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

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

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

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

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: 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.
Anesthesia ; Chronic Pain ; Ethics Committees ; Fluoroscopy ; Humans ; Ligaments ; Needles* ; Nerve Block ; Ultrasonography*

Recent studies(Rorke et al., 1968: Moir 1970: Baraka, 1970: Fox and Houle, 1971) have demonstrated that the maternal arterial oxygen tension during Cesarean section is an important determinant of fetal oxygenation and consequently of the clinical condition of the infant at birth for oxygen is transferred by simple diffusion across the placenta to the fetus. Fetal blood oxygen tension is affected by the arteiral oxygen tension and concentration of the mother, and also is affected by uterine blood flow(Fox and Houle, 1971). The enlarged uterus pushes the diaphragm upwards. This results in a change in position of the heart which is lifted upwards, shifted to the left and anteriorly, and a change in the thoracic cage, and heart rate is increased about 10~12 beats above normal. There is a significant increase in cardiac output which reaches a peak 30~50% above normal until term, and in respiratory rate, so that it follows that oxygen consumption increases but its direct cause is the metabolic need of the uterus, placenta and fetus(Atkinson et al., 1977). As well as increased oxygen consumption in parturients hypoxia may occur in situations of difficult intubation, laryngoscopy for intubation, extubation and during endotracheal suctioning. Because of the markedly decreased oxygen tension, these procedures are more dangerous than for non-parturients. Therefore sufficient oxygenation is recommanded(Archer and Marx, 1974). We selected at random 78 adult female patients who had received Cesarean section and other surgical procedures under general anesthesia with intubation at Severance Hospital from September to November, 1980. They were divided into 3 groups. Group 1 was ventilated with 100% oxygen for 5 minutes followed by 1 minute of apnea. Group 2 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea. Group 3 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea with endotracheal suction. We analysed the decrease in oxygen tension between parturients and onoparturients. The results were as follows: 1) During apnes, the decreases in arterial blood oxygen tension were significantly greater (p<0.05) in parturients than in non-parturients in the 100% oxygen group. 2) During apnea, the decreases in arterial blood oxygen tension were significantly greater(p<0.05) in parturients than in non-parturients in the 50% oxygen group. 3) During apnea, the decreases in oxygen tension were significantly greater(p<0.05) in paturients than in non-paturients in the 50% oxygen and endotracheal suction group. These results indicate the importance of preoxygenation prior to endotracheal intubation and endotracheal suction and also of prompt reoxygenation following endotracheal intubation, extubation and endotracheal suction.
Adult ; Anesthesia, General ; Anoxia ; Apnea* ; Cardiac Output ; Cesarean Section ; Diaphragm ; Diffusion ; Female ; Fetal Blood ; Fetus ; Heart ; Heart Rate ; Humans ; Infant ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Mothers ; Oxygen Consumption ; Oxygen* ; Parturition ; Placenta ; Pregnancy ; Respiratory Rate ; Suction ; Uterus