The Committee on Safety of the Japan Society of Pain Clinicians (JSPC) has investigated the adverse events (AEs), which are categorized from level 0 to 5 according to the severity by “the incident severity classification system recommended by the National University Hospital Council of Japan” in pain-related management of all Japanese board-certificated training facilities since 2009. By referring to this classification system, it is mandatory to report AEs of 3a or above and more detailed reports are requested for AEs of 3b or above. Here we report AEs and facility information in 2019 and 2020. In this survey, we received responses from 98％ of the facilities in both years. There were 8 cases of 3b or above AEs in 2019 and 7 cases in 2020 related to analgesics/additives, and 64 cases in 2019 and 52 cases in 2020 related to nerve block/interventional therapy. It is necessary to share the results among the members of the JSPC and enhance the recognition of risk management in pain treatment settings.

Objective: We report cases of trigeminal neuralgia that was difficult to treat with medication or other nerve block therapy. Methods: Five patients with trigeminal neuralgia of the second branch of the trigeminal nerve all had inadequate response to medical treatment. 4 patients had difficulty with Gasserian ganglion block or had residual pain even when it could be performed. 1 patient initially opted for large palatine nerve block. Infraorbital nerve block was used in all patients. Results: Compared with fluoroscopic nerve blocks such as Gasserian ganglion block, palatine nerve block is a simple procedure with less invasion and pain for patients. In all patients, the pain disappeared for more than 1 year.

Anterior cutaneous nerve entrapment syndrome (ACNES) is one of the causes of abdominal pain. We report that ultrasound-guided blocks were effective for cases in which ACNES developed 10 days after laparoscopic surgery and six years after laparotomy. Both cases showed normal laboratory and imaging findings. Carnett's sign was positive in both cases. The first case was an 81-year-old woman who underwent laparoscopic pyloric gastrectomy for gastric cancer. Ten days after surgery, tenderness was observed in the sutured parts after drain removal. An ultrasound-guided rectus sheath block was applied three times to treat the pain. The second case was a 53-year-old man who underwent laparotomy for perforated appendicitis. Six years after the operation, tenderness appeared on the sutured parts when abdominal pressure was applied. Exploratory laparoscopy was performed but the cause of the pain could not be determined, and ACNES was considered. Repeated ultrasound-guided rectus sheath blocks and transversus abdominis plane blocks were applied to treat the pain.