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윤덕미 대한의사협회 2011 대한의사협회지 Vol.54 No.7
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.
Buprenorphine 천골강내(薦骨腔內) 주입(注入)에 의(依)한 술후(術後) 제통효과(除痛效果)
윤덕미,고순영,오흥근,Yoon, Duck-Mi,Koh, Soon-Young,Oh, Hung-Kun 대한통증학회 1988 The Korean Journal of Pain Vol.1 No.1
Caudal buprenorphine was investigated as a postoperative analgesic in a randominzed double blind study of 45 patients after abdominal surgery. At the end of surgery, patients were given 0.2 mg of caudal buprenorphine in 20 ml saline(n=30, experimental group) or no injection(n=15, control group). Pain relief was evaluated by the subsequent need for systemic analgesics(pethidine). Arterial blood gas and micturition disturbance were evaluated. In the buprenophine group, use of systemic analgesics was significantly reduced for the first 24 hours postoperatively. Arterial blond gas study values 2 hollers after buprenorphine administration were within normal range. 8 patients of the buprenorphine group developed urinary retention requiring temporary Nelaton catheterization of the bladder. Caudal buprenorphine for postoperative pain control was a good alternate method of postoperative pain management.
윤덕미,강원석,이승룡,안은경 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.2
Herpes zoster is primarily a disease of sensory portion of the nervous system and one of motor portion as well. Herpes zoster radiculopathy can be usually easily diagnosed in the presence or previous history of the characteristic cutaneous eruptions. Motor involvement dose not always coincide in location with the cutaneous lesions. Along with the radicular distribution of pain, motor neuron involvement can mimic other clinical conditions such as disc herniation, tumor infiltration, or infection. Even if the diagnosis of herpes zoster radiculopathy may be delayed, it must be put off until any other diseases or underlying causes are ruled out, especially in case motor symptoms and signs are major clinical features, or there is a topographic dissociation between dermatomes and myotomes involved. We report a patient with spinal cord tumor revealed in the evaluation and management of herpes zoster-related radiculopathy.
윤덕미,서영선,오흥근,Yoon, Duck-Mi,Suh, Young-Sun,Oh, Hung-Kun 대한통증학회 1990 The Korean Journal of Pain Vol.3 No.1
Three hundred and eighty-nine cases of splanchnic nerve block were retrospectively divided into 3 groups according to the change of alcohol concentration. In Group 1 (26 cases), about 7 ml of 1% lidocaine was used bilaterally as test block followed by an injection of 20 ml of 50% alcohol bilaterally. In Group 2 (286 cases) the same test block was followed by the same amount of pure and 50% alcohol. In Group 3 (77 cases) and used 30 ml of 75% alcohol bilaterally. The overall success rate of the first alcohol block in group 1, 2 and 3 was 73.1%, 92.0% and 84.4% respectively. From the above results, that splanchnic nerve block by pure alcohol was the most reliable method for upper abdominal cancer patients.
윤덕미,Yoon, Duck-Mi 한국호스피스완화의료학회 2009 한국호스피스.완화의료학회지 Vol.12 No.2
암성 통증의 80%는 진통제를 투여하는 약물치료로서 조절될수 있지만 $10{\sim}20%$는 다른 대책이 필요하다. 신경파괴제를 사용하는 블록은 이런 경우 중요한 역할을 한다. 신경블록은 암환자의 통증을 예방하고 삶의 질을 증가시킬수 있다. 특히 암성 통증이 신체 말단부위나 어떤 한 부위에 국한되 있는 경우 말초신경블록이나 교감신경블록은 좋은 효과를 나타낸다. 신경파괴제를 사용하는 교감신경블록 특히 복강신경총블록은 조기에 시행하면 훨씬 효과적이며 장기간 효과를 나타낸다. 환자 선택이 성공적인 결과를 얻는데 중요하다. 신경파괴제를 사용하는 신경블록은 복부 및 골반강내 암성통증을 감소시키고 진통제의 사용량을 감소시킬뿐 아니라 진통제에 관련된 부작용을 감소시키므로서 삶의 질을 향상시킨다. 따라서 조기단계에서 보다 적극적인 신경블록요법이 권고된다. More than 80% of cancer-related pain is pharmacologically controllable, whereas $10{\sim}20%$ 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.