슬관절 전치환술에서 수술 중 수술 부위 국소 진통제 주사의 효과

국문 초록 (Abstract)

목적: 슬관절 전치환술 시 수술부위 국소 진통제 주사에 의한 술 후 통증의 감소 효과 및 환자의 선호도를 알아보았다.
대상 및 방법: 2005년 3월부터 2005년 10월까지 양측 슬관절 전치환술을 시행한 환자 50명을 대상으로 한쪽 슬관절에는 morphine, norepinephrine, epinephrine을 혼합한 50 cc를 봉합 직전에 절개부위를 중심으로 주변 연부조직에 주입하였고(실험군), 다른 한쪽은 동량의 생리 식염수를 주입하였다(대조군). 통증의 정도를 visual analogue scale (VAS)을 이용하여 수술 전, 수술 후 4시간, 12시간, 1일, 2일, 4일, 7일, 14일에 조사하였고, 술 후 4일, 7일, 14일에 측정한 운동 범위, 배액량 및 환자의 선호도를 분석하였다.
결과: 수술부위 국소 진통제 주사를 시행한 실험군에서 술 후 4시간, 술 후 12시간, 술 후 1일에서 VAS의 유의한 감소를 관찰할 수 있었고(p＜0.05), 술 후 2일, 4일, 7일, 14일에서는 유의한 차이를 관찰할 수 없었다. 술 후 4일, 7일, 14일에 측정한 운동 범위와 배액량은 두 군 간에 유의한 차이가 없었다(p＞0.05). 환자의 선호도에 있어서 90%에서 국소 진통제 주사를 시행한 슬관절을 선호하였다.
결론: 슬관절 전치환술 중 수술 부위에 국소 진통제 주사는 술 후 1일까지의 급성 통증기에서 환자의 슬관절 통증 완화에 효과가 있었으며 대부분의 환자가 국소 진통제 주입을 선호하였다.

다국어 초록 (Multilingual Abstract)

Purpose : This study was performed to evaluate the effect and complications of an intraoperative regional analgesic injection in primary total knee replacement arthroplasty (TKRA).
Materials and Methods : As a prospective study, 50 patients who underwent bilateral TKRA were injected with 50 cc of mixed analgesics (morphine, norepinephrine and epinephrine) into the joint capsule, muscles around the knee joint on one side (study side) and the same amount of the normal saline on the other side (control side) before closure. The level of postoperative pain was evaluated in the visual analogue scale (VAS) at postoperative 4 hours, 12 hours, 1, 2, 4, 7, 14 days. The range of motion at postoperative 4, 7, and 14 days, the amount of hemovac drainage and the patients preference were also evaluated.
Results : There was a significant decrease in the VAS on the study side at postoperative 4 hours, 12 hours and 1 day (p＜0.05). There was no difference in the VAS thereafter. Patients preferred the injection site in 90% (45 side). The ROM at 4, 7, 14 days and hemovac drainage were similar in both sides (p＞0.05).
Conclusion : An intraoperative regional analgesic injection in primary TKRA is effective in reducing the level of acute postoperative knee pain with minimal complications with the majority of patients preferring it.

목차 (Table of Contents)

• 서론
• 대상 및 방법
• 결과
• 고찰
• 결론
• 참고문헌
• 국문초록

참고문헌 (Reference)

1 "The use of epidural bupivacaine following total knee arthroplasty" 18 : 894-901, 1989

2 "The effect of continuous epidural analgesia on postoperative pain and duration of hospitalization in total knee arthroplasty" 30-37, 1990

3 "Spinal versus general anesthesia for orthopedic surgery:anesthesia drug and supply costs" 102 : 524-529, 2006

4 "Soft tissue and intra-articular injection of bupivacaine and morphine has a beneficial effect after total knee arthroplasty" 428 : 125-130, 2004

5 "Severe neurological complication after central neuraxial blockades in Sweden 1990- 1999" 101 : 950-959, 2004

6 "Postoperative joint replacement pain:description and opioid requirement" 6 : 239-245, 1991

7 "Peripheral nerve blocks improve analgesia after total knee replacement surgery" 87 : 93-97, 1998

8 "Perioperative pain therapy for knee endoprosthetics" 35 : 153-161, 2006

9 "Pain relief from intra-articular morphine after knee surgery:a qualitative systematic review" 71 : 127-134, 1997

10 "Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty" 43 : 1021-1026, 1999

11 "Intra-articular morphine and/or bupivacaine in the management of pain after total knee arthroplasty" 12 : 546-552, 1997

12 "Intra-articular morphine and/or bupivacaine after total knee replacement" 81 : 301-303, 1999

13 "Intra-articular injection of bupivacaine in knee- replacement operations.Results of use for analgesia and preemptive blockade" 78 : 734-738, 1996

14 "Efficacy of Intra-articular bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: a randomized double-blind study" 31 : 26-33, 2006

15 "Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery" 91 : 8-15, 1999

16 "Effects of intravenous patient-controlled analgesia with morphine and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty" 87 : 88-92, 1998

17 "Continuous versus single-injection lumbar plexus blocks:comparison of the effects on morphine use and early recovery after total knee arthroplasty" 30 : 541-547, 2005

18 "Continuous femoral nerve blockade or epidural analgesia after total knee replacement:a prospective randomized controlled trial" 101 : 1824-1829, 2005

19 "Bedside femoral block performed on the first postoperative day after unilateral total knee arthroplasty:a randomized study of 49 patients" 18 : 192-196, 2005

20 "Analgesia for total hip and knee arthroplasty:a multimodal pathway featuring peripheral nerve block" 14 : 126-135, 2006