1. 가설 ‘수술후 진통제의 경락외 투여군, 규칙적 근육 투여군과 전통적 근육 투여군간에는 동통정도에 차이가 있을 것이다.’는 통각에서만 유의한 차이를 보여(F=3.16, p<.05) 부분적으로 지지되었다.
2. 가설 ‘수술후 진통제의 경막외 투여군, 규칙적 근육 투여군과 전통적 근육 투여군간에는 생리적 반응에 차이가 있을 것이다.’는 수면상태에서만 유의한 차이를 보여(F=5.55, p<.01) 부분적으로 지지되었다.
3. 전통적 근육 투여군과 경막외투여군의 수술후 진통제 투여시간간격은 경막외투여군이 더 긴것으로 나타났다.
4. 수술후 36시간까지 동통은 보통이상이었으며, 변화양상은 규칙적으로 진통제를 제공하지 않은 전통적 근육 투여군과 경막외투여군이 통각변화에 주기를 나타내었다.
5. 성별, 연령, 성격, 신체위험 기질불안과 동통과는 유의한 상관관계가 없는 것으로 나타났다.
6. 수술후 경미한 합병증 발생의 빈도에서는 경막외투여군에서 배뇨곤란의 발생이 다른 두군보다 두배 이상 높은 것으로 나타났다.
이상의 연구결과에 의하면 경막외투여군이 동통감소에는 좋은 효과를 나타냈으나 배뇨곤란의 합병증 발생이 높았으며, 세 군간에 생리적 반응에서는 수면상태외에는 차이가 적게 나타났으므로 수술후환자의 진통제 투여방법의 선택은 환자의 동통수준과 생리적 반응을 기반으로 정해야 할 것이다.
그러나 진통제를 동통이 심해지기 전에 투여하는 것이 진통제 량을 감소시키면서 진통효과에 좋다는 보고들이 있으므로 일회 진통제 투여량과 진통제 투여시간을 달리하여 반복연구를 해볼 것을 제안한다.
The Effect of Three Analgesic Administration Methods on Postoperative Pain and
Recovery Rate after Gastrectomy
Hur, Hea Kung
Department of Nursing The Graduate School of Yonsei University
(Directed by Prof. Yoo, Ji Soo, RN, Ph.D.)
An acute pain is the common experience following surgery. After upper abdominal
surgery more than 70% of the patients complained of having moderate to marked pain.
The experience of postoperative pain negatively influences physiological well
being and delays recovery from the operation.
This study was designed to determine an effective method of analgesic
administration for postoperative pain relief in patients who had had upper
abdominial surgery.
An experimental design method of cost test only was used for this clinical study.
Thirty patients who had undergone major operations were randomly divided into
three equal groups to receive different regimens of analgesics over the first 24
hours postoperatively.
Patients in group A received 8.9mg of morphine by epidural infusion, those in
group B received 150mg of meperidine intramuscularly, every four hour for 24 hours,
and those in group C received 94mg of meperidine intramuscularly as needed.
The subjects in this study were patients from surgical wards in a large hospital
in Seoul, Korea. The data was collected was from June 12, 1990 to August 30, 1990.
The instruments used for this study were the physiological danger trait anxiety
scale developed by Endler et. al., the personality stale developed by Eysenck, the
pain scale developed by Gracely et. al. and the physiological responses list
developed by the researcher.
Data was analyzed using x**2- teat, t -test, ANOVA, Duncan muliple test, Repeated
measures ANOVA, Pearson correlation coefficient and Cronbach α
The results of this study were as follows;
1. Hypothesis 1 :‘The pain score will differ for patients receiving analgesic by
epidural infusion, regular four hourly intramucular injections and intramuscular
injections as needed’ was partly supported.
Among the three groups, patients receiving the epidural infusion of morphine
reported the lowest pain sensation score(F=3.16, p<.05).
2. Hppothesis 2 : ‘The physiological response will differ for patients receiving
analgesic by epidural infusion, regular four hourly intramuscular injections and
intramuscular injections as needed’ was partly supported.
The physiological response in which there was a significant difference between
three groups was the ability to sleep at night(F=5.55, p<.01 ). Among three
groups, patients receiving epidural infusion of morphine reported the best
condition, that is, no sleeping disturance due to pain.
3. Patients receiving an epidural infusion of morphine had a longer interval time
between analgesic injections than those receving intramuscular injections of
meperidine as needed.
4. All the patients in thin studs had a moderate pain score for the first 36
hours postoperatively. But the hourly pattern for postoperative pain showed that
the scores of patients in the epidural infusion group and those in the
intramuscular injections as needed group had a cyclic pattern for the pain
sensation score.
5. There was no statistically significant correlation among age, sex,
personality, physical danger trait anxiety and the pain score.
6. Patients receiving an epidural infusion of morphine had urinary retention
twice frequent than as compared to those in the other two groups.
In summary patients receiving an epidural infusion of morphine showed the lowest
pain sensation score, but the highest frequency of urinary retention. There was no
statistically significant difference in the physiological responses among the three
groups except for the ability to sleep at night.
Therefore it is difficult to choose one method of analgesic administration for
postoperative pain relief. It is important that the choice of analgesic
administration should be based on the nurses' pain assessment and patients'
physiological response.
[영문]
An acute pain is the common experience following surgery. After upper abdominal surgery more than 70% of the patients complained of having moderate to marked pain.
The experience of postoperative pain negatively influences physiological well being and delays recovery from the operation.
This study was designed to determine an effective method of analgesic administration for postoperative pain relief in patients who had had upper abdominial surgery.
An experimental design method of cost test only was used for this clinical study.
Thirty patients who had undergone major operations were randomly divided into three equal groups to receive different regimens of analgesics over the first 24 hours postoperatively.
Patients in group A received 8.9mg of morphine by epidural infusion, those in group B received 150mg of meperidine intramuscularly, every four hour for 24 hours, and those in group C received 94mg of meperidine intramuscularly as needed.
The subjects in this study were patients from surgical wards in a large hospital in Seoul, Korea. The data was collected was from June 12, 1990 to August 30, 1990.
The instruments used for this study were the physiological danger trait anxiety scale developed by Endler et. al., the personality stale developed by Eysenck, the pain scale developed by Gracely et. al. and the physiological responses list developed by the researcher.
Data was analyzed using x**2- teat, t -test, ANOVA, Duncan muliple test, Repeated measures ANOVA, Pearson correlation coefficient and Cronbach α
The results of this study were as follows;
1. Hypothesis 1 :‘The pain score will differ for patients receiving analgesic by epidural infusion, regular four hourly intramucular injections and intramuscular injections as needed’ was partly supported.
Among the three groups, patients receiving the epidural infusion of morphine reported the lowest pain sensation score(F=3.16, p<.05).
2. Hppothesis 2 : ‘The physiological response will differ for patients receiving analgesic by epidural infusion, regular four hourly intramuscular injections and intramuscular injections as needed’ was partly supported.
The physiological response in which there was a significant difference between three groups was the ability to sleep at night(F=5.55, p<.01 ). Among three groups, patients receiving epidural infusion of morphine reported the best condition, that is, no sleeping disturance due to pain.
3. Patients receiving an epidural infusion of morphine had a longer interval time between analgesic injections than those receving intramuscular injections of meperidine as needed.
4. All the patients in thin studs had a moderate pain score for the first 36 hours postoperatively. But the hourly pattern for postoperative pain showed that the scores of patients in the epidural infusion group and those in the intramuscular injections as needed group had a cyclic pattern for the pain sensation score.
5. There was no statistically significant correlation among age, sex, personality, physical danger trait anxiety and the pain score.
6. Patients receiving an epidural infusion of morphine had urinary retention twice frequent than as compared to those in the other two groups.
In summary patients receiving an epidural infusion of morphine showed the lowest pain sensation score, but the highest frequency of urinary retention. There was no statistically significant difference in the physiological responses among the three
groups except for the ability to sleep at night.
Therefore it is difficult to choose one method of analgesic administration for postoperative pain relief. It is important that the choice of analgesic administration should be based on the nurses' pain assessment and patients' physiological response.