한국임상약학회지 (Korean Journal of Clinical Pharmacy)

  • 제28권1호
  • /
  • Pages.17-23
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  • 2018
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  • 1226-6051(pISSN)
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  • 2508-786X(eISSN)
한국임상약학회 (Korean College Of Clinical Pharmacy)
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수술 후 자가통증조절장치 사용 환자에서 propacetamol과 fentanyl 복합제 및 fentanyl 단일제제의 효과 비교

Comparison of Propacetamol plus Fentanyl and Fentanyl alone with Patient Controlled Analgesia after Total Knee Arthroplasty

  • 김민형 (이화여자대학교 임상보건융합대학원) ;
  • 정효근 (중앙보훈병원 약제실) ;
  • 박소현 (이화여자대학교 대학원 생명약학부) ;
  • 이정연 (이화여자대학교 임상보건융합대학원)
  • Kim, Minhyung (Graduate School of Converging Clinical & Public Health, Ewha Womans University) ;
  • Jeong, Hyokeun (Veterans Health Service Medical Center) ;
  • Park, Sohyun (Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University) ;
  • Rhie, Sandy Jeong (Graduate School of Converging Clinical & Public Health, Ewha Womans University)
  • 투고 : 2018.01.18
  • 심사 : 2018.03.19
  • 발행 : 2018.03.02
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초록

Objective: Opioid analgesics, for postoperative pain management, are an indispensable group of medication; however, they also have a variety of adverse drug reactions (ADR). Multimodal methods, combining non-opioid analgesics with opioid analgesics, have been investigated to increase the effects of analgesics and reduce ADR with opioid-sparing effects. The purpose of this study was to compare the effects of patient-controlled analgesia (PCA) with fentanyl alone, and PCA with fentanyl and intravenous (i.v.) propacetamol to determine the effects of pain control, cumulative opioid usage, and opioid ADR. Methods: The subjects were patients who underwent total knee arthroplasty at the Seoul Veterans hospital from January 1, 2015 to December 31, 2016. The study period was from postoperative day 0 (POD0) to day 3 (POD3), and the retrospective study was conducted using electronic medical records. Results: Pain severity was significantly low at POD1 (p = 0.017), POD2 (p = 0.003), and POD3 (p = 0.002) in the multimodal group. The fentanyl only group frequently reported both moderate and severe pain at a statistically significant level. This was consistent with the analysis of the pro re nata (PRN) intramuscular analgesia usage at the time of numerical rating scale (NRS) 4 and above. The opioid-sparing effect confirmed that the average opioid dose equivalent to i.v. morphine dose was 9.4 mg more than that used for the multimodal group in the fentanyl only group. The ADRs and length of stay between the two groups were not statistically different. Conclusion: The results of this study suggest that the combination therapy of fentanyl and i.v. propacetamol is superior to fentanyl monotherapy.

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참고문헌

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