• Journal of Korean Foot and Ankle Society
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• v.25 no.1
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• pp.32-37
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• 2021

Patients with chronic lateral ankle instability often experience a range of associated injuries. The well-known comorbidities include intra-articular pathologies (osteochondral lesion, soft tissue or bony impingement, and loose body), peroneal tendon pathologies, neural injuries, and other extra-articular pathologies. Surgeons should have a high index of suspicion for these associated pathologies before operative intervention, correlate the clinical findings, and plan the treatment. Despite the restoration of ankle stability following ligament repair or reconstruction surgery, a high prevalence (13%~35%) of postoperative residual pain has been reported. This pain can negatively affect the clinical outcomes and patient satisfaction. This study examined the causes of persistent pain after surgical treatments for chronic ankle instability.

• The Korean Journal of Pain
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• v.37 no.4
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• pp.332-342
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• 2024

Background: Pre-operative ilioinguinal-iliohypogastric nerve block (II-IHNB) has a proven role in lessening acute postoperative pain and opioid consumption following hernia repair. However, its role in preventing post-herniorrhaphy groin pain (PHGP) is still unknown. The current study aims to assess pre-operative II-IHNB's impact on PHGP three and six months after open inguinal hernia repair under spinal anesthesia. Methods: Seventy patients posted for inguinal hernia surgery were randomly allocated into group A (received ultrasound-guided II-IHNB with 10 mL of 0.5% ropivacaine and 4 mg [1 mL] dexamethasone) and group B (received ultrasound-guided II-IHNB with 11 mL of 0.9% normal saline). The time to first analgesic request, pain scores, opioid consumption, DN4 score, and PHGP at 3 and 6 months were analyzed using appropriate statistical tests. Results: The numerical pain rating scale at movement in group A was significantly reduced at all the time intervals of 3, 6, 12, and 24 hours compared to group B. Total opioid usage was lower in group A (3.71 mg [3.90]) versus group B (12.14 mg [4.90]) with a mean difference of -8.43 mg (95% CI -10.54, -6.32), P < 0.001. The time required for the first rescue analgesic was significantly longer in group A (360 min [180-360]) versus (180 min [180-360]) in group B (P < 0.001). However, there was no difference in the incidence of PHGP at three and six months between the two groups. Conclusions: Pre-operative ultrasound-guided II-IHNB reduces postoperative analgesic requirement but does not reduce the incidence of chronic PHGP following hernia surgery at 6 months.

• The Korean Journal of Pain
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• v.33 no.1
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• pp.40-47
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• 2020

Background: Duloxetine is an antidepressant that is also useful in chronic neuropathic and central origin pain. In this study, the role of duloxetine in decreasing acute postoperative pain after lumbar canal stenosis surgery is explored. Methods: In this single center, triple blinded, and placebo-controlled trial, 96 patients were randomized for statistical analysis. The intervention group received oral duloxetine 30 mg once a day (OD) for 2 days before surgery, 60 mg OD from the day of surgery to the postoperative second day and 30 mg OD for the next 2 days (a total duration of 7 days). A placebo capsule was given in the other group for a similar time and schedule. The same standard perioperative analgesia protocols were followed in both groups. Results: Total morphine consumption up to 24 hours was significantly decreased in the duloxetine group (P < 0.01). The time to the first analgesia requirement was similar in both groups but the time to the second and third dose of rescue analgesia increased significantly in the duloxetine group. The time to ambulation was decreased significantly (P < 0.01) in the duloxetine group as compared to the placebo group. Pain scores remained similar during most of the time interval. No significant difference was observed in the complication rate and patient satisfaction score recorded. Conclusions: Duloxetine reduces postoperative pain after lumbar canal stenosis surgery with no increase in adverse effects.

• The Korean Journal of Pain
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• v.31 no.3
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• pp.155-173
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• 2018

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.

• The Korean Journal of Pain
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• v.3 no.1
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• pp.59-62
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• 1990

Epidural block is used for surgical analgesia, postoperative pain management, obstetric relief and management of chronic pain. Long-term pain control for chronic pain is achieved by development of epidural catheter placement technic. But long term placement of epidural catheteter has several problems, epidural hematoma, epidural absess and neural damage. We had successfully managed long-term placement of epidural catheter in patient with diabetic neuropathy who was susceptable to infection. The duration of epidural catheter placement was 416 days and specific complication was not occurred.

• The Korean Journal of Pain
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• v.29 no.4
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• pp.239-248
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• 2016

Background: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to "Bonferroni adjustments". In patients with CPPP, the ${\Delta}ct$ values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results: The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions: The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential role in the pathogenesis of CPPP.

• The Korean Journal of Pain
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• v.21 no.1
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• pp.80-83
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• 2008

Local infiltration in surgical wounds can reduce postoperative pain with very few side effects. We experienced two cases of chronic pain after forehead lift surgery. A 41-year-old male patient was suffering from a headache at the crown of the head and pain from the posterior neck. A 54-year-old female patient had pain around the forehead, worsened by psychological stress. They underwent forehead lift surgery 10 years and 8 months ago, respectively. Conservative treatments such as medication and physical therapy were not effective. After wound infiltration with 1% lidocaine more than ten times, pain significantly resolved in both patients.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.317-320
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• 1998

Since Reiestad and Str$\ddot{o}$mskag reported interpleural installation of local anesthetic solutions as a technique for the management of postoperative pain in the patients undergoing cholecystectomy, renal surgery and breast surgery, many physician applied this technique for upper abdominal pain from various reasons such as technically simple, effective pain relief, less respiratory depression. So we tried interpleural analgesia in two patients who suffered from severe upper abdominal pain. One had upper abdominal pain due to chronic pancreatitis and the other had right upper abdominal pain after PTBD (percutaneous transhepatic bile drainage) for biliary cirrhosis and systemic jaundice. Both were injected 10 ml of 1% lidocaine and infused continuously with 1% lidocaine (2 ml/hr) using 2-Day Baxter$^{(R)}$ infusor. After bolus injection of lidocaine, pain scores (VAS 0~100) were recorded below 25mm and had not exceed that level during continuous infusion. After removing the catheters, two patients were all satisfied with this therapy. Our experiences with this technique showed that continuous infusion of local anesthetics through an interpleural catheter is effective in the control of refractory upper abdominal pain without any complication.

• Journal of Physiology & Pathology in Korean Medicine
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• v.26 no.2
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• pp.206-211
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• 2012

Here we described 8 patients treated with acupuncture and moxiburstion due to chronic postoperative pain as a comlication of gastrointestinal surgery. The patients were suffering from pain that continued for more than 6 months after laparotomy for gastric cancer (n=1), rectal cancer (n=2), cholangiocarcinoma (n=2), hepatocellular carcinoma (n=2) and ischemic colitis (n=1), respectively. Mean time elased from surgery were 31.25(${\pm}21.72$)months, pain grade on first visit by VAS(visual analogue scale, 0~10mm) was 3.75(${\pm}0.97$)point, and acupuncture and moxiburstion were performed 12.63(${\pm}5.74$)times during 5.5(${\pm}2.4$)weeks, on average. At the end of treatment, pain was decreased 2.75(${\pm}0.97$)point compared to first visit. Based on the that results, it is reasonable to assume that acupuncture and moxiburstion can be effective to persistent post-surgical pain after laparotomic gastrointestinal surgery, at least to some laparotomized patients.

• The Korean Journal of Pain
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• v.24 no.2
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• pp.74-80
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• 2011

Background: Lidocaine patch (L5P) has demonstrated short-term efficacy in treating both acute surgical pain and chronic neuropathic pain with tolerable side effects. Percutaneous endoscopic lumbar discectomy (PELD) is the mainstay of minimally invasive spine surgery (MISS). Sufficient analgesia during PELD surgery makes the patient consider it real MISS. This study was performed to evaluate the efficacy and adverse effects of lidocaine patch in patients who underwent PELD under local anesthesia. Methods: L5P (L group) or placebo (P group) was randomly applied on the skin of the back covering the anticipated path of the working channel before 1 hour of surgery in 100 patients who underwent a single level PELD at L4-L5. Efficacy of the lidocaine patch was assessed by patient's numeric rating scale (NRS) of pain at each stage during the surgery and by a 5-scale grading of the satisfaction with the anesthesia of the operator and patients after surgery. Results: Mean NRS scores at the stages of needle insertion, skin incision, serial dilation and insertion of working channel, and subcutaneous suture were significantly lower in the L group than the P group. Postoperative operator's and patients' satisfaction scores were also significantly higher in L group than in the P group. There were subtle adverse effects in both groups. Conclusions: L5P provided better pain relief during PELD, especially at the stage of needle insertion, skin incision, serial dilation and insertion of working channel, and subcutaneous suture. It also provided higher patient and operator postoperative satisfaction, with only subtle adverse effects.