전슬관절치환술 후 경막외 자가조절진통 약제에 혼합한 Naloxone의 효과

Effects of Naloxone Mixed with Patient-Controlled Epidural Analgesia Solution after Total Knee Replacement Surgery

  • 권민아 (단국대학교 의과대학 마취통증의학교실) ;
  • 박효원 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 이애령 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 김태형 (성균관대학교 의과대학 삼성서울병원 마취통증의학과) ;
  • 이관우 (단국대학교 의과대학 마취통증의학교실) ;
  • 김석곤 (단국대학교 의과대학 마취통증의학교실) ;
  • 최덕환 (성균관대학교 의과대학 삼성서울병원 마취통증의학과)
  • Kwon, Min A (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University) ;
  • Park, Hyo Won (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Ae Ryong (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Tae Hyung (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Gwan Woo (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University) ;
  • Kim, Seok Kon (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University) ;
  • Choi, Duck Hwan (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2006.09.28
  • 심사 : 2006.11.28
  • 발행 : 2006.12.30

초록

Background: Patient-controlled epidural analgesia (PCEA), using a local anesthetic-opioid mixture, has been effectively applied after total knee replacement (TKR) surgery, which is associated with intense postoperative pain that requires postoperative analgesia for both rehabilitation and the pain itself. However, adverse opioid-related effects, such as nausea, vomiting and pruritus, are commonly encountered. It was our hypothesis that the adverse opioid-related effects could be reduced by the addition of naloxone, an opioid antagonist, to a mixture of fentanyl-ropivacaine PCEA. Methods: In 120 patients undergoing elective TKR surgery, epidural or combined spinal-epidural (CSE) anesthesia was performed and PCEA applied. In the control group (n = 65), 0.16% ropivacaine and $3{\mu}g/ml$ fentanyl ($2.4{\mu}g/ml$ for those older than 65 yrs) were administered. In the naloxone group (n = 55), naloxone ($2{\mu}g/ml$) was coadministered with the above regimen. The incidence and severity of postoperative nausea and vomiting, and the frequency of pruritus, the visual analog score (VAS) and the PCEA volume used were assessed 6 and 24 hrs after surgery. Results: The incidence of nausea and vomiting during the early postoperative period, and those of pruritus during the late postoperative period were significantly lower in the naloxone group. The VAS pain scores, the PCEA volume used and amount of rescue IV meperidine were similar in the two groups. Conclusions: A small dose of naloxone mixed with an opioid significantly reduces the incidence and severity of adverse opioid-related effects in PCEA, without reducing the analgesic effect.

키워드

참고문헌

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