후방 척추 감압술을 시행한 척추관 협착증 환자에서 수술 후 통증조절 방법간의 효과 비교 = Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

다국어 초록 (Multilingual Abstract)

Study Design: Prospective study.
Objectives: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression.
Summary of Literature Review: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary.
Materials and Methods: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively.
Results: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p<0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p<0.05).
Conclusions: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.

국문 초록 (Abstract)

연구 계획: 전향적 연구목적: 본 연구에서는 요추부 협착증으로 후방 척추 감압술을 시행 받은 환자에게 경막외강 내 및 정맥 내 경로를 통한 3가지 통증조절방법을 적용한 뒤각 방법간의 통증조절효과 및 구역감, 구토감(postoperative nausea and vomiting (PONV))을 비교하고자 하였다.
선행 연구문헌의 요약: 척추 수술은 수술 후 심한 통증을 유발하므로 통증관리를 위한 효율적이고 안전한 통증조절방법은 필수적이다.
대상 및 방법: 술 후 임상증상 및 통증의 호전여부를 판단하기 위하여 단분절 후방 척추 감압술을 시행 받은 52명의 환자를 무작위로 총 3군으로 나누어 18명에게 전신 마취 후 수술 시작 직전 경막외강 내 일회 약물 투여, 16명에게 술 후 지속성 경막외강 내 약물 투여장치를 적용, 18명에게 술 후 정맥내 자가통증조절장치를 적용하였다. 수술 직후, 4시간 후, 12시간 후, 1일 후, 2일 후 환자가 호소하는 통증 정도를 시각통증등급 (Visual Analogue Scale [VAS[)를 이용하여 평가하였고, 통증조절약물 투여 후 환자가 호소하는 구역감, 구토감의 횟수와 정도를 조사하였다.
결과: 통증조절효과의 비교에서 지속성 경막외강 내 약물 투여(CEI) 군이 유의하게 좋았고, 일회성 경막외강 내 약물 투여(SEI) 군과 정맥 내 통증자가조절장치(IV-PCA) 군이 뒤를 이었다(p<0.05). 술 후 통증조절에 따른 PONV는 PCA 군에서 다른 두 군보다 발생빈도가 높았다(p<0.05).
결론: 지속성 경막외강 내 약물투여(CEI)는 후방 척추 감압술 후 통증 조절에 효과적이며 PONV의 발생을 최소화한다.


약칭 제목: 후방 척추 감압술을 시행한 척추관 협착증 환자에서 수술 후 통증조절 방법간의 효과 비교

참고문헌 (Reference)

• 1 Preble L, "Varying narcotic requirements among orthopedic patients" 73 : 1990
• 2 Eilers K, "Use of peridural catheters in the treatment of postoperative pain after spinal instrumented fusion–an experience report" 140 (140): 621-625, 2002
• 3 Shaw BA, "The safety of continuous epidural infusion for postoperative analgesia in pediatric spine surgery" 16 (16): 374-377, 1996
• 4 Bianconi M, "The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery" 98 (98): 166-172, 2004
• 5 Turner A, "The efficacy of surgically placed epidural catheters for analgesia after posterior spinal surgery" 55 (55): 370-373, 2000
• 6 Byung Joon Shin, "The Effect of Epidural Morphine for pain Management after Spinal Surgery" 1 (1): 216-222, 1994
• 7 Egbert AM, "Randomized trial of postoperative patient-controlled analgesia vs. intramuscular narcotics in frail elderly man" 150 (150): 1897-1903, 1990
• 8 Lowry KJ, "Postoperative pain control using epidural catheters after anterior spinal fusion for adolescent scoliosis" 26 (26): 1290-1293, 1976
• 9 Schenk Michael R, "Postoperative analgesia after major spine surgery: patientcontrolled epidural analgesia versus patient-controlled intravenous analgesia" 103 (103): 1311-1317, 2006
• 10 Joshi GP, "Postoperative analgesia after lumbar laminectomy: epidural fentanyl infusion versus patient-controlled intravenous morphine" 80 (80): 511-514, 1995
• 11 Sechzer PH, "Patient-controlled analgesia (PCA): a retrospective" 72 (72): 735-736, 1990
• 12 Harrison DM, "Epidural narcotic and patient controlled analgesia for post-cesarean section pain relief" 68 (68): 454-457, 1988
• 13 Behar M, "Epidural morphine in treatment of pain" 1 (1): 527-529, 1979
• 14 Blumenthal S, "Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery" 102 (102): 175-180, 2005
• 15 Maurer K, "Continuous spinal anesthesia/analgesia vs. single-shot spinal anesthesia with patient-controlled analgesia for elective hip arthroplasty" 47 (47): 878-883, 2003
• 16 Ferrante FM, "A statistical model for pain in patient controlled analgesia and conventional intramuscular opioid regimens" 67 (67): 457-461, 1988
• 17 Klatt Joshua W. B., "A randomized prospective evaluation of 3 techniqued of post operative pain management after posterior spinal intrumentation and fusion" 38 (38): 1626-1631, 1976
• 18 Cassady JF Jr, "A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents" 25 (25): 246-253, 2000
• 19 Cassady JF Jr, "A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents" 25 (25): 246-253, 2000
• 20 Wu Meng-Huang, "A comparison of three types of postoperative pain control after posterior lumbar spinal surgery" 36 (36): 2224-2231, 1976