요추궁 절제술 후 진통을 위한 소량의 지주막하강내 Morphine과 지속적 경막외 아편유사제-국소마취제 혼합물의 병용투여 효과
Postoperative Analgesic Effect of Combined Low Dose Intrathecal Morphine and Continuous Epidural Opioid Local Anesthetic Mixture after Lumbar Laminectomy
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Abstract
Background: Epidural opioid-local anesthesia has been used for postlaminectomy analgesia. However, it sometimes has a poor analgesic effect in the early postoperative period. This study was designed to assess the postlaminectomy analgesic effect of combined low-dose intrathecal morphine and continuous epidural opioid-local anesthesia. Methods: Seventy five patients, aged 40-70 years and scheduled for a lumbar laminectomy, were randomly allocated into three groups. The groups received either a single dose of 0 (saline injection) (n = 25), 0.1 mg (n = 25) or 0.2 mg (n = 25) intrathecal morphine, respectively, which was followed by continuous epidural fentanyl 5μg/ml, morphine 50μg/ml and 0.1% bupivacaine, at the rate of 2 ml/h. The visual analogue scale (VAS) was observed in the recovery room and 2, 4, 6, 12 and 24 h postoperatively; the side effects were also assessed. Results: There were significant differences in the VAS scores between the intrathecal morphine groups and saline group and in the recovery room at 2 and 4 h between the intrathecal morphine 0.1 mg and 0.2 mg groups. The incidence of side effects increased in the intrathecal morphine groups. Conclusions: The combined low-dose intrathecal morphine and continuous epidural fentanyl-morphine-bupivacaine showed good analgesic effects after a lumbar laminectomy.
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