Eunsoo Kim

Hee Yong Kang, Chung Hun Lee, Doo-Hwan Kim, Yeon-Dong Kim, Won-Joong Kim, Eunsoo Kim, Jae Hun Kim, Hyun Jung Kim, Yangki Minn, Kyungseung Yang, Jinyoung Oh, Yongjae Yoo, So Young Lim, Mihn-Sook Jue, Eun Joo Choi, Kunhee Han, and Seong-Soo Choi. Korean J Pain -0001;0:. https://doi.org/10.3344/kjp.25161

Younghoon Jung, Seungbin Park, Won Yong Lim, Jeongmin Hong, Jiseok Baik, Hyeon Jeong Lee, Jae-Young Kwon, and Eunsoo Kim. Korean J Pain -0001;0:. https://doi.org/10.3344/kjp.24419

Pericapsular nerve group (PENG) block was introduced as an effective way to control postoperative pain in patients who have undergone hip surgery. Therefore, we would like to discuss how to perform PENG block accurately on the basis of two cases, both of which involved hip fracture patients. Ultrasound-guided continuous PENG block was performed, and postoperative pain was adequately controlled in both cases. To mount the catheter in the correct position, it should be inserted after the needle enters at the lowest angle possible. If it is confirmed that the psoas tendon is pushed upward without an increase in injection pressure during drug injection, an accurate continuous PENG block has been achieved. We also analyzed fluoroscopic images to determine how the drug spread, and we observed that the drug spread around the hip capsule along the iliacus and psoas muscle.

Background and Objectives: Endoscopic epidural neuroplasty (EEN) facilitates adhesiolysis through direct epiduroscopic visualization, offering more precise neural decompression than that exhibited by percutaneous epidural neuroplasty (PEN). We aimed to compare the effects of EEN and PEN for 6 months after treatment with lower back and radicular pain in patients. Methods: This retrospective study compared the visual analog scale (VAS) and Oswestry disability index (ODI) scores in patients with low back and radicular pain who underwent EEN or PEN with a steering catheter. The medical records of 107 patients were analyzed, with 73 and 34 undergoing EEN and PEN, respectively. Results: The VAS and ODI scores decreased at all time points after EEN and PEN. VAS and ODI scores decreased more in the EEN group than those in the PEN group at 1 day and 1- and 6-months post-procedure, indicating superior pain relief for both lower back and radicular pain through EEN. Conclusions: EEN is a superior treatment of pain control than PEN in lower back and radicular pain patients.

Minsoo Kim, Sun Kyung Park, Woong Mo Kim, Eunsoo Kim, Hyuckgoo Kim, Jun-Mo Park, Seong-Soo Choi, and Eun Joo Choi. Korean J Pain 2024;37:119-31. https://doi.org/10.3344/kjp.24022

Population aging refers to the increase in the proportion of elderly individuals in a population resulting from longer life expectancy and declining fertility and tends to characterize upper-middle and high-income countries, such as Organization for Economic Cooperation and Development (OECD) member countries. Statistics Korea reported that 18.4% of the total population was elderly (aged > 65 years) in 2023 [1]. If this trend continues, the elderly population will constitute over 20% of the population and Korea will become a super-aged society by 2025. The number of surgeries performed on elderly individuals continues to rise as the population ages. As the elderly population has age-related organ reserve decline and various medical comorbidities, surgery can provide a conclusive approach to treating several diseases related to aging. Although symptom relief and life extension are undeniable benefits of surgery, the risk of postoperative complications is more remarkable for the elderly than for the young [2]. Over 300 million people undergo major surgery annually, 85% of which undergo noncardiac surgery (NCS) [3]. Elderly patients are more vulnerable to perioperative adverse cardiac events (PACEs) and major adverse cardiac events, such as myocardial infarction or injury, cardiac arrest, or congestive heart failure, are firmly associated with perioperative death [4]. Adverse cardiac events can also result in significant complications, prolonged hospital stays, and increased medical costs [5]. In a national cohort of the United States, cardiovascular risk factors (e.g., hypertension, dyslipidemia, diabetes mellitus, obesity, and chronic kidney disease) and atherosclerotic cardiovascular disease (CVD), including coronary artery disease, peripheral artery disease, and prior stroke, increased over time among surgical patients undergoing major NCS [6]. However, the incidence of perioperative major adverse cardiovascular and cerebrovascular events declined from 3.1% to 2.6% in the same national cohort database [7]. These results suggest that the surgical population is getting older and sicker over time and that advancements in cardiovascular medicine, surgical techniques, and anesthetic management during the perioperative period are related to the decline in fatal cardiac events and mortality. The current issue of the Korean Journal of Anesthesiology includes a nationwide multicenter retrospective cohort study conducted by Choi et al. [8] that uses Common Data Model data from seven tertiary hospitals and demonstrates an association between PACEs , defined as a composite of heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, myocardial infarction, coronary revascularization, or stroke within 30 days of surgery, and mortality after NCS. This study showed that the overall incidence of PACEs was 2.88% and PACEs were associated with increased 1-year and 3-year mortality. After 1:4 propensity score matching, the mortality rate was higher in the PACE group at the 1-year (6.0% vs. 4.4%; hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P =

BACKGROUND Ketamine, a compelling candidate for neuropathic pain management, has attracted interest for its potential to elevate brain-derived neurotrophic factor (BDNF) levels. We aimed to assess the effects of intrathecally administered ketamine on the cerebrospinal fluid (CSF) levels of BDNF(c-BDNF) and allodynia in a rat model of traumatic brain injury (TBI). MATERIAL AND METHODS Forty-five rats were divided into 3 groups: sham operation (Group S), untreated TBI (Group T), and ketamine-treated TBI (Group K), with 15 rats in each group. Rats were anesthetized, and their skulls were secured in a stereotactic frame before undergoing craniotomy. A controlled cortical impact (CCI) was induced, followed by injection of ketamine (3.41 µg/g) into the CSF in Group K. In Group T, no drug was injected after CCI delivery. On postoperative days (POD) 1, 7, and 14, the 50% mechanical withdrawal threshold (50% MWT) and c-BDNF levels were assessed. RESULTS Groups T and K exhibited a significantly lower 50% MWT than Group S on POD 1(6.6 [5.7, 8.7] g, 10.0 [6.8, 11.6] g, and 18.7 [11.6, 18.7] g, respectively; P<0.001). The c-BDNF levels in Group K were significantly higher than those in Groups S and T on POD 1 (18.9 [16.1, 23.0] pg/ml, 7.3 [6.0, 8.8] pg/ml, and 11.0 [10.6, 12.3] pg/ml, respectively; P=0.006). CONCLUSIONS Intrathecal ketamine administration did not exhibit anti-allodynic effects following mild TBI. c-BDNF level is a promising potential indicator for predicting the expression of allodynia after mild TBI.

The authors report a case of newly manifested severe junctional bradycardia following dexmedetomidine administration during spinal anesthesia in a polypharmacy patient. A 77-year-old woman receiving multiple medications, including a beta-blocker and a calcium channel blocker, underwent right total knee arthroplasty. After spinal anesthesia, intravenous dexmedetomidine was initiated as a sedative; her heart rate decreased, followed by junctional bradycardia (heart rate, 37–41 beats/min). Dexmedetomidine was discontinued, and a dopamine infusion was initiated. Seven hours after surgery, junctional bradycardia persisted; a temporary transvenous pacemaker was inserted, and the beta-blocker and calcium channel blocker were discontinued. The patient was discharged on postoperative day 11 without any sequelae. Anesthesiologists should be aware of dexmedetomidine’s inhibitory effects on the cardiac conduction system, especially in geriatric patients taking medications with negative chronotropic effects and in combination with neuraxial anesthesia.

Objectives: To compare the analgesic efficacies of erector spinae plane (ESP) block and thoracic epidural analgesia (TEA) in video-assisted thoracic surgery (VATS). Methods: Sixty patients undergoing VATS received patient-controlled TEA with a basal rate of 3 ml/hour (h), a bolus of 3 ml (Group E), or ESP block with programmed intermittent bolus infusions of 15 mL/3 h and a bolus of 5 ml (Group ES) for 2 postoperative days. The primary outcome was to compare pain scores at rest 24 h postoperatively between the 2 groups. Secondary outcomes included NRS score for 48 h, procedural time, dermatomal spread, use of rescue medication, adverse events, and patient satisfaction. Results: Patients with continuous ESP block had a higher NRS score than those with TEA but no statistical difference at a specific time. The dermatomal spread was more extensive in the TEA group than in the ESP block group (p=0.016); cumulative morphine consumption was higher in the ESP block group (p=0.047). The incidence of overall adverse events in the TEA group was higher than in the ESP block group (p=0.045). Conclusion: Erector spinae plane block may be inferior to TEA for analgesia following VATS, but it could have tolerable analgesia and a better side effect profile than TEA. Therefore, it could be an alternative to TEA as a component of multimodal analgesia.