• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.455-461
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• 2018

Background: Surgical-site, multimodal drug injection has recently evolved to be a safe and useful method for multimodal pain management even in patients with musculoskeletal trauma. Methods: Fifty consecutive patients who underwent plating for mid-shaft and distal clavicular fractures were included in the study. To evaluate whether surgical-site injections (SIs) have pain management benefits, the patients were divided into two groups (SI and no-SI groups). The injection was administered between the deep and superficial tissues prior to wound closure. The mixture of anesthetics consisted of epinephrine hydrochloride (HCL), morphine sulfate, ropivacaine HCL, and normal saline. The visual analogue scale (VAS) pain scores were measured at 6-hour intervals until postoperative hour (POH) 72; stress biomarkers (dehydroepiandrosterone sulfate [DHEA-S], insulin, and fibrinogen) were measured preoperatively and at POH 24, 48, and 72. In patients who wanted further pain control or had a VAS pain score of 7 points until POH 72, 75 mg of intravenous tramadol was administered, and the intravenous tramadol requirements were also recorded. Other medications were not used for pain management. Results: The SI group showed significantly lower VAS pain scores until POH 24, except for POH 18. Tramadol requirement was significantly lower in the SI group until POH 24, except for POH 12 and 18. The mean DHEA-S level significantly decreased in the no-SI group ($74.2{\pm}47.0{\mu}g/dL$) at POH 72 compared to that in the SI group ($110.1{\pm}87.1{\mu}g/dL$; p = 0.046). There was no significant difference in the insulin and fibrinogen levels between the groups. The correlation values between all the biomarkers and VAS pain scores were not significantly different between the two groups (p > 0.05). Conclusions: After internal fixation of the clavicular fracture, the surgical-site, multimodal drug injection effectively relieved pain on the day of the surgery without any complications. Therefore, we believe that SI is a safe and effective method for pain management after internal fixation of a clavicular fracture.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.3
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• pp.185-192
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• 2021

Purpose : Our study aimed to compare the effectiveness of low-level laser therapy (LLLT) and light-emitting diode therapy (LEDT) for chronic pain intensity reduction and body temperature increase in older adults with chronic pain. Methods : Overall, 144 of 332 participants' records were used in this retrospective chart review. The study was conducted at a private health center in Busan city and the integrative medical center of a tertiary care hospital in Daegu city, South Korea. Patients experiencing chronic pain for over 6 months were assigned to either the LLLT or LEDT group. Both groups underwent 16 sessions of phototherapy held twice a week for 8 weeks, with each session lasting 60 minutes. The primary outcomes for both groups were the mean visual analogue scale (VAS) scores and body temperatures in both groups. The secondary outcome was the correlation between changes in body temperature and pain intensity. Measurements were recorded at the baseline and at each follow-up session. Results : A decrease in pain intensity and an increase in body temperature (p<.001) were observed in both groups. There was a significant difference in the VAS scores and temperature changes between the groups (p<.001). Odditionally, there were significant differences in the patterns of change in the VAS score and body temperature between the groups as the sessions progressed (p<.01), and a strong inverse correlation between body temperature and pain intensity changes were observed (p<.01). Conclusion : The use of photobiomodulation therapy at a specific wavelength may improve pain severity and simultaneously increase the body temperature among elderly people with chronic pain.

• The Journal of Korean Physical Therapy
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• v.33 no.2
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• pp.84-90
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• 2021

Purpose: This study examined the effects of social distancing in COVID-19 on musculoskeletal problems and the quality of life. Methods: One hundred and thirty-five subjects participated in this study and responded to an online survey on stress from the social distancing in COVID-19, computer and smartphone usages, musculoskeletal pain, and quality of life. The stress from social distancing was assessed by a Visual Analogue Scale (VAS). The Neck Disability Index (NDI), Oswestry Disability Index (ODI), and Boston Carpal Tunnel Questionnaire (BCTQ) were provided to assess the musculoskeletal pain, and Short Form-36 (SF-36) was provided to assess the quality of life. Frequency analysis, descriptive statistics, Pearson's correlation coefficient, and independent t-test were used for data analysis. Results: Statistically significant, but low positive correlation stress from the social distancing (VAS) and NDI (r=0.19, p<0.05) and ODI (r=0.18, p<0.05), and negative correlation between stress from the social distancing (VAS) and SF-36 (r=-0.17, p<0.05). The NDI score was significantly greater in the group with high stress than in the group with low stress from social distancing (p<0.05). Conclusion: This study is meaningful in that it evaluated, through the physical therapy approaches, the potential side-effects on physical and mental health in various social changes caused by COVID-19. The results of this study may be used as basic data in future studies related to COVID-19.

• Neurospine
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• v.15 no.4
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• pp.348-352
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• 2018

Objective: Postoperative dynamic cryo-compression (DC) therapy has been proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopedic joint reconstruction surgery. Our aim was to analyze the analgesic efficacy of DC therapy after adult lumbar spinal surgery. Methods: DC was applied for 30 minutes every 6 hours after surgery. Pain was measured by a visual analogue scale (VAS) in the preoperative period, immediately after surgery, and every 6 hours postoperatively for the first 72 hours of the hospital stay. Patients' pain medication requirements were monitored using the patient-controlled analgesia system and patient charts. Twenty patients who received DC therapy were compared to 20 historical controls who were matched for demographic and surgical variables. Results: In the postanesthesia care unit, the mean VAS back pain score was $5.87{\pm}0.9$ in the DC group and $6.95{\pm}1.0$ (p=0.001) in the control group. The corresponding mean VAS scores for the DC vs. control groups were $3.8{\pm}1.1$ vs. $5.4{\pm}0.7$ (p < 0.001) at 6 hours postoperatively, and $2.7{\pm}0.7$ vs. $6.25{\pm}0.9$ (p<0.001) at discharge, respectively. The cumulative mean analgesic consumption of paracetamol, tenoxicam, and tramadol in the DC group vs. control group was $3,733.3{\pm}562.7mg$ vs. $4,633.3{\pm}693.5mg$ (p<0.005), $53.3{\pm}19.5mg$ vs. $85.3{\pm}33.4mg$ (p<0.005), and $63.3{\pm}83.4mg$ vs. $393.3{\pm}79.9mg$ (p<0.0001), respectively. Conclusion: The results of this study demonstrated a positive association between the use of DC therapy and accelerated improvement in patients during early rehabilitation after adult spine surgery compared to patients who were treated with painkillers only.

• The Korean Journal of Pain
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• v.32 no.3
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• pp.206-214
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• 2019

Background: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB ($33.0{\mu}g$; interquartile range [IQR], $27.0-69.5{\mu}g$) than in the control group ($92.8{\mu}g$; IQR, $40.0-155.0{\mu}g$) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). Conclusions: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

• Journal of Korean Foot and Ankle Society
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• v.23 no.2
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• pp.52-57
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• 2019

Purpose: An ingrown nail is common in military trainees who are exposed to highly demanding activities. Although the matrixectomy procedure has been the main treatment modality, several drawbacks may follow after the procedure, such as infection, periostitis, and continued pain that causes a delayed return to duty. This study examined the outcomes of a simple partial nail extraction with the hypothesis that this procedure may bring an earlier return to duty, lower the perioperative complications, and produce a comparable recurrence rate. Materials and Methods: The medical records of patients who had surgical treatment for an ingrown nail in the authors' institution between April 2016 and December 2017 were reviewed retrospectively. Under the inclusion and exclusion criteria, 28 patients with a simple partial nail extraction (group A) and 29 patients with a partial nail extraction with matrixectomy (group B) were investigated. As the clinical outcome, the visual analogue scale (VAS) and satisfaction score, time to return to duty, complications, and recurrence rate were checked and compared between the groups. Results: The VAS scores of group B were significantly higher during the first (p<0.001) and second (p=0.026) follow-up week than group A. The time to return to duty was shorter in group A (7.8 days) than group B (10.1 days), and this difference was significant (p<0.001). Group B had five patients with complications, whereas group A had none (p=0.028). No differences in the recurrence rate (p=0.197) and patient satisfaction (p=0.764) were found between the groups. Conclusion: In this study, simple partial nail extraction in military trainees resulted in lower postoperative pain, lower complication rates, and earlier return to duty than the procedure with matrixectomy. Military trainees are temporarily exposed to highly demanding activities. Thus, a satisfactory outcome would be expected with simple partial nail extraction without performing a radical procedure, such as a matrixectomy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.2
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• pp.76-82
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• 2019

Objectives: To appraise the effectiveness of platelet-rich fibrin (PRF) in the management of established dry socket in terms of pain, inflammation, and wound healing. Materials and Methods: Two hundred patients with established alveolar osteitis were studied to determine the efficacy of PRF and zinc oxide eugenol (ZOE) for pain control, inflammation reduction, and wound healing. Patients were randomly allocated to Group A (PRF) or Group B (ZOE). Patients were examined on the 1st, 3rd, 7th, and 14th postoperative day and evaluated for pain using visual analogue scale scores, inflammation with a gingival index score, and wound healing through a determination of the number of bony walls exposed. Results: Group A showed better results in terms of pain remission, control of inflammation, and wound healing compared to Group B. Results between groups were statistically significant (P<0.05). Conclusion: PRF is a better alternative than ZOE for the effective management of alveolar osteitis.

• Clinics in Shoulder and Elbow
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• v.22 no.4
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• pp.195-202
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• 2019

Background: This study investigates the effects of neuromuscular electrical stimulation (NMES) in preventing deltoid atrophy during the first 12 weeks after arthroscopic rotator cuff repair. Methods: Eighteen patients undergoing arthroscopic repair of a medium-sized rotator cuff tear by a single surgeon, were randomized into two groups: NMES and transcutaneous electrical nerve stimulation (TENS). Each group used the respective device for 6 weeks after surgery. Pain was measured at baseline, 6, and 12 weeks postoperatively, using the visual analogue scale (VAS); range of motion (ROM), abduction strength and functional scores were measured at baseline and 12 weeks postoperatively. Deltoid thickness and cross-sectional areas were measured using magnetic resonance imaging at 12 weeks postoperatively. Results: At 12 weeks post-surgery, no statistically significant difference was observed between the NMES and TENS groups in the pain VAS, the Disabilities of the Arm, Shoulder and Hand score, ROM, and abduction strength. Postoperative decrease in the thickness of the anterior, middle, and posterior deltoid, at the level just below the coracoid, was -2.5%, -0.7%, and -6.8%, respectively, in the NMES group, and -14.0%, -2.6%, and -8.2%, respectively, in the TENS group (p=0.016, p=0.677, and p=0.791, respectively). At the level of the inferior glenoid tubercle, postoperative decrease in area of the deltoid was -5.4% in the NMES group and -14.0% in the TENS group, which was significantly different (p=0.045). Conclusions: NMES has the potential for reducing deltoid atrophy after arthroscopic rotator cuff repair, suggesting that NMES might help minimize postoperative atrophy after various shoulder surgeries.

• Korean journal of dermatology
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• v.56 no.9
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• pp.531-538
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• 2018

Background: Herpes zoster is a common dermatologic disorder. However, it rarely occurs in children and adolescents in Gwangju-Jeonnam province. Objective: This study aimed to analyze the epidemiological features and clinical characteristics of herpes zoster in children and adolescents. Methods: A retrospective survey was conducted on patients who visited the department of dermatology of Chosun University Hospital in Gwangju-Jeonnam province within the past 8 years. The medical records of 103 patients aged <18 years were reviewed. We analyzed for age, gender, accompanying symptoms, dermatomal distribution, underlying disease, treatment, and complications with serologic test. Results: The male-to-female ratio of the participants was 1.08:1, and their mean age was 13.0 years. Underlying diseases were observed in 3% (3/102) of the patients. The most common dermatomal distribution was thoracic dermatome (34%), followed by trigeminal (26%), cervical (20%), lumbar (15%), and non-skin (6%). The most common accompanying symptoms were headache (10%), fever (3%), and myalgia (3%). No difference was observed between patients who were varicella-zoster virus (VZV) IgM-positive and those who were VZV IgM-negative in terms of dermatome, visual analogue scale (VAS), severity, and body mass index (BMI). Conclusion: In children and adolescents with herpes zoster, the gender ratio and dermatomal distribution were similar to those previously reported, except for the low rate of underlying diseases. The incidence of herpes zoster in children was not significantly associated with immunosuppression and underlying diseases. Higher VZV IgM titer was not associated with dermatomal distribution, higher VAS score, or BMI. This study first compared the serological test results of children.

• Journal of Medicine and Life Science
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• v.18 no.1
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• pp.11-15
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• 2021

In elderly patients, the vital parameters tend to fluctuate based on the blood volume status, which may cause sudden hypovolemic shock if the postoperative bleeding continues. Particularly, those who undergo surgery for arthritis needs to pay extra attention because the bleeding may persist over the joints after the surgery. Therefore, appropriate pain control is required to reduce the postoperative blood loss. This retrospective chart review study was conducted to assess the postoperative pain control and reduction of blood loss with a single injection of saphenous nerve block (SNB) in elderly patients with osteoarthritis. We reviewed the electronic medical records of patients who underwent knee total arthroplasty with spinal anesthesia between January and May 2016. A total of 51 patients participated in this study. All patients were treated with intravenous patient-controlled analgesia for the postoperative pain control, and additional analgesic agents were administered at a visual analogue scale above a score of 6. In 25 patients, SNB was performed using ultrasound with the administration of 0.75% ropivacaine (15 mL) after the surgery. Patients who received additional analgesics were significantly low in the nerve block group (P=0.009). Additionally, the volume of blood loss from catheter drainage was significantly low at 2 and 3 days postoperatively (P=0.013 and P=0.041, respectively) in the nerve block group. In patients who underwent total knee arthroplasty with osteoarthritis, only a single injection of saphenous nerve block was sufficient for the postoperative pain control and reduced bleeding.