전자궁 적출술 시 0.6% Ropivacaine을 이용한 경막외 마취

홍지희,김애라 啓明大學校 醫科大學 2001 계명의대학술지 Vol.20 No.2

본 연구는 같은 술 중 진통효과와 근이완을 유지하면서 술 후 운동 신경차단의 회복이 빠른 농도를 찾기 위해 0.6%ropivacame 150㎎과 120㎎에 각각 fentanyl100㎎을 혼합하여 경막외 마취에 사용하고 술 중 진통효과와 근이완효과를 비교 검토하였다. 환자 51명을 대상으로 1군(n= 17, 0.75% ropivacaine 20 ㎖), 2군 (n= 17, 0.6% ropivacaine 25 ㎖ + fentanyl 100㎍), 3군(n= 17, 0.6% ropivacaine 20 ㎖ + fentanyl 100㎍)으로 나누어 발현시간, 감각 차단의 정도, 술중 근이완 정도, 진통 효과, 운동 차단의 회복시간 및 저혈압의 빈도를 측정하여 아래와 같은 결과를 얻었다. 1군, 2군, 3군에 있어서 감각차단, 술 중 근이완 정도, 진통효과, 저혈압의 빈도는 유의한 차이가 없었으나 0.6% ropivacaine 120 ㎎과 fentanyl의 혼합은 1, 2군에 비해서 운동 신경 차단으로부터의 회복시간이 유의성있게 짧았다. 또한 운동신경 차단으로부터의 회복은 1군과 2군 모두에서 환자에 따라 심한 차이를 보이는 것이 특징이었으나 3군에 있어서는 회복시간이 비교적 고른 분포를 보였다. Ropivacaine closely resembles hupivacaine with propyl group substituted for butyl group at the same position. Ropivacaine is 100% S-isomer with more safety but less cardiotoxicity than bupivacaine. Because of this, ropivacaine can be safely used in epidural anesthesia. However, ropivacaine caused a motor block lasting more than 5 hours in some patients. Therefore this study was undertaken to find an optimal concentration of ropivacaine with the effective analgesic and muscle relaxation but rapid recovery from the motor block. Fifty one patients scheduled for total hysterectomy were randomly selected and divided into 3 groups. The patients were placed in sitting position and epidural space was confirmed by loss of resistance with air. Epidural catheter was placed at the L_(2-3) or L_(3-4) interspace using median approach with a 18 G Tuohy needle. About 15 min prior to skin incision, group Ⅰ received 20 ㎖ of 0.75% ropivacaine, group Ⅱ received 25 ㎖ of 0.6% ropivacaine plus 100 ㎍ fentanyl, and group Ⅲ received 20 ㎖ of 0.6% ropivacaine plus 100 ㎍ of fentanyl. During operation, sensory block was assessed by cold test every 5 min and motor block by Bromage scale. There were no significant differences between the group Ⅰ, Ⅱ and Ⅲ in analgesic and muscle relaxation effect, but there was a significant difference in the recovery from motor block in the group Ⅲ. 20 ㎖ of 0.6 % ropivacaine and 100 ㎍ of fentanyl were found to the optimum concentration for the epidural anesthesia in total hysterectomy.

견관절경 수술 후 Ropivacaine, Ropivacaine과 Fentanyl, Ropivacaine, Fentanyl과 Ketorolac의 관절강 내 지속적 주입 시 진통효과에 대한 비교연구

김일석 ( Il Seok Kim ),신근만 ( Keun Man Shin ),강상수 ( Sang Soo Kang ),장지수 ( Ji Su Jang ),홍성준 ( Sung Jun Hong ),윤영준 ( Yeong Joon Yoon ),이희제 ( Hee Je Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3

Background: Arthroscopic shoulder surgery can result in severe postoperative pain. A variety of methods have been used to control pain in postoperative period and the results are variable. The purpose of this study was to compare the relative analgesic efficacies of the postoperative intraarticular infusion of ropivacaine, ropivacaine/fentanyl, and ropivacaine/fentanyl/ketorolac after arthroscopic shoulder surgery. Methods: Thirty patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to three groups. At the end of surgery, 0.5% ropivacaine 20 ml was infused into the articular space and a continuous infusion catheter was inserted into intraarticular operated site. After surgery, continuous infusion of 0.5% ropivacaine 100 ml (Group 1, n=10), 0.5% ropivacaine 100 ml including fentanyl 10 μg/kg (Group 2, n=10), or 0.5% ropivacaine 100 ml including fentanyl 10 μg/kg and ketorolac 150 mg (Group 3, n=10) was started through catheter at rate of 2 ml/hr with bolus dose of 0.5 ml with a lock out time of 15 minutes for 2 days. The level of pain was assessed using a visual analogue scale (VAS) postoperative 2, 6, 12, 24 and 48 hours and the amounts of supplemental analgesics were recorded. Results: The VAS was significantly lower after 2, 6, 12 hours in Group 2 than in Group 1. In Group 3, the VAS was significantly lower all hours than in the other two groups. Conclusions: The combination of fentanyl and ketorolac with ropivacaine did provide better postoperative analgesia than the other groups after arthroscopic shoulder surgery. (Korean J Anesthesiol 2009; 56: 303∼8)

슬관절 인공관절 치환술 후 대퇴신경 차단술의 Ropivacaine 농도 변화에 따른 결과 비교

허정욱(Jung-Wook Huh),박만준(Man-Jun Park),고영철(Young-Chul Ko),하동준(Dong-Jun Ha),박숙현(Sook-Hyun Park),박태홍(Tae-Hong Park),박준형(Joon-Hyung Park) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.3

목적: 슬관절 전치환술 후 통증을 줄이는 여러 가지 방법이 있으며 그 중 말초신경 차단술이 유용하게 사용되고 있다. Ropivacaine을 사용한 대퇴신경 차단술(femoral nerve block, FNB)은 효과적으로 통증을 감소시키나 대퇴사두근력을 약화시켜 낙상 등의 위험성을 높인다. 본 연구는 FNB 시 ropivacaine 농도의 변화에 따라 통증 및 대퇴사두근력에 미치는 영향에 대해 비교하여 보고하고자 한다. 대상 및 방법: 2016년 1월부터 2016년 12월까지 퇴행성 관절염으로 슬관절 전치환술을 시행한 120명의 환자를 대상으로 하였다. FNB의 ropivacaine 농도에 따라 환자들을 세 군으로 나누었다(1군: 0.125% ropivacaine 6 ml FNB, 2군: 0.2% ropivacaine 6 ml FNB, 3군: normal saline 6 ml FNB). 모든 환자는 술 후 3시간째 1% lidocaine 10 ml와 0.75% ropivacaine 10 ml로 FNB를 시행받고 수술 다음날 6시간 간격으로 총 4회에 걸쳐 0.2% ropivacaine, 0.125% ropivacaine, normal saline 6 ml를 도관을 통해 각각 주입하였다. 시각통증척도(visual analogue scale, VAS) 점수로 통증 정도를 측정하였고, medical research council (MRC) grade와 슬관절의 신전 가능 정도를 측정하여 대퇴사두근력을 평가하였다. 결과: 술 후 1일 18시와 술 후 2일 6시에 측정한 VAS 점수는 3군이 나머지 군과 비교하여 유의하게 통증 점수가 높았고, MRC grade는 2군이 나머지 군과 비교하여 유의하게 점수가 낮았으며 슬관절 신전 운동 정도는 2군이 나머지 군과 비교하여 유의하게 각도가 작았다. 결론: 슬관절 전치환술 후 0.125% ropivacaine으로 FNB를 시행하여 대퇴사두근력의 약화 없이 통증 조절의 효과를 얻을 수 있을 것으로 생각된다. Purpose: Peripheral nerve block is one of the many options available to reduce pain after total knee arthroplasty. Among the various kinds of peripheral nerve block procedure, femoral nerve block (FNB) using ropivacaine is a very effective method for reducing pain. However, it has been known to cause weakness in the quadriceps femoris, resulting in an increased risk of fall during ambulation after surgery. The purpose of this study was to compare the effectiveness of FNB on pain and muscle strength with different concentrations of ropivacaine. Materials and Methods: Our study was performed on 120 patients with knee osteoarthritis who had undergone total knee arthroplasty between January 2016 and December 2016. Patients were divided to 3 groups depending on the concentration of ropivacaine: Group 1 received 0.125% ropivacaine 6 ml FNB; group 2 received 0.2% ropivacaine 6 ml FNB; group 3 received normal saline 6 ml FNB. FNB with 1% lidocaine 10 ml and 0.75% ropivacaine 10 ml was performed to all groups at 3 hours after surgery. From the day after surgery, each group of patients were injected 4 times with FNB on their own designated concentration of ropivacaine with an interval of 6 hours. The severity of pain was estimated by visual analogue scale (VAS) and the strength of quadriceps femoris was measured using medical research council (MRC) grade and knee extension angle. Results: VAS score in group 3 was significantly higher compared to other groups; MRC grade in group 2 was significantly lower than in other grades, and knee extension angle in group 2 was significantly lower than in other groups at 6 pm on the day of and at 6 am on the day after surgery. VAS score, MRC grade, and extension angle of all groups showed no significantly difference at other times. Conclusion: FNB with 0.125% ropivacaine after total knee arthroplasty shows effective reduction of pain without inducing quadriceps femoris weakness.

후방 척추 수술 환자에서 ‘PF-72와 0.75% 로피바카인염산염 혼합액’과 ‘0.75% 로피바카인염산염 단독사 용’ 및 ‘무처치’ 대조군간 유효성 및 안전성 비교평가-전향적, 단일기관, 피험자 단일 눈가림, 무작위 배정, 탐색 임상시험

최성우,장해동,강덕원,방청원,이재철,이재준,황창순,오근상,신병준 대한척추외과학회 2019 대한척추외과학회지 Vol.26 No.1

Study Design: Prospective pilot study Objectives: The efficacy and safety of ‘PF-72’ for management of postoperative acute pain through a mixed ‘PF-72’ and 0.75% ropivacaine hydrochloride solution in patients with posterior spine surgery was evaluated as ‘0.75% ropivacaine’ and ‘untreated’ controls. Summary of Literature Review: Postoperative acute pain is major surgical side effect that lead to the deterioration of the quality of life. Traditional pain control results in variable side effects, and multimodal pain management has been recommended as an alternative. Local anesthetics is a short-acting time lower than 12 hours. There is controversy about the efficiency and stability of thermoreactive hydrogel products as a drug delivery system. Materials and Methods: Patients scheduled for posterior spine surgery were enrolled by the inclusion criteria. In the treated group, PF- 72 and ropivacaine mixture was injected to the surgical wound before closure. In control group 1, only 0.75% ropivacaine hydrochloride was injected. In the control group 2, the surgical site was without injection. Ten patients were randomly assigned to each group and standardized drugs for pain control were applied postoperatively and rescue regimens were applied when necessary. Postoperative pain score and the cumulative area under the curve (AUC) of pain score were compared. The percentage of subjects who were painless (pain score ≤ 3) was examined at each observation point. The first time of injection and the total dose of the rescue regimen were examined. Postoperative nausea and vomiting (PONV) were also evaluated. Results: There was no significant difference in demographic data. The sum AUC of pain scores in the treated group was significantly lower than that in the control group 1 and 2 at all observation times. The proportion of painless patients was significantly higher in the treated group than in the control group 2. There was no significant difference between the first administration time and the total usage of the rescue regimen, and the percentage of patients with PONV at all time points. There was no statistically significant difference in the incidence of adverse events. Conclusion: PF-72 and ropivacaine mixture showed significant effects for pain management up to 72 hours postoperatively for the patients who underwent posterior spinal surgery without fatal complications. 연구 계획: 전향적 연구(탐색 임상시험) 목적: 후방 척추 수술 환자를 대상으로 ‘PF-72’와 0.75% 로피바카인염산염(Ropivacaine HCl) 국소마취액의 혼합액을 통해 수술 후 급성통증 완화에 대한‘PF-72’의 초기 유효성과 안전성을 ‘0.75% 로피바카인염산염(Ropivacaine HCl) 단독사용’ 및 ‘무처치’ 대조군과 비교 평가하고자 하였다. 선행 연구문헌의 요약: 수술 후 급성통증은 재원 기간의 증가, 만성 통증, 삶의 질 저하 등을 유발하는 주요 수술부작용 중 하나이다. 전통적인 방식의 통증 조절 방법은 다양한 부작용을 초래하며, 최근 이에 대한 대안으로 다중요법이 추천 되고 있다. 수술 부위 국소마취제 투여는 12시간 미만의 짧은 작용시간이 단점이며, 통증조절약물 전달 시스템으로서 온도 반응성 하이드로겔(Hydrogel) 제품의 경우 아직까지 그 효율성과 안정성에 대해 논란이 있다. 대상 및 방법: 후방 척추 수술이 예정된 환자 중 선정 기준을 통해 대상군을 선정하였다. PF-72는 수술부위에 약물을 효과적으로 전달하는 고분자화합물로서 시험군에서는 수술부위를 봉합하기 직전에 PF-72와 로피바카인염산염(Ropivacaine HCl) 혼합액을 주입하고, 대조군1에는 PF-72없이 0.75% 로피바카인염산염(Ropivacaine HCl) 만을 주입하였으며, 대조군 2에서는 약물 주입 없이 일반적인 수술 절차에 따라 수술부위를 봉합하였다. 각 군에 10명의환자가 균등하게 무작위 배정되었다. 수술 후 피험자의 통증 관리를 위하여 기관 표준 절차에 따라 피험자 모두에게 표준화된 약물을 적용하였으며, 필요시 구제약물을 사용하였다. 1차 평가 변수는, 수술 후 통증 평가 점수를 기록하고, 각 관찰 시점까지의 총합(area under the curve, AUC)을 비교하였다. 각관찰 시점마다 무통상태(통증점수 3점 이하)의 피험자 비율도 조사하였다. 2차 평가 변수는 구제 약물이 처음 투여된 시점과 총 투여량을 조사하였다. 안전성 평가는 수술 후 구역 및 구토 증상에 대해 postoperative nausea and vomiting (PONV) 분류를 이용하여 조사하였다. 결과: 총 30명의 환자가 등록되었으며, 남자 13명, 여자 17명이었고, 평균 나이는 62.3(27-79)세였다. 각 군에서 피험자의 성별, 연령 등의 인구학적 기초자료 및 기본 병력 등의 자료 분석 결과 시험군과 대조군간의 유의한 차이는 없었다. 1차 평가 변수의 경우 모든 관찰시점에서 시험군의 통증점수의 합이대조군 1, 2에 비해 통계학적으로 유의하게 낮았다. 무통상태환자의 비율은 시험군이 대조군2에 비해 유의하게 높은 비율을 보였다(p=0.0108). 2차 평가변수인 구제 약물의 첫 투여 시간과 총 사용량은 세 군 간의 유의한 차이가 관찰되지 않았다. 모든 관찰시점에서 PONV 척도 별 환자 비율은 유의한 차이를 보이지 않았고, 세 군의 이상 사례 발현율도 유의한 차이를 보이지 않았으며, 모두 경증의 이상 사례로 시험기기와의 인과관계에서 관련성이 없었다. 결론: 후방 척추 수술을 시행 받은 환자들의 수술 후 통증 관리를 위해 PF-72와 로피바카인염산염(Ropivacaine HCl) 혼합액을 수술 부위에 투여하여 수술 후 72시간까지 효과적인 통증조절이 가능함을 확인했으며, 안전성 면에서도 치명적인 이상 사례가 발생하지 않았다. 약칭 제목: 후방척추수술에서 PF-72 전달체를 이용한 통증조절

임상연구 : 견관절경 수술 후 통증 관리: 견봉하 지속적 자가통증조절 시 Ropivacaine의 효과적인 농도에 관한 연구

박윤정 ( Youn Jung Park ),정미화 ( Mi Hwa Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Background: The aim of this study was to estimate the effective concentration of subacromial ropivacaine for the control of postoperative pain after arthroscopic shoulder surgery. Methods: In a prospective, randomized double-blind trial, 60 patients were divided equally into 3 groups; Groups I, II, and III. At the end of surgery, a bolus dose (0.75% ropivacaine 150 mg, depomedrol 40 mg) was injected via the trocar and a continuous subacromial infusion catheter was inserted into all patients. The drugs were administered for 48 hours after surgery. Group I was given 0.11% ropivacaine in 96 ml of normal saline, which consisted of 0.75% ropivacaine (15 ml), and fentanyl (10μg/kg). Group II received 0.15% ropivacaine in 96 ml saline consisting of 0.75% ropivacaine (20 ml) and fentanyl, (10μg/kg). Group III received 0.23% ropivacaine in saline consisting of 0.75% ropivacaine (30 ml) and fentanyl (10μg/kg). The rate of continuous infusion was, 2 ml/hr. The VAS for pain at rest and the range of motion (ROM) exercise, the amounts of supplemental analgesics and side effects were assessed postoperative 3, 9, 24 and 48 hours. Results: There was no significant difference in the VAS for pain at rest and ROM exercise as well as in the amounts of supplemental analgesics between the three groups. Conclusions: 0.11% ropivacaine with 10μg/kg fentanyl provides effective postoperative analgesia at rest and during ROM exercise after arthroscopic shoulder surgery. (Korean J Anesthesiol 2006; 50: 552~6)

하지수술시 Fentanyl과 병용한 0.75% 등비중 Ropivacaine을 이용한 척추마취

임일환,이상곤,반종석,민병우 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Background: Opioids and local anesthetics administered together intrathecally have a potent synergistic analgesic effect and less hypotention using a minidose of local anesthetic. This study was designed to investigate the safety and efficacy of two doses of intrathecal isobaric ropivacaine/fentanyl in patients undergoing an operation of the lower extremities. Methods: Thirty patients undergoing an elective orthopedic surgical operation of the lower extremities were randomly assigned to two groups for spinal anesthesia. Patients in group Ⅰ (n = 15) received 0.75% ropivacaine 14 mg/fentanyl 20㎍, and patients in group Ⅱ (n = 15) received 0.75% ropivacaine 16 mg/fentanyl 20㎍. After spinal anesthesia, we measured the time to T10, peak dermatomal level, time to peak sensory level, time to maximum motor blockade, duration of complete motor block and duration of complete sensory block using the pin prick test and Bromage motor scale. Also circulatory variables were monitored every 5 min and side effects were measured for 3 day after spinal anesthesia. Results: There were no significant differences between the groups in time to T10, peak dermatomal level, time to peak sensory level, time to maximum motor blockade and duration of complete motor block, but duration of complete sensory block was significantly longer in the 0.75% ropivacaine 16 mg/fentanyl 20㎍ group than the 0.75% ropivacaine 14 mg/fentanyl 20㎍ group. Conclusions: Intrathecal 0.75% ropivacaine 14 mg/fentanyl and 0.75% ropivacaine 16 mg/fentanyl were equally suitable for a lower extremity operation. (Korean J Anerthesiol 2002; 43: 600~605)

임상연구 : 부인과 수술환자에서 Sufentanil과 병용한 0.1% Levobupivacaine 또는 0.1% Ropivacaine의 술 후 경막외 진통 비교

양춘우 ( Chun Woo Yang ),박정민 ( Jeong Min Park ),임영수 ( Young Su Lim ),조춘규 ( Choon Kyu Cho ),김경식 ( Kyong Sik Kim ),김응균 ( Eung Kyun Kim ),정성미 ( Sung Mee Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

Background: Ropivacaine and levobupivacaine are recently introduced amide local anesthetics that are structurally similar to bupivacaine. In this study, we compared the quality of postoperative analgesia and the side effects of 0.1% ropivacaine/sufentanil and 0.1% levobupivacaine/sufentanil. Methods: Sixty patients scheduled for gynecologic surgery under general anesthesia were randomized to receive either 0.1% ropivacaine with sufentanil (ropivacaine group) or 0.1% levobupivacaine with sufentanil (levobupivacaine group) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 5 ml/h during the 48 hour period following surgery. Visual analogue scale (VAS) scores at rest and on coughing, sitting and movement, the degree of ambulation, additional analgesic requirements and side effects were assessed. Results: In the levobupivacaine group, VAS scores at rest and on coughing, sitting and movement were lower than in the ropivacaine group (P < 0.05). In the ropivacaine group more patients were able to walk unaided (P < 0.05). There were no differences in local anesthetic consumption, additional analgesic requirements and side effects between the groups. Conclusions: Both 0.1% ropivacaine with sufentanil and 0.1% levobupivacaine with sufentanil provided effective postoperative epidural analgesia, but ropivacaine produced lesser motor block. (Korean J Anesthesiol 2007; 53: 746~52)

The effect of high concentration of magnesium with ropivacaine, gentamicin, rocuronium, and their combination on neuromuscular blockade

이원지,이수일,이지현,최소론,이승철,이종환 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.1

Background: Magnesium, ropivacaine, gentamicin, and rocuronium block neuromuscular (NM) transmission by differentmechanisms. Therefore, concurrent administration of these agents may induce prolonged muscle paralysis viasynergistic interaction. This study investigated the efficacy and safety of NM block caused by the administration of highconcentrations of magnesium in combination with ropivacaine, gentamicin, and rocuronium. Methods: Eighty-three left phrenic nerve-hemidiaphragms from male SD rats (150–250 g) were hung in Krebs solution. Three consecutive single twitch tension (ST, 0.1 Hz) and one tetanic tension (TT, 50 Hz for 1.9 s) were obtainedbefore drug application and at each new drug concentration. The concentration of MgCl2 and MgSO4 in Krebs solutionwas increased until an 80 to 90% reduction in ST was reached. To test the effects of combinations of NM agents, a Krebssolution was premixed with MgCl2 alone, MgCl2 and ropivacaine, or MgCl2, ropivacaine, and gentamicin. The concentrationof ropivacaine, gentamicin, or rocuronium was then progressively increased until an 80 to 90% reduction in ST wasreached. The effective concentrations were estimated with a probit model. Results: The potency of MgCl2 was greater than that of MgSO4, and pretreatment with MgCl2 increased the potency ofgentamicin and rocuronium. Unexpectedly, MgCl2 did not potentiate ropivacaine, and the potency of gentamicin androcuronium failed to show an increase when premixed with 0.5 μM ropivacaine. Conclusions: The concomitant administration of high concentrations of magnesium and ropivacaine together with clinicallyrelevant concentrations of gentamicin or rocuronium potentiated NM blockade but not with clinically relevant concentrationsof ropivacaine.

이상근 내 로피바카인 주입 시 0.075%와 0.1% 농도에서 운동 기능 이상발생 비교

이은준,이강근,백승엽 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.4

Background: Motor weakness occurs frequently after piriformis injection and it could put patients at risk of falls. We investigated the appropriate concentration and volume of ropivacaine required to minimize motor dysfunction. Methods: A total of 120 patients who received piriformis injection were included in this study. Piriformis injections of triamcinolone 10 mg in various concentrations (0.1%, 0.075%) and volumes (8, 10, 12 ml) of ropivacaine were administered in 20 patients, respectively. One hour after the injection, we compared motor function according to the concentrations and volumes of ropivacaine. Results: There were significant differences (P < 0.05) in the occurrence of motor dysfunction according to body mass index (BMI) and the concentration of ropivacaine. No significant differences were found in terms of gender, age, weight, height, or the volume of ropivacaine. Logistic regression analysis showed that the likelihood of motor dysfunction with administration of 0.1% ropivacaine was 58.249 times greater than that with administration of 0.075% concentration (P < 0.001), while BMI did not have a significant effect on motor dysfunction. Conclusions: According to the results of this study, 0.075% ropivacaine rather than 0.1% ropivacaine is appropriate in terms of reducing motor dysfunction after piriformis injection.

임상연구 : 경막외 통증자가조절 시 0.2% Ropivacaine과 150 μg/ml Alfentanil 혼합된 0.15% Ropivacaine의 효과 비교

황성미 ( Sung Mi Hwang ),권오민 ( O Min Kwon ),이재준 ( Jae Jun Lee ),임소영 ( So Young Lim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Background: The lower levels of cardiotoxicity and motor block make ropivacaine well suited as an epidural infusion for postoperative analgesia. This study examined the analgesic efficacy of an epidural infusion of ropivacaine alone and in combination with alfentanil after major abdominal surgery. Methods: Thirty patients undergoing major abdominal surgery under general anesthesia were divided into two groups receiving patient-controlled thoracic epidural analgesia with 0.2% ropivacaine (Group I) and 0.15% ropivacaine +150μg/ml alfentanil (Group II). The motor block, side effects, VAS (visual analog pain scale) score on coughing and resting, additional analgesics use, and patient`s satisfaction were checked for 24 hours after a loading dose injection. Results: The VAS score in group II was significantly lower than in group I, and the patients in group II were more satisfied than those in group I (P < 0.05). However, there were more side effects in group II. Conclusions: Postoperative epidural infusion of 0.15% ropivacaine with 150μg/ml alfentanil is more effective than 0.2% ropivacaine only. (Korean J Anesthesiol 2006; 50: 541~5)