With prolonged life expectancy and economic development, most people want a good quality of life. In this regard, the pain control becomes an important part in the medical care in addition to the treatment of the disease per se. Anesthesiologists have been practicing pain medicine for decades, with the unique application of specific nerve blocks. Pain clinic is a specialized department for pain management. The main therapeutic modality practiced at pain clinics in Korea is the nerve block. Nerve block is performed by an injection of an anesthetic or destructive substance hear a nerve or nerve plexus to interrupt its function for a brief or extended period, respectively. Nerve blocks play an important role in diagnosis, prognosis, and treatment of chronic pain. Nerve block intercepts the vicious cycle of pain as well as takes off the pain. Moreover, by improving the local blood flow, it also has an indirect effect on the treatment of pain. Sympathetic nerve block is used not only for pain relief, but also for the treatment of disease mainly accompanying sympathetic hyperactive symptoms. Pain clinic manages several kinds of intractable chronic pain. The rise in the number of pain clinics increases awareness of chronic pain with a considerable impact on our society.
Autonomic Nerve Block ; Chronic Pain ; Diagnosis ; Economic Development ; Korea ; Life Expectancy ; Nerve Block ; Pain Clinics* ; Pain Management* ; Prognosis ; Quality of Life

BACKGROUND: Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy. METHODS: SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB. RESULTS: The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes. CONCLUSIONS: We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased.
Blood Pressure ; Blood Volume ; Ear ; Heart Rate ; Horner Syndrome ; Humans ; Lidocaine ; Oxygen ; Spectrum Analysis ; Stellate Ganglion

More than 80% of cancer-related pain is pharmacologically controllable, whereas 10~20% of patients require interventional treatments. Neurolytic nerve block can play a major role in cancer pain treatment, and it has been proposed to prevent the development of pain and improve the quality of life of patients with cancer. If the pain is well localized and restricted to certain peripheral parts of the body, spinal peripheral or sympathetic nerve blocks may result in excellent therapeutic effects. Neurolytic sympathetic block, especially Celiac plexsus block (CPB) performed in earlier stages, is effective with successful long term results. However, selection of patients is critical for succeful outcomes. Neurolytic plexus block significantly improves the quality of life of patients and reduces abdominal and pelvic cancer pain, analgesic consumption and adverse opioids-related side effects. Interventional pain management should be considered at earlier stages to provide patients with the best quality of life possible.
Autonomic Nerve Block ; Humans ; Nerve Block ; Pain Management ; Pelvic Neoplasms ; Quality of Life

This article reviews the pharmacologic management of osteoarthritis, low back pain, and neuropathic pain. In order to manage chronic pain appropriately, pharmacologic management, such as adequate drug selection, is the most important in clinical situations. Pain is classified as nociceptive, neuropathic, or mixed pain according to its mechanism. For effective pain control, we choose analgesics depending on adequate evaluation and understanding of the pathophysiology of pain. Nociceptive pain like osteoarthritis is controlled by acetaminophen, nonsteroidal antiinflammatory drugs, and opioids according to the pain intensity. However, our recommendation for neuropathic pain is antidepressants and anticonvulsants as first line treatments. Low back pain arises from nociceptive and neuropathic mechanisms, classified as mixed pain syndrome. Therefore, the rational management of low back pain targets the different mechanisms of pain by combining agents with different mechanisms of action.
Acetaminophen ; Analgesics ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents ; Chronic Pain ; Low Back Pain ; Neuralgia ; Nociceptive Pain ; Osteoarthritis ; Pain Perception

The educational goal of premedical education is to provide a desired college-level training in liberal arts as well as sciences, and to provide a basis for future medical studies. However, there has been concern that the current premedical education at Korea University has been unproductive and has not met the educational goals. The objectives of this study were to evaluate the current premedical academic curriculum at Korea University and to provide baseline data for developing an improved premedical curriculum. A survey involving faculty, residents, and students from Korea University Medical School was conducted. The results of the study suggested that the current premedical curriculum was not relevant to future medical studies and the General Studies Program as a source for learning liberal arts and humanities, were not appropriate. There was a growing need for structural and functional integration between premedical and medical studies and in addition to requirement of reinforcing the social and human sciences into the premedical curriculum.
Curriculum* ; Education, Premedical ; Humanities ; Humans ; Korea* ; Learning ; Schools, Medical

Pain in an extremity that develops following trauma, infection, thrombophlebitis and many other leaions has been recognized for years and designated by a variety of names. These syndromes appear to have the same physiopathology and response to therapy. All of them are characterized by exeessive unduly prolonged pain, vasomotor and other autonomic disturbances, delayed recovery of function and trophic changes. We have treated two cases of reflex sympathetic dystrophy. One case was only treated by stellate gangUon block repeated 26 times and the other case required surgical thoracic sympathectomy for complete recovery after 60 repeated stellate ganglion blocks. We report these two cases of reflex sympathetic dystrophy and review the literature.
Extremities ; Recovery of Function ; Reflex Sympathetic Dystrophy* ; Reflex* ; Stellate Ganglion ; Sympathectomy ; Thrombophlebitis

Succinylcholine(SCC) is well known to elevate the serum potassium level and to threaten life in some cases. In order to minimize the elevation of serum potassium following SCC, several attempts have been made such as SCC tamming and pretreatment with pancuronium or lidocaine or diazepam. Our study was undertaken to evaluate the change of serum potassium following induction in 60 patients divided into 7 different groups; group l. SCC 1mg/kg; group ll. SCC 2 mg/kg, grouplll, SCC 1mg/kg after SCC 10mg; group IV, SCC 1mg/kg after pancuronium 0.015mg/kg, group V. Pnacuronium 0.1mg/kg; group VI, SCC 1mg/kg after Lidocaine 1mg/kg; grou VII, SCC 1mg/kg after Diazepam 0.2mg/kg. The results were as follows: 1) Serum potassium were increased 0.14mEq/L in group l and 0.17 mEq/L in group ll. 2) Serum potassium were decreased in group lll, VI and VII than their control values but they were not statistically significant. 3) The decrease in serum potassium was most significant in group IV and V.
Calcium ; Diazepam ; Humans ; Lidocaine ; Pancuronium ; Potassium ; Succinylcholine

This study was done to see the changes in the serum transaminase and LDH levels after general anesthesia in open heart surgery. We selected at random 60 patients who had received open heart surgery under cardiopulmonary bypass with mild to moderated hypothermia. They were divided into 3 groups depending on the anesthetic agents, halothane, penthrane and morphine group. Serum transaminase and LDH levels were checked before operation and also about 24 hours after operation; SGOP; spectrophotometirc assay by end-point method with Sequential Multiple Autoanalyser(SMA), SGPT; Spectrophotometric assay by kinetic method with SMA, LDH; Spectrophotometric assay by kinetic method. The results were as follows: 1) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents after open heart surgery. 2) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents in congental heart disease. 3) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents in acquired heart disease.
Alanine Transaminase ; Anesthesia, General ; Anesthetics ; Cardiopulmonary Bypass ; Halothane ; Heart Diseases ; Heart* ; Humans ; Hypothermia ; Methoxyflurane ; Morphine ; Thoracic Surgery*

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.
Abducens Nerve ; Abducens Nerve Diseases ; Blood Patch, Epidural ; Headache ; Intracranial Hypotension ; Paralysis ; Post-Dural Puncture Headache ; Supine Position

BACKGROUND: Perioperative noxious stimuli and inflammation may induce peripheral and central sensitization. Together, these changes contribute to the state of postinjury pain hypersensitivity found postoperatively. Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurones and may therefore, reduce postoperative pain. We studied whether or not intravenous meperidine infusion before induction could affect postoperative pain and analgesic consumption when compared with intravenous meperidine infusion at peritoneum closure. METHODS: Female patients scheduled for cesarean section were randomly assigned to one of two groups for prospective study. Group I (n=10) received intravenous meperidine (0.5 mg/kg) 5 minutes before induction of anesthesia and group II (n=10) received the same treatment at peritoneal closure. Both groups had a continuous infusion of meperidine (5 mg/hr) immediately after intravenous bolus meperidine. Postoperative pain relief was provided with intravenous meperidine from a PCA system (Walkmed , Medex, USA). Postoperative visual analogue pain scores (VAS), meperidine consumption and side effects were examined and compared between the groups for two postoperative days. RESULTS: At two hours post surgery VAS at rest were below 3 in both groups and were not statistically significant. VAS on motion were slightly higher than VAS at rest in both groups and were not statistically significant. There was no significant difference in meperidine consumption. There were minor side effects such as nausea, somnolence, dizziness and pruritus, but no patients needed any treatment and all of them were satisfied. CONCLUSION: Preemptive or postincisional intravenous PCA with meperidine was equally effective for postoperative analgesia after cesarean section, with minor side effects. These results suggested that there was no reason for applying preemptive analgesia for cesarean section patients. Further studies will be needed to evaluate preemptive effects of intravenous meperidine or other analgesics in cesarean section patients.
Analgesia* ; Analgesics ; Anesthesia ; Central Nervous System Sensitization ; Cesarean Section* ; Dizziness ; Female ; Humans ; Hypersensitivity ; Inflammation ; Meperidine* ; Nausea ; Neurons ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Pregnancy ; Prospective Studies ; Pruritus