회복실 환자의 임상적 고찰

문동언,김용신,박철주,유건희,옥광익,강준구,한영문,김오진,김성년 최신의학사 1992 最新醫學 Vol.35 No.12

만성통증 환자에서 항우울제의 사용

문동언 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2

Antidepressant pharmacotherapy presents many challenges to clinicians dealing with patients suffering from chronic pain. Depression in patients with more pain is associated with pain complaints and greater impairments. Depression and pain share a biological pathway and neurotransmitters, which have implications for their concurrent treatments. Treated in isolation, each of these conditions can prove difficult to treat. Collectively, depression and pain often present significantly greater challenges to the clinician. Antidepressants may be used as a primary treatment modality for depression in a patient dealing with chronic pain, at other times, these agents may be used to treat certain specific chronic pain syndromes, possibly in the face of concomitant depression. Clinicians should be aware of the many peculiarities associated with this broad class of medications. Included in this review are considerations for drug selection, dose escalation and common drug related problems (e.g., adverse drug reactions). In addition, attention has been paid to the appropriate selection of an agent for use in the primary management of either pain or depression.

대상포진후 신경통의 약물치료

문동언 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2

Postherpetic neuralgia (PHN) is a common complication of herpes zoster, particularly in the elderly and people with severe symptoms and presentation. This reviews summarizes the published results of randomized trials involving the treatment for PHN conditions. Anticonvulsants, such as gabapentin, carbamazepine and lamotrigine, and tricyclic antidepressants, including amitriptyline and nortriptyline, have demonstrated efficacy in several studies in relieving the pain associated with PHN. However, the lack of head-to-head comparison studies of these agents has limited the conclusions that can be reached. Using quality-of-life study outcomes, treatment strategies must encompass the impact of therapeutic agents on the comorbid conditions of sleep disturbance, mood and the anxiety disorders associated with PHN. Despite these treatment advances, many patients remain refractory to current therapy, and the prevention of PHN has therefore become an important focus of current research. Looking to the future, emerging therapies, such as pregabalin and newer N-methyl-D-aspartate receptor blockers, may provide physicians and patients with new treatment options for the more effective relief of herpetic pain.

진통제의 올바른 사용법

문동언 藥業新聞社 1993 醫藥情報 Vol.1993 No.8

제2 흉부 척추옆블록 후 동측 상지 피부온도 상승의 평가

문동언,김은성,문석환,이재민 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.01

Background: A thoracic paravertebral block is effective at treating unilateral pains of the arm, chest, and abdomen. In when administering a thoracic paravertebral block it is essential to know whether the sympathetic block is complete. The aim of the present study was to evaluate sympathetic denervation after a T2 paravertebral block by measuring the skin temperature of the ipsilateral upper extremity. Methods: Eleven patients scheduled for video-assisted thoracoscopic sympathectomy for palmar hyperhydrosis were selected for this study. Right side T2 paravertebral block was performed with 8 ml of 2% lidocaine using a 22-gauge needle under fluoroscopic guidance. Bilateral skin temperatures were measured on both middle finger tips before block, and 1, 3, 5, 7, 10 and 15 minutes after injecting 8 ml of 2% lidocaine. Results: The ipsilateral skin temperatures significantly increased with time after T2 paravertebral block administration. Contralateral skin temperatures were increased after the block, but this was not statistically significant. Mean depths from the skin to the transverse process of T2 and from the transverse process to the paravertebral space were 3.75 ± 1.25 cm, and 1.0 ± 0.23 cm respectively. Mean denervated dermatomes were 3.63 ± 1.32 after paravertebral block. Conclusions: This clinical study reveals that a single-site injection of 8 ml of 2% lidocaine produces multidermatomal ipsilateral somatic and sympathetic nerve block. We ascertained that the T2 paravertebral block is effective for adequate sympathetic blockade of the upper extremity.

암성통증의 치료

문동언 대한통증학회 2002 The Korean Journal of Pain Vol.15 No.1

대상포진후 신경통의 치료중 발생한 갑상선중독 발증

문동언,서재현,최미경 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.2

Thyrotoxic crisis is a life-threatening exacerbation of hyperthyroidism seen during periods of stress, which requires early recognition and adequate treatment. A 52-year-old female who suffered from severe right thoracic pain due to postherpetic neuralgia with hyperthyroidism, has been initially treated with antiviral agent and anticonvulsant in the department of neurology. She was transfered to our pain clinic because of uncontrolled severe pain. In our pain clinic, continuous thoracic epidural administration of bupivacaine and clonidine and oral analgesic medications produce visual analog scale from 8-9 to 5-6. She was admitted because of partially controlled pain and she was performed intercostal neurolysis with 10% phenol. As a result, visual analog scale was decreased from 5-6 to 2-3. After 3 days admission, extreme irritability, delirium, tachypnea, mild fever and tachycardia(heart rate: 160-180/min) were developed suddenly. Three hours later of proper treatment with oxygen inhalation, rapid fluid administration, diazepam 10 mg injection and antithyroid drug medication, heart rate and consciousness were returned to normal. Thoracic sympathetic ganglion neurolysis with absolute alcohol was performed without any sequelaes for the treatment of remnant visceral pain. And then, she was discharged with the relief of pain. The purpose of the present report is to review our experience with the clinical manifestations and management of thyrotoxic crisis developed during the treatment of postherpetic neuralgia, and to review of the treatment of thyrotoxic crisis and postherpetic neuralgia.

수술부위 표식과 Time Out수행율 강화를 위한 프로세스 개선

문동언,홍상현,이명렬,양승주,진영화,방병문,안준희,이로사,노연호,이명희 한국의료QA학회 2008 가을학술대회 Vol.2008 No.3

흉강경하 흉부교감신경절제술을 이용한 안면다한증 치료

문동언(Dong Eon Moon),박병철(Byung Cheul Park),김 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

Endoscopic transthoracic sympathectomy(ETS) has recently become estabilished as a successful treatment for severe palmar and axillary hyperhidrosis. Descriptions have been published of neurolytic, operative and alternative endoscopic procedures involving thermocoagulation, laser coagulation, or or nonvideo-assisted ganglionectomy using equip- ment not widely available, with low morbidity and excellent results. All methods have advantage and disadvantages. A 19-year-old male who suffered from severe hyperhidrosis on face, palms and axillary areas, has been initially treated with stellate ganglion block in other pain clinic. He was transfered to our pain clinic for endoscopic thoracic sympathectomy. The patient was intu- bated left side 34 Fr. double lumen tube and positioned left semi-lateral position for right sympathectomy. Right side pneumothorax was created by clamping the ipsilateral side of the double lumen tube and aspiration of air. 11-mm trocar was introduced through incision at the third intercostal space in anterior axillary line, and then additional two 11-mm and 5-mm trocar was introduced through second and fifth intercostal space in mid axillary line. The lung was gently retracted and the parietal pleura over the heads of the appro- priate ribs excised using 5-mm sharp insulated coagulating microprocesss. The T4, T3, and T2 ganglions, as well as accompanying rami communicantes, and other branchs arising from upper thoracic nerves to the brachial plexus and surrounding tissues were carefully dissected, coagulated. During sympathectomy, skin temperature of middle was continuously monitored. Elevation of palmar skin temperature intraoperatively indicated an adequate sympathectomy with a definite therapeutic effect. A No. 28 Fr. thoracotomy tube was in- troduced through a troca under video guidance, placed under water seal after the lung was reinflated. the controlateral side was performed same procedure. After bilateral sym- pathectomy, chest tubes were removed, and then, he was discharged 2 days after operation with great satisfaction. The ETS provides a well-tolerated, cost-effective alternative to thoracic sympathectomy for primary hyperhidrosis and sympathetic mediated neuropathic pain disorder. And T2 ganglion is considered the key ganglion for the treatment of primary hyperhidrosis. The low incidence of compensatory sweating may by explained by the limited extent of the sym pathectomy.

구상암 환자에서의 갓세르 신경절 및 하악신경 차단 - 증례 보고-

문동언(Dong Eon Moon),박규호(Kyu Ho Park),서재현(J 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.1

Most neoplasm of the floor of the mouth are squamous cell carcinoma. They originate from anterior midline floor of the mouth and penetrate into the sublingual gland. Invasion of the mandible is a late manifestation. Lymphatic spread is the submaxillary and subdigastric nodes and advanced lesions of them produce severe pain, The initial step in managing patients with cancer pain is the oncology therapy in the form of radiotherapy, surgery, or chemotherapy, alone or combined. When oncologic therapy is ineffec- tive, the pain must be treated by systemic analgesic, psychologic, neurostimulating, regional analgesic,and meuroablative techniques. We successfully treated with gasserian ganglion block on the left side and mandibular nerve block on the right side with pure alcohol in the patient having severe submandibular, lower lip and tongue pain.