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제왕절개술후 통증치료시 지속적 경막외 국소마취제와 Tramadol의 병용투여의 효과
강포순(Po Soon Kang),조재군(Jae Kun Cho) 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1
N/A Background: Tramadol administered epidurally is known to have one-thirtieth the potency of morphine for treatment of pain following abdominal surgery. We designed a prospective, randomized, controlled study to evaluate the analgesic efficacy and safety of combined epidural infusion of bupivacaine and tramadol with 2-day infusor as ompared to bupivacaine and morphine combined epidural infusion. Methods: Sixty healthy women scheduled for Cesarean delivery were assigned randomly in double- blind fashion: Group 1 (n=20) were given a mixture of morphine 10 mg(1 ml), 0.5% bupivacaine 40 ml a#nd normal saline(NS) 40 ml; Group 2(n=20) a mixture of tramadol 300 mg(6 ml), 0.5% bupivacaine 40 ml and NS 54 ml; Group 3(n=20) or a mixture of tramadol 500 mg(10 ml), 0.5% bupivacaine 50 ml and NS 50 ml, of continuous dose via epidural route following 1% lidocaine 6 ml as bolus dose for 48 hours postoperatively. We evaluated the analgesic efficacy and side effects of these three groups using visual analogue pain scale (VAPS) and verbal rating scale (VRS). Results: VAPS of group 1 and 3 were lower than group 2, and VAPS of group 1 was lower than group 3(12, 24, 36, 48 hours), VRS of group 1 and 3 were lower than group 2 (12, 24, 36 hours). There were incidences of pruritus was 16 patients in group l. Conclusions: Tramadol does possess the analgesia effect of morphine, but has the added analgesia following increment. Further research to determine the most effective administration method and reguired dosage of tramadol is further needed.
임상연구 : 제왕절개술을 위한 경막외 마취 시 0.5% Levobupivacaine과 0.5% Ropivacaine 비교
양춘우 ( Chun Woo Yang ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),류승훈 ( Seung Hun Ryu ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
Background: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. Methods: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. Results: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 ± 66.6 min, ropivacaine 176.5 ± 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. Conclusions: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block. (Korean J Anesthesiol 2007; 52: 284~90)
허리뼈 가시돌기 세로크기 차이를 이용한 4-5 허리뼈 가시사이 공간 확인법
김현우 ( Hyun Woo Kim ),진경욱 ( Gyong Uk Jin ),임영수 ( Young Su Lim ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),조춘규 ( Choon Kyu Cho ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: The appropriate landmark of spinal puncture is important for preventing spinal cord injury. L4 spinous process (SP) is the largest in size and L5 is the smallest. In this study `height of SP` is the longitudinal length of SP on lumbar AP view. The purpose of this study was to identify the L4-5 interspinous space (ISS) using difference between L4, 5 SP heights. Methods: Sixty-six patients scheduled for spine surgery were enrolled. After induction of general anesthesia, patients were changed to a prone position. The lumbar vertebrae were palpated from the lowest point of the lumbar spine and cranially. We palpated the difference in spinous process heights and marked the point of step-off from L4 SP to L5 SP. The level was radio-logically confirmed. Direction of estimation error and the effects of spondylolisthesis, sex, and obesity were also analyzed. Results: The number of accurate identification of the L4-5 ISS in males was 36 (85.7%), in females was 17 (70.8%), and in total 53 (80.3%). The difference between L4 and L5 SP heights (DL4-5SPHs) and sex affect the results. DL4-5SPHs were larger in concordant patients than in discordant patients (7.2±4.9 mm: 5.0±1.6 mm, P<0.05). Among errors, there were more cephalad identified cases compared to caudad identified ones (12.1%: 7.6%). Conclusions: The identification of L4-5 ISS using SP height difference was considerably accurate. So, we considered this might be a useful method for spinal anesthesia. (Korean J Anesthesiol 2009; 56: 652~7)