전슬관절치환술에서 선행진통이 수혈에 미치는 영향 = The Effects of Preemptive Analgesia to Blood Transfusion in Total Knee Arthroplasty

다국어 초록 (Multilingual Abstract)

Background:Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. In recent studies, preemptive analgesia was useful for control of postoperative pain in patients undergoing TKA. In particular, cyclooxygenase-2 inhibitor (celecoxib) is recommended for preemptive analgesia. As a large amount of blood is lost during TKA, blood transfusion is often required. In this study, we evaluated the difference of intraoperative blood loss, complications of operation, and hemodynamic change between the celecoxib group and the control group in TKA surgeries.
Methods:A total of 58 patients who underwent TKA from January 2013 to June 2013 in our hospital were evaluated through a retrospective study. Patients in the celecoxib group received 200 mg of oral celecoxib 1 to 2 hours before TKA. Those in the control group received no medication 1 to 2 hours before TKA. Preoperative and postoperative hemoglobin level, estimated blood loss, infused fluid volume, and intraoperative complications (nausea, vomiting) were assessed. Mean blood pressure was recorded immediately, and 30, 60, and 90 minutes after spinal anesthesia, after transfer to the post anesthesia care unit.
Results:No significant differences in demographic data (age, height, weight, operation time, nausea, and vomiting) were observed between the two groups. The intraoperative fluid volume of the celecoxib group was lower than that of the control group (782.8±240.6 vs 1382.4±369.2; P＜0.05). No differences in hemodynamic changes (intraoperative blood pressure) were observed between the two groups.
Conclusion:Perioperative use of an inhibitor of cyclooxygenase 2 is an effective component of multimodal analgesia, which has no effect on hemodynamic change and side effects during TKA.

국문 초록 (Abstract)

배경: 전슬관절 치환술은 중등도 이상의 수술후 통증을 일으킬 수 있다. 최근의 연구에서 선행진통은 전슬관절 치환술을 받는 환자의 수술 후통증 조절 방법으로 유용하다고 알려져 있다. 특히 cyclooxygenase-2 inhibitor인 celecoxib는 선행진통에 대해 추천되는 약제이다. 한편 전슬관절 치환술을 시행하는 동안에는 다량의 출혈이 발생하게 되어 수혈이 요구되는데, 이번 연구에서 저자들은 전슬관절 치환술을 받는 환자를 대상으로 수술 중 출혈량, 합병증(구역, 구토), 혈역학적 변화를 celecoxib를 준 그룹과 대조군과 비교하였다.
방법: 2013년 1월부터 6월까지 TKA를 시행받은 환자 58명을 대상으로 후향적 연구를 통해 분석하였다. Celecoxib군은 전슬관절 치환술을 받기1∼2시간 전에 200 mg의 경구 celecoxib를 복용하였다. 대조군은 전슬관절 치환술을 받기 1∼2시간 전에 약물을 복용하지 않았다. 술중 술 후 헤모글로빈 수치, 출혈량, 주입된 수액 용량, 수술중 합병증(구역, 구토) 및 시간에 따른 수술 중 혈역학적인 변화(혈압)를 두 군간 비교하였다.
결과: 두 군의 인구학적인 변수(나이, 키, 몸무게, 수술 시간, 마취시간, 구역, 구토)는 통계학적으로 유의한 차이가 없었다. Celecoxib group의 주입된 수액 용량은 대조군 보다 통계학적으로 유의하게 적게 나타났다. 두 군간 혈역학적인 변화는 유의한 차이를 보이지 않았다.
결론: TKA 수술 시 수술 후 통증을 줄이기 위한 선행진통을 시행하는 것은 출혈량이나 혈역학적 변수에 영향을 미치지 않는다.

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