Accidental Discovery of Pregnancy-associated Septic Sacroilitis on Ultrasound

Pain in the sacroiliac joint and lower back is common during pregnancy and postpartum periods. However, pregnancy related septic sacroilitis is very rare. A 37-year-old pregnant woman had a sudden severe lower back pain two days in advance of the delivery. However, she delivered a healthy baby under cesarean section in good condition. Laboratory tests revealed elevated erythrocyte sedimentation and C-reactive protein, but her initial magnetic resonance imaging of lumbar spine and abdominal pelvis computed tomography were normal. Therefore, she was considered having a general acute back pain that many postpartum patients can have. Conservative treatment was received until she was referred to pain clinic. While we were planning pain management under ultrasound guided, we encounterd mass-like lesion on her left sacroiliac joint accidentally. Sacroiliac MRI was taken immediately and It revealed septic sacroilitis. Pregnant with high ESR, CPR with severe localized sacroiliac joint pain should be suspected of pregnancy related septic sacroilitis.ope

질산 표면처리에 의해 형성한 저니켈 듀플렉스 스테인리스강의 부동태막과 그 내식특성

스테인리스강은 부식에 강하고 내마모성 및 내산화성 등이 우수하여 다양한 산업분야에서 사용되어지고 있다. 특히 오스테나이트와 페라이트상이 혼합된 듀플렉스 스테인리스강은 우수한 내식성, 높은 강도, 양호한 가공성, 안정적 가격변동의 특징을 가진 철강재로써 그 사용량이 꾸준히 증가하고 있다. 스테인리스강의 여러 합금 원소 중 내식성과 직접적인 역할을 하는 크롬 이외에, 니켈은 페라이트의 상변태에 큰 영향을 주는 원소이다. 니켈은 오스테나이트계 스테인리스강의 가격 변동성에 큰 영향을 미치기 때문에 이를 대체하려는 연구가 진행되었고, 그 결과, 니켈의 함량은 줄이고 망간과 질소 등을 첨가한 저니켈 듀플렉스 스테인리스강(STS 329 Formability Lean Duplex, FLD)이 등장하였다. 하지만 STS 329 FLD 내 니켈의 감소로 인하여 내식성 등 보완해야할 문제가 발생하고 있다. 스테인리스강의 내식성을 증대시키는 다양한 방안이 존재하며 그 중 표면처리법은 공정이 단순하고 가격 경쟁력이 우수한 장점이 있다. 표면처리법 중 화학적 부동태화(Chemical passivation)는 구연산, 질산 등을 이용하여 부동태막에서 부동태막의 크롬산화물의 치밀도의 증가, 개재물(Inclusion)의 제거 등에 의하여 내식성을 증대시키는 방법이다. 이러한 처리법 중 질산 용액에 산화제를 첨가할 경우 산화환원전위의 상승으로 인하여 수산화크롬(Cr2(OH)3)이 산성 환경에서 내식성이 우수한 산화크롬 (Cr2O3)으로 고체상 변화하여 부동태막의 내식성이 더욱 증가한다. 기존에는 산화제로 중크롬산나트륨이 주로 사용되었으나, 중크롬산나트륨의 환경적 문제로 인한 제제로 새로운 대체제의 개발이 시급한 상황이다. 본 논문에서는 질산 환경에서 화학적 부동태화 처리법에 의해 STS 329 FLD의 부동태막의 형성에 대하여 연구하였다. STS 304와 STS 329 FLD의 글로우 방전 분광 분석법(Glow discharge optical emission spectrometer)을 이용하여 깊이별 원소분포의 특성차이 및 합금원소의 상대비율과 STS 304와 STS 329 FLD의 양극분극 곡선(Anodic polarization curve)을 특성을 비교하여 STS 329 FLD의 STS 304 대비 내식특성을 고찰하였다. 또한 산화제로서 Na2MoO4의 첨가에 의해 형성되는 부동태막의 형성 메카니즘에 대하여 고찰하였다. 실험 결과, 몰리브덴산나트륨을 질산 용액에 첨가함으로써 몰포로지, 부동태막의 깊이별 원소 분포 특성, 내식 특성에 영향을 미쳤다. 몰포로지에서 몰리브덴산나트륨이 첨가됨에 따라 표면의 개재물이 감소하였다. 그로 인하여 양극분극 곡선에서 공식전위가 증가하였고, 조도 측정 결과에서 표면의 거칠기가 증가하였다. 부동태막의 깊이별 원소 분포는 몰리브덴산나트륨이 첨가됨에 따라 부동태막의 표면층에서 철의 함량은 감소하였고, 크롬은 증가하였다. 그로인해 양극분극 곡선에서 부식전류가 감소하였다. 전기화학적 임피던스 측정결과에서 몰리브덴산나트륨을 첨가한 경우에 부동태막의 커패시턴스가 증가하였다. 이는 부동태막 두께의 감소에 의한 증가뿐만 아니라 부동태막의 최외곽에 흡착된 몰리브덴이 이온상태로 존재함으로써 최외곽 표면은 양이온 선택층, 내층은 음이온 선택층 형성으로 인하여 커패시턴스가 증가한 것으로 사료된다. 부동태막이 몰리브덴의 흡착에 의해서 전기적 이중층을 형성함에 따라 양극분극 곡선에서 부식전위가 상승하였다. 또한 몰리브덴산나트륨이 첨가된 질산용액에서 표면 처리시간이 길어짐에 따라 크롬의 함량이 증가하여 부식전류가 감소하였고 표면의 개재물의 감소로 인해 공식전위가 증가하였다. 부동태막의 두께는 시간이 증가함에 따라 감소하였다. 최외곽 표면의 몰리브덴의 함량은 60분에서 감소하였으며, 그 영향으로 전기화학적 임피던스의 커패시턴스가 감소하였다. 이러한 결과들을 토대로 몰리브덴산나트륨이 중크롬산나트륨의 대체제로서 가능성을 확인하였고, STS 329 FLD의 내식성 향상에 대한 기초적인 지침을 제시할 수 있었다.|Over several decades, stainless steels are used in various industrial fields, due to corrosion, abrasion and oxidation resistances. Duplex stainless steels which are mixed with austenite and ferrite phases are steadily increasing in their use as steels with good corrosion resistance, high strength, good formability and stable price fluctuation. In addition to chromium, which plays a direct role in the corrosion resistance of various alloying elements in stainless steel, nickel is a factor that greatly affects the phase transformation of ferrite to austenite. Nickel has had a significant impact on the price volatility of austenitic stainless steels, and studies have been undertaken to replace them. As a result, stainless steel(STS 329 Formability Lean Duplex, FLD) with nickel reduced and manganese and nitrogen was added was developed. However, there is a problem that corrosion resistance is reduced due to reduction of nickel. There are various ways to increase the corrosion resistance of stainless steel, among which surface treatment has advantages of simple process and excellent price competitiveness. Chemical passivation among the surface treatment methods is a method of increasing the corrosion resistance by increasing the density of the chromium oxide of passive films and removing the inclusions in passive films by using citric acid or nitric acid. When a stronger oxidizing agent is added to the nitric acid solution, the corrosion resistance of passive films is further increased. In the past, sodium dichromate was mainly used as an oxidizing agent, but sodium molybdate appeared as an alternative agent due to the environmental problem of sodium dichromate. It is necessary to propose a model of how sodium molybdate affects the corrosion resistance through the action on the surface. In this study, I studied about the formation of passive films on the low nickel duplex stainles steel, STS 329 FLD, by chemical passivation surface treatment. Passive films were formed in nitric acid solutions containing 0 ~ 4.0wt.% sodium molybdate for 30 ~ 60minutes. The morphology, GDOES depth profiles of STS 304 and STS 329 FLD and potentiodynamic anodic polarization curves and EIS were investigated for the formation mechanism of the passive films. Experimental results show that addition of sodium molybdate to the nitric acid solution affected the morphology, the elemental distribution characteristics, and the corrosion resistance characteristics of the passive films. Surface inclusions decreased with the addition of sodium molybdate in the morphology. As a result, the pitting potential increased in the anodic polarization curves, and the roughness profile of the surface increased. As the elemental distribution of the passive films was increased by adding sodium molybdate, the content of iron decreased and chromium increased in the passive films. As a result, the corrosion current(Icorr) decreased in the anodic polarization curves. The electrochemical impedance(EIS) measurements results showed that the capacitance of the passive films increased when sodium molybdate was added. It is considered that not only the increase due to the decrease of the passive films thickness but also the existence of the molybdenum adsorbed on the outermost part of the passive films is due to the formation of the cation selective layer on the outermost surface and the formation of the anion selective layer on the inner passive films. As the passive films formed an electrical bilayer by the adsorption of molybdenum, the corrosion potential(Ecorr) was increased in the anodic polarization curves. In the nitric acid solution with sodium molybdate addition, as the surface treatment time became longer, the content of chromium increased and the corrosion current decreased and the pitting potential increased due to decreased of surface inclusions. The thickness of the passive films decreased with time. The content of molybdenum on the outermost surface decreased in 60minutes, and the capacatance of the electrochemical impedance decreased due to the decrease of molybdenum. Finally, we confirmed the possibility of sodium molybdate as an alternative to sodium dichromate and provided basic guidelines for improving the corrosion resistance of STS 329 FLD1. 서 론 1.1 연구배경 및 목적 1 1.2 연구내용 3 2. 이론적 배경 2.1 스테인리스강의 특성 4 2.1.1 스테인리스강의 장점 5 2.1.2 스테인리스강의 야금학적 특성 7 2.1.3 듀플렉스(Duplex) 스테인리스강 11 2.2 스테인리스강의 표면처리 15 2.2.1 연마 15 2.2.2 화학적 처리 19 2.3 부동태막의 형성 25 2.3.1 부동태막의 형성 기구 26 2.3.2 부동태막의 열역학 28 2.3.3 부동태막의 반응속도론 29 2.3.4 부동태막의 특성 34 2.4 부동태막의 파괴 42 2.4.1 공식 43 2.4.2 틈부식 52 3. 실험 방법 3.1 시편 제작 54 3.2 재료의 특성 분석 및 평가 58 3.2.1 레이저 현미경(LSM)에 의한 표면 조도 측정 58 3.2.2 주사전자현미경(SEM)에 의한 표면 몰포로지 관찰 58 3.2.3 전자미소분석(EPMA)에 의한 표면의 원소별 분포관찰 58 3.2.4 글로우방전방출분광법(GDOES)에 의한 깊이별 원소분포 59 3.2.5 전기화학적 분석에 의한 부동태막 구조와 내식특성 분석 60 4. 실험 결과 및 고찰 4.1 저니켈 듀플렉스 스테인리스강(STS 329 FLD)의 자연부동태막 특성 63 4.1.1 부동태막의 깊이별 원소 분포 63 4.1.2 자연 부동태막의 내식 특성 69 4.2 질산 표면처리 중 첨가한 Na2MoO4 농도에 따른 스테인리스강의부동태막 특성 72 4.2.1 부동태막의 몰포로지 관찰 72 4.2.2 부동태막의 깊이별 원소 분포 81 4.2.3 부동태막의 표면 특성 분석 100 4.2.4 부동태막의 내식 특성 106 4.3 질산 용액 중 첨가한 0.5wt.% Na2MoO4 표면처리 시간에 따른스테인리스강의 부동태막 특성 108 4.3.1 부동태막의 몰포로지 관찰 108 4.3.2 부동태막의 깊이별 원소 분포 114 4.3.3 부동태막의 표면 특성 분석 125 4.3.4 부동태막의 내식 특성 127 4.4 질산 표면처리한 저니켈 스테인리스강의 부동태막의 형성 메카니즘 130 5. 결 론 134 참고 문헌 136Maste

An anesthetic experience in a patient with Seckel syndrome: A case report

Seckel syndrome is an autosomal recessive, primordial dwarfism. The clinical symptoms and signs include severe intrauterine and postnatal growth retardation, nanocephaly, proportional dwarfism, bird-like faces, beak-like triangular nose, and mental retardation. We report a successful anesthetic management including endotracheal intubation with the GlideScope(R) video laryngoscope in an 18-year old man with Seckel syndrome for curettage of chronic osteomyelitis of pelvic boneope

Treatment of a Twelfth Rib Syndrome

Twelfth rib syndrome is thought to be due to intercostal nerve irritation by a mobile twelfth rib, and presents with upper abdominal pain, or low thoracic pain. This syndrome appears to be a fairly common entity and diagnosis is based on clinical findings. Patients with twelfth rib syndrome can be misdiagnosed when it has been overlooked. We report a case of a 34-year-old male along with a presentation of twelfth rib syndrome. One patient was transferred from urologic clinic to pain clinic due to right flank pain and admitted. The patient had direct tenderness on twelfth rib area and direct tenderness was reproducible. Pain increased when the patient flexed laterally, rotated trunk. There were no specific abnormal findings in laboratory test, electrocardiogram, and radiologic examination. After intercostal nerve block and epidural block, pain decreased and the patient was dischargedope

Chronic Mandibular Osteomyelitis with Normal Value of C-reactive Protein

A 58-year-old male was referred to our pain clinic with right lower facial pain of visual analogue scale 8/10 cm. One week ago, his right lower 3rd molar was extracted for vesicles at the buccal mucosal membrane and right lower facial hypoesthesia. Immunoserologic tests revealed negative varicella-zoster virus immunoglobulin-M, positive immunoglobulin-G and normal value of C-reactive protein. Buccal mucosa biopsy revealed squamous epithelial hyperplasia. Medications for pain control was pregabalin 150 mg PO bid, amitriptyline 10 mg PO hs, fentanyl patch 12.5 Ռg/h, carbamazepine 200 mg PO hs. C-arm guided block and pulsed radiofrequency lesionning was performed at mandibular branch of the right trigeminal nerve. And then VAS score was reduced to 4/10 cm. On facial bone CT, facial MRI and 3-phase bone scan, chronic osteomyelitis was suspected on the right mandible. Herpes zoster by atypical clinical manifestations was excluded. After additional biopsy and culture on lesion, antibiotics were used to treat the osteomyelitis and surgical follow-up was planned for surgical removal of necrotic tissue.ope

The Expression of the Ca++ Channel α2δ Subunit and TRPM8 in the Dorsal Root Ganglion of Sympathetically Maintained Pain and Sympathetic Independent Pain Rat Models

Background Peripheral nerve injury induces up-regulation of the calcium channel alpha2delta (α2δ) subunit and TRPM8 in the dorsal root ganglion (DRG) which might contribute to allodynia development. We investigated the expression of the α2δ subunit and TRPM8 in the DRG of sympathetically maintained pain (SMP) and sympathetic independent pain (SIP) rat model. Methods For the SMP model, the L5 and L6 spinal nerves were ligated tightly distal to the DRG. For the SIP model, the tibial and sural nerves were transected, while the common peroneal nerve was spared. After a 7 day postoperative period, tactile and cold allodynia were assessed using von Frey filaments and acetone drops, respectively. Expression of the α2δ subunit and TRPM8 in the L5 and L6 DRG were subsequently examined by a Western blot. Results There were no significant differences between the two models for the thresholds of tactile and cold allodynia. Expression of the α2δ subunit in the ipsilateral DRG to the injury was increased as determined on a Western blot as compared to that in the contralateral or sham-operated DRG of the SMP model, but there was no difference in expression seen with the use of the SIP model. There was no difference in the expression of TRPM8 in the ipsilateral DRG to the injury and the contralateral or sham-operated DRG of either model. Conclusions Up-regulation of the α2δ subunit in injured DRG may play a role that contributes to tactile allodynia development in SMP, but not TRPM8 to cold allodynia after peripheral nerve injurope

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

PURPOSE: We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia. MATERIALS AND METHODS: In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries. RESULTS: Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV. CONCLUSION: Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel's score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.ope

Participation of K(ATP) Channels in the Antinociceptive Effect of Pregabalin in Rat Formalin Test

BACKGROUND: Pregabalin is an anticonvulsant and analgesic agent that interacts selectively with the voltage-sensitive-Ca(2+)-channel alpha-2-delta subunit. The aim of this study was to evaluate whether the analgesic action of intrathecal (IT) pregabalin is associated with K(ATP) channels in the rat formalin test. METHODS: IT PE-10 catheters were implanted in male Sprague-Dawley rats (250-300 g) under inhalation anesthesia using enflurane. Nociceptive behavior was defined as the number of hind paw flinches during 60 min after formalin injection. Ten min before formalin injection, IT drug treatments were divided into 3 groups: normal saline (NS) 20 µl (CON group); pregabalin 0.3, 1, 3 and 10 µg in NS 10 µl (PGB group); glibenclamide 100 µg in DMSO 5 µl with pregabalin 0.3, 1, 3 and 10 µg in NS 5 µl (GBC group). All the drugs were flushed with NS 10 µl. Immunohistochemistry for the K(ATP) channel was done with a different set of rats divided into naïve, NS and PGB groups. RESULTS: IT pregabalin dose-dependently decreased the flinching number only in phase 2 of formalin test. The log dose response curve of the GBC group shifted to the right with respect to that of the PGB group. Immunohistochemistry for the K(ATP) channel expression on the spinal cord dorsal horn showed no difference among the groups 1 hr after the formalin test. CONCLUSIONS: The antinociceptive effect of pregabalin in the rat formalin test was associated with the activation of the K(ATP) channel. However, pregabalin did not induce K(ATP) channel expression in the spinal cord dorsal horn.ope

Alternative Method of Retrocrural Approach during Celiac Plexus Block Using a Bent Tip Needle

BACKGROUND: This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB). METHODS: CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a 10° bent tip needle under a 20° oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured. RESULTS: The imaginary safe oblique angle range was 26.4-34.2° and 27.7-36.0° on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient. CONCLUSIONS: We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a 20° oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.ope

Significance of active range of motion as pain indicator in cervical facet joint pain

의학과/석사[한글]서론: 경부통이 있는 환자에서 경추의 능동적 운동범위의 측정은 일상적으로 행해지는 이학적 검사이다. 본 연구는 일반적인 중력각도기를 사용하여 경부통이 있는 환자에서 경추 후지 내측지 차단술 전 후에 경추의 능동적 운동범위를 측정하여 그 변화를 관찰하였으며, 그 변화가 시각통증척도 점수와는 어떤 상관관계가 있는지 살펴보기 위한 것이다. 경추부 후지 내측지 차단술 시술 전후에 시각통증척도 점수와 능동적 운동범위를 측정하여, 시술 전에 비해서 시술 후에 어떻게 변화되는지 확인하고, 시술 전과 시술 후 1시간, 시술 후 1주일에 측정된 시각통증척도 점수 및 능동적 운동범위 자체가 상관관계가 있는지 살펴보고, 시술 전 시각통증척도 점수와 시술 전후 측정된 능동적 운동범위변화가 상관관계가 있는지 살펴보고자 한다.대상 및 방법: 병원 윤리위원회의 심사를 통과하고, 대상환자에게 본 연구의 방법과 목적을 설명하고 환자의 동의 하에 연구를 시행하였다. 2009년 3월부터 6월 사이에 본원 통증클리닉을 방문한 18세에서 65세 사이의 경부통 외에는 특별한 질환을 가지고 있지 않은 환자들을 대상으로 하였다. 경부통 중에서 후관절통(facet joint pain)을 가진 환자들만을 대상으로 하였고, 신경뿌리병증(radiculopathy)이 있거나, 추간판성 통증(discogenic pain)이 의심되는 환자는 제외하였다. 이런 환자들 중에서 2주간 물리치료나 약물치료를 실시하여 통증 조절이 되지 않는 경추 후관절통 환자 48명을 대상으로 하였다. 시술 전 1차로 능동적 운동범위와 시각통증척도 점수(VAS score)를 측정하였고, 경추 후지 내측지 차단술을 시행한 후, 1시간 후에 2차로 능동적 운동범위와 시각통증척도 점수를 측정하였다. 1주일 후에 3차로 능동적 운동범위와 시각통증척도 점수를 측정하였다. 시술 전 측정치와 1시간, 1주일 후 측정치의 시간에 따른 변화의 유의성을 검증하였다. 전체 환자에서 시술 전후에 시각통증척도 점수와 능동적 운동범위의 상관관계를 확인하였다. 양쪽을 시술한 군을 제외하고 오른쪽을 시술한 군과 왼쪽을 시술한 군의 합, 30명에 대해서, 시술한 쪽을 기준으로 동측(ipsilateral), 반대측(contralateral)으로 나누어 각각 시술 전 시각통증척도 점수와 시술 후 능동적 운동범위변화의 상관관계를 확인하였다. 결과: 48명(오른쪽 차단 12명, 왼쪽 차단 18명, 양쪽 차단 18명)의 환자에서 경추 후지 내측지 차단 전, 차단 후 1시간, 차단 후 1주일에 측정한 시각통증척도 점수 및 능동적 운동범위를 반복측정분산분석(repeated measured ANOVA)으로 분석한 결과 목의 굴곡을 제외한 모든 값에서(p<0.05) 통계적으로 유의한 변화를 보였다. 시술 후 1시간, 시술 후 1주일에서 각각 시각통증척도 점수 -30.1%, -38.6%, 목의 신전 9.6%, 10.2%, 목의 오른쪽 측면 굽힘 18.5%, 15.5%, 왼쪽 측면 굽힘 8.5%, 10.9%, 목의 오른쪽 회전 9.2%, 13.9%, 왼쪽 회전 12%, 17.7%의 변화가 있어 시술 전후 시각통증척도 점수와 능동적 운동범위는 각각 호전을 보였지만, 시각통증척도 점수와 능동적 운동범위의 상관관계는 낮았다. 나이, 성별, 시술분절의 수, 시술한 쪽의 차이에 의한 능동적 운동범위의 유의한 차이는 없었다. 그러나, 양쪽을 시술한 18명을 제외한 30명에서 시술 전 시각통증척도 점수와 시술 1주일 후의 능동적 운동범위변화의 상관관계에서는 동측, 반대측 회전에서 각각 p=0.017 (R=-0.433), p=0.042 (R=-0.374)로 통계적으로 유의한 역 상관관계가 있는 것으로 나타나서 시술 전 시각통증척도 점수가 낮은 환자일수록 시술 후 능동적 운동범위의 증가가 커지는 경향을 보여 주었다.결론: 경추 후관절통 환자에서 경추 후지 내측지 차단술 시행 후 시각통증척도 점수가 감소하였으며 능동적 운동범위는 목의 굴곡을 제외하고 유의하게 증가하였다. 각 측정 시점에서 시각통증척도 점수와 능동적 운동범위의 상관관계는 높지 않았다. 양측을 차단한 18명을 제외한 30명에서 시술 전 시각통증척도 점수와 시술 1주일 후 동측, 반대측 회전의 변화 사이에 통계적으로 유의한 역 상관관계가 있었다. 따라서, 시술 전 시각통증척도 점수가 높은 환자는 시각통증척도 점수의 감소를 통증평가지표로 삼을 수 있고, 시술 전 시각통증척도 점수가 낮은 환자는 시술 후 1주일에 회전변화를 측정하여 통증평가지표로 삼을 수 있을 것이다. [영문]Introduction: The cervical active range of motion should be checked daily by a physical examination in patients with neck pain. This study examined the change in the active range of motion and the visual analogue scale score after a cervical medial branch block and the correlation between the active range of motion and visual analogue scale score after a cervical medial branch block using a commonly used gravity-based goniometer. The visual analogue scale score, active range of motion was measured before and after a cervical medial branch block, and the correlation between a visual analogue scale score before the cervical medial branch blocks and the change in the active range of motion at 1 hour, and 1 week after the cervical medial branch block was examined. The correlation between the visual analogue scale score and active range of motion before, 1 hour and 1 week after the cervical medial branch block was also examined. Objectives and Methods: After gaining approval of the hospital ethical committee, the aims and method of this study were explained to the patients. The subjects were 48 patients who visited our pain clinic from March 2009 to June 2009. The patients were 18-65 years old and had no disease except for neck pain. Patients with cervical radiculopathy and discogenic pain were excluded. Patients with facet joint pain that was not relieved by physical therapy and medication for 2 weeks were included. The active range of motion, visual analogue scale score was measured before, 1 hour and 1 week after the cervical medial branch block. The change in the active range of motion, visual analogue scale score was examined at each time. Excluding the group given injections in both sides, the remaining 30 patients given a right and left injection were divided into the ipsilateral, and contralateral groups, respectively. The correlation between the visual analogue scale score before the cervical medial branch block, and the change in the active range of motion in the ipsilateral and contralateral group (we excluded flexion and extension) was examined. The correlation between the visual analogue scale score and the active range of motion was investigated in all patients at each time. Results: An analysis of 48 patients (right 12, left 18, both 18) by repeated measured ANOVA showed significant changes in the active the cervical medial branch block was examined. The correlation between the visual analogue scale score and active range of motion before, 1 hour and 1 week after the cervical medial branch block was also examined. Objectives and Methods: After gaining approval of the hospital ethical committee, the aims and method of this study were explained to the patients. The subjects were 48 patients who visited our pain clinic from March 2009 to June 2009. The patients were 18-65 years old and had no disease except for neck pain. Patients with cervical radiculopathy and discogenic pain were excluded. Patients with facet joint pain that was not relieved by physical therapy and medication for 2 weeks were included. The active range of motion, visual analogue scale score was measured before, 1 hour and 1 week after the cervical medial branch block. The change in the active range of motion, visual analogue scale score was examined at each time. Excluding the group given injections in both sides, the remaining 30 patients given a right and left injection were divided into the ipsilateral, and contralateral groups, respectively. The correlation between the visual analogue scale score before the cervical medial branch block, and the change in the active range of motion in the ipsilateral and contralateral group (we excluded flexion and extension) was examined. The correlation between the visual analogue scale score and the active range of motion was investigated in all patients at each time. Results: An analysis of 48 patients (right 12, left 18, both 18) by repeated measured ANOVA showed significant changes in the active range of motion except for flexion, and the visual analogue scale score before, 1 hour and 1 week after the cervical medial branch block. The change at 1 hour and 1 week after cervical medial branch block was respectively, -30.1% and -38.6% in the visual analogue scale score, 9.6% and 10.2% in extension, 18.5% and 15.5% in right lateral bending, 8.5% and 10.9% in left lateral bending, 9.2% and 13.9% in right rotation, and 12% and 17.7% in left rotation. There was no correlation between the visual analogue scale score and active range of motion at any time, even though the VAS and active range of motion had improved. In 30 patients injected on either side, there was an inverse correlation between the visual analogue scale score before the cervical median branch block and the change in the ipsilateral, contralateral rotation at 1 week after the cervical medial branch block (p = 0.017 and 0.042; R=-0.433 and -0.0374). Conclusions: In patients with facet joint pain, there were significant decreases in the visual analogue scale score, and increases in the active range of motion after the cervical medial branch block. The visual analogue scale score was not associated with the active range of motion at each time point. The change in the ipsilateral and contralateral rotation at 1 week after the cervical medial branch block was inversely correlated with the visual analogue scale score before the cervical medial branch block. In patients with a high VAS before the cervical medial branch block, a low VAS would be a pain indicator. However, in patients with a low VAS before the cervical medial branch block, monitoring the increase in ipsilateral or contralateral rotation of the neck 1 week after a cervical medial branch block would be a new method for assessing the level of pain.ope