위절제술 후 경막외 자가통증조절 시 ropivacaine에 첨가된 sufentanil과 morphine의 효과 비교

Abstract

BACKGROUND: Early pain control after gastrectomy is essential to minimize complication. We have compared the analgesic efficacy and side effects of sufentanil versus morphine for postoperative epidural analgesia. And we investigated the optimal dosage of sufentanil.

METHODS: Sixty of seventy-five patients underwent gastrectomy were randomly allocated into three groups to receive ropivacaine 0.15% + sufentanil 0.5µgram/hour (group S1), or ropivacaine 0.15% + sufentanil 1.0µgram/hour (group S2) or ropivacaine 0.15% + morphine 32µgram/hour (group M). Before surgery, an epidural catheter was inserted at T 7-9 level and sufentanil 20µgram in group S1 and S2 or morphine 2 mg in group M were injected via the epidural catheter. After completion of surgery, continuous epidural infusion was started using PCEA device. Basal infusion rate, lock out time, bolus dose were 4 ml/hour, 20 minutes and 4 ml, respectively. Resting VAS, coughing VAS and side effects were recorded : immediate after awakening, 6, 12, 24, 48 hours after surgery. Forced vital capacity was assessed before and at 6, 24, 48 hours after surgery.

RESULTS: There were no significant differences in resting VAS, coughing VAS and FVC among three groups. The number of side effects, especially pruritus and sedation were significantly more in group M than group S1 and S2 (P < 0.05). No difference was seen between group S1 and S2.

CONCLUSION: Thoracic epidural application of sufentanil combined with ropivacaine provides effective analgesia after gastrectomy, which is comparable to the analgesia with ropivacaine plus morphine and it provides less side effects especially pruritus and sedation. In addition, the optimal dosage of sufentanil was 2microgram/hour.