• Journal of Chest Surgery
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• 제40권11호
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• pp.752-758
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• 2007

배경: 수장부다한증의 치료 후 손의 원활한 활동을 위해 적당한 보습성을 유지하고 보상성 다한증과 같은 합병증이 없는 경우에 보다 높은 만족도를 나타낼 것이다. 저자들은 수부다한증의 치료 후 보상성 다한증을 피하기 위한 노력의 일환으로 두부족으로 영향을 미치는 교감신경의 보존을 위해 제4번 흉부교감신경절 상부의 신경다발을 차단하는 시술을 시행하였다. 대상 및 방법: 흉부 제4번 교감신경절을 상하 완전 차단한 1군과 보다 간편하게 흉부 제4번 교감신경절 상부 차단술만 시행한 2군으로 분류하였고, 두 방법의 장기성적을 평가하기 위하여 수술 후 만족도 등에 대한 전화설문 조사를 실시하였다. 대상 환자는 71명(남자 45명, 여자 26명)이며, 1군은 31명(평균 연령 25.5세), 2군은 40명(평균 연령 25.9세)이었고 추적 조사기간은 1군이 수술 후 평균 24.9개월, 2군은 18.9개월이었다. 결과: 수술 후 수술부위에 땀이 나는 정도는 1군에서 전혀 나지 않는다(41.9%), 환경에 따라 약간 난다(48.4%)에 비해 2군은 각각 60.0%, 35.0%였다. 수술 후 땀이 나기 시작한 경우는 1군이 58.1%, 2군이 40.0%였고, 수술 후 손의 건조한 정도는 별다른 불편이 없다고 한 경우가 1군에서 높았고 손크림을 바를 정도라고 응답한 경우는 2군에서 높았다. 보상성 다한증의 발생은 없거나 생활에 불편하지 않은 경우가 각각 71.0% (1군), 62.5% (2군)로 응답하였고, 수술을 후회하는 경우는 1군이 1명, 2군이 2명 있었다. 보상성 다한증의 발생부위는 1군이 등, 허벅지, 가슴 순이었고 2군은 등, 가슴, 배 순이었다. 미각성 다한증은 1군에서 몹시 불편하거나(25.8%), 약간 생겼지만 불편하지는 않다(45.2%)고 한 반면, 2군은 몹시 불편한 경우는 12.5%, 미각성 다한증이 생기지 않은 경우가 45%였다. 수술 후 얼굴에 나는 땀의 정도는 양 군 대다수가 불편이 없다고 응답하였다. 수술 후 만족도는 1군과 2군 대부분이 치료에 만족하였다. 결론: 흉부 제4번 교감신경절 완전 차단술과 상부 차단술은 수장부 다한증의 치료에 효과적이며, 보상성 다한증의 발생을 줄이고 증세를 완화하는 효과가 있다. 특히 흉부 제4 번 교감신경절 상부 차단술은 수술이 쉽고 안전하며 미각성 다한증의 발생이 저하되고, 수술 후 환자의 만족도가 높았다.

• The Korean Journal of Pain
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• 제23권2호
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• pp.131-136
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• 2010

Background: We prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect. Methods: Among 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups. Results: The incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (${\chi}_2$ = 14.773, P = 0.001). $DT^{post}$ (postblock temperature difference between ipsilateral and contralateral great toe, $4.6{\pm}2.8^{\circ}C$, $1.8{\pm}1.6^{\circ}C$, P < 0.001 for group A and B) and $DT^{net}$ ($DT^{post}$ - $DT^{pre}$, $3.9{\pm}2.7^{\circ}C$, $1.5{\pm}1.5^{\circ}C$, P < 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was $8.1{\pm}0.9$ for group A and $3.2{\pm}1.6$ for group B (P < 0.001). Conclusions: The LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of $DT^{net}$ and $DT^{post}$.

• The Korean Journal of Pain
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• 제1권1호
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• pp.103-105
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• 1988

Ramsey Hunt Syndrome occurs when herpes zoster afters the facial nerve. It causes vesicular eruption of the pinna, external auditory meaturs and ear drum, severe otalgia with associated facial paralysis and vertigo. We experienced a case of Ramsey Hunt syndrome and managed it with repeated sympathetic blocks using a stellate ganglion block. We achieved early resolution of the eruption, relief of pain and prevention of postherpetic neuralgia. We concluded that SGB was effective treatment against Ramsey Hunt Syndrome.

• The Korean Journal of Pain
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• 제11권1호
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• pp.101-104
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• 1998

Backgrouds: Twent five years have passed since the opening of the first pain clinic in korea, in 1973 at Yonsei University Hospital. The number of pain clinics are gradually increasing in recent times. It is important to plan for future pain clinics with emphasis on improving the quality of pain management. Therefore we reviewed the patients in our hospital to help us in planning for the future of our pain clinic. Methods: We analyzed 2656 patients who had visited our Kim Chan Pain Clinic, accordance to age, sex, disease, and type of treatment block, from July 1996 to August 1997. Results: The prevalent age group was in the fifties, 27.3%, seventy years and older compromised 9.2%. The most common disease were as follows: lower back pain(46.2%); cervical and upper extremities pain(23.1%); trigeminal neuralgia(7.2%); and hyperhydrosis(5.8%) Both nerve blocks and medication were prescribed as treatment. Lumbar epidural block(16.3%) and stellate ganglion block(15.6%) were the most frequent blocks performed among various nerve blocks. Among nerve block under C-arm guidance, lumbar facet joint block(24.4%) and lumbar root block(22.5%) were performed most frequently. Trigeminal nerve block(18.4%), thoracic(17.0%) and lumbar sympathetic ganglion block(11.4%) were next most prevalent blocks performed frequent block. Conclusions: Treatments at our hospital were focused on nerve blocks and medications prescriptions. Nerve blocks are of particular importance in the diagnosis and treatment of chronic pain. However in future, to raise the quality of pain management, we need to fucus on a multidisciplinary/interdisciplinary team approach.

• 생명과학회지
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• 제17권11호
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• pp.1472-1476
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• 2007

본 연구는 정상적인 안압을 가진 비글견에서 4가지의 다른 농도를 가진 lidocaine을 사용하여 앞쪽목신경절차단 후 안압의 변화를 관찰하기 위하여 시행하였다. 실험군은 전향적 교차시험으로 10두의 비글견을 2%, 1%, 0.5% 및 0.25% lidocaine group으로 4군으로 나뉘었다. 모든 실험견들은 4 가지의 다른 농도를 가진 2 ml의 lidocaine을 사용하여 각 4번의 앞쪽목신경절 차단을 받았으며 신경 차단은 무작위로 1주일 간격으로 각각 시행되었다. 실험결과 호르너 증후군은 모든 실험군에서 관찰되었다. 1% lidocaine group에서는 대조군과 비교하여 차단 후 5분에서 안압의 유의한 상승이 있었으며(p<0.05), 2%와 1% lidocaine group의 안압은 앞쪽목신경절 차단 후 25분과 45분 사이 감소하였으나, 0.5%와 0.25% lidocaine group은 변화가 없었다. 이상의 결과를 종합하면, 앞쪽 목신경절 차단술은 정상 안압의 변화에 영향을 미치며 0.5%와 0.25% lidocaine은 안압을 변화시키기에는 부적당한 농도로 사료된다.

• The Korean Journal of Pain
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• 제6권2호
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• pp.275-279
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• 1993

Reflex sympathetic dystrophy is a syndrome characterized by persistent, burning pain, hyperpathia, allodynia & hyperaesthesia in an extremity, with concurrent evidence of autonomic nervous system dysfunction. It generally develops after nerve injury, trauma, surgery, et al. The most successful therapies are directed towards blocking the sympathetic intervention to the affected extremity by regional sympathetic ganglion block or Bier block with sympathetic blocker; other traditional treatments include transcutaneous electrical stimulation, immobilization with cast & splint, physical therapy, psychotherapy, administration of sympathetic blocker, calcitonin, corticosteroid and analgesic agents. The purpose of this report is to evaluate and describe the effects of magnetic resonance following unsatisfactory results with traditional treatments of RSD. A 17 year old female patient, 1 year earlier, had received excision and drainage of pus at the right femoral triangle due to an injury caused by a stone. Afterwards, she experienced burning pain, knee joint stiffness, and muscle dystrophy of the right thigh, especially when standing and walking. Despite a year of number of traditional treatments such as: lumbar sympathetic block, continuous epidural analgesia, transcutaneous electrical stimulation, & administration of predisolone, her pain did not improve. Surprisingly, the patients was able to walk free from pain and difficulty after just one application of magnetic resonance. The patient has been successfully treated with further treatment of two to three times a week for approximately ten weeks. More recently, magnetic resonance has been demonstrated to produce effective results for the relief of pain in a variety of diseases. From our experiences we recognize magnetic resonance as a therapeutic modality which can provide excellent results for the treatment of RSD. It has been suggested that polysynaptic reflex which are disturbed in RSD may be modulated normally on the spinal cord level through the application of magnetic resonance.

• The Korean Journal of Pain
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• 제11권2호
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• pp.220-225
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• 1998

Background: The patients of facial hyperhidrosis have been known that they had much difficulties in interpersonal relationships and social activities due to excessive hidrosis when they were in stress, hot weather, or having meals. Previous drug therapy and stellate ganglion block have only temporary effects. The surgical method, $T_1$ sympathetomy has the risk of Hornor's syndrome. For that reasons, the sympathicotomy of proximal and distal portions of $T_2$ sympathetic ganglion with electroresectoscope used in transurethral resection seemed to be appropriate procedure, and we would like to report the results of our procedure. Method: Under the general anesthesia with semi-sitting position, and the portal was made through the small incision along the upper border of the 4th rib at the crossing point of mid-axillary line. After the partial collapse of lung by insufflation of 300 to 500 ml of $CO_2$, $T_2$ sympathetic ganglion was identified and resected proximally and distally with electro-cauterization. Finally the lung was expanded by limiting flow until the airway pressure reached 30 to 40 cm$H_2O$, and the wound was closed after removal of electroresectoscope. Result: There was no postoperative complication requiring surgical interventions. The facial sweating was stopped immediately after the operation and all the patients appeared to be satisfied. Conclusion: $T_2$ sympathicotomy with TUR electroresectoscope is thought be the minimal invasive and highly successful method in the treatment of facial hyperhidrosis. But longer terms follow-up will be needed to prove this result.

• The Korean Journal of Pain
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• 제19권1호
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• pp.68-71
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• 2006

Background: Stellate ganglion block (SGB) is a selective sympathetic blockade that affects the head, neck and the upper extremities. It is an important method that has been frequently used in pain clinics due to its wide range of indications. But there were some problem with performing SGB at C6 or C7. Thus, various techniques have been recently introduced to successfully perform SGB; among them, there is the oblique approach. This study was performed to evaluate the effectiveness of the oblique approach for performing SGB in C7. Methods: Forty six patients with sudden hearing loss were studied. In group I, the patient underwent C7 oblique SGB with 1% mepivacaine (3 ml) under fluoroscopic guidance. In group II, the patients underwent the C7 classical anterior approach SGB with 1% mepivaine (5 ml) under fluoroscopic guidance. We compared the occurrence of Horner's syndrome, the side effects and the changes of temperature of the skin of the hand. Results: The rate of Horner's syndrome was 81.5% in the group I and 84.2% in the group II. The rate of incurring increased skin temperature (${\geq}34^{\circ}C$) of the fingers was 77.7% and 79.4% in each group, respectively. Conclusions: The C7 oblique approach for SGB showed the same SGB effect compared with the C7 anterior approach for SGB, and there were also fewer complications. We conclude that C7 oblique SGB may be a beneficial method for treating patients with this particular malady.

• The Korean Journal of Pain
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• 제7권1호
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• pp.69-73
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• 1994

A 37 years old man who suffered from right facial palsy was treated successfully with the application of both magnetic resonance diagnostic analyser(MRA) and stellate Ganglion block(SGB). SGB is effective in treatment of facial palsy resulting from abolishing cerebral vascular spasm and increasing cerebral blood flow. Short daily period of exposure to appropriate MRA can also modulate the balance of autonomic nervous system that are responsible for sympathetic overflow resulting the edema and poor circulation on the course of the facial nerve. It was seemed that recovery of facial palsy by application of both MRA and SGB was faster than by SGB only.

• The Korean Journal of Pain
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• 제36권2호
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• pp.216-229
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• 2023

Background: The role of the sympathetic nervous system appears to be central in causing pain in complex regional pain syndrome (CRPS). The stellate ganglion block (SGB) using additives with local anesthetics is an established treatment modality. However, literature is sparse in support of selective benefits of different additives for SGB. Hence, the authors aimed to compare the efficacy and safety of clonidine with methylprednisolone as additives to ropivacaine in the SGB for treatment of CRPS. Methods: A prospective randomized single blinded study (the investigator blinded to the study groups) was conducted among patients with CRPS-I of the upper limb, aged 18-70 years with American Society of Anaesthesiologists physical status I-III. Clonidine (15 ㎍) and methylprednisolone (40 mg) were compared as additives to 0.25% ropivacaine (5 mL) for SGB. After medical treatment for two weeks, patients in each of the two groups were given seven ultrasound guided SGBs on alternate days. Results: There was no significant difference between the two groups with respect to visual analogue scale score, edema, or overall patient satisfaction. After 1.5 months follow-up, however, the group that received methylprednisolone had better improvement in range of motion. No significant side effects were seen with either drug. Conclusions: The use of additives, both methylprednisolone and clonidine, is safe and effective for the SGB in CRPS. The significantly better improvement in joint mobility with methylprednisolone suggests that it should be considered promising as an additive to local anaesthetics when joint mobility is the concern.