경막외 진통법이 수술 후 부작용의 빈도 및 경과에 미치는 영향

Background: Epidural PCA (patient controlled analgesia) is a well known postoperative pain control method. However its side effects are not well understood. This study will look into the frequency and progress of the side effects of the epidural PCA using bupivacaine and fentanyl mixture after gynecological surgery. Methods: About 100 female patients undergoing lower abdominal gynecologic surgery under the general anesthesia were studied regarding the side effects such as failure of pain control, nausea, vomit, sedation, pruritus, motor block and hypotension. Visual analogue scale (VAS) was used for the measurement of pain at rest and cough. The frequency and the progress of the side effects were also recorded at 2, 6, 12, 24, 36 and 48 hours after the surgery. The relationship between the insertion site of epidural PCA catheter and motor block, hypotension and the use of rescue drug were also analyzed. Results: VAS scores at cough were 12 to 21 point higher than at rest. Nausea and motor block were more severe than other side effects. The group having epidural PCA catheter inserted in the upper lumbar epidural space showed more severe motor block than the group having it inserted in the lower thoracic epidural space. Conclusions: The frequency of nausea and motor block were relatively higher than other side effects. So it is necessary to take a careful observation and an immediate treatment for these side effects in postoperative pain management using epidural PCA. Also the severity of motor block depends on the insertion site of epidural PCA catheter. Lower thoracic epidural space is considered to be a better insertion site than upper lumbar epidural space in reducing the motor block side effect. (Korean J Anesthesiol 2004; 46: 696～701) KCI Citation Count: 0