제왕절개술후 자가진통법을 이용한 정맥내 Nalbuphine은 경막외 Morphine과 Bupivacaine혼합제를 대치할 수 있나?

• Published in: The Korean journal of pain Vol. 10; no. 1; pp. 34 - 41
• Main Authors: 이종석, Jong Seok Lee, 이윤우, Youn Woo Lee, 윤덕미
• Format: Journal Article
• Language: Korean
• Published: 대한통증학회 1997
• Subjects: intravenous; Analgesics: morphine; nalbuphine; Anesthetics; Local: bupivacaine; Pain: postoperative; Analgesia, patient-controlled(PCA): epidural
• ISSN: 2005-9159; 1226-2579; 2093-0569

Background: Patient-controlled analgesia(PCA) is a safe and effective technique for providing posto- perative pain relief. Studies that compare epidural vs intravenous routes of opiate administration show conflicting results. We designed a prospective, randomized, controlled study to evaluate the safety and efficacy of epidural(EPI-PCA) morphine-bupivacaine versus intravenous (IV-PCA) nalbuphine when administered with a PCA system. Methods: Forty healthy women were randomly assigned to receive an epidural bolus of morphine 3 mg and 0.5% bupivacaine 10 ml, followed by a EPI-PCA with 0.01% morphine and 0.143% bupiva- cane (basal infusion l ml/hr, bolus 1 ml, lock-out interval 30 min) or intravenous bolus of nalbuphine 0.1 mg/kg followed by a IV-PCA with nalbuphine(basal infusion 1 mg/hr, bolus 1 mg/1ml, lock-out interval 20 min) for pain relief after cesarean delivery. This study was conducted for 2 days after cesarean section to compare the analgesic efficacy, side effects, patient satisfaction either as EPI-PCA or as IV-PCA. Results: EPI-PCA group had significant lower visual analog pain scale(VAS) at immediate postop- erative period, whereas no significant difference was observed when pain was assessed at other time sequenee. Urinary retention and pruritus were more frequent with EPI-PCA group, although the incidence of other side effects were the same. Conclusions: Although EPI-PCA with morphine-bupivacaine was of significantly lower VAS at immediate postoperative period, IV-PCA with nalbuphine is a safe and effective alternative to EPI-PCA with morphine-bupivacaine for providing pain relief after cesarean delivery. Further studies about IV-PCA with nalbuphine ate needed to control the immediate postoperative pain and to further improve effective pain management.