Propriospinal myoclonus after cervical epidural blockade: A case report / 대한마취과학회지

Myoclonus is one of the rare complications after the neuroaxial blockade. We report a patient who developed propriospinal myoclonus following cervical epidural steroid injection. An outpatient, 73-years-old man, complaining of a tingling sensation from the right shoulder of supraspinatous region to the ipsilateral hand, particularly along the C6 dermatome, visited our pain clinic center. In cervical magnetic resonance imaging scan, the disc between 6th and 7th cervical vertebrae was herniated and pressed the nerves to the right side. We performed cervical epidural steroid injection, using triamcinolone acetonide 40 mg with 0.25% bupivacaine HCL 5 ml. After the first injection, he had no problem, but following the second injection, myoclonic movements were developed and lasted for 6 hours along only the right side of the whole body without other neurologic complications. The myoclonic movement improved by intravenous injection of clonazepam 0.5 mg and the patient completely recovered without any neurologic sequelae on that day.

Propriospinal myoclonus after cervical epidural blockade: A case report / 대한마취과학회지

Myoclonus is one of the rare complications after the neuroaxial blockade. We report a patient who developed propriospinal myoclonus following cervical epidural steroid injection. An outpatient, 73-years-old man, complaining of a tingling sensation from the right shoulder of supraspinatous region to the ipsilateral hand, particularly along the C6 dermatome, visited our pain clinic center. In cervical magnetic resonance imaging scan, the disc between 6th and 7th cervical vertebrae was herniated and pressed the nerves to the right side. We performed cervical epidural steroid injection, using triamcinolone acetonide 40 mg with 0.25% bupivacaine HCL 5 ml. After the first injection, he had no problem, but following the second injection, myoclonic movements were developed and lasted for 6 hours along only the right side of the whole body without other neurologic complications. The myoclonic movement improved by intravenous injection of clonazepam 0.5 mg and the patient completely recovered without any neurologic sequelae on that day.

Cervicogenic Headache Caused by Cervical C3-C4 Intervertebral Disc Herniation : A case report

Cervicogenic headache is a syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck. Although the pathophysiology and source of pain in this condition have been debated, the pain is believed to be referred from one or more muscles, occipital nerves, facet joints, intervertebral discs, or vascular structures. Among the various possible pain sources, cervicogenic headache from discogenic origin (disc herniation or damaged annulus fibrosus) has been called "discogenic cervical headache". We report a case of cervicogenic headache caused by C3-C4 intervertebral disc herniation. A 33-year-old man presented with headache and posterior neck and right shoulder pain. These symptoms did not improve after therapy with medication, trigger point injection, intramuscular stimulation, greater occipital nerve block, third occipital nerve block, or cervical medial branch block. However, after diagnostic cervical epidural block, the patient's symptoms improved dramatically. Diagnostic magnetic resonance imaging findings confirmed C3-C4 intervertebral disc herniation.

Surface Anatomical Landmark and Optimal Insertion Angle in Cervical Epidural Block

OBJECTIVE: The aim of this study is to evaluate the surface anatomical landmark for the cervical epidural block by investigating the proportion of patient's prominence in the 7th cervical vertebra. And the most optimal insertion angle over the mid point between the 6th and the 7th cervical spinous process is also measured. METHOD: Patients who did a plane x-ray examination of cervical spine were selected. We performed plane x-ray after marking on cervical vertebra prominence that was assumed as the spinous process of the 7th cervical vertebra by inspection and palpation. We identified where the marker were located on the spinous process. Moreover, we measured optimal insertion angle in the plane x-ray of cervical spine lateral. RESULTS: A total 100 cases were identified. The vertebra prominence was on the 7th cervical vertebra in 62 cases and the 6th cervical vertebra in 29 cases. The 1st thoracic vertebra was in the 2 cases and the 6th and 7th cervical vertebra in the 7 cases. CONCLUSION: The vertebra prominence was identified as the spinous process of the 7th cervical vertebra in sixty two percent of the cases. And the most optimal insertion angle is a -25.28 degree angle from the perpendicular line of the skin.

Vertebral Spreading Segments of Cervical Epidural Injection: a Comparative Study with 5 ml and 10 ml of Injected Volume / 대한통증학회지

BACKGROUND: Although cervical epidural block can be a useful therapeutic treatment for head, neck and upper extremities pain, there is no consensus regarding the volume of injection required for pain management. Herein, the spreading in the vertebral segments after a cervical epidural injection of either a 5 or 10 ml volume was studied. METHODS: A total of 78 patients, suffering from head, neck and upper extremity pain, were selected. Cervical epidural blocks were performed consecutively with 5 ml (n = 42) and 10 ml (n = 36) of 0.4% mepivacaine and 222 mg I/ml iopamidol at the C7 T1 levels. Both anteroposterior (AP) and lateral radiographs were obtained under fluoroscopy, and the upper and lower epidural spreading of the contrast media in relation to the vertebral level was evaluated. RESULTS: The cervical epidural blocks were performed without complications. The rostral spreading of the contrast media in the vertebral segments in groups 1 and 2 were 5.6 +/- 1.1 and 6.1 +/- 1.1, respectively. The caudal spreading of the contrast media in the vertebral segments in groups 1 and 2 were 5.4 +/- 3.4 and 7.2 +/- 3.9, respectively. The total numbers of segments with vertebral spreading of the contrast media in both directions showed significant differences between the two groups. The numbers of patients who showed spreading of the contrast media up to C2 vertebral segment showed no significant differences between the two groups. CONCLUSIONS: 5 and 10 ml epidural injection volumes may be adequate for the spread of contrast media to the entire cervical spine. A 5 ml epidural injection volume, compared to a 10 ml volume, may be ample when considering the possibility of unnecessary caudal spreading of drugs and volume related complications in the management of head, neck and upper extremity pain.

Improvement of Migraine by Cervical Epidural Block: A case report / 대한통증학회지

Migraine is a disabling headache that can occur with or without aura. We present here a case of migraine that was effectively managed by a series of cervical epidural blocks. A 41-year-old woman who had suffered from severe headache on her left temporal area for 12 years visited our pain clinic. Her 11-point numeric pain rating scale was 10 out of 10 at the first visit and the symptoms were associated with homonymous visual disturbances, paresthesia on the left face, shoulder and arm, and general weakness. For the first 5 years after the headaches began, her headache was relatively well controlled by acetaminophen; after then, the acetaminophen wasn't effective. After wandering from this hospital to the next one in search of relief, she managed to visit our pain clinic. We tried several blocks including cervical epidural block, and she was continuously medicated with sumatriptan. Her headache was gradually relieved. Now, her 11-point numeric rating scale is 1-2 out of 10 at the most during her headache attacks.

A Cervical Epidural Block Combined with Light General Anesthesia in Takayasu's Arteritis: A case report / 대한마취과학회지

Takayasu's arteritis is a chronic and occlusive inflammatory disease of uncertain etiology affecting medium to large sized arteries. We anesthetized a patient who had Takayasu's arteritis affecting both common carotid arteries, the left anterior descending coronary artery, and the left subclavian artery. During beating heart coronary artery bypass graft and aorto-carotid bypass graft we chose a cervical epidural block combined with light general anesthesia as an anesthetic technique. We managed the patient successfully with consistant hemodynamic stability. The operation was done without cardiopulmonary bypass and the patient was returned to consciousness immediately after the end of the operation. We extubated the endotracheal tube in the operating room without pain. The patient maintained hemodynamic stability in the intensive care unit and we controlled the pain via a cervical epidural catheter with morphine and 0.1% bupivacaine.