전자궁적출술 후 경막외 Bupivacaine과 Fentanyl에 첨가된 Ketamine이 술 후 통증에 미치는 영향

Influence of Ketamine on the Analgesic Effect of Epidural Bupivacaine and Fentanyl after a Transabdominal Hysterectomy

  • 정재윤 (순천향대학교 의과대학 부천병원 마취통증의학교실) ;
  • 방경호 (순천향대학교 의과대학 부천병원 마취통증의학교실) ;
  • 김상현 (순천향대학교 의과대학 부천병원 마취통증의학교실) ;
  • 김용익 (순천향대학교 의과대학 부천병원 마취통증의학교실)
  • Jung, Jai Yun (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital) ;
  • Bang, Kyung Ho (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital) ;
  • Kim, Sang Hyon (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital) ;
  • Kim, Yong Ik (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital)
  • 투고 : 2005.03.23
  • 심사 : 2005.06.30
  • 발행 : 2005.12.10

초록

Background: There have been many attempts to alleviate pain after surgery, but there is no common approach to the control of postoperative pain. The use of epidural opioids, with local anesthetics, has been a widely employed formula to date. Ketamine, an N-methyl-d-aspartate receptor antagonist, has an excellent analgesic effect. Although there have been many reports on the dose and route of administrating analgesics, there have been few concerning the continuous epidural infusion of ketamine with fentanyl. We designed this study to find the effects of ketamine compared to those of epidurally injected bupivacaine and fentanyl, and used this trial to study any potential side effects. Methods: In a double blind trial, 55 patients received either fentanyl, $0.3{\mu}g/kg/h$ (Group F), or fentanyl, $0.3{\mu}g/kg/h$, and ketamine, 0.1 mg/kg/h (Group FK), added to 0.125% bupivacaine, at rates as high as 2 ml/h, for patient controlled epidural analgesia (PCEA) following a transabdominal hysterectomy. Ten minutes before the operation, patients received 10 ml of 0.125% bupivacaine, with either 0.5 mg/kg ketamine or the same amount of normal saline with $50{\mu}g$ fentanyl added. The pain scores and the side effects were recorded at 1, 3, 6 and 24 hour post operation. Results: There were no differences in the pain scores or side effects between the two groups. Conclusions: We failed to find any effect of the addition of epidural ketamine compared to the that of the bupivacaine and fentanyl formula. However, it is suggested that further investigations will be required on the dose and route of administration.

키워드

참고문헌

  1. Yamamoto T, Yaksh TL: Spinal pharmacology of rhe thermal hyperesthesiainduced by constriction injury of sciatic nerve: excitatory aminoacid antagonists. Pain 1992; 49: 121-8.
  2. Lee HJ, Kwak SH, Jeong CY, 1m WM: Effects of epidural keamine for postoperative pain management. Korean Journal of Anesthesiology 1998; 34: 376-82.
  3. Kim HS, Baik SW, Kim IS, Chung KS: Epidural ketamine for postoperative analgesia. The Journal of The Korean Pain Society 1998; 1: 192-8.
  4. Chia YY, Liu K, Liu YC, Chang HC, Wong CS: Adding ketamine in a multimodal patient-controlled epidural regimen reduces postoperative pain and analgesic consumption. Anesth Analg 1998; 86: 1245-9. https://doi.org/10.1097/00000539-199806000-00021
  5. Subramaniam B, Subramaniam K, Pawar DK, Sennaraj B: Preoperative epidural ketamine in combination with morphine does not have a clinically relevant intra- and postoperative opioid-sparing effect. Anesth Analg 2001; 93: 1321-6.
  6. Subramaniam K, Subramaniam B, Pawar DK, Kumar L: Evaluation of the safety and efficacy of epidural ketamine combined with morphine for postoperative analgesia after major upper abdominal surgery. J Clin Anesth 2001; 13: 339-44.
  7. Lee HJ, Sung CH: Effect of epidural ketamine combined with bupivacaine and meperidine on postoperative pain and analgesic consumption after cesarean section. Korean J Anesthesiol 2001; 41: 39-46.
  8. Kim MO, Joo KH, Kim MY, Shin HW, Lee BJ, Suh KS: The effect of epidural low dose ketamine plus morphine on the postoperative pain control. Korean J Pain 1999; 12: 205-10.
  9. Weir PS, Fee JP: Double-blind comparison of extradural block with three bupivacaine-ketamine mixtures in knee arthroplasty. Br J Anaesth 1998; 80: 299-301.