위 절제술 후 통증 조절을 위해 경막외강으로 투여한 morphine과 bupuvacaine의 혼합제가 장운동에 미치는 영향

Abstract

Background: Postoperative ileus is a universal complication after major intraabdominal surgery. Choice of postoperative analgesia may affect the rate of functional recovery of bowel. Epidural analgesia with morphine and bupivacaine is a popular method for pain relief. However little is known about the effects of this regimen on bowel motility. Methods : Forty patients undergoing partial or total gastrectomy were randomized into two groups. All groups received a standardized general inhalation anesthesia with enflurane. Control group received traditional intramuscular(IM) administration of meperidine for the postoperative analgesia. Experimental group received a bolus of epidural 0.5% bupivacaine 10 ml followed by continuous epidural infusion of 0.21% bupivacaine with 0.01% morphine, started at the end of operation with the basal infusion rate of 1 ml/hours, bolus 1 ml, and lockout interval 30 min during 48 hr. We compared the analgesic effect, side effects and restoration of bowel function(first passage of flatus and feces)between two groups. Postoperative pain was assessed using the 10 cm visual analog pain scale (0=no pain, 10=worst imaginable pain) at rest. Scores were taken at 1, 6 hours after operation and 7 AM, 6 PM of the 1st postoperative day and 7 AM of the 2nd postoperative day. Results : Experimental group revealed superior analgesia(p＜0.005) but had a greater incidence of nausea, pruritus and urinary retention. No significant difference was found in restoration of bowel function between two groups. Conclusion : There was no superior effect of epidural analgesia with morphine and bupivacaine on bowel motility after gastrectomy than the effect of traditional IM meperidine administration.