• 대한정형외과 초음파학회지
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• 제7권2호
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• pp.105-112
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• 2014

목적: 미추 경막외 차단술은 요통과 하지 방사통에 효과적으로 외래환자의 치료에 자주 사용되고 있으나 임상 경험이 풍부한 의사에 의해 시술되어도 25%의 실패율이 보고되고 있다. 저자들은 초음파 유도하 미추 경막외 차단술의 유효성을 추간판 탈출증 환자군과 척추관 협착증 환자군으로 나누어 결과를 비교하였다. 대상 및 방법: 요통과 하지 방사통을 호소하여 본원 외래에 내원한 55명의 환자를 대상으로 초음파 유도하 미추 경막외 차단술을 시행하였다. 환자를 복와위 자세로 눕힌 후 방사형 탐지자(round probe)를 이용하여 22게이지 바늘이 천-미추막을 통과한 것을 확인 후 약물을 투여하였다. 추간판 탈출증 환자군은 31명이었으며, 척추관 협착증 환자군은 24명이었다. 임상적 평가는 시각통증척도(VAS)를 이용하여 통증의 변화를 평가하였으며, 시행 전, 시행 후, 시행 2주 후, 시행 4주 후 전화 인터뷰와 외래 방문 시 조사하였다. 결과: 초음파 유도하 미추 경막외 차단술은 55예 중 53예에서 바늘이 성공적으로 삽입되어 96.4%의 성공률을 보였다. 추간판 탈출증 환자군과 척추관 협착증 환자군에서 성별의 차이는 없었으나 나이는 추간판 탈출증군에서 $42.3{\pm}10.8$세로 척추관 협착증군의 $62.8{\pm}15.1$세와 비교할 때 유의한 차이가 있었다(p<0.001). 시각통증척도는 추간판 탈출증 군에서 시행 전 6.8, 시행 후 3.1, 시행 2주 후 1.8, 시행 4주 후 1.77로 나타났으며, 척추관 협착증 군에서 시행 전6.9, 시행 후 3.6, 시행 2주 후 4.3, 시행 4주 후 4.9로 나타났다. 시행 전에 비해 시행 후 시각통증척도는 양 군에서 유의하게 호전되었으며(p<0.001), 나이를 보정한 후의 결과, 시간에 따라 양 군간 시각통증척도의 차이는 통계적으로 유의하였다(p<0.001). 결론: 초음파 유도하 미추 경막외 차단술은 높은 성공률을 보이며 척추관 협착증 환자군에 비해 추간판 탈출증 환자군에서 더 효과적인 것으로 사료된다.

• The Korean Journal of Pain
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• 제19권2호
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• pp.181-186
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• 2006

Background: Although cervical epidural block can be a useful therapeutic treatment for head, neck and upper extremities pain, there is no consensus regarding the volume of injection required for pain management. Herein, the spreading in the vertebral segments after a cervical epidural injection of either a 5 or 10 ml volume was studied. Methods: A total of 78 patients, suffering from head, neck and upper extremity pain, were selected. Cervical epidural blocks were performed consecutively with 5 ml (n = 42) and 10 ml (n = 36) of 0.4% mepivacaine and 222 mg I/ml iopamidol at the C7⁣-T1 levels. Both anteroposterior (AP) and lateral radiographs were obtained under fluoroscopy, and the upper and lower epidural spreading of the contrast media in relation to the vertebral level was evaluated. Results: The cervical epidural blocks were performed without complications. The rostral spreading of the contrast media in the vertebral segments in groups 1 and 2 were $5.6{\pm}1.1$ and $6.1{\pm}1.1$, respectively. The caudal spreading of the contrast media in the vertebral segments in groups 1 and 2 were $5.4{\pm}3.4$ and $7.2{\pm}3.9$, respectively. The total numbers of segments with vertebral spreading of the contrast media in both directions showed significant differences between the two groups. The numbers of patients who showed spreading of the contrast media up to C2 vertebral segment showed no significant differences between the two groups. Conclusions: 5 and 10 ml epidural injection volumes may be adequate for the spread of contrast media to the entire cervical spine. A 5 ml epidural injection volume, compared to a 10 ml volume, may be ample when considering the possibility of unnecessary caudal spreading of drugs and volume related complications in the management of head, neck and upper extremity pain.

• The Korean Journal of Pain
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• 제8권2호
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• pp.225-234
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• 1995

Low back pain(LBP) is one of the most common ailment. There were two type of LBP in the clinic. One of them is low back pain with leg pain, the other one is low back pain without leg pain. Author explain the reasons, characters. mechanism, diagnosis, and reported 156 cases of LBP. There are various method to treatment of low back pain in recent. The first selection for treatment of LBP were intervertebral block added "+" type block(IVP "+" TB). according to author's experience, the rate of Excellent and good were account for 96.2%. Other method of LBPO therapy were also used in Pain clinic, such as psoas compartment block, caudal block, epidural steroid block, zygapophysial joint block, nerve root block, subarachnoid neural block, Lumbar sympathetic block, etc. Finally, author introduced Pain clinic in China. divided to three titles: (1) history, (2) CASP and scientific activity, (3) pain therapy in China.

• The Korean Journal of Pain
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• 제11권2호
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• pp.314-316
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• 1998

Psoas compartment block has been used to provide anesthesia and analgesia of hip joint. This block is advocated for relief of pain of various origins in the thigh, leg and lumbar area. A-40-year-old women complained of pain in the left thigh and lumbar area after operation of the second lumbar vertebral compression fracture. To relieve pain, caudal block was performed. This block reduced in lumbar pain but left thigh pain persisted. So, we were performed psoas compartment block using mepivacaine and dexamethasone, which relieved the pain in the left thigh and lumbar area. We recommend psoas compartment block as useful and simple method for patients with thigh and lumbar area pain, especially when the epidural block is not feasible.

• The Korean Journal of Pain
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• 제3권1호
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• pp.44-50
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• 1990

Epidural injection of narcotics for postoperative pain relief has been well reported. Caudal nalbuphine was assessed as a postoperative analgesic in a randomized double blind study of 80 patients after perianal surgery. Caudal block was carried out with 1.5% lidocaine 25 ml (Group 1) in 20 patients, and mixed with nalbuphine 3 mg (Group 2) in 20 patients, nalbuphine 5 mg (Group 3) in 20 patients, and nalbuphine 10 mg (Group 4) in 20 patients. Pain relief was evaluated by the subsquent need for systemic analgesics (Pethidine). In group 4, the use of systemic analgesics was significantly reduced for the first 24 hours postoperatively. Urinary retention was not correlated with nalbuphin dose.

• The Korean Journal of Pain
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• 제31권2호
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• pp.125-131
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• 2018

Background: The thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs. Methods: A total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy. Results: The cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00-2.00) for Group A, 2.50 (2.00-3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00-3.00) for Group B, and 2.00 (2.00-3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image. Conclusions: Injection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.

• The Korean Journal of Pain
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• 제11권2호
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• pp.288-293
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• 1998

We had retrospective analysis of 421 patients who were consulted from other departments. From 1994 to 1997, these patients received nerve blocks, intravenous lidocaine infusion, lasers and so on for their pain. From these results, we are gathering information and making some recommandations. The largest percentage of patients were in their fifties with a distribution of 32.8% male and 55.1% female. The most common condition requiring treatment was low back pain 44.6%, followed by cancer pain 19.2%, cervical pain 7.4%, and shoulder pain 4.3%. In case of low back pain, the largest portion was HNP(27%), followed by spinal stenosis(16%), sprain(11%), and postlaminectomy(10%). The most common cacer was colorectal(28.4%) and the next was stomach(19.7%). The most commonly done nerve block was stellate ganglion block 32.3%, followed by lumbar epidural block 24.5% and caudal block 7.2%.

• The Korean Journal of Pain
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• 제35권1호
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• pp.106-113
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• 2022

Background: Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. Methods: This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. Results: A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. Conclusions: Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.

• The Korean Journal of Pain
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• 제1권1호
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• pp.74-79
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• 1988

Caudal narcotic analgesia was assesses after the injection of 3mg morphine diluted in 30ml (physiologic) saline into the sacral canal in 15 Patients after upper abdominal surgery, in 20 patients after lower abdominal surgery under general anesthesia, and in 20 patients after perianal surgery under caudal block. Pain relief was evaluated by the subsequent need for systemic analgesics. All eases had considerable relief from pain an4 the morphine was effective for 12 or more hours. There were no significant differances between pain relief of the upper abdominal and lower abdominal surgery group, upper abdominal and perianal surgery group, and lower abdominal and perianal surgery group (p>0.05, p>0.05, p>0.05). It is suggested that the morphine, which was administered into the sacral, cannal, reached the subarachnoid space and produced it's effect by direct action on the specific opiate receptors in the substantia gelatinosa of th.8 posterior horn cell of the spinal cord. Consequently, whether analgesia from epidural narcotics appears to be segmental in distribution or not is still in controversy.

• The Korean Journal of Pain
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• 제2권1호
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• pp.61-65
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• 1989

Chloroma is a localized myeloblastic tumor which may develop during the course of myelogenous leukemia or as a presenting sign of the disease. A 47-year-old female diagnosed as chronic myelogenous leukemia in her hematologic remission period complained of left lower leg pain. The lumbar-spine series showed multiple osteolytic changes in the left lateral border of the lumbar spine. An inhomogenous soft tissue mass involving left lateral aspects of lumbar vertebrae was identified by CT-scanning. At the first pain attack, lumbar epidural steroid and local anesthetic injection could abolish her pain and the patient could go a few days without pain. The following radiation therapy could also improve the symptom and retain the pain free interval. One month later, a second pain attack occurred and lumbar and caudal epidural steroid and local anesthetic injections could result only in an incidental relief of pain. Radiation and chemotherapy were started but failed to relieve pain. A neurolytic block was considered but the patient's general condition was aggravated and even verbal communication with her became impossible.