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정형외과 수술후통에 대한 지주막하강내 Morphine 의 영향
김완식,박동호,유희구,황재현,김경헌,황영희,전세웅 대한마취과학회 1985 Korean Journal of Anesthesiology Vol.18 No.4
To assess the postoperative analgesic effect of intrathecal morphine, it was given with 0.5% isobaric bupivacaine intrathecally after orthopedic surgery. The patients were divided into three groups. In group Ⅰ(control group) 0.5% bupivacaine 3 ml was administered with normal saline 0.2 ml to 10 patients. In group Ⅱ(experimental group) 0.5% bupivacaine 3 ml was administered with morphine hydrochloride 0.5 mg to 10 patients and in group Ⅲ(experimental group) morphine hydrochloride 1.0 mg to 10 patients. The duration of the postoperative analgesic effect, frequency of analgetic jection and incidence of side effects wore checked and compared. The results of this study were as follows: 1) The mean time of duration of analgesia was prolonged significantly in group Ⅱ compared to group Ⅰ(p<0.05) and very significantly in group Ⅲ(p<0.005) and also a significant difference between group Ⅱ and group Ⅲ(p<0.01). 2)The frequency of analgetic injection in the postoperative period was lower in group Ⅱ than in groupⅠ and no patient was injected in group Ⅲ. 3) The mean time to maximal analgesic block was 19.5 minutes and the mean time to mxaimal motor block was 17.7 minutes. There was no difference among the three groups. 4) The mean time of recovery from the sensory blockade and motor blockade was 6.1 hours and 4.2 hours. Htere was no difference among the three groups. 5) Among the three groups there was little change in a the cardiovascular system due to suppression of the autonomic nervous system after induction of spinal anesthesia. 6) In all groups the systemic complications occurred such as nausea, vomiting, micturition difficulty, itching, constipation, headache and backache. This complications did not appear to be dose dependent and not occurred in patients not receiving morphine. Severe delayed respiratory depression was noted 2 cases in group Ⅲ.
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