Percutaneous epidural adhesiolysis (PEA) uses a larger volume of drug solution than epidural block and it can be dangerous if the solution is misadministered into the subarachnoid space. Detection of myelography findings during PEA is very important to avoid subarachnoid block, but this can be sometimes difficult to determine. We report two cases in which PEA was performed under biplane fluoroscopic guidance; however, we could not detect a myelogram that overlapped with an epidural contrast image. We should always keep in mind that unintentional myelography are always possible during PEA, and CT scan should be performed to detect unintentional myelography.

A 15-year-old female patient was referred to our department because she had been suffering from low back pain for 2 years and her symptoms did not improve after a thorough examination and treatment at her previous doctor. MRI showed intervertebral joint edema, and her clinical symptoms suggested that her pain was caused by her intervertebral joints. A intervertebral joint block under sedation was performed for diagnostic purposes, and the patient's symptoms temporarily relieved. Intervertebral joint block and posterior medial branch block pulsed radiofrequency under sedation were performed for pain exacerbation. Sedated nerve blocks are not recommended for early detection of complications, but may be an option in younger patients with high anxiety. We experienced a case in which an intervertebral joint block under sedation was effective in a young patient with chronic low back pain.

During mandibular osteoplasty, ultrasound-guided mandibular nerve block for anterior face pain was performed using the Gasserian ganglion block landmarks as a reference. The skull base around the foramen ovale was visualized through echography, and ropivacaine was injected 3 cm lateral to the oral commissures when a mandibular nerve twitch was observed, symbolizing nerve stimulation. During the surgery, the patient's vitals were stabilized by a combination of a low dose opioids, which may have had some degree of analgesic effects.

We experienced a teenage case of nonfreezing cold injury (NFCI) in a patient who spent approximately 2 weeks exposure in a cold environment. Following a bath that warmed the lower extremities, the patient abruptly experienced severe pain and difficulty walking, despite no frostbite in the skin or soft tissues. The sensory examination on both feet revealed no response to cold temperature and pinprick stimuli, but severe allodynic pain caused by light touch. Vasodilation and sympathetic nerve block did not change the pain. NFCI was diagnosed, and treatment with amitriptyline, pregabalin, tramadol, and continuous lumbar epidural block was started, but walking was difficult due to severe allodynia when weight was placed on the sole of the feet. After about 2 months treatment including physical rehabilitation, the neropathy were suddenly recovered, the pain disappeared and walking has also become possible.

We report a case of a 53-year-old super-obese woman who was treated with acupuncture for sequelae of peripheral facial nerve palsy associated with Ramsay Hunt syndrome. The paralysis score on the Yanagihara 40-point system at the first visit was 4 points. 17 days after onset, the patient was referred to the Anesthesiology Department, where she underwent polarized near-infrared light therapy and SSP therapy. 7 months after onset, the score improved to 14 points. However, since facial tightness did not improve, acupuncture was started 9 months after onset. A total of 10 treatments were conducted, once every 1 to 2 weeks. The accompanying symptoms such as facial tightness, stiff neck and shoulders, and cold feet improved, thereby relieving anxiety and increasing the score to 20 points. Thus, in pain clinics, acupuncture may be considered a safe and effective treatment for improving sequelae and quality of life in patients with peripheral facial nerve palsy and high-risk background factors.

The patient was a woman in her 50s. She had pain below her ankle joint and was hospitalized due to extensive thrombosis and arterial occlusion below the renal abdominal aorta. She was diagnosed as chronic limb-threatening ischemia (CLTI) of the lower limb. Although amputation was needed, she did not wish to undergo aggressive treatment. Pain was well controlled with radiofrequency thermocoagulation (RF) performed four times. RF of peripheral nerves for CLTI is an effective option for pain relief, considering the patient's prognosis and the balance of activity of daily living.

Hydromorphone is similar to morphine in structural formula, pharmacological effect, adverse effect and metabolism. Although it can be used in relatively safe for patients with reduced renal function, neuroexcitation is reported in the case of high dose or long duration. The patient was 79 year old male suffered from the squamous cell cancer of the left pulmonary upper lobe with middle grade renal dysfunction. After hydromorphone was administered by continuous subcutaneous infusion for 3 days he appeared neuroexcitation, and smoothly recovered with rotation to morphine by continuous subcutaneous infusion. Accumulation of hydromorphone-3-glucuronide metabolite from hydromorphone is associate with the development of neuroexcitation. Hydromorphone has to be used with careful observation even though small dosage or short duration.