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김연동,문현석 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.1
Background Pain medicine often requires medico-legal involvement, even though diagnosis and treatments have improved considerably. Multiple guidelines for pain physicians contain many recommendations regarding interventional treatment. Unfortunately, no definite treatment guidelines exist because there is no complete consensus among individual guidelines. Pain intervention procedures are widely practiced and highly associated with adverse events and complications. However, a comprehensive, systemic review of medical-dispute cases (MDCs) in Korea has not yet been reported. The purpose of this article is to analyze the frequency and type of medical dispute activity undertaken by pain specialists in Korea. Methods Data on medical disputes cases were collected through the Korea Medical Association mutual aid and through a private medical malpractice liability insurance company. Data regarding the frequency and type of MDCs, along with brief case descriptions, were obtained. Results Pain in the lumbar region made up a major proportion of MDCs and compensation costs. Infection, nerve injury, and diagnosis related cases were the most major contents of MDCs. Only a small proportion of cases involved patient death or unconsciousness, but compensation costs were the highest. Conclusions More systemic guidelines and recommendations on interventional pain management are needed, especially those focused on medico-legal cases. Complications arising from pain management procedures and treatments may be avoided by physicians who have the required knowledge and expertise regarding anatomy and pain intervention procedures and know how to recognize procedural aberrations as soon as they occur.
The characteristics of zoster-associated prodromal symptoms in Korea
김연동,이공희,이철형,Kim, Yeon-dong,Lee, Gong-heui,Lee, Cheolhyeong Korea Convergence Society 2021 한국융합학회논문지 Vol.12 No.8
대상포진 환자의 대상포진 연관통증은 발진이 치유된 후에도 수년 동안 발생하여 오랫동안 지속될 수 있다. 이 경우 환자는 포진 후 신경통이 있는 것으로 진단된다. 대상포진의 전구 증상은 지속적이거나 간헐적인 통증과 함께 나타날 수 있으며 종종 다른 증상을 동반하여 오진 및 부적절한 치료를 초래한다. 이 연구의 목적은 국내 다기관 연구를 통해 대상포진 연관통증의 전구 증상 특성을 조사하는 것이다. Zoster-associated pain (ZAP) in patients with herpes zoster (HZ) may persist for a long time, occurring even years after the rash has healed. In this case, the patient is diagnosed as having postherpetic neuralgia (PHN). Prodromal symptoms can present with constant or intermittent pain, and are often accompanied by other symptoms, resulting in misdiagnosis and/or inappropriate treatment. The aim of this study is to investigate the characteristics of the prodromal symptoms of ZAP through a multicenter study in Korea.
김연동,유재용,심준호,허현주,김형태 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.3
Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded.Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively.Conclusions: Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety. (Korean J Pain 2016; 29: 179-84)