The aims of this study were to investigate the current clinical practice of ultrasound (US)guided stellate ganglion block (SGB) using a bi-national survey of Korea and Japan, and to clarify the anatomical relation of the cervical sympathetic trunk with the prevertebral fascia at the level of cervical vertebrae. The current clinical practice of US-guided SGB in Korea and Japan was investigated using an Internet survey, which received 206 (10.2%) replies from Korea and 97 (8.8%) replies from Japan. The survey questionnaire addressed the actual clinical practice for US-guided SGB, including where the tip of the injection needle is placed. Additionally, 16 half necks of 8 embalmed cadavers were used in an anatomical study. An inplane needle approach technique and administering 5 ml of local anesthetic were preferred in both countries. However, the type of local anesthetic differed, being lidocaine in Korea and mepivacaine in Japan. The final position of the needle tip also clearly differed in an US image, being predominantly positioned above the prevertebral fascia in Korea (39.3%) and under the prevertebral fascia in Japan (59.8%). In all of the anatomic dissections, the cervical sympathetic trunk was over the prevertebral fascia at the level of the sixth vertebra and under the prevertebral fascia at the level of the seventh vertebra. These results are expected to improve the knowledge on the current clinical practice and to suggest future studies.

Background Various developments in imaging techniques, interventional procedures, and medications for pain management have beneficial consequences. However, the nature of pain management often results in physicians becoming involved in medico-legal disputes with patients who purposely or accidentally bring litigation. Methods Data on medical disputes cases related to pain management were collected and analyzed through the Korea Medical Dispute Mediation and Arbitration Agency from 2012 to 2016. Results In total, we identified 210 public-disclosed cases; of these, we identified 36 cases related to pain management. The department of orthopedics (n = 9, 25%) was the most related to these pain management cases. Pain management was most commonly offered for pain in the lumbar region (n = 13, 37%), lower extremities (n = 12, 34%), and for infection (n = 7, 19%). The time spent resolving disputes ranged from 8.0 to 17.5 months and the final settlement amount ranged from 1,800,000 to 15,000,000 Korean won. Causal relationships and medical malpractice were the most common controversial subjects of legal debate. Conclusions Various characteristics of medical disputes related to pain management in Korea were identified. Information regarding medical disputes in pain management should be available to help prevent further disputes and litigation, which is also useful to both patients and pain physicians. Guidelines and recommendations for pain management are needed, especially those focused on medico-legal cases.

The aim of this study was to clarify the distribution patterns of the cutaneous nerves on the dorsum of the foot. This study investigated 130 feet of 77 cadavers. The distribution patterns of the sural (SN) and deep fibular nerves (DFN) were classified into five and four types, respectively. In Type A, the SN was only distributed to the lateral side of the fifth toe. In Type B, the nerve was distributed to the medial side of the fourth toe and both sides of the fifth toe. In Type C, the nerve was mainly distributed to the lateral side of the fifth toe. In Type D, the nerve was distributed to the lateral side of the third toe and both sides of the fourth and fifth toes. In Type E, no SN was found. In Type α, the DFN was simultaneously distributed to the lateral side of the first toe and the medial side of the second toe. In Type β, the nerve was distributed like in Type α and additionally to the medial side of the first toe. In Type γ, the nerve was distributed like in Type α and additionally to the lateral side of the second toe and the medial side of the third toe. In Type δ, no DFN was found. The results of this study will help physicians to reduce the incidence of iatrogenic nerve injury and improve the quality of diagnoses of relevant nerves in this body region. Clin. Anat. 33:592-597, 2020.