympathectomy. Spinal cord stimulation (SCS) is thought to be an effective modality yieding good results in treating intractable neuropathic pain. Therefore RSD might be a good indication for SCS. We treated a patient with RSD who responded well to lumbar sympathetic blockade (LSB) with radiofrequency thermocoagulation and SCS. The patient had a left ankle sprain requiring a case for the lower leg for 2 weeks. The patient suffered increasing pain and swelling on the lower part of that leg. We thought to block the lumbar sympathetic chain utillzing radiofrequency thermocoagulation 2 days after LSB with local anesthetics. The results provided accepatable pain relief (VAS $8{\rightarrow}15$) but the patient still could not walk due to remaining pain which was further aggravated by walking. After SCS, pain relief improved (VAS $5{\rightarrow}13$) and patient could walk without assistance.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.263-266
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• 2005

The ganglion impar is a solitary retroperitoneal structure at the caudal end of the paravertebral sympathetic chain. Block of this ganglion has been advocated as a means of managing intractable perineal pain. In 1990, Plancarte et al performed a neurolytic block of the ganglion impar using 4-6 ml of 10% phenol through the intergluteal skin over the anococcygeal ligament. However, technical difficulties are encountered with the placement of the needle while performing this technique, with complications from the injection of phenol also being a possibility. In 1995, a modified approach for blocking the ganglion impar through the sacrococcygeal ligament was introduced by Wemm and Saberski. We used a radiofrequency (RF) lesion generator to create a controlled and localized lesion with a lower incidence of neural damages compared to chemical neurolysis. RF thermocoagulation of the ganglion impar through the sacrococcygeal ligament was performed on a 70-year-old male patient with constant anal pain using a curved TEW electrode. The patient has been relieved of his pain, without serious complication. Therefore, this technique may be an easier and safer approach, which is associated with fewer chances of complications.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.211-216
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• 1994

Celiac plexus block is performed to relieve intractable upper abdominal cancer pain. Generally, celiac plexus blocks have been performed under control of X-ray fluoroscopy to determine the position of the needle tip and the spread of contrast media. During the period from March 1992 to February 1994, we have performed 21 cases of neurolytic celiac plexus block to alleviate pain of intra-abdominal malignancy. We retrospectively evaluated the location of the needle tip and the spread of contrast media. P-A views of simple abdomen demonstrated the locations of the needle tip: 66.7% of the left needle tips were in upper 3/1 of L1 (6 cases) and $T_{12}-L_1$ interspace (8 cases), 50% of the right needle tips were in upper 1/3 of $L_1$, (6 cases) and $T_{12}-L_1$ interspace (4 cases). Contrast media from the right needle spread upward to middle 1/3 of $T_{10}$ (5 cases) and middle 1/3 of $T_{11}$ (5 cases), downward to middle 1/3 of $L_1$ (6 cases) and lower 1/3 of $L_1$ (3 cases). Contrast media from the left needle were spread upward to middle 1/3 of $T_{10}$ (5 cases) and evenly to other spaces, downward to middle 1/3 of $L_1$, (4 cases) and $L_1-L_2$ interspace (6 cases). We analyze the spread of contrast media according to distance from needle tip by authors score system. Contrast media of right needle spread upward 6.1 and downward 3.4, that of left needle spread upward 6.5 and downward 3.7.

• The Korean Journal of Pain
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• v.28 no.1
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• pp.22-31
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• 2015

Background: The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors. Methods: Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed. Results: Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable. Conclusions: The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.