The Korean Journal of Pain

  • 제20권2호
  • /
  • Pages.123-129
  • /
  • 2007
  • /
  • 2005-9159(pISSN)
  • /
  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지
DOI QR코드

DOI QR Code

경막외 Naloxone 투여가 경막외 Sufentanil에 의한 가려움증에 미치는 영향

Effects of Epidural Naloxone on Pruritus Induced by Epidural Sufentanil

  • 임의성 (마디병원 마취통증의학과) ;
  • 김기준 (연세대학교 의과대학 마취통증의학교실) ;
  • 윤주선 (연세대학교 의과대학 마취통증의학교실) ;
  • 남순호 (연세대학교 의과대학 마취통증의학교실) ;
  • 공명훈 (고려대학교 의과대학 마취통증의학교실)
  • Lim, Eui Sung (Department of Anesthesiology and Pain Medicine, Madi Hospital) ;
  • Kim, Ki Jun (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Yoon, Joo Sun (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Nam, Soon Ho (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Kong, Myoung Hoon (Department of Anesthesiology and Pain Medicine, Korea University College of Medicine-)
  • 투고 : 2007.07.25
  • 심사 : 2007.10.05
  • 발행 : 2007.12.10
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Postoperative pruritus following the administration of epidural narcotics is a very common and undesirable side effect. Therefore, we evaluated the use of a combination of naloxone and sufentanil via patient controlled epidural analgesia to determine if the incidence of pruritus was decreased when compared to the use of sufentanil alone. Methods: Patients scheduled for subtotal gastrectomy under general anesthesia were enrolled in a prospective, double-blinded and randomized trial. All patients received a $20{\mu}g$ epidural bolus of sufentanil in 5 ml of 0.2% ropivacaine. Following administration of the epidural, patients in the sufentanyl group (S) received a continuous epidural comprised of sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine, whereas patients in the naloxone group (N) received an epidural infusion comprised of naloxone ($4{\mu}g/ml$) and sufentanil ($0.75{\mu}g/ml$) in 0.2% ropivacaine. The infusion rate, demand dose and lockout interval were 5 ml/hr, 0.5 ml and 15 minutes respectively. Next, the occurrence of postoperative analgesia and side effects were evaluated by blinded observers. Results: The incidence of pruritus (47.4% versus 20.0%, P = 0.013) and nausea (42 .1 % versus 20.0%, P = 0.043) were lower in group N than in group S. In addition, there were no significant differences observed in the visual analogue scale, the incidence of vomiting or the incidence of sedation. Furthermore, epidural infusion of naloxone at $0.25-0.4{\mu}g/kg/hr$ did not affect the requirement for postoperative sufentanil. Conclusions: Epidural naloxone reduces epidural sufentanil induced pruritus and nausea without reversing its analgesic effects.

키워드

참고문헌

  1. Ueda H, Fukushima N, Kitao T. Ge M, Takagi H: Low doses of naloxone produce analgesia in the mouse brain by blocking presy naptic autoinhibition of cnkephalin release. Neurosci Lett 1986, 65: 247-52 https://doi.org/10.1016/0304-3940(86)90269-7
  2. Rawal N, Schon U. Dahlstrom B. lnnnrisi CE, Tandon B. Sjo srrand U, et al: Influence of naloxone infus ion on analgesia and respiratory depress ion following epidural morphine. Anesthesiology 1986; 64: 194-201 https://doi.org/10.1097/00000542-198602000-00011
  3. Gan TJ, Ginsberg B. Glavs PSt Fortney J. Jhnveri R. Perno R: Opioid-sparing effects of a low-dose infus ion of naloxone in patient-administered morphine sulfate. Anesthesiology 1997; 87: 1075-81 https://doi.org/10.1097/00000542-199711000-00011
  4. Crain SM, Shen KF: Antagonists of excitatory opioid receptor functions enhance morphine's analgesic potency and attenuate opioid tolerance/dependence liability. Pain 2000; 84: 121-31 https://doi.org/10.1016/S0304-3959(99)00223-7
  5. Choi JH. Lee J. Choi JH. Bishop MJ: Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacainc. Can J Anacsth 2000; 47: 33-7 https://doi.org/10.1007/BF03020728
  6. Jeon Y, Hwang J, Kang J, Han S, Rhcc K. Oh Y: Effects of epidural naloxone on pruritus induced by epidural morphine: a randomized controlled trial. lnt J Obstci Anesth 2005; 14: 22-5 https://doi.org/10.1016/j.ijoa.2004.06.001
  7. Lee JM, Choi JH: Effects of epidural naloxone on intestinal hypomotility caused by epidural morphine after gas trcctomy. Korean J Anesthesiol 1999; 37: 73-8 https://doi.org/10.4097/kjae.1999.37.1.73
  8. Cousins MJ, Mather LE: Intrathecal and epidur al administration of opioids. Anesthesiology 1984; 61: 276-310
  9. Kjellberg F, Tranter MR: Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials. Eur J Anacsthesiol 2001; 18: 346-57 https://doi.org/10.1097/00003643-200106000-00002
  10. Tuned G. Ozalp G. Savli S. Cunolcr O. Kaya M, Kadiogullari N: Epidural ropivaca inc or sufentanil-ropivacainc infusions for post-thoraco tomy pain. Eur J Cardiothorac Surg 2005, 28: 375-9 https://doi.org/10.1016/j.ejcts.2005.05.017
  11. Schug SA. Scott OA, P;.tyne J. Mtxmcy PH. Hagglof B: Posloperative analgesia by conlinuous extradural infusion of ropivaeainc after uppcr ahdom inal surgery. Br J Anaesth 1996; 76: 487-91 https://doi.org/10.1093/bja/76.4.487
  12. Szarvas S, Harmnon D, Murphy D: Neuraxial opioid-induced pruritus: a revicw. J Clin Anesth 2003; 15: 234-9 https://doi.org/10.1016/S0952-8180(02)00501-9
  13. Sanansilp V, Arecwalana S. Tonsukchai N: Droperidol and the s ide ef fects of epidural morphine after cesarcan section. Anesth Analg 1998; 86: 532-7 https://doi.org/10.1097/00000539-199803000-00016
  14. Vereauteren MP, Vandeput DM. Meert TF. Adriaensen HA: Patient-controlled epidural analgesia with sufentanil following caesarean section: the effect of adrenaline and clonidine admixture. Anaesthesia 1994; 49: 767-71 https://doi.org/10.1111/j.1365-2044.1994.tb04447.x
  15. Waxler B, Mondragon SA, Patel SN, Nedumgottil K: Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil. Can J Anaesth 2004; 51: 685-9 https://doi.org/10.1007/BF03018426
  16. Horta ML, Morejon LC, Da Cruz AW, Dos Santos GR, Welling LC, Terhorst L, et al: Study of the prophylactic effect of droperidol, alizapride, propofol and promethazine on spinal morphine-induced pruritus. Br J Anaesth 2006; 96: 796-800 https://doi.org/10.1093/bja/ael072
  17. Kim JY, Lee SJ, Koo BN, Noh SH, Kil HK, Kim HS, et al: The effect of epidural sufentanil in ropivacaine on urinary retention in patients undergoing gastrectomy. Br J Anaesth 2006; 97: 414-8 https://doi.org/10.1093/bja/ael172
  18. Cepeda MS, Africano JM, Manrique AM, Fragoso W, Carr DB: The combination of low dose of naloxone and morphine in PCA does not decrease opioid requirements in the postoperative period. Pain 2002; 96: 73-9 https://doi.org/10.1016/S0304-3959(01)00425-0
  19. Cepeda MS, Alvarez H, Morales O, Carr DB: Addition of ultralow dose naloxone to postoperative morphine PCA: unchanged analgesia and opioid requirement but decreased incidence of opioid side effects. Pain 2004; 107: 41-6 https://doi.org/10.1016/j.pain.2003.09.011
  20. Sartain JB, Barry JJ, Richardson CA, Branagan HC: Effect of combining naloxone and morphine for intravenous patient- controlled analgesia. Anesthesiology 2003; 99: 148-51 https://doi.org/10.1097/00000542-200307000-00024
  21. Glass PS, Jhaveri RM, Smith LR: Comparison of potency and duration of action of nalmefene and naloxone. Anesth Analg 1994; 78: 536-41
  22. Kakinohana M, Marsala M, Carter C, Davison JK, Yaksh TL: Neuraxial morphine may trigger transient motor dysfunction after a noninjurious interval of spinal cord ischemia: a clinical and experimental study. Anesthesiology 2003; 98: 862-70 https://doi.org/10.1097/00000542-200304000-00012
  23. Okutomi T, Saito M, Mochizuki J, Amano K: Prophylactic epidural naloxone reduces the incidence and severity of neuraxial fentanyl-induced pruritus during labour analgesia in primiparous parturients. Can J Anaesth 2003; 50: 961-2 https://doi.org/10.1007/BF03018748
  24. Blaise G: Should we use naloxone epidurally? Can J Anaesth 2003; 50: 875-8 https://doi.org/10.1007/BF03018731
  25. Scott DA, Blake D, Buckland M, Etches R, Halliwell R, Marsland C, et al: A comparison of epidural ropivacaine infusion alone and in combination with 1, 2 and 4 ${\mu}$ g/ml fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery. Anesth Analg 1999; 88: 857-64 https://doi.org/10.1097/00000539-199904000-00033
  26. Brodner G, Mertes N, Van Aken H, Pogatzki E, Buerkle H, Marcus MA, et al: Epidural analgesia with local anesthetics after abdominal surgery: Earlier motor recovery with 0.2% ropivacaine than 0.175% bupivacaine. Anesth Analg 1999; 88: 128-33 https://doi.org/10.1097/00000539-199901000-00024
  27. De Cosmo G, Primieri P, Adducci E, Fiorenti M, Beccia G: Epidural analgesia in abdominal surgery: 0.2% ropivacaine with sufentanil. Minerva Anestesiol 2004; 70: 503-8
  28. Brodner G, Mertes N, Van Aken H, Mollhoff T, Zahl M, Wirtz S, et al: What concentration of sufentanil should be combined with ropivacaine 0.2% wt/vol for postoperative patient-controlled epidural analgesia? Anesth Analg 2000; 90: 649-57 https://doi.org/10.1097/00000539-200003000-00027