하지 수술을 받는 환아에서 요추 접근법을 통한 수술 후 경막외 자가 통증 조절의 유용성

Abstract

Purpose : To evaluate the safety and efficacy of postoperative patient controlled epidural analgesia via the lumbar approach in children undergoing lower extremity surgery. Materials and Methods : 40 patients between the ages of 5 and 12 years were randomly allocated into two groups; one group received conventional pain medications (intramuscular injection of ketorolac 1 mg/kg t.i.d. and meperidine 0.5 mg/kg p.r.n.) and the other group received patient controlled epidural analgesia. The composition of the analgesics in the experimental group was 0.1% bupivacaine +fentanyl 2 g/mL in 100 mL of normal saline. Pain scores were measured 3 times using a standardized pain scale containing questions regarding side effects - upon arrival at the ward, 6 hours thereafter and 24 hours after the first measurement. Results : Pain scores were significantly lower in the epidural group with minimal side effects requiring no further treatment (p<0.01). A significant correlation was found between the number of boluses and the incidence of nausea/vomiting in epidural group (p<0.01). Conclusion : This study demonstrates the safety and efficacy of patient controlled epidural analgesia using low concentrations of bupivacaine and fentanyl, in pediatric patients undergoing lower extremity surgery.