Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Pain Control after Total Hip Replacement Arthroplasty Using Periarticular Multimodal Drug Injection

인공 고관절 전치환술에서 관절 주위 다중약물투여를 이용한 통증조절

  • Choi, Jang-Seok (Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Kim, Jung-Han (Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Gwak, Heui-Chul (Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Kim, Jung-Won (Department of Orthopedic Surgery, Busan Seail Hospital) ;
  • Min, Young-Kyoung (Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University)
  • 최장석 (인제대학교 의과대학 부산백병원 정형외과학교실) ;
  • 김정한 (인제대학교 의과대학 부산백병원 정형외과학교실) ;
  • 곽희철 (인제대학교 의과대학 부산백병원 정형외과학교실) ;
  • 김정원 (부산 세일병원 정형외과) ;
  • 민영경 (인제대학교 의과대학 부산백병원 정형외과학교실)
  • Published : 2010.12.31
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Abstract

Purpose: This study attempted to evaluate the pattern of change of the pain after total hip arthroplasty (THA) and to confirm the effect of periarticular multimodal drug injection (PMDI) on controlling the early postoperative pain. Materials and Methods: Of the total patients who underwent primary THA at our hospital because of osteonecrosis of the femoral head from March to October 2008, 60 patients were enrolled in this study. The subjects were divided into three groups. Groups 1 & 2 received periarticular injection. Group 1 included the patients who were injected with a combination of opioid, long-acting local anesthetics, a non-steroidal anti-inflammatory drug and epinephrine. Group 2 received a combination of morphine and ropivacaine and group 3 was not injected with any analgesics. The visual analogue scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, 14 days and 1 month after surgery, the frequency that patients pushed the self-controlled pain medication machine for 2 days after surgery and the amount of clonac that was injected according to the needs of the patients were used as objective measures. Results: The VAS score at postoperative 4 hours to 3 days among the groups showed a significant difference (P<0.05), but the VAS scores at postoperative 5 days to 1 month among the groups showed no significant difference (P>0.05). The frequency of pushing the self-controlled pain medication machine among the groups and the amount of clonac according to the needs of the patients among the groups showed that there were significant decreases at the operation day, the postoperative 1, 2 day and the 3 days (P<0.05). Conclusion: PMDI has a significant effect on controlling the early postoperative pain after THA.

목적: 인공고관절 전치환술 이후 통증의 변화양상 및 술 후 초기 통증 조절을 위한 고관절 주위에 다양한 방식의 주사제 주입의 효과를 알아보고자 하였다. 대상 및 방법: 2008년 3월부터 10월까지 대퇴골두 괴사로 인공고관절 전치환술을 받은 환자를 대상으로 하였다. 대상 환자를 세 군으로 분류하였으며, 1군과 2군은 고관절 주위에 주사제 주입을 하였다. 1군은 아편 유사 진통제와 지속성 부분 마취제, 비스테로이드소염제, 에피네프린 병용 투여한 군이며, 2군은 아편 유사 진통제와 지속성 부분 마취제를 투여한 군이며, 3군은 투여하지 않은 군이다. 시각통증 등급을 술 후 4시간 및 8시간, 12시간, 24시간, 2일, 3일, 5일, 14일, 1달 후 측정 하였으며, 환자가 술 후 2일간 자가 통증 조절기를 누른 횟수와 환자의 요청에 의해 투여된 클로낙주의 용량을 측정하였다. 결과: 각 군간 술 후 3일까지의 시각통증등급은 통계적으로 유의한 차이를 보였다.(P<0.05) 그러나 술 후 5일 이후에서는 통계적으로 유의한 차이를 보이지 않았다.(P>0.05) 각 군간 술 후 2일간 자가 통증 조절기를 누른 횟수 및 술 후 3일간 클로낙주 투여 용량은 통계적으로 유의한 감소가 있었다.(P<0.05) 결론: 인공고관절 전치환술 이후 고관절 주위에 다양한 방식의 주사제 주입은 술 후 초기 통증 감소에 효과가 있었다.

Keywords

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