• The Korean Journal of Pain
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• v.9 no.2
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• pp.419-422
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• 1996

Pain arising from pelvic viscera and perineum is frequently associated with discomfort and disability and caused by local trauma, inflammation and malignancy within the pelvis. Although various interventions have been proposed for the management of intractable perineal pain, their efficacy and applications are limited. The ganglion impar is a solitary retroperitoneal structure located at the level of the sacrococcygeal junction that marks the terminations of sympathetic chains. We propose that blockade of the ganglion impar is an effective method in the management of patient suffered from perianal pain due to advanced rectal cancer.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.202-207
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• 2000

Background: Superior hypogastric plexus block has been advocated as a useful technique for the treatment of cancer related pelvic pain. The aim of this study was to evaluate the effect of neurolytic trans-intervertebrodiscal superior hypogastric plexus block for pelvic cancer pain. Methods: Twenty-eight patients with gynecologic, colorectal or genitourinary cancer who suffered intractable pain were studied. We performed superior hypogastric plexus block by trans-intervertebrodiscal approach at L5/S1 level under the C-arm fluoroscopic guide unilaterally or bilaterally. Ten ml of 100% dehydrated alcohol was injected through each needle. We evaluated the change of visual analog pain score (VAS; 0~100 mm) and daily dose of oral morphine sulphate at the time of pre-block and 7 days after the block. Results: Fourteen patients (50%) had satisfactory pain relief (VAS<30) while five patients (18%) had moderate pain control (VAS 30~60). The remaining nine patients (32%) had mild or little pain relief (VAS>60) and their daily oral morphine doses were above 160 mg. Additional pain control method may be needed for those patients who received high dose of opioid before neurolytic block. Conclusions: We conclude trans-intervertebrodiscal neurolytic superior hypogastric plexus block was effective in relieving pelvic cancer pain. Neurolytic block, earlier stage, may provide better effects for more comfortable life at the end stage for cancer patients.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.164-170
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• 1988

Neurolysis of the celiac plexus is performed to relieve intractable pain caused by carcinoma of the stomach, liver and pancreas, and upper abdominal metastasis of tumors having more distant origins. It is also occasionally effective in controlling the pain of chronic pancreatitis. Alcohol celiac plexus blocks were done in 22 patients of whom 18 had intractable upper abdominal pain from cancer and 4 had pain from chronic pancreatitis. In most cases, an initial diagnostic block with 0.2 percent bupivacaine was followed by the therapeuntic block performed by injecting 50ml of 60 percent ethyl alcohol. Good to excellent pain relief occurred in 86 percent of patients. Duration of pain relief was from 4 months to 7 months in 55 percent of patients. Complications and side effects were infrequently seen but did include a 16 percent decrease of mean systolic arterial pressure and 16 cases of facial flushing. This block is remarkably safe as well as effective for the relief of upper abdominal pain from cancer origin.

• Journal of Gastric Cancer
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• v.12 no.4
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• pp.249-253
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• 2012

Chronic abdominal pain remains a challenge to all known diagnostic and treatment methods with patients undergoing numerous diagnostic work-ups including surgery. However, the surgical treatment of patients with chronic intractable abdominal pain is controversial. There has been no discussion of the indications for adhesiolysis in cases of obstruction or strangulation of the bowel, and adhesiolysis by laparotomy has never gained acceptance as a treatment modality for chronic abdominal pain. One of the reasons for this lack of acceptance is the high complication rate during and after adhesiolysis. Laparoscopic surgery has been accepted as a technique for diagnostic and therapeutic procedures in general surgery. Laparoscopy allows surgeons to see and treat many abdominal changes that could not otherwise be diagnosed. Here we report two cases of successful symptomatic improvement through laparoscopic adhesiolysis for chronic abdominal pain without intestinal obstruction after total gastrectomy.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.103-107
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• 1992

Thoracic sympathetic ganglion block was not applied routinely because of high incidence of complication such as pneumothorax. We successfully managed a patient with sternal pain and a patient with scapular pain by thoracic sympathetic ganglion block. We concluded that thoracic sympathetic ganglion block was an effective treatment for intractable cancer pain. However precise anatomical knowledgement is essential.

• The Korean Journal of Pain
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• v.4 no.1
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• pp.31-36
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• 1991

Intraspinal alcohol or phenol administration has been used for the treatment of intractable pain due to terminal cancer. It has been alleged to produce good pain relief with minimal complication if performed carefully. We analysed 35 patients who received epidural or subarachnoid neurolytic block out of 83 patients with malignancy who were referrecl to our pain clinic. Most of the patients needed additional treatment modalities including epidural catheterization or systemic narcotic administration. The incidence of complication was high, especially when the neurolytic agents were administered in the lumbar region. This suggest that intraspinal neurolytic block is unreliable and unsafe, although it may temporarily reduce the analgesic requirement.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.200-204
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• 1991

Neurolytic splanchnic nerve block is a relatively safe and effective method for the relief of intractable pain caused by upper abdominal cancer. We have experienced a case of severe acute respiratory failure during splanchnic nerve block under control of X-ray fluoroscopy. We think that the most likely cause of the acute respiratory failure was an asthmatic attack due to anxiety and dyspnea from the injury or stimulation of the diaphragm and pleura in this case.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.89-92
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• 1997

Neurolytic splanchnic nerve block is effective for treatment of intractable upper abdominal cancer pain. Conventional approach for splanchnic nerve block is conducted in the prone position to ensure proper orientation and to allow insertion of needles on each side of the vertebral body. However, the prone position has some technical disadvantages as this position is frequently poorly tolerated by a majority of patients with advanced cancer due to severe abdominal pain, ascites and so on. Male patient, 53-year old with transverse colon cancer, carcinomatosis peritonei and $L_1,\;L_2$ vertebral body metastasis, was admitted for treatment of severe right upper quadrant and right iliac crest pain. We performed neurolytic splanchnic nerve block with transdiscal technique in the lateral decubitus position under fluoroscopic guidance, and well noted the usefulness and the advantage of this technique. The benefits of this technique are safe, simple and effective because the lateral position is better tolerated by patients and makes bony landmarks more accessible during fluoroscopy.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.69-74
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• 1996

Background: Efficacy of spinal opioids for the treatment of intractable cancer pain has been reported by several authors. The epidural route seems to be a more reliable and effective method of pain control as compared to the intrathecal route which can lead to opioids by portal system. Methods: Medical records were reviewed of 18 patients who had been treated with epidural morphine via an implanted port-A-Cath from Mar. 1991 to Sep. 1994. Results: Patients were treated for a mean of 92 days. There were wide variation of dose requirements. The minimum daily dose ranged from 2 to 10mg, and maximum daily dose from 3 to 30 mg. Verbal rating scale were below moderate until 100th days after posrtal implantation. When 3 patients suffered from aggravated pain associated with vertebral metastasis. Five of 11 patients who were administered medication longer than 50 days reguired increased doses ranging from 3 mg to 25 mg which were higher as compared to initial doses. These patients also experienced pain due to vertebral metastasis. There were no report of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockade. Conclusion: Continuous epidural morphine administration via Port-A-Cath is an effective method with minimal complication.

• The Korean Journal of Pain
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• v.27 no.2
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• pp.139-144
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• 2014

Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from $7{\pm}1.0$ at baseline to $3.6{\pm}1.4$ on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.