전자궁 적출술 시 0.6% Ropivacaine을 이용한 경막외 마취 = Epidural Anesthesia with 0.6% Ropivacaine in Total Hysterectomy

국문 초록 (Abstract)

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.

다국어 초록 (Multilingual Abstract)

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.