견관절 수술 후 통증에 대한 관절강내 자가 통증조절과 간헐적 사각근간 상완신경총 차단의 비교 (Intermittent Interscalene Brachial Plexus Block vs. Continuous Intraarticular Infusion for the Management of Postoperative Pain after Shoulder Surgery)

서지정보

· 발행기관 : 대한마취통증의학회
· 수록지 정보 : Anesthesia and Pain Medicine / 3권 / 3호 / 162 ~ 166페이지
· 저자명 : 최우종

초록

Background: Severe postoperative pain is a well-known problem
following shoulder surgery. This study evaluates the clinical
efficacy of intermittent interscalene brachial plexus block (ISBPB)
compared with that of continuous intraarticular infusion (IAPCA) for
the management of postoperative pain after shoulder surgery.
Methods: Fifty seven patients, scheduled for shoulder surgery
during general anesthesia, were randomly allocated to one of two
groups. Group ISBPB (n = 19) received a preoperative interscalene
brachial plexus block using 20 ml of 0.5% bupivacaine
followed by insertion of a 20-gauge polyamide catheter. This
catheter was connected to a patient-controlled analgesia pump set
immediately after surgery to administer a bolus of 0.75% ropivacaine
15 ml at lockout time intervals 8 hours. Group IAPCA (n = 38)
received patient- controlled analgesia with 0.2% ropivacaine 100 ml
(basal rate 2 ml/hr, bolus 0.5 ml, lockout time 15 min). Both groups
received intravascular patient-controlled analgesia with fentanyl 10−
15 μg/ml (basal rate 1 ml/hr, bolus 2 ml, lockout time 15 min). All
patients were given pethidine 25 or 50 mg when visual analogue
score (VAS) ＞ 40 mm. VAS, circulatory and respiratory stress
parameter (heart rate, noninvasive blood pressure and respiratory
rate) and consumption of pethidine were measured during 72 hours
following surgery at intervals of 8 hours.
Results: The mean VAS scores in the ISBPB group were
significantly lower than in the IAPCA group for 72 hr after surgery
(P ＜ 0.01). Pethidine consumption in the ISBPB group was
significantly lower than in the IAPCA group (P ＜ 0.01).
Conclusions: We concluded that intermittent interscalene brachial
plexus block is an effective method of postoperative analgesia after
major shoulder surgery.

영어초록

Background: Severe postoperative pain is a well-known problem
following shoulder surgery. This study evaluates the clinical
efficacy of intermittent interscalene brachial plexus block (ISBPB)
compared with that of continuous intraarticular infusion (IAPCA) for
the management of postoperative pain after shoulder surgery.
Methods: Fifty seven patients, scheduled for shoulder surgery
during general anesthesia, were randomly allocated to one of two
groups. Group ISBPB (n = 19) received a preoperative interscalene
brachial plexus block using 20 ml of 0.5% bupivacaine
followed by insertion of a 20-gauge polyamide catheter. This
catheter was connected to a patient-controlled analgesia pump set
immediately after surgery to administer a bolus of 0.75% ropivacaine
15 ml at lockout time intervals 8 hours. Group IAPCA (n = 38)
received patient- controlled analgesia with 0.2% ropivacaine 100 ml
(basal rate 2 ml/hr, bolus 0.5 ml, lockout time 15 min). Both groups
received intravascular patient-controlled analgesia with fentanyl 10−
15 μg/ml (basal rate 1 ml/hr, bolus 2 ml, lockout time 15 min). All
patients were given pethidine 25 or 50 mg when visual analogue
score (VAS) ＞ 40 mm. VAS, circulatory and respiratory stress
parameter (heart rate, noninvasive blood pressure and respiratory
rate) and consumption of pethidine were measured during 72 hours
following surgery at intervals of 8 hours.
Results: The mean VAS scores in the ISBPB group were
significantly lower than in the IAPCA group for 72 hr after surgery
(P ＜ 0.01). Pethidine consumption in the ISBPB group was
significantly lower than in the IAPCA group (P ＜ 0.01).
Conclusions: We concluded that intermittent interscalene brachial
plexus block is an effective method of postoperative analgesia after
major shoulder surgery.

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