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오차현,Chan Noh,Hongsik Eom,Sangmin Lee,Seyeon Park,이선열,Yong Sup Shin,Youngkwon Ko,Woosuk Chung,Boohwi Hong 대한통증학회 2020 The Korean Journal of Pain Vol.33 No.2
Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicu-lar approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach.Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicu-lar brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated.Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis.Conclusions: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.
오차현,Hong Boohwi,조유민,Chung Woosuk,Kim Hoseop,Shin Suyeon,Choi Ah Young,임채성,고영권,Kim Yoon-Hee,이선열 대한마취통증의학회 2021 Anesthesia and pain medicine Vol.16 No.3
Background: The optimal insertion length for right subclavian vein catheterization in infants has not been determined. This study retrospectively compared landmark-based and linear regression model-based estimation of optimal insertion length for right subclavian vein catheterization in pediatric patients of corrected age < 1 year. Methods: Fifty catheterizations of the right subclavian vein were analyzed. The landmark related distances were: from the needle insertion point (I) to the tip of the sternal head of the right clavicle (A) and from A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. The optimal length of insertion was retrospectively determined by reviewing post-procedural chest radiographs. Estimates using a landmark-based equation (IA + AB – intercept) and a linear regression model were compared with the optimal length of insertion. Results: A landmark-based equation was determined as IA + AB – 5. The mean difference between the landmark-based estimate and the optimal insertion length was 1.0 mm (95% limits of agreement –18.2 to 20.3 mm). The mean difference between the linear regression model (26.681 – 4.014 × weight + 0.576 × IA + 0.537 × AB – 0.482 × postmenstrual age) and the optimal insertion length was 0 mm (95% limits of agreement –16.7 to 16.7 mm). The difference between the estimates using these two methods was not significant. Conclusion: A simple landmark-based equation may be useful for estimating optimal insertion length in pediatric patients of corrected age < 1 year undergoing right subclavian vein catheterization.
Hong Boohwi,오차현,조유민,이수민,Park Seyeon,김윤희 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.6
Fascial plane blocks are useful for multimodal analgesia after cardiac surgery since they can provide effective analgesia without the serious risks associated with conventional techniques such as neuraxial hematoma and pneumothorax. This narrative review covers blocks performed at the parasternal intercostal, interpectoral, pectoserratus, serratus anterior, erector spinae, and retrolaminar planes, which are targets for fascial plane blocks in cardiac surgery. Brief anatomical considerations, mechanisms, and currently available evidence are reviewed. Additionally, recent evidence on fascial plane blocks for subcutaneous-implantable cardioverter-defibrillator implantation are also reviewed.
Thoracic interfascial plane block for multimodal analgesia after breast lumpectomy
홍부휘,김여정,오차현,윤수경,윤상원,박현우,이원형,김윤희,고영권 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.2
Background: Thoracic interfascial plane block is useful as a component of multimodal analgesia in patients undergoing mastectomy. However, multimodal analgesia tends not to be provided during lumpectomy as it is one of the less aggressive procedures among breast cancer surgeries. Therefore, we investigated the effects of thoracic interfascial plane block as more effective analgesia after breast lumpectomy. Methods: Forty six patients (20–80 years old, female) with breast cancer scheduled to undergo lumpectomy were randomly assigned to two groups. Postoperative pain control in the control group consisted only of intravenous patient-controlled analgesia (PCA). In the block group, intravenous PCA was used after serratus intercostal fascial plane block and pecto-intercostal fascial plane block. The primary outcome was the 24 h cumulative postoperative fentanyl consumption. Pain severity, additional rescue analgesic requirement, side effects, and patient satisfaction were also evaluated. Results: Postoperative fentanyl consumption in the block group was significantly reduced compared with the control group (median, 88.8 [interquartile range, 48.0, 167.6] vs. 155.2 [88.8, 249.2], P = 0.022). The pain score was significantly lower in the block group only in the post-anesthesia care unit (2.9 ± 1.8 vs. 4.3 ± 2.3, P = 0.022). There were no differences in the incidence of postoperative nausea and vomiting and the requirement for additional analgesics between the groups. The satisfaction score was significantly higher in the block group. Conclusions: Thoracic interfascial plane block after lumpectomy reduces opioid usage and increases patient satisfaction with postoperative pain control. Thoracic interfascial plane block is useful for multimodal analgesia after lumpectomy.
조유민,Park Jiho,오차현,정우석,송승현,이지은,강한솔,고영권,김윤희,Boo Hwi Hong 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.6
Background: The corner pocket (CP) approach for supraclavicular block (SCB) prevents ulnar nerve (UN) sparing due to needle proximity to the lower trunk. Improved ultrasound resolution has suggested that the intertruncal (IT) approach is a suitable alternative method. We compared efficiency of these two approaches on the UN blockade.Methods: Sixty patients were randomized to undergo SCB using the ultrasound-guided CP or IT approach. For lower trunk blockade, 10 ml of local anesthetic agents (1 : 1 mixture of 0.75% ropivacaine and 1% lidocaine) were injected in the CP (CP approach) or between the lower and middle trunks (IT approach). Additional 15 ml was injected identically to block the middle and upper trunks in both groups. Sensory and motor blockade was evaluated after intervention. Results: Complete sensory blockade (75.9% [22/29] vs. 43.3% [13/30], P = 0.023) and complete motor blockade (82.8% [24/29] vs. 50.0% [15/30], P = 0.017) of the UN at 15 min after SCB were significantly more frequent in the IT than in the CP group. Sensory block onset time of the UN was significantly shorter in the IT compared to the CP group (15.0 [10.0; 15.0] min vs. 20.0 [15.0; 20.0] min; P = 0.012). Conclusions: The IT approach provided a more rapid onset of UN blockade than the CP approach. These results suggest that the IT approach is a suitable alternative to the CP approach and can provide faster surgical readiness.
조유민,Park Seyeon,오차현,Pak Yujin,Jeong Kuhee,Yun Sangwon,Noh Chan,정우석,김윤희,고영권,홍부휘 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.3
Background: Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). This study aimed to determine the relative efficacy of regional analgesic interventions for VATS using a network meta-analysis (NMA). Methods: We searched the Medline, EMBASE, Cochrane Controlled Trial Register, Web of Science, and Google Scholar databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of the following interventions: control, thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus plane block (SPB), and intercostal nerve block (INB). The primary outcome was opioid consumption during the first 24-h postoperative period. Pain scores were also collected during three different postoperative periods: the early (0–6 h), middle (6–18 h), and late (18–24 h) periods. Results: A total of 21 RCTs (1391 patients) were included. TPVB showed the greatest effect on opioid consumption compared with the control (mean difference [MD] = −13.2 mg; 95% CI [−16.2, −10.1]). In terms of pain scores in the early period, ESPB had the greatest effect compared to control (MD = −1.6; 95% CI [−2.3, −0.9]). In the middle and late periods, pain scores showed that TPVB, ESPB and INB had superior analgesic effects compared to controls, while SPB did not. Conclusions: TPVB had the best analgesic efficacy following VATS, though the analgesic efficacy of ESPBs was comparable. However, further studies are needed to determine the optimal regional analgesia technique to improve postoperative pain control following VATS.
Spinal anesthesia during cesarean section in a liver transplant recipient -A case report-
정우석,신용섭,노찬,오차현 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.3
Liver transplantation (LT) has been widely performed and hasbecome the treatment of choice in patients with medically nontreatableliver disorders. With surgical and medical advancements,LT recipients are now able to live a near-to-normal life. Pregnancyhas also become possible in female LT patients. However, thereare still several potential risk factors that must be considered inthese particular patients. LT patients have a higher risk ofanesthesia and are at high risk for delivering babies with prematurityand low birth weight. We report a case of successful spinalanesthesia in a 31-year-old LT patient for cesarean section.