요부 추궁절제술중 경막외강에 투여한 Morphine과 Methylprednisolone의 진통효과

Abstract

The purpose of this study is to obtain information of simple and effective methods for the pos-tlaminectomy pain control, and to reduce the consumption of supplemental analgesic drugs and side effects. In a double blind study, 75 patients scheduled for lumbar laminectomy were randomly divided into five groups according to the epidurally instilled drugs, such as, morphine 2mg,Group M2; morphine 3mg,Group M3; methylprednisolone 80 mg, Group D; morphine 2mg plus methylprednisolone 80mg, Group M2D; normal saline as a control Group C. All of the drugs were prepared in 2ml normal saline solution. The following items were recorded in the postoperative period: Pain score using visual analogue scale(VAS) at 6, 12, 24, 48 hours after the operation; the episode of supplemental systemic analgesic; the need for postoperative urethral catheterization; any evidence of respiratory depression; pruritus; nausea and vomiting. The results were as follows. I) VAS score were not significantly different between control group and group M2(p>0.05), but usually less in the group M2 and supplemental analgesic consumption was significantly less in the group M2 than in the control group. 2) VAS score were less in the group M3 than in the group M2 and significantly less than in the control group at 6 hour after operation and also supplemental analgesic consumption was significantly less in the group M3. 3) Group D revealed similar VAS score with group M2 at 6 and 12 hour but significantly lower VAS score at 24 and 48 hour after operation than group M2. 4) VAS score were the most significantly less in the group M2D at 6,12,24,48 hour after operation than in the control group and supplemental analgesic consumption was significantly less in the group M2D. 5) Side effects were not significantly different among all groups. These findings suggest that epidurally instilled morphine 3mg, or methylprednisolone 80mg or both before the closure of the laminectomy wound is effective, simple and safe method for the post-laminectomy pain control and reducing supplemental intramuscular analgesics without specific complication.