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인공 고관절 전치환술 후 관절 주위 연부 조직에 주입한 Bupivacaine과 Morphine이 수술 후 통증에 미치는 영향: 전향적 연구

The Efficacy of a Periarticular Soft Tissue Injection of Bupivacaine and Morphine in Total Hip Arthroplasty: a Prospective Study

김영호|김이석|조창민|심재항|황규태
대한고관절학회 (The Korean Hip Society)|2010.12|Hip and Pelvis|제22권 제4호|pp. 266-272

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인공 고관절 전치환술BupivacaineMorphineTotal hip arthroplasty관절 주위 연부 조직Periarticular soft tissue injection

초록

목적: 인공 고관절 전치환술 후 고관절 주위 연부 조직에 혼합 주입한 bupivacaine과 morphine 이 술 후 통증 조절에 미치는 효과에 대해 전향적 연구를 통하여 알아보고자 하였다. 대상 및 방법: 2008년 2월부터 2010년 1월까지 본원에서 인공 고관절 전치환술을 시행 받은 환자를 대상으로 하였다. 모든 환자는 술 전, 후 COX-2 선택적 차단제와 술 후 24시간 동안 경막외 자가 통증 조절 장치(PCEA, Patient Controlled Epidural Analgesia)를 사용하였으며 모두전신 마취 하에 수술을 시행하였다. 50명의 환자를 두 군으로 무작위 선정하여, 수술 시 인공 고관절을 정복한 직 후에 25명(A군)은 생리 식염수 50 ml를 관절 주위 연부 조직 주입하였고, 25명(B군)은 morphine HCL 5 mg 0.5 ml, 0.5% chirocaine (Levo-bupivacaine) 50 mg 40 ml,1:200,000 epinephrine 0.25 ml와 생리 식염수를 혼합하여 전체 50 ml를 관절 주위 연부 조직에 주입하였다. 술 후 6, 12시간에는 휴식시, 술 후 24, 48, 72시간에는 휴식시와 수동적 관절 운동(30􀆆)시 통증 변화를 Visual Analogue Scale (VAS)을 이용하여 측정하였다. 자가 통증 조절약물의 사용량 및 통증에 대한 추가 약물의 사용량에 대해 비교 조사하였다. 또한 관절 주위에 주입한 약물과 관련된 부작용에 대해 조사하였다. 결과: 두 군간의 비교 결과, 술 후 6, 12시간의 휴식시, 24, 48, 72시간 휴식시와 수동적 관절 운동시의 VAS와 술 후 24시간 동안 사용한 자가 통증 조절 약물의 사용량 모두 혼합 약물을 주입한군(B군)에서 낮은 결과를 나타내었다 (P<0.05). 통증에 대한 추가 약제의 사용량은 혼합 약물을주입한 군(B군)에서 적게 사용되었으나 두 군간의 통계학적 차이는 없었다. 관절 주위에 주입한약물과 관련된 부작용은 관찰되지 않았다. 결론: 인공 고관절 전치환술시 관절 주위 연부 조직에 약물을 혼합 주입하는 방법은 술 후 통증을효과적으로 감소시키고 추가적인 진통제 사용을 줄일 수 있는 유용한 방법으로 사료된다.

Abstract

Purpose: We wanted to assess the benefits and safety of periarticular soft tissue injection of bupivacaine and morphine in total hip arthroplasty by conducting a prospective randomized trial. Materials and Methods: Between February 2008 and January 2010, a prospective, randomized study was performed on fifty patients with an American Society of Anesthesiology stage of I or II. All the patients were administered COX-2 inhibitor and we used PCEA (Patient Controlled Epidural Analgesia) for 24 hours postoperatively. All the patients underwent their operation under general anesthesia. Fifty randomly selected patients were divided into two groups. After reduction of the hip joint, 50 ml of normal saline was intraoperatively injected into 25 patients (Group A) and 50 ml of locally injected analgesia that included 0.5 ml 5 mg of morphine HCL, 40 ml of 0.5% 50 mg chirocaine (Levo-bupivacaine) and 9.5 ml of normal saline was injected into the capsule and the soft tissue and muscle around the hip joint in 25 patients (Group B). The analgesic efficacy was evaluated by the visual analogue scale (VAS) at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and during a passive exercise (30 ) state. The consumption of PCEA and additional analgesic drugs was also evaluated postoperatively. Results: Significant differences were found between the 2 groups (P<0.05) with regard to the VAS at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and a passive exercise state. During 24 hours postoperatively, in the mixed analgesia injected group, the consumption of PCEA was significantly lower than that in the normal saline injected group (P<0.05). No significant differences were found for the consumption of additional analgesic drugs between the 2 groups (P>0.05). Conclusion: Intraoperative periarticular soft tissue injection of bupivacaine and morphine can significantly reduce pain and it can reduce the requirement for patient-controlled analgesia, with no apparent risks, following total hip arthroplasty.

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