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성상신경절차단 후 발생한 경부 혈종에 의한 상기도 폐쇄 증례 보고
노장호,윤경봉,김원옥,윤덕미,이정인 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2
An 81 year old man, suffering from sudden sensorineural hearing loss, received stellate ganglion block while receiving a continuous intravenous infusion of heparin. Four hours after stellate ganglion block, he complained of neck pain and swelling. 36 hours later, he developed dyspnea. A plain radiograph and computed tomograph of the neck revealed narrowing of the upper airway. After a tracheostomy, the dyspnea improved. He was discharged without sequelae 19 days later. We recommend that proper compression of the injected site for over 5 minutes is necessary to avoid a hematoma, and careful observation and immediate treatment should be performed when a hematoma occurs.
초음파 영상의 유도를 이용한 미추경막외블록의 성공률과천골관 내에서의 바늘의 방향
노장호,김원옥,윤경봉,윤덕미 대한통증학회 2007 The Korean Journal of Pain Vol.20 No.1
Background: Caudal block is useful when anesthesia for surgery or treatment for chronic pain is needed, but this procedure has a failure rate of up to 25% even when it performed byan experienced physician. This high failure rate is usually due to improper needle placement. Methods: After gaining approval of the ethics committee, 46 patients received caudal blocks under ultrasound guidance; these were performed after the anatomical structures in the sacral hiatus had been measured with ultrasound. All these procedures were performed by the same anesthesiologist. The position and direction of the needle were identified using fluoroscopy by injecting a radio-opaque contrast through the needle. The time taken from thelidocaine injection to verification of the needle was measured and the planned nerve block was then carried out. Results: All cases of needle insertion into the sacral canal under ultrasound guidance were successful. The average duration of the procedure and the trial count were 134.1 ± 10.1 seconds and 1.2 ± 0.1, respectively. In 12 of the 46 cases (26%), the needle deviated either left or right in the sacral canal, so the direction of the needle had to be adjusted. The distance between two cornua, the depth of the sacral hiatus and the thickness and length of the sacrococcygeal ligament were 17.1 ± 0.4, 3.9 ± 0.3, 2.3 ± 0.1 and 24.9 ± 0.9 mm, respectively. Conclusions: Ultrasound guidance can increase the success rate of inserting a needle into the sacral canal. However, even when ultrasound is used, the needle can deviate either left or right in the sacral canal.(Korean J Pain 2007; 20: 40-45)
요추부 내측분지차단술에서 Lidocaine과 Bupivacaine의 비교
문상호,노장호,이송,김지형,신원식 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.1
Study Design: This is a retrospective clinical study. Objectives: To compare the efficacy of lidocaine and bupivacaine for the ultrasound-guided lumbar medial branch block in chronic lowback pain. Summary of Literature Review: There is no study for comparison of the efficacy between lidocaine and bupivacaine for the medialbranch block. Materials and Methods: From August 2011 to May 2013, 186 patients were assigned 0.5% lidocaine(n=136) or 0.25%bupivacaine(n=45) for the ultrasound-guided lumbar medial branch block. All procedures have been performed by the same operator, and23G, 10 cm needle was placed and drug was injected under ultrasound guide. To target medial branches from lumbar spinal nerve, thegroove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients wereevaluated by pre- and post-interventional(1 hour) Visual Analog Scale and analyzed statistically. Results: Reduction of VAS score in bupivacaine group is significantly greater than that in lidocaine group and post-interventional VASscore in bupivacaine group is significantly lower than that in lidocaine group through analysis of covariance test with adjusted preinterventionalVAS score. In multivariate analysis, while age, sex and treatment level were not significant factors, pre-interventionalVAS score and the kind of drug were significant factors. Severe pain before treatment and bupivacaine was indicator of better result. Bupivacaine group reduced pain score in the VAS 2.285 more than lidocaine group with adjustment with other factors. Conclusions: Bupivacaine is more effective than lidocaine in the reduction of pain after ultrasound-guided lumbar medial branch blocksin posterior facet joint syndrome. 연구 계획: 후향적 임상 연구목적: 만성 요통 환자에서 초음파 유도하 내측 분지 차단술을 시행한 환자 중 lidocaine을 사용한 군과 bupivacaine을 사용한 군을 비교하여 어느 약제가우수한가를 분석하고자 하였다. 선행문헌의 요약: 내측 분지 차단술에서 lidocaine과 bupivacaine을 비교한 보고는 없다. 대상 및 방법: 2011년 8월에서 2013년 5월까지 시행한 186명의 내측 분지 차단술 환자들 중 0.5% lidocaine을 주입한 136명과 0.25% bupivacaine을주입한 45명을 비교 분석하였다. 한 명의 의사가 모든 증례를 시술하였으며 초음파 유도하에 23G, 10 cm 주사 바늘을 삽입하고 약제를 주사하였다. 요추 신경의 내측 분지를 목표로 하기 위하여 횡축 영상에서 상 관절 돌기와 횡 돌기의 교차점에 바늘이 놓이도록 하였다. 차단술 전과 시술 후 1시간이경과한 시점에서 Visual Analog Scale (VAS) score를 측정하여 통증 정도를 통계학적으로 비교 분석하였다. 결과: 두 군간의 균질성 분석 상 시술 전 양군의 통증의 VAS에 유의한 차이가 있었기에 이를 보정하고자 ANCOVA test를 시행하여 시술전 VAS의 영향을 교정한 후의 분석에서 bupivacaine군이 유의하게 시술전, 후 VAS의 감소 정도가 많았고 시술 후 VAS도 유의하게 낮았다. 다변량 분석으로 나이, 성별, 처치 level, 시술 전 VAS, 투여 약제 등을 분석하였을 때, 시술전, 후 VAS의 감소 정도는 시술 전 VAS와 투여 약제에 대해서만 의미 있는 결과를 보였다. 즉 시술전 VAS가 높을수록 VAS의 감소 정도가 컸다. 또한 다른 변수의 영향을 보정한 후에도 bupivacaine이 lidocaine보다 2.285만큼 VAS를 유의하게 향상시켰다. 결론 : 후방 관절 증후군에서 초음파 유도하 내측 분지 차단술의 약제 중 bupivacaine이 lidocaine보다 통증 감소면에서 더 우수하였다.