• The Korean Journal of Pain
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• v.9 no.1
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• pp.264-267
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• 1996

Cervical epidural block can be useful in the management of acute and chronic pain of the head, neck, shoulder, and arm, for selected patients. In spite of the widespread use of cervical epidural blocks for pain, there is limited published data on the specific technique and complications regarding the procedure. High levels of epidural block do not appear to be associated with clinically significant circulatory or ventilatory changes unless the concentrations of local anesthetics used are great enough to produce paralysis of intercostal and phrenic nerves. However, high level of epidural block is associated with sympathetic block which may affect responses of circulatory and ventilatory systems. Accordingly, the possibility of major complications of cervical epidural block must be borne in mind. We experienced two cases of respiratory arrest during cervical epidural block with bupivacaine. This is a report regarding complications of cervical epidural block.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.97-99
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• 1989

Epidural block is used extensively in each of the fields of surgical anesthesia, obstetric anesthesia, and diagnosis and management of acute and chronic pain. New developments in the understanding of pain conduction have extended the use of continuous epidural blockade to the administration of drugs that selectively block pain conduction while leaving sensation and motor power essentially unchanged. The safety and the reliability of spinal epidural catheter techniques have permitted relief of acute and chronic pain. However, one of the important aspects of the management of the epidural catheter is the possibility of epidural infection. We have experienced a case of epidural infection during control of post-herpetic neuralgia and discuss management of the epidural catheter in this article.

• The Korean Journal of Pain
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• v.24 no.1
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• pp.44-47
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• 2011

We report a case of failed epidural anesthesia despite successful identification of the epidural space, loss of resistance technique, hanging drop method and drip infusion. This case evaluated the use of computed tomography to confirm epidural catheter position, which showed the catheter accidentally positioned at the T2 lamina. Because epidural anesthesia can even after successful procedure using standardized techniques such as loss of resistance, we recommend performing the procedure under fluoroscopic guidance to improve success rate and patient safety.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.65-68
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• 1998

Background: Epidural steroid injection(ESI) is often adminstered to treat lower back pain, but its effect iveness on postepidural backache have not yet been determined. Methods: Sixty patients scheduled for cesarean section under epidural anesthesia were randomly assigned to receive, 1 ml of normal saline(Group 1), or 5 mg of dexamethasone (Group 2), epidurally via indwelling catheter after delivery. Results: The incidences of postepidural backache occured significantly more often in Group 1(56.7%) than in Group 2(26.7%)(P<0.05). There was a significant association between postepidural backache and multiple attempts at epidural needle placement. Conclusion: Epidural dexamethasone has a preventive effect on postepidural backache.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.104-108
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• 1997

Spontaneous intracranial hypotension, a syndrome of low CSF pressure, occurs without preceding events such as lumbar puncture, back trauma, operative procedure or medical illness. The most characteristic symptom is an occipital or frontal headache which is aggrevated in the erect position and relieved in the supine position. This syndrome usually resolves spontaneously or with strict bed rest. When the headach persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of spontaneous intracranial hypotension. Epidural blood produces an organized clot which effectively tamponade any dural CSF leak. The rapid relief of headache immediately after the infusion of blood occur by some other mechanism, such as an increase in subarachnoid pressure that is known to occur with infusion of fluid into the lumbar epidural space. We report three cases of spontaneous intracranial hypotension successfully treated with epidural blood patch.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.281-284
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• 1997

Continuous epidural blockade is a widely accepted, useful technique for providing anesthesia and analgesia. But there have been several anecdotal reports of complications such as: abnormal position, knotting, shearing of the catheter, etc. We experienced a case of shearing of the end of an epidural catheter which was difficult to remove from epidural space of a 39-year-old patient. Ultrasonogram proved to be very effective to confirm the presence and position of the retained catheter. We surgically removed the retained catheter as it could potentially lead to infection of the epidural space. We advocate the ultrasonogram as an effective procedure to confirm and locate retained epidural catheter.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.349-353
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• 1996

Background: Although the paramedian approach for epidural blockade is useful in some clinical situation, the parameters which are correlated with the distance from skin to the epidural space has not been established. Methods: We studied in 143 patients having elective continuous epidural blocks for relief of postoperative pain. All blocks were performed using paramedian approach with Tuohy needle in the lumbar (group 1, n=100) and thoracic (group 2, n=45) area. We measured the distance from skin to the epidural space, body weight, height, and the angle between the shaft of the needle and the skin. Data were analyzed by linear regression. The relationships between parameters identified by the F-test with a P value of less than 0.05 were considered statistically significant. Results: The mean distance from skin to the lumbar epidural space was $4.4{\pm}0.7$ cm. significant correlation between the body weight and the depth of lumbar epidural space ($\gamma$ value : 0.492) was noted with regression equation of depth(cm)=2.293+0.034${\times}$body weight (kg). Also the significant correlation between the ponderal index (PI) and the depth of lumbar epidural space ($\gamma$ value : 0.539) was noted with regression equation of depth(cm)=1.703+0.07${\times}$PI, The mean distance from skin to the thoracic epidural space was $5.2{\pm}0.7cm$ which did not correlated with other anatomic measurements. Conclusion: We found that PI and body weight are the suitable predictors of the depth of the lumbar epidural space, but not the thoracic epidural space.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.147-151
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• 1991

Cervical epidural steroid injection, although not as familiar to many anesthesiologists, can be useful in the management of patients with acute and chronic neck, shoulder and arm pain. My clinic personally contacted and interviewed thirty patients with cervical radiculopathy who received cervical epidural steroid injection. Twenty seven percent of the patients had a excellent response(greater than 75% improvement) and fifty percent of the patients had a good response (greater than 50% improvement) to an injection of steroid into the cervical epidural space. We have concluded that cervical epidural steroid injection was very effective in the management of cervical radiculopathy and represented a possible alternative to surgery. Many anesthesiologists should add to their armamentarium the use of such techniques in the management of cervical radiculopathy.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.155-159
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• 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.

• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.410-413
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• 2016

Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.