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하복부 수술 환자에서 수술전과 수술중에 투여한 경막외 Morphine 의 진통효과 비교
Effect of Pre-emptive Analgesia by Epidural Morphine in Lower Abdominal Surgery
고성훈(Seong Hoon Ko),최훈(Huhn Choe),김동찬(Dong Chan Kim),송희선(He Sun Song),이상귀(Sang Kyi Lee),한영진(Young Jin Han)
UCI I410-ECN-0102-2009-510-004597883
* 발행 기관의 요청으로 이용이 불가한 자료입니다.

Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain, Inhibition of these changes may be of value in the reduction of postoperative pain. Several clinical studies have shown that pretreatment with local anesthetics, opioids, NASAIDs and N-methyl-D-aspartate(NMDA) antagonist are effective in relieving postoperative pain. We compared the efficacy of pre-emptive and post-incisional epidural analgesia with morphine 2 mg in 0.25% bupivacaine(8 ml) on the postoperative pain. Seventy patients (ASA physical status I, 2) scheduled for elective lower abdominal surgery were randomized to one of two groups of equal size and prospectively studied in a double-blind manner. Group I received epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) before surgical incision followed by epidural normal saline(8 ml) just before termination of the surgery. Group 2 received epidural normal saline(8ml) before surgical incision, followed by epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) just before termination of the surgery. Anesthesia was induced with thiopental sodium(4~6 mg/kg) and maintained with N2O/O2 and enflurane. Paralysis was achieved with pancuronium. Percentage of maximal possible effect(MPE) was significantly higher(P<0.05) in group 1 (85.3%) than in group 2 (70.8%). Secondary analgesic requirement was less in group 1(9/35 patients, 25.7%) than in group 2 (15/35 patients, 42.9%). Visual analog scale pain and mood score and Prince-Henry pain score are not significantly different between two groups. We conclude that pre-emptive epidural analgesia with morphine and bupivacaine may be more effective in relieving postoperative pain than post-incisional analgesia in lower abdominal surgery.(Korean J Anesthesiol 1995; 29: 895~902)

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