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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.
Hong, Boohwi,Bang, Seunguk,Chung, Woosuk,Yoo, Subin,Chung, Jihyun,Kim, Seoyeong The Korean Pain Society 2019 The Korean Journal of Pain Vol.32 No.3
Background: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB ($33.0{\mu}g$; interquartile range [IQR], $27.0-69.5{\mu}g$) than in the control group ($92.8{\mu}g$; IQR, $40.0-155.0{\mu}g$) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). Conclusions: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.
Boohwi Hong,Seunguk Bang,Woosuk Chung,Subin Yoo,Jihyun Chung,Seoyeong Kim 대한통증학회 2019 The Korean Journal of Pain Vol.32 No.3
Background: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. Methods: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). Results: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 g; interquartile range [IQR], 27.0-69.5 g) than in the control group (92.8 g; IQR, 40.0-155.0 g) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001).Conclusions: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.
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.
Sangwon Yun,Boohwi Hong,Hoseop Kim,Woosuk Chung,Youngkwon Ko,Yoon-Hee Kim 조선대학교 의학연구원 2021 Medical Bilogical Science and Engineering Vol.4 No.1
Cerebral venous sinus thrombosis (CVST), a rare cerebrovascular event, occurs in approximately 5 out of 1,000,000 people. Because subarachnoid hemorrhage (SAH) due to CVST during emergency cesarean section is rare, this condition is difficult to recognize and diagnose in patients under anesthesia. This report describes a parturient who experienced severe headache and motor weakness during an emergency cesarean section. The first manifestation of CVST was a severe headache, which overlapped with the presentation of SAH, making early diagnosis verydifficult. Anesthesiologists should be aware of the risk of CVST in pregnant women and closely monitor those who experience slight changes in intraoperative neurological symptoms.
Pak Yujin,Baek Sujin,Bang Minhae,Kim Hoseop,Jo Yumin,Oh Chahyun,Hong Boohwi 조선대학교 의학연구원 2023 Medical Bilogical Science and Engineering Vol.6 No.1
Regional anesthesia has become an alternative to general anesthesia in patients with risk factors that may cause perioperative complications. The transversalis fascial plane block (TFPB) is a useful regional technique for blocking the ilioinguinal and iliohypogastric nerves. An 87-yearold female patient with symptomatic severe aortic stenosis was scheduled to undergo open reduction and fixation with an autogenous iliac crest bone graft (ICBG) for the nonunion of the proximal shaft of an ulnar fracture. General anesthesia was avoided due to cardiac comorbidities; therefore, regional anesthesia was considered. ICBG can be performed under spinal anesthesia. However, we performed TFPB since severe aortic stenosis is a contraindication for spinal anesthesia. A brachial plexus block was performed for the primary forearm surgical site. The surgery proceeded safely without any hemodynamic compromise or special events. TFPB for ICBG can be a useful alternative in patients with severe cardiac comorbidities to avoid perioperative risks.
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.