• The Korean Journal of Pain
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• v.10 no.1
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• pp.131-133
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• 1997

Number of elderly patients requiring nerve blocks have been increasing in recent years. We had two elderly patients who suffered stroke one day and three days after lumbar facet joint block and lumbar single epidural block respectively. Both patients due to their advanced age had potential risk factor to suffer one or more of the following; stroke, hypertension, and diabetes mellitus. Due to our experience with these patients, we suggested the following: (1) Nerve blocks should be reconsidered for elderly patient who posesses a potential risk factor to suffer a stroke. (2) Prior to invasive block administration of mild sedatives or analgesics may provide beneficial effects for patients with hypertension. (3) Adequately informed consent must be fully discussed time of consultation with patient scheduled for nerve block especially for elderly and risky patient.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.101-103
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• 1997

Common oral lesions of lichen planus (LP) are bilateral lace-like white patches in the buccal and lingual mucosae. Oral LP of chronic erosive and ulcerative forms develop carcinomas among approximately 1% of affected patients. A 64 year old male patient suffering from LP with early verrucous carcinoma on lips, tongue, and hard palate for approximately 8 years was refered to the pain clinic from department of dermatology. He complained of severe pain (VAS 9.5) on lips, oral cavity and left of the face. For 18 consecutive days we performed stellate ganglion blocks (SGB) with 6 ml on his left side of face. Patients pain decreased to (VAS 3.0) after 18 SGB. After a total of 31 SGB patient was discharged free of pain. pain recurred (VAS 3.5) 22 days after discharge. We then performed SGB, twice weekly and pain was effectively relieved after total 54 SGB. But patient needed to take oral analgesics due to nocturnal pain.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.97-100
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• 1997

We treated a 56 year old male ailing of painful herpetic eruption on his 2nd, 3rd and 4th left cervical spinal segment. On the 18th day, patient also suffered an abrupt left facial palsy, accompanied with ongoing postherpetic neuralgia even though the skin eruption had been cured. This patient visited our pain clinic on his 46th day of illness and was teated with continuous cervical epidural block for 9 days, and stellate ganglion block plus oral analgesics and antidepressant for 12 days. The combination of treatments resulted in marked improvement of facial palsy and postherpetic neuralgia. A possible explanation of facial palsy accompanied with herpes zoster on cervical spinal segment could be related to Hunt's hypothesis that geniculate ganglion forms a chain connecting the high cervical ganglion below. Another possibility may be related to a compression injury of the facial nerve by long-term severe edema on the soft tissue of the face, the periauricular area and parotid gland around the facial nerve, and edema on the facial nerve itself emerging out from the cranium.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.217-220
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• 1999

Background: Transcutaneous Electrical Nerve Stimulation (TENS) has been widely used for pain relief after surgery instead of opioid analgesics therapy. This study was designed to study the effectiveness of TENS on perianal pain after anal surgery. Methods: Forty-eight patients who underwent anal surgery were evaluated in this suudy. Caudal anesthesia with 1.5% lidocaine 30 ml mixture 1：200,000 epinephrine was performed. TENS was done at 100 Hz for 25 min. duration, postoperatively at 4 hrs and 24 hrs. Pain was also measured at the 4 hrs and 24 hrs postoperatively by visual analogue scale (VAS). VAS value were compared before and after TENS application. Results: Values of VAS after TENS were significantly lower compared to those before TENS. Conclusions: From these results, we concluded, TENS may be effective for postoperative perianal pain relief after anal surgery.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.105-110
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• 2000

Central neuropathic pain may occur in 10~20% of the patients after spinal cord injury. The central pain syndrome include spontaneous continuing and intermittent pain as well as evoked pain. The pain is evoked by non-noxious stimulation of the region (allodynia) and repeated stimulation (wind-up phenomenon). Four patients were referred suffering from severe pain, allodynia and hyperaesthesia after spinal cord injury. They had received conventional treatment with non-steroidal anti-inflammatory drugs, steroid, anticonvulsant, antidepressant and rehabilitation which failed to provide pain relief. We administered combination of low doses of morphine and ketamine (10 mg) through the epidural catheter with other conventional therapy. Satisfactory pain relief was achieved in each patient. The reduction of pain was not associated with severe side effects. The most bothersome side effect of ketamine was dizziness in one patient, only caused by bolus injection (ketamine 10 mg with normal saline 10 ml). This suggests synergy from this combination that provides an alternative treatment for central pain.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.237-241
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• 2000

Vertebral compression fractures commonly afflict the elderly. Some patients suffer from severe mechanical pain in spite of treatments with strong analgesics and bracing. Vertebroplasty, which was originally used for vertebral hemangioma, is effective for patients who do not respond to these more conservative treatments. However, the procedure has some risk. Leaks of bone cement into perineural tissues can be a serious complication. In contrast to the lumbar vertebrae, the outer margin of the pedicle of the thoracic vertebrae is almost in line with the outer margin of the body. This, combined with the thinner pedicle of the thoracic vertebrae, makes proper needle placement difficult. The posterolateral approach is preferred to the transpedicular approach in order to avoid the danger of destroying the inner cortex of the pedicle. But there can be a problems with the standard posterolateral approach. The rib can be broken, the pleura can be punctured. A new and safer approach is possible. Before penetrating the bone, the needle is positioned at the upper margin of the transverse process, 5 mm away from the pedicle. To achieve this positioning, the needle must puncture the skin 1~1.5 cm laterally and 3~5 mm cranially to the target point on the bone. This approach was used for 10 patients and we achieved good results with no serious complication.

• Journal of Korean Neurosurgical Society
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• v.45 no.4
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• pp.246-248
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• 2009

Atlantoaxial rotatory fixation (AARF) in adult is a rare disorder that occurs followed by a trauma. The patients were presented with painful torticollis and a typical 'cock robin' position of the head. The clinical diagnosis is generally difficult and often made in the late stage. In some cases, an irreducible or chronic fixation develops. We reported a case of AARF in adult patient which was treated by immobilization with conservative treatment. A 25-year-old female was presented with a posterior neck pain and limitation of motion of cervical spine after a traffic accident. She had no neurological deficit but suffered from severe defect on the scalp and multiple thoracic compression fractures. Plain radiographs demonstrated torticollis, lateral shift of odontoid process to one side and widening of one side of C1-C2 joint space. Immobilization with a Holter traction were performed and analgesics and muscle relaxants were given. Posterior neck pain and limitation of the cervical spine' motion were resolved. Plain cervical radiographs taken at one month after the injury showed that torticollis disappeared and the dens were in the midline position. The authors reported a case of type I post-traumatic AARF that was successfully treated by immobilization alone.

• Journal of Hospice and Palliative Care
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• v.11 no.1
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• pp.51-54
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• 2008

Qualify of life is the main consideration in pain management and palliative care for patients with advanced cancer. Cancer pain is primarily relieved with pharmacological therapy including aretaminophen, nonsteroidal anti-inflammatory drugs, adjuvant analgesics, and opioids. In addition to pharmacological therapy, the neurolytic celiac plexus block is claimed to be an effective approach in management of advanced pancreatic cancer pain. We report our patient who has been treated for advanced cancer pain with multiple neurolytic blocks. The clinical result suggests that combined neurolytic blocks improved the quality of life of patient who had advanced ranter pain by reducing both the intensity of pain and opioid consumption, without serious complications.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.60-64
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• 1998

Background: We compared butorphanol and fentanyl for opioids use in patient-controlled analgesia(PCA) with ketorolac to determine a suitable drug combination for postoperative pain control. Methods: Sixty patients were equally divided into 2 Groups. Group 1 (n=30) butorphanol 10 mg with ketorolac 180 mg; Group 2 (n=30) fentanyl 1 mg with ketorolac 180 mg, diluting 100 ml solutions intravenously via PCA pump after total abdominal hysterectomy under general anesthesia. Total infusion dosage of PCA drug, VAS pain scores, and side effects of both group were manitored. Results: Total infusion dosages were as follows: (Group 1) butorphanol 8.3 mg with ketorolac 149.7 mg; (Group 2) fentanyl $646.6\;{\mu}g$ with ketorolac 116.2 mg. The two groups showed similar pain scores auld side effects. Conclusions : Both butorphanol and fentanyl were effective for postoperative pain control using PCA pump, but butorphanol was more economical. The putative potency ratio of butorphanol to fantanyl was 12.8 : 1.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.258-262
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• 1998

Background: In view of the safety and effectiveness of butorphanol as a postoperative analgesic, we designed to compare its activity and side effects with those of ketoprofen, when administered intramuscularly. Methods: Ninety four patients, scheduled for elective total abdominal hysterectomy, received either ketoprofen 100 mg (ketoprofen group) or butorphanol 2 mg (butorphanol group) intramuscularly after surgery. For the first six hours after injection of butorphanol or ketoprofen, the patients were asked to reevaluate the intensity of pain, using numeric rating scale (NRS) and pain score. If the pain score was above 2, supplemental ketoprofen was administered IM. Incidence of side effects were also checked. Results: Butorphanol group showed lower NRS and pain score for the first four hours compared to ketoprofen group, but the incidence of drowsiness was higher in butorphanol group. There were no significant difference in the incidence of other side effects such as nausea and dizziness. In both group, there were neither respiratory depression nor pruritus. Conclusions: Butorphanol gave better relief of postoperative pain compared to ketoprofen. Butorphanol might be a useful drug for postoperative analgesia after hysterectomy with minor side effects.