A 29-year-old male patient was referred to our department for chronic pain control due to a brachial plexus injury. He was referred to our department for chronic pain control due to a pulled brachial plexus injury. After a thorough examination, male hypogonadism was suspected, and therapeutic intervention was performed, resulting in good pain control. Finding factors that can improve the patient's ADL and quality of life is also an important task for pain clinicians.

We report a case in which a splanchnic nerve block for osteophyte formation resulted in diaphragmatic puncture during the procedure and was converted to a celiac plexus block. A man in his 70s with severe opioid-resistant abdominal pain due to pancreatic tail cancer was scheduled for a splanchnic nerve block. Pre-block imaging revealed osteophyte formation in his spine. While performing the block, the needle tip traversed the osteophyte and reached the diaphragmatic crus, resulting in diaphragmatic contrast. With the safety of the needle position confirmed by CT-like imaging, we proceeded to advance the needle and performed the celiac plexus block. Unnoticed diaphragmatic puncture during neuroleptic drug injection may cause complications such as upper abdominal, lateral thoracic, and shoulder discomfort, along with diaphragmatic nerve palsy. Need to pay attention to contrast findings during the block.

Lumbar facet joint hypoplasia is a very rare congenital disease that can cause low back pain. We report a case of lumbar facet joint pain (LFJP) with hypoplasia of the lumbar facet joint, in which interventional treatment was performed using 3D-CT images. The patient was a male in his twenties. CT showed hypoplasia of the right L5/S1 facet joint and there were spontaneous pain and tenderness in the same area, These findings led us to suspect LFJP. Facet block (FB) under fluoroscopic guidance was attempted, but it was difficult to identify the facet joint due to its morphological abnormality, so it was carried out by comparing 3DCT images together. Since FB was effective, we diagnosed his pain as LFJP. Because the effect of FB was short-term, facet rhizotomy was also performed using 3D-CT images, and long-term pain relief was obtained. In the case of nerve block with morphological abnormalities as in the present case, 3DCT images were very useful.

We report a case of postoperative residual pain for L4 schwannoma treated with pulsed radiofrequency (PRF) to the L4 nerve root using Shamrock view (SV) and anterior approach through fascia iliaca compartment (FI) in the supine position. The patient, a 50-year-old man, was diagnosed with right L4 schwannoma and had undergone tumor resection with motor branch preservation at another hospital. Following the surgery, he developed pain and numbness in his right lower extremity. He came to our hospital because of his residual pain. We performed an ultrasound-guided pulsed radiofrequency (PRF) treatment at 42℃ for 8 minutes on the right L4 nerve root via SV and FI in the supine position, as we could confirm the schwannoma and the nerve root within the psoas muscle. The patient experienced pain relief from the PRF treatment. Our case suggests that lower lumbar root PRF with an extraperitoneal approach in the supine position can be effective when conventional methods are challenging.