• Journal of Korean Neurosurgical Society
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• v.45 no.4
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• pp.209-212
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• 2009

Objective : Avascular necrosis (AVN) of the vertebral body is known as a relatively uncommon phenomenon in a vertebral compression fracture (VCF). The outstanding radiologic findings of AVN are intravertebral vacuum phenomenon with or without fluid collection. Several reports revealed that PVP or balloon kyphoplasty might be the effective treatment modalities for AVN. We also experienced excellent results when using PVP for the treatment of AVN of the vertebral body, and intend to describe the treatment's efficacy in this report. Methods : Thirty-two patients diagnosed with AVN of the vertebral body were treated with PVP. We measured the pre- and post-operative anterior body height and kyphotic angulation. The visual analogue scale (VAS) was used to determine the relief of back pain. Results : The anterior body height (pre-operative : 1.49 cm, post-operative : 2.22 cm) and kyphotic angulation (pre-operative : 14.47 degrees, post-operative : 6.57 degrees) were significantly restored (p<0.001). VAS was improved from 8.9 to 3.7. Pseudoarthrosis was corrected in all cases, which was confirmed by dynamic radiographs. Fluid collection was found in sixteen cases and was aspirated with serous nature. No organism and tumor cell were noted. Conclusion : PVP proved to be an effective procedure for the treatment of AVN of the vertebral body, which corrected dynamic instability and significantly restored the anterior body height and kyphotic angulation.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.100-107
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• 2015

Objective : To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors. Methods : This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days). Conclusion : Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.60-66
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• 1993

The clinical effects of epidural nalbuphine were compared to those of epidural morphine in sixty Cesarean delivery. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered nalbuphine 5 mg(Group N5), nalbuphine 10 mg(Group N10) or morphine 3 mg(Group M3) through an indwelling epidural catheter at the time of peritoneal closure. During the first postoperative 24 hours, their analgesic effects were evaluated by visual analogue scale(0-10), respiration rates and Trieger dot test. The severity of side effects(0-2) was also evaluated. The results were as follows ; 1) The number of patients who needed additional epidural analgesics was least in group M3 (p<0.05). There was no significant difference between group N5 and group N10. 2) The duration between the first and second epidural administration was ; 19.2 hours in group M3, 8.6 hours in group N10 and 5.4 hours in group N5. There was a significant difference each group (p<0.05). 3) From the fourth post operative hour, both groups receiving nalbuphine showed a higher VAS score compared to group M3(p<0.05). 4) The incidence of pruritus, nausea, vomiting and voiding difficulty were more severe in group M3 compared with the other groups. However the severity did not increase with increasing nalbuphine dosage. 5) There were no patients showing objective sedation or low respiration rate(10 times/minute). We concluded that epidural administration of nalbuphine 5 mg or 10 mg is one way of post operative pain control. Its side effects were less than epidural morphine, but it is a less convenient in the method of analgesia.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.538-542
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• 1993

An approach to the treatment of post-operative pain by the injection of bupivacaine into the pleural space through an intrapleural cathter has been studied. Among 24 thoracotomy patients, bupivacaine was injected only to experimental group[ 12 patients ] when the patient was able to head up for oneself during recovery from anesthesia. The pain and ROM[ range of motion ] scores, respiration rate, PaCO2 level of both experimental and control group were measured at the time of head-up and 30 and 120 minutes thereafter.The scores of pain and ROM of experimental group were significantly[ P value < 0.05 ] decreased in 30 minutes and 120 minutes after bupivacaine injection compared with those of control group but respiration rate and PaCO2 level were not changed significantly. With this result, we can suggest that intrapleural injection of bupivacaine is useful for pain relief following thoracotomy.

• Kosin Medical Journal
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• v.33 no.2
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• pp.245-251
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• 2018

Prophylactic antibiotics that are used to prevent post-operative infection can commonly cause anaphylactic reactions during anesthesia. It is therefore necessary to perform a skin test before antibiotics are administered in order to diagnose and prevent anaphylactic reactions. However, the results of the antibiotic skin test can differ according to the drug, dose, and reagent concentration. We report a case of anaphylactic shock with bronchospasm and cardiovascular collapse immediately following administration of the prophylactic cefazedone after induction of general anesthesia for laparoscopic cholecystectomy.

• Kosin Medical Journal
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• v.33 no.2
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• pp.215-222
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• 2018

An incidentaloma is a tumor found incidentally without clinical symptoms or suspicion; the lesion may be adrenal, pituitary, or thyroidal. We report the case of an asymptomatic individual with preoperatively undiagnosed pheochromocytoma (size: 4.86 cm) that was revealed using elective nonadrenal surgical procedures. The patient demonstrated peri- and post-operative hypertensive crisis and tachycardia. Three days after the dramatic onset of symptoms, the patient expired due to pulmonary edema, multiple organ failure, and terminal sepsis, despite administration of extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation. A left medial kidney mass obtained at autopsy confirmed pheochromocytoma.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.22 no.2
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• pp.149-157
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• 2015

Purpose: The objectives of this study were to assess the influence of family presence in the PACU (Post Anesthesia Care Unit) on anxiety, emergency delirium, pain and length of stay in the recovery room for elderly patients undergoing surgery for which general anesthesia has been used. Methods: The study was a nonequivalent control group pre-post test design. Eighty elderly patients over 65 years who underwent surgery under general anesthesia were recruited. Forty were assigned to the experiment group, patients together with a family member and 40 to the control group, with no family member present. Patients' anxiety, emergency delirium, pain and length of time in the recovery room were evaluated at 10 minute and 30 minute after arrival in the PACU. Results: Patients with family members in the PACU showed significantly decreased levels of anxiety at 10 and 30 minutes and significantly lower levels of emergency delirium and pain at 30 minutes. However there was no difference between the 2 groups for length of time in the recovery room. Conclusion: The results of this study indicate that being with family members in the PACU after surgery under general anesthesia is effective for reducing elderly patients' anxiety, delirium and pain during time in the recovery room.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.55-59
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• 1993

Using a visual analogue scale, we compare the effect of patient-controlled analgesia and conventional intramuscular opioid regimen in 68 patients undergoing lower abdominal or gynecological surgery. We also recorded the incidence of side effects. We checked visual analogue scale 4 hours interval for 30 cases managed by patient-controlled analgesia and 38 cases of conventional intramuscular opioid group managed by obstetrician. We maintained fentanyl $0.33{\mu}g/kg/hr$ and set self administrable bolus dose $5.0{\mu}g$(lockout interval: 15 min) in patient-controlled analgesia group. Conventional intramuscular bolus injection group were administered meperidine 50 mg for 4 hour interval. Mean visual analogue scale scores obtained by patient-controlled analgesia group and intramuscular bolus injection group were $2.49{\pm}0.67$ and $4.53{\pm}1.28$(p<0.05). Side effects such as; no significant incidence of respiratory depression, urinary retention, postural hypotension, nausea, vomiting and pruritus were developed by either group. These results suggest that patient-controlled analgesia was more effective method compared with conventional intraumuscular opioid injection regimen for post-operative pain management.

• The Korean Journal of Pain
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• v.37 no.4
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• pp.310-319
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• 2024

Background: This study aimed to investigate the analgesic and preventive effect of low-level laser therapy (LLLT) on the incisional pain model and spinal nerve ligation (SNL) model in rats and identify the possible mechanisms of action. Methods: Male Sprague-Dawley rats were used, divided into different treatment groups. The single application group received LLLT before or after skin incision or SNL. The consecutive application group received LLLT for six consecutive days post-incision, three days pre-incision, or three consecutive days pre-SNL. The control group underwent skin incision or SNL without LLLT. The von Frey test was used to quantify the pain associated with mechanical allodynia. Pro-inflammatory cytokine level and alterations in nerve growth factor (NGF) expression were measured by using ELISA and immunohistochemistry, respectively in the skin, muscle of the paw, and spinal cord dorsal horn (SCDH). Results: In the incisional pain model, LLLT showed significant analgesic and preventive effect. LLLT ameliorated SNL-induced mechanical allodynia but LLLT had no preventive effect. LLLT decreased interleukin-1β (IL-1β) expression levels in the skin, muscle, and SCDH and reduced the optical density of skin and spinal cord NGF in the incisional pain model. Conclusions: LLLT alleviated incisional pain and neuropathic pain caused by SNL in rats, and reduced the levels of IL-1β and NGF in the peripheral tissue and SCDH in the incisional pain model. LLLT might be effective in patients with post-operative pain and peripheral neuropathic pain.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.188-191
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• 1988

Recent studies have shown that narcotic drugs produce an intense prolonged analgesic action when injected into the subarachnoidal or extradural space of animals and man. In order to study the effects of intrathecal injection of morphine on postoperative pain relief and segmental block effect, we administered 0.25 mg of morphine sulfate (0.25 mg of morphine/1 ml normal saline) into lumbar subarachnoid space prior to brahial plexus block for upper extremity surgery group The results were as follows: 1) more than 20 hours analgesic effect at least 2) no segemental block effect in analgesia 3) some adverse effect (Nausea, Vomiting, Pruritus, Urinary retention).