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김문규,김순임,옥시영,김상호,이세진,박선영,이수명,정보일 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.3
Background: The ultrasound-guided transverse abdominis plane block (TAPB) reduces postoperative pain after laparoscopic abdominal surgery. But, its effect post laparoscopic totally extraperitoneal hernia repair (TEP) is not clear. In this study, we evaluated the analgesic effect of ultrasound-guided TAPB in TEP. Methods: In this prospective, randomized study, forty adult patients (ASA I-II) scheduled for a TEP under general anesthesia were studied. In the TAPB group (n = 20), an ultrasound-guided bilateral TAPB was performed with 0.375% ropivacaine 15 ml on each side after the induction of general anesthesia. The control group (n = 20) did not have TAPB performed. Fentanyl 50 μg was repeatedly injected as per the patient’s request in the recovery room. Pain scores at rest and on coughing were assessed postoperatively in the recovery room (20 min, at discharge) and at 4, 8, and 24 hours after surgery. Results: In the recovery room, pain scores (numeric rating scale, 0-10) at postoperative 20 min were lower in the TAPB group (3.9 ± 1.6, 4.9 ± 1.8) than the control group (6.9 ± 1.6, 8.0 ± 1.6) at rest and on coughing. Also, pain scores upon discharge from the recovery room were lower in the TAPB group (3.2 ± 1.2, 4.2 ± 1.5) than the control group (5.3 ± 1.6, 6.5 ± 1.8) at rest and on coughing. Conclusions: The ultrasound-guided TAPB in patients that had undergone TEP reduced postoperative pain scores and the fentanyl requirement in the recovery room. Also, pain scores on coughing were reduced until postoperative 8 hours.
Is the Spinous Process of T7 Usually at the Same Level as the Inferior Tips of the Scapulae?
김문규,옥시영,김상호,이세진,박선영,고은효,배현용,허경을 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.1
Objective: Appropriate placement of thoracic epidural catheter provides an adequate postoperative analgesia in chest and upper abdominal surgery. Usually, when thoracic epidural puncture is performed, both scapular lower tips and the thoracic (T)7 spinous process is assumed to be at the same horizontal level. The aim of this study is to identify the thoracic epidural puncture in the sitting position, with the neck flexed and arms crossed, may change the relationship between the thoracic vertebrae and the scapular lower tips. Methods: One hundred patients with postoperative patient controlled epidural analgesia using thoracic epidural catheters were enrolled. It is presumed that the both scapular lower tips and T7 spinous process is at the equal level when performing thoracic epidural puncture. The actual insertion level of the Tuohy needle was examined by radiography when the patient was in the sitting position. Results: Out of 100 patients, there were 62% that were in the same level as the scapular lower tips and T7 spinous process. However,1% of the patients leveled at T4, 1% at T5, 25% at T6, 18% at T8, and 1% at T9. Conclusion: When performing the thoracic epidural puncture under the sitting position, the relationship of the T7 and the scapular lower tips may change. The change of position of scapular lower tips varied among T6.82±0.70. Therefore, to be precise, it is advised to utilize C-arm guide when epidural puncture is carried out.
교합장치가 발음시 하악위 및 하악의 비틀림 회전운동에 미치는 영향
김문규,한경수,김종영,양근영,Kim, Moon-Gyu,Han, Kyung-Soo,Kim, Jong-Young,Yang, Keun-Young 대한안면통증구강내과학회 2001 Journal of Oral Medicine and Pain Vol.26 No.1
This study was performed to investigate the effects of occlusal appliance on the mandibular position and the mandibular rotational torque movement during speech. For this study, 20 patients with temporomandibular disorders(TMDs) and 20 normal subjects without any signs and symptoms in the masticatory system were selected as the patient group and as the normal group, respectively. Biopak $system^{(R)}$(Bioresearch Inc., Milwaukee, USA) and a sentence of 'Sue is missing her house' were used for recording and for observing of speech pattern. There were five mandibular positions observed in this study, that is, mandibular rest position, 'ssi', 'her', 'ha', and 's' speech position. In each position, slant and A-P distance in sagittal plane, vertical distance and lateral distance in frontal plane were measured. Amount of the mandibular rotational torque movement were measured at 'her', 'ha' speech position and for all through speech movement. Centric relation splint(CRS) was placed in both groups, but anterior or posterior bite plane were placed in normal subjects only. Data collected were processed and analysed by SPSS windows program. The results of this study were as follows : 1. Mandibular positions in both groups were not different before adaptation, with CRS, and after removal, but total amount of the mandibular rotational torque movement was greater in patients. 2. Mandible was slightly placed anteriorly with CRS at 'her' and 'ha' speech position in patients, but was placed anteriorly at all the five positions in normal subjects. 3. Difference with type of occlusal appliance in normal subjects were noted only for vertical distance at 'ssi' and 'ha' speech position, and the distance with CRS were more than that with posterior bite plane. 4. Mandibular rotational torque movement at 'her' and 'ha' speech position was greater in patients, but the difference was disappeared after appliance removal. And the torque movement was greater at 'ha' speech position than that at 'her' speech position in frontal plane. It could be concluded that the adaptation of occlusal appliance showed a tendency to locate the mandible anteriorly during speech in both groups, but did not affect total mandibular rotational torque movement which was greater in patients.
T2 부위의 척주세움근면차단 후 국소마취제 확산에 대한 Magnetic Resonance Imaging 영상
김문규 순천향대학교 순천향의학연구소 2021 Journal of Soonchunhyang Medical Science Vol.27 No.1
It has been reported that erector spinae plane block (ESPB), which was performed at the mid-thoracic level, can be effective for the visceral and somatic pain of the thoracic region. The magnetic resonance imaging (MRI) images showed the diffusion of the contrast medium into the transforaminal and epidural spaces after ESPB, and these MRI findings helped to understand the mechanism of the analgesic effect. There have also been reports that ESPB at the upper thoracic level can reduce the pain of the shoulder and upper extremities. However, no MRI images have been reported to support the mechanism of analgesic effect in the cervical region. We report for the first time the MRI images of local anesthetic spread after ESPB at the T2 level.
X-ray를 이용한 경부 피부에서 경막외강까지의 깊이 예측
김문규,최동혁,최동혁,김호준,박선영,김상호,정지원,유재화,조호범,옥시영 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.1
Background: Previous studies have shown that measuring the distance from the skin to the ligamentum flavum by ultrasound preceding cervical epidural block can be beneficial in excluding false loss of resistance. However, the measurement value using ultrasound may vary depending on the degree of operator experience. Therefore, we aimed to determine the depth from skin to cervical epidural space by using lateral cervical spine X-ray, which is a more intuitive method. Methods: We enrolled 102 adult patients who were scheduled to undergo cervical epidural anesthesia for vascular bypass surgery of upper arm. After attaching a steel rod on the needle insertion site, lateral cervical spine X-ray was taken before the epidural procedure. We measured the distance from the steel rod to the midpoint of interlaminar space on the spinolaminar line. The X-ray depth was compared with needle depth. Results: Of the 102 enrolled patients, 18 patients including 13 in whom we were unable to measure X-ray depth were excluded from the analysis. In total, 84 patients were included in the analysis. Concordance correlation coefficient between the X-ray-measured depth and needle depth was 0.925. Bland-Altman analysis indicated a mean difference of ± 1.96 SD with 0.06 ± 0.56 cm. Conclusions: Lateral cervical spine X-ray can be useful for prediction of the midline depth from skin to epidural space, particularly for operators who are not skilled at spine ultrasound or the use the C-arm fluoroscopy.