소파술시 자궁경부주위 차단마취 주사후 시술까지의지연시간이 통증에 미치는 영향
The Effect on Pain of Waiting between Paracervical Blockand Procedure in Dilatation & Curettage
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목적 : 우리나라에서는 공식적으로 연간 약 60만 건의 인공유산이 행하여지고 있는데, 이런 선택적 유산의 방법으로 소파술이 널리 시행된다. 또한, 폐경후 호르몬 대체요법 사용의 증가와 더불어 폐경후 출혈의 진단목적으로 소파수술의 중요성이 점점 강조되고 있다. 이런 소파술시 자궁경부주위 차단마취후 소파수술시까지의 지연시간이 통증과 환자의 만족도에 미치는 효과를 검증하고자 수행하였다. 연구 방법 : 소파술을 시행한 92명을 대상으로 무작위 방법으로 조사하였으며, 자궁경부주위 차단마취후 시술시까지 지연시간이 없는 집단을 A군, 지연시간이 5분인 집단을 B군으로 정한 후에 자궁경관 개대시, 소파술시, 시술 후 30-45분 후 세 차례에 걸쳐 VAS (visual analog scale)을 이용하여 통증수치와 시술에 대한 만족도를 측정하였다. 결과 : A군 (n=53)과 B군 (n=39)에 있어서 자궁경관 개대시, 소파술시, 시술 후 30-45분 후 모두에서의 통증수치와 시술에 대한 만족도는 통계학적으로 유의한 차이를 보이지 않았다. 결론 : 소파술을 시행하는데 있어서 자궁경부주위 차단마취후 시술 시까지의 지연시간이 통증과 환자의 만족도에 영향을 미치지 못한다. 따라서 자궁경부주위 차단마취에서 국소마취제의 주된 역할은 말초신경의 차단 보다 오히려 조직의 기계적 확장이라고 생각된다.
Abstract
Objective : In Korea, approximately 600 thousand artificial abortions are done officially during the course of a year, and dilatation & curettage is commonly used as a method for selective abortion. In addition, because of the increasing use of hormone replacement therapy for treating postmenopausal syndrome and for the diagnostic purposes for postmenopausal bleeding, the importance of dilatation & curettage is emphasized more and more. Our objective was to verify the effects of delayed time between paracervical block and the procedure of dilatation & curettage on pain and patient satisfaction. Methods : 92 women who underwent dilatation and curettage were picked and divided into 2 groups randomly. In group A there was no transit delay time between paracervical block and the procedure, and in group B, there was 5 minutes delay time. We used the VAS (Visual Analogue Scale) to measure numerical value of pain and patient satisfaction during uterine cervical dilatation, the actual procedure of curettage, and 30-45 minutes after the procedure. Results : There was no statistically meaningful difference on the pain value and patient satisfaction between group A and group B measured during uterine cervix dilatation, curettage, and 30-45 minutes after the procedure. Conclusion : The transit delay time between paracervial anesthesia and dilatation &curettage had no specific effects on the pain or patient satisfaction of the procedure. Therefore, the main role of paracervical anesthesia is not to block the peripheral nerve, but instead to dilatate the tissue mechanically.
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