슬관절경 수술 후 관절강 내 주입한 Bupivacaine 및 Morphine이 통증에 미치는 영향

Postoperative Analgesic Effect of Intraarticular Bupivacaine or Morphine After Arthroscopic Knee Surgery

전신 흡입 마취로 슬관절경 수술을 받은 건강한 환자 60명을 대상으로 슬관절경내 Morphine 3 mg을 주입한 군(20명)과 0.25% Bupivacaine 20 ml을 주입한 군(20명)과 약제를 주입하지 않은 대조군(20명)의 통증 정도를 술후 1, 2, 4, 6, 12, 24시간 동안 Visual Analogue Pain Scale을 이용하여 비교 평가하여 다음과 같은 결론을 얻었다. 1) 슬관절강내 0.25% Bupivacaine 20 ml을 주입한 군에서 술후 첫 1, 2시간 동안 통계학적으로 의의있는 통증 점수를 나타내었다. 2) 슬관절강내 Morphine 3 mg을 주입한 군에서는 술후 4시간부터 통계학적으로 의의있는 통증 점수가 나타난 뒤 실험이 끝날 때까지 지속적인 진통효과를 나타내었다. 3) 구역, 구토, 소양증, 뇨정체, 호흡억제 등의 전신적인 부작용은 나타나지 않았다. 이상과 같이 소량의 Morphine을 관절강내 주입함으로써 술후 통증을 감소시켜 진통제의 사용량을 줄일 수 있었다.

Recent studies have shown that opiods can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. This study sougt to compare the effects of morphine with those of bupivacaine administered intraarticularly upon pain after arthroscopic knee surgery. In a ramdomized manner, 60 healthy patients received either morphine(3 mg in 20 ml NaCl ; n=20), bupivacaine(20 ml, 0.25% ; n=20) intraarticularly at the completion of surgery, and others were not administered(n=20) under general anesthesia after 1, 2, 4, 6, 12 and 24h of postoperative day, pain was assessed by a visual analogue pain scales, time to first analgesic use were recorded. Pain scores were significantly greater in the morphine group than two groups at 1h. From 4th until the end of the study period, pain scores were significantly greater in the bupivacaine group than in the other two group. Anagesic requirements were significantly greater in the morphine group than two groups at 1h but were significantly greater in the bupivacaine group than in the other groups throughout the remainder of the study period. The results suggest that intraarticular morphine produces an analgesic effect of delayed onset but of remarkably long duration.