Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Effects Of Continuous Epidural Analgesia For Fractured Ribs

늑골골절 환자에서 지속적 경막외 신경차단에 의한 진통효과

  • 안상구 (순천향대학교 의과대학 흉부외과학교실) ;
  • 김재영 (순천향대학교 의과대학 흉부외과학교실, 순천향대학교 구미병원 마취과)
  • Published : 1996.09.01
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Abstract

Patients with fractured ribs necessarily suffer from severe chest ain, which prevents coughing, deep breathing and bronchial toilette, cause atelectasis and pulmonary shunting. Relief of chest pain is benecial to patients, providing consort and facilitating physiotherapy and effective expectoration. We compared the efficacy of pain relief be!ween continuous epidural analgesia and conventional intramlrscular analgesia in 20 patients with fractured ribs. Among 20 patients, epidural analgesia was done or 10 patients(experimental group) and the remainder ten received intramuscular analgesia(control group). The pain and ROM(range of motion) scores, vital sign, PaO2, forced vital capacity(FVC) and forced expiratory volume for 1 second(FEVI) were checked on immediate admission and 12, 24 hours, third, fifth, and seventh day after starting of continuous epidural block. The pain and ROM scores were decreased and the PaO2, FRC and FEVI were significantly increased in experimental group. The side effects of epidural analgesia were mild and reversible. With th se result, we can suggest that epidural analgesia is more effective for pain relief and restoration of pulmonary mechanics in patients with fractured ribs.

늑골골절을 입은 환자들은 심한 흉통으로 괴로워하며 이 통증은 기침, 심호흡과 기도세척을 방해하여 결국 무기폐와 호흡부전등을 초래할 수 있다. 통증의 완화는 환자를 편하게 해주고 효과적인 물리요법으로 객담배출을 용이하게한다. 늑골골절 환자에서 경막외 신경차단의 효과를 측정하기 위하여 20명의 환자를 대상으로 경막외 진통제을 투여한 10명은 실험군, 진통제를 근육주사한 10명은 대조군으로 정하 여 통증호소와 운동장애의 정도, 말초동맥혈 산소분압 및 폐기능(FRC, FEVI)의 변화를 입원직후와 경막외 진통제투여 시작후 12, 24시간 및 3일, 5일 그리고 7일째에 각각측정조사 하였다. 신경차단군에서 통증호소와 운동장애의 정도는 감소하였고 동맥혈 산소치는 약간 증가하였으나 의의가 없었으며 FRC와 FEVI는 유의하게 증가하였다. 경막외 신경차단의 부작용은가벼웠으며 쉽게 치료되었다. 위의결과로 저자들은 늑골골절 환자에서 경막외 신경차단에 의한진통법이 동통완화효과와 폐기능 향상에 괄목할만한 효과을 나타내므로 이의 임상적 이용이 바람직하다고 생각한다.

Keywords

References

  1. Acta Anaestheiol Scand v.31 The effect of thoracic epidural analgesia on respiratory function after cholecystectomy Hendolin,H.
  2. Lancet v.2 Pastoperative changes in gas tensions arterial blood and in ventilatory function Diament,M.L.;Palmer,K.N.V.
  3. Surg Clin North Am v.44 Immediate complication following thoracotomy for pulmonary disease Wylie,R.H.;Bowman,F.Q.
  4. General principles of postoperative care;General thoracic surgery(3rd ed.) Renee,S.H.;Thomas,W.S.(ed.)
  5. Anesthesiology v.37 Hypoxemia during and after anesthesia Marshall,B.E.;Wyche,M.Q.
  6. Br J Anaesth v.47 The management of postoperative pain Wallace,P.G.M.;Norris,W.
  7. Arch Surg v.110 Changes in functional residual capacity of the lung after operation Meyers,J.R.;Lembeck,L.;O'Kane,H.;Bane,A.E.
  8. Anensth Analg v.60 Postoperative recovery of pulmonary function Craig,D.B.
  9. J Appl phys v.26 Surfactant function and anesthetic agents Woo,S.W.;Berlin,D.;Hedley whyte J.
  10. 대흉외지 v.26 개흉술후 벽측흉막의 신경차단법에 의한 진통효과 임창영;김요한
  11. Anesthesiology v.67 Continuous thoracic epidural analgesia for postoperative pain relief following thoracotomy : A randomized prospective study Logas,W.G.;El Bas,N.;El Ganzouri,A.(et al.)
  12. JAMA v.188 Effect of morphine on breathing pattern Egbert,L.D.;Bendixen,H.H.
  13. Br Med J v.283 Improved pain relief after thoracotomy Cundy,J.M.
  14. Lancet v.1 Epidural morphine in treatment of pain Behar,M.;Magora,F.;Olshwang,D.;Davidson,J.T.
  15. Br J Anaesth v.53 Continuous pain relief for multiple fractured ribs O.Kelly E.;Garry B.
  16. 대흉외지 v.25 경막외 진통법이 개흉술후 환자에게 미치는 영향 이용재;신화균;권오춘(등)
  17. Br J Aneath v.47 Intercostal nerve block for postoperative somatic pain following surgery of thoracic and upper abdomen Moor,D.C.
  18. Int Anesthesiol Clin v.15 The effect of anesthetic drugs and diseases on the chemical regulation of ventilation Kafer,E.R.;Marsh,H.M.