제왕절개술후 경막외 자가통증조절과 정맥 자가통증조절의 제통효과 및 부작용 비교

박진완(JW Park),김동희(DH Kim),이원기(WK Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

Objective: Epidural anesthesia in cesarean section is a good and popular method for operation and postoperative pain control. But anxiety of patients for pain during and after epidural anesthesia is present. So some of patients want general anesthesia to avoid anxiety during operation, and want to control postoperative pain, too. We compared postoperative analgesia and side effects by using patient-controlled epidural and intravenous analgesia after cesarean section. Methods: Ninty four pregnant women who received cesarean section were divided into epidural and intravenous [IV] group. Epidural group received epidural anesthesia and controlled postoperative pain by patient-controlled epidural analgesia. IV group received general anesthesia and controlled postoperative pain by patient-controlled intravenous analgesia. The patients used patient-controlled analgesia [PCA] pump according to their allocated group. The assessments for pain score with VRS, patient`s satisfaction score and side effects were made until 48 hours after operation. Results: There was no significant differences in VRS and patient`s satisfaction score in both group [P>0.05]. The frequency of nausea/vomiting, urinary retention and lower extremity numbness were less in IV group than in epidural group. Conclusion: This study suggests that both patient-controlled epidural and intravenous analgesia can be used effectively as a postoperative pain control after cesarean section.

수술 후 통증조절을 위한 지속적 경막외제통 및 정맥내 자가조절법 2,510예에 대한 임상분석

배상철,곽수달,강규식 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

Background: The efficacy and safety of continuous epidural analgesia(CEA) and intravenous patient-controlled analgesia(IV-PCA) for postoperative analgesia on hospital wards was studied. And then we started postoperateve pain management service using a continuous epidural analgesia and intravenous patient-controlled analgesia. Method: A retrospective study was performed to evaluate the effects of continuous epidural analgesia(CEA): 0.125% bupivacaine 100ml + morphine 5~7mg or clonidine 1800㎍ and intravenous patient-controlled analgesia(IV-PCA): normal saline 20ml + fentanyl 800~1000㎍ or nalbuphine 80~100mg, for postoperative pain relief of 2,510 surgical patients who received general-epidural or epidural-regional anesthesia. Anesthesia records, patients charts, and pain control records were received and classified according to: age, sex, department, operation site, degree of pain relief by CEA and IV-PCA, and side effects(including nausea, vomiting, pururitis, urinary retention and respiratory depression). Results: 1) The study included CEA were 1,022(40.7%) patients and IV-PCA were 1,488(59.3%) patients. 2) From the total of 2,510 patients, there were 2,253(89.8%) female patients; 2,078(82.8%) patients were from Obstetrics and Gyneco]ogy. 3) In the operation site, lower abdomen were 2,053(81.8%), lower extremity were 206(8.2%), upper abdomen 136(5.4%) were order of decreasing frequency. 4) Ninety one percent of the patients experienced mild or no pain in the postoperative course. 5) There were most common complication is the nausea and vomiting. 6) There were eight cases of respiratory depression. The course of treatment consisted of: cesation of infusion, and then administration of oxygen and intravenous naloxone. Conclusions: According to our experiences, we conclude that CEA and IV-PCA is an effective, relatevely safe and highly satisfactory method for postoperative pain management.

유방절제술 후 광배근 근피판을 이용한 즉시 유방재건술 환자에서 경추 경막외 및 정맥내 자가통증조절의 효과 비교

강규식 ( Kyu Sik Kang ),김창원 ( Chang Won Kim ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),유시현 ( Sie Hyeon Yoo ),정진헌 ( Jin Hun Chung ),정지원 ( Ji Won Chung ),김상호 ( Sang Ho Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6

Background: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. Methods: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n=30), 0.15% ropivacaine+fentanyl 4 μg/ml] or IV-PCA [Group IV-PCA (n=30) fentanyl 20 μg/kg+ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C) 7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. Results: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV-PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. Conclusions: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction. (Korean J Anesthesiol 2009; 56: 669~74)

Intravenous Patient-controlled Analgesia for Postoperative Pain Management in Patients with Cerebral Palsy

Won Joan Yoo(유원준),Chin Youb Chung(정진엽),In Ho Choi(최인호),Tae-Joon Cho(조태준),Joon O Lee(이준오),Hee-Soo Kim(김희수),Chong Sung Kim(김종성) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.5

목적: 뇌성마비 환자에서 fentanyl과 ketorolac을 이용한 경정맥 자가 통증 치료법(intravenous patient-controlled analgesia) 의 수술 후 통증 조절에 대한 안전성과 효용성을 평가하고자 하였다. 대상 및 방법: 60명의 환자를 대상으로 수술의 복잡성에 따라 대 수술과 소 수술로 나누어 두 군으로 분류하였고 각 군을 수술 후 통증 조절 방법에 따라 fentanyl과 ketorolac을 이용한 경정맥 자가 통증 치료법을 사용한 군과 pethidine정맥 주사를 사용한 군으로 세분하였다. 통증의 강도는 Wong-Baker’s faces pain scale에 따라 평가하였다. 결과: 대 수술군에서는 경정맥 자가 통증 치료법을 사용한 환자군에서 pethidine을 사용한 환자군보다 유의한 통증의 감소가 있었고 소 수술군에서는 경정맥 자가 통증 치료법을 사용한 환자군과 pethidine을 사용한 환자군 사이에 유의한 통증 감소 효과의 차이는 없었다. Fentanyl과 ketorolac을 이용한 경정맥 자가 통증 치료법과 pethidine정맥 주사 요법에 따른 부작용은 큰 차이를 보이지 않았다. 결론: Fentanyl과 ketorolac을 이용한 경정맥 자가 통증 치료법은 뇌성마비 소아 환자에서 수술 후 중등도 이상의 통증 조절에 있어 안전하고 효과적이다. Purpose: The purpose of this study was to evaluate the safety and efficacy of intravenous patient-controlled analgesia (PCA) with fentanyl and ketorolac for postoperative pain management in patients with cerebral palsy. Materials and Methods: Sixty patients were categorized based on operation complexity into either a minor operation group or a major operation group, and then subdivided based on the analgesic methods used, i.e., intravenous PCA with fentanyl and ketorolac or intravenous pethidine injection. Pain intensity was assessed using the Wong-Baker's faces pain scale. Results: In the major operation group, patients that received PCA had significantly lower pain scores than those who received intravenous pethidine injection, while no significant differences in pain scores were observed in the minor operation group. Moreover, the side effects of these two analgesic methods did not differ significantly. Conclusion: Intravenous PCA with fentanyl and ketorolac is effective and safe for moderate to severe postoperative pain control in pediatric patients with cerebral palsy.

무통분만

이해진,전진영 대한의사협회 2010 대한의사협회지 Vol.53 No.1

We discuss recent advances in the administration of labor analgesia aimed at a more effective birthing experience for parturient women. Patient-controlled epidural analgesia (PCEA) is the most effective method of labor pain relief in medical practice. It also provides more consistent and predictable labor analgesia. When a parturient women has a contraindication to epidural analgesia, systemic analgesia techniques are provided as a guide to effective analgesia. PCEA of “low-dose” or “light mixtures” of local anesthetics and lipophilic opioids has allowed anesthesiologists to provide reasonable pain relief for most parturient women while decreasing the total dose of local anesthetics and opioids, thus minimizing the side effects of each agent. Fentanyl analgesia utilizing patient -controlled intravenous analgesia (PCIA), may provide effective self-titrated pain relief, although they are not as effective as the epidural method. Recently, remifentanil was suggested as the opioid of choice for labor analgesia. Potential advantages of remifentanil include better titration of analgesia and neonatal outcome. However,all systemic opioids rapidly cross the placenta. These drugs may cause neonatal respiratory and neurobehavioral depression. In order to reduce the incidence of breakthrough pain, more research on computer-integrated patient-controlled analgesia technology may be necessary. The study of a new local anesthetic drug that has less motor blockade and cardiotoxicity than ropivacaine is desirable, while PCEA is the most effective form of labor analgesia currently available. If epidural analgesia is contraindicated, PCI remifentanil bolus alone may be a suitable systemic analgesia for labor pain.

Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia for laparoscopic radical prostatectomy

( Boo Young Hwang ),( Jae Young Kwon ),( So Eun Jeon ),( Eun Soo Kim ),( Hyae Jin Kim ),( Hyeon Jeong Lee ),( Jihye An ) 대한통증학회 2018 The Korean Journal of Pain Vol.31 No.3

Background: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. Methods: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. Results: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. Conclusions: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP. (Korean J Pain 2018; 31: 191-8)

복식자궁전적출술과 인공슬관절 치환술 환자에서 정맥내 자가통증조절이 수술 후 진통에 미치는 효과

최영균,남현옥,이정한,이근무,정순호,김영재,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: Intravenous patient-controlled analgesia(IV PCA) is gaining wide spread popularity in the management of postoperative pain control. The purpose of this study is to evaluate the severity of pain after TAH and TKRA through comparing visual analogue scale(VAS) of pain of each patients who received identical IV PCA protocol, and to improve our IV PCA protocol. Methods: TAH group includes twenty female patients who were scheduled for TAH. TKRA group includes twenty female patients who were scheduled for TKRA. Each group received fentanyl 50㎍ about 30minutes before the end of surgery, followed by IV PCA with fentanyl 1500 ㎍, ketolorac 300mg, ondansteron 8mg, normal saline 56㎖(total 96ml, basal infusion rate 1㎖/hr, bolus dose 1㎖, lockout time 10 minutes). VAS scores were recorded at 1, 6, 12, 24, 48 hours postoperatively. Total bolus doses and patients' satisfaction were checked after the end of analgesia. Results: VAS scores of TKRA group were significantly higher than those of TAH group at 12, 24, 48 hours postoperatively. VAS scores of both group progressively decreased(P<0.05). Patients' satisfaction score showed no significant difference between two groups. Total bolus dose of TKRA group was significantly higher than that of TAH. Conclusion: The postoperative pain of TKRA was more severe than that of TAH. TKRA group needed more profound postoperative pain control than TAH group. We should consider the increase of early postoperative period analgesic doses to acquire optimal pain control of both group.

Comparison of palonosetron with ondansetron in prevention of postoperative nausea and vomiting in patients receiving intravenous patient-controlled analgesia after gynecological laparoscopic surgery

김유일,Soo Yeong Moon,Dong Un Song,Ki Hyun Lee,Jae Wook Song,Young Eun Kwon 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.2

Background: Postoperative nausea and vomiting (PONV) are common complications after anesthesia and surgery. This study was designed to compare the effects of palonosetron and ondansetron in preventing PONV in high-risk patients receiving intravenous opioid-based patient-controlled analgesia (IV-PCA) after gynecological laparoscopic surgery. Methods: One hundred non-smoking female patients scheduled for gynecological laparoscopic surgery were randomly assigned into the palonosetron group (n = 50) or the ondansetron group (n = 50). Palonosetron 0.075 mg was injected as a bolus in the palonosetron group. Ondansetron 8 mg was injected as a bolus and 16 mg was added to the IV-PCA in the ondansetron group. The incidences of nausea, vomiting and side effects was recorded at 2 h, 24 h, 48 h and 72 h, postoperatively. Results: There were no significant differences between the groups in the incidence of PONV during 72 h after operation. However, the incidence of vomiting was lower in the palonosetron group than in the ondansetron group (18% vs. 4%, P = 0.025). No differences were observed in use of antiemetics and the side effects between the groups. Conclusions: The effects of palonosetron and ondansetron in preventing PONV were similar in high-risk patients undergoing gynecological laparoscopic surgery and receiving opioid-based IV-PCA.

임상연구 : 수술 전 경막외진통과 정맥 통증자가조절장치의 병합이 골유합술과 추경나사못 고정술의 수술 후 통증완화에 미치는 효과

심규대 ( Kyu Dae Shim ),이상호 ( Sang Ho Lee ),황경일 ( Kyung Il Hwang ),김광희 ( Kwang Hee Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3

Background: Postoperative pain control following bone fusion and pedicle screw fixation is insufficient with IV-PCA alone. Therefore, the effect of preoperative epidural analgesia in addition to IV-PCA was evaluated for postoperative pain control following bone fusion and pedicle screw fixation surgery. Methods: Eighty patients, scheduled to undergo bone fusion and pedicle screw fixation, were randomly assigned to two groups; the study (n = 40) or control groups (n = 40). After induction, the patient was turned into the prone position, and morphine 2 mg and 10 ml of 0.2% ropivacaine were injected into the L1/2 epidural space, after dye confirmation, under C-arm guidance for the study group, with 10 ml normal saline injected into the L1/2 epidural space for the control group. After induction, IV-PCA was applied in both groups. After the operation, the NRS (numerical rating scale) and side effects were evaluated immediately post-op, and at 24 and 48 hours after the operation. Results: In the study group, the NRS was more reduced for all periods compared with the control group, but the incidences of nausea/vomiting and pruritus were no different from the control group. Conclusions: It was concluded that preoperative epidural analgesia, in addition to IV-PCA, was a good postoperative pain control method following bone fusion and pedicle screw fixation. (Korean J Anesthesiol 2007; 52: 296~300)

정맥 내 자가 조절 진통을 받는 환자의 술 후 초기 통증 조절을 위한 진통제의 비교

지영석 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.4

Background: This study was performed to compare postoperative pain and sedation among meperidine 50 mg PRN intramuscular injection, meperidine 50 mg routine intramuscular injection and fentanyl 50μg routine intravenous injection at the end of surgery for early postoperative pain control in patients with intravenous patient-controlled analgesia (IV PCA). Methods: In group P (n = 35), meperidine 50 mg was injected intramuscularly on request of patients. In group M (n = 35) and F (n = 35), meperidine 50 mg was injected intramuscularly or fentanyl 50μg was injected intravenously at the end of surgery, respectively. Pain score was measured with verbal rating scale (VRS; 0−10) at 30 min, 1 hr, and 6 hr, and sedation score was evaluated with Observer’s assessment of alertness/sedation scale (OAA/S) at 30 min, and 1 hr after extubation. Additional fentanyl 50 μg was injected intravenously if patient requested pain control in group P and if VRS was higher than 5 point at 30 min after extubation or patients requested pain relief in group M and group F. Results: Sedation scores of group M were higher than group P and group F. Group P had a higher VRS score than group M and group F at 30 min after extubation. Dose of additional fentanyl 50 μg injection was similar among three groups. Conclusions: Fentanyl 50μg intravenous injection at the end of surgery with additional fentanyl 50μg injection on patient’s request may be good method for early pain control for IV-PCA patients.