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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.
김일석,신근만,강상수,장지수,홍성준,윤영준,이희제 대한마취통증의학회 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.
빗장 아래 팔신경얼기 차단 환자에서의 0.75% 또는 0.5% Ropivacaine의 비교
박정민,정성미,조춘규,임영수,구자현,허윤무,송장호,양춘우 대한마취통증의학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Background: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery. Methods: We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed. Results: There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine. Conclusions: Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block. Background: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery. Methods: We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed. Results: There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine. Conclusions: Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.
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
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.
정중법을 이용한 빗장 아래 상완 신경총 차단 환자에서의 0.5% Levobupivacaine과 0.5% Ropivacaine의 비교
조춘규,김중연,정성미,권희욱,강포순,김철웅,한정욱,양춘우 대한마취통증의학회 2009 Korean Journal of Anesthesiology Vol.56 No.2
Background: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery. Methods: We included 60 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.5% levobupivacaine or 0.5% ropivacaine. We observed which nerve type was stimulated and scored the sensory and motor block. The quality of block was assessed intraoperatively. The duration of sensory and motor block and complications were assessed. Results: There were no significant differences in frequencies of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant difference in duration of sensory block, but duration of motor block was prolonged after 0.5% levobupivacaine. There were no complications. Conclusions: Both 0.5% levobupivacaine and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block. Background: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.5% levobupivacaine and 0.5% ropivacaine for upper limb surgery. Methods: We included 60 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.5% levobupivacaine or 0.5% ropivacaine. We observed which nerve type was stimulated and scored the sensory and motor block. The quality of block was assessed intraoperatively. The duration of sensory and motor block and complications were assessed. Results: There were no significant differences in frequencies of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant difference in duration of sensory block, but duration of motor block was prolonged after 0.5% levobupivacaine. There were no complications. Conclusions: Both 0.5% levobupivacaine and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.
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.
Bupivacaine과 ropivacaine이 Xenopus oocyte에 발현된 HERG 전류에 미치는 영향
김국성,이규승,김효신,손숙진,이상도,김광진,전병화,김윤희,박진봉 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1
Bupivacaine is an amide-type local anesthetic widely used for regional anesthesia. Ropivacaine is developed as a less cardiotoxic alternatives to bupivacaine. In the present study, we have analyzed the effects of bupivacaine and ropivacaine on HERG currents expressed in Xenopus oocytes. Bupivacaine and ropivacaine(3∼1,000μM) blocked HERG currents in a concentration dependent manner. EC_(50) was 26.1±3.1μM(n_(R) 0.65±0.04) and 43.5±7.9μM(n_(H) 0.99±0.13) in bupivacaine and ropivacaine, respectively. Bupivacaine and ropivacaine did not affect the activation and deactivation kinetics of HERG channels. However, the drugs decreased the slope conductance measured from fully activated current-voltage relationship curves. These results suggest that bupivacaine and ropivacaine have a similarinhibitory effect on HERG channels, which could be a possible cellular mechanism of LQT or ventricular arrythmia by the drugs.
황용(Yong Hwang),신상열(Sangyol Shin),오태훈(Tae Hoon Oh) 한국산학기술학회 2018 한국산학기술학회논문지 Vol.19 No.7
본 연구는 비뇨기과 복강경 수술을 받은 환자를 대상으로 수술 부위에 국소마취제인 Ropivacaine을 침윤주사 하였을 때 수술 후 발생하는 어깨 및 상복부 통증에 대한 진통 효과에 대해 알아보고자 하였다. 2015년 3월부터 2017년 6월까지 본원 비뇨기과에서 복강경하 신절제술을 시행 받은 97명의 환자 중에서 수술 부위에 Ropivacaine 침윤주사를 시행 받은 52명의 환자들을 대상으로 하였다. 술 후 통증을 수술 직후, 술 후 24, 48, 72시간의 간격으로 시각 통증 점수를 이용하여 평가하였으며 수술시간, 수술 후 식이섭취 시작, 수술시간, 술 후 재원기간 등을 비교하였다. 어깨와 상복부의 통증 점수가 두 그룹간에 수술직후와 수술 후 24시간뒤에 의미 있는 차이가 발생하였다. 국소마취제를 침윤하지 않은 그룹에서 수술 후 24시간까지 이산화탄소량의 증가에 따라 통증에 차이가 있었으나, 국소마취제를 침윤한 그룹에서는 수술 중 사용한 이산화탄소양에 따른 통증 차이는 없었다. 국소마취제 주입에 따른 환자들의 보행시기, 식사 시작, 입원 기간에 큰 차이는 없었다. 본 연구 결과 국소마취제 Ropivacaine의 침윤 사용이 복강경 수술 후 24시간까지 어깨 및 상복부 통증의 감소에 효과가 있는 것으로 관찰되었다. 따라서 복강경 수술 중 많은 양의 이산화탄소를 사용한 경우에는 복강경 수술 부위에 Ropivacaine을 사용한 주입법이 술 후 조기에 발생하는 통증을 효과적으로 조절할 수 있다. The aim of this study was to evaluate the effect of Ropivacaine on pain following laparoscopic surgery. Between March 2015 and June 2017, all 97 patients with renal mass who elected to receive laparoscopic nephrectomy were reviewed, retrospectively. Normal saline (0.9%) was used as a control in 45 patients while Ropivacaine was used for local anesthesia in the instillation group (n=52). Pain score (visual analog scale) of the shoulder and upper abdominal area between the two groups was significantly different between recovery time and 24 h (p〈0.05), with no significant differences between 48 and 72 h (both p〉0.05). In the instillation group, pain score of shoulder and abdominal pain in the two groups according to the amount of CO2 used was not significantly different between recovery time and 24, 48, and 72 h (all p〉0.05). Ropivacaine reduced shoulder and upper abdominal pain that occurred within 24 h after surgery. Effective pain control with Ropivacaine is needed in the early postoperative period when a large amount of CO2 is used in laparoscopic surgery.