복합부위통증증후군 환자의 이환 부위 수술 전후의 통증관리 -증례보고-

Perioperative Pain Management in the Patient with Complex Regional Pain Syndrome -A case report-

  • 조지연 (서울대학교 의과대학 마취통증의학교실) ;
  • 이미금 (서울대학교 의과대학 마취통증의학교실) ;
  • 이효민 (서울대학교 의과대학 마취통증의학교실) ;
  • 최윤숙 (서울대학교 의과대학 마취통증의학교실) ;
  • 윤혜정 (서울대학교 의과대학 마취통증의학교실) ;
  • 이철중 (서울대학교 의과대학 마취통증의학교실) ;
  • 이상철 (서울대학교 의과대학 마취통증의학교실) ;
  • 김용철 (서울대학교 의과대학 마취통증의학교실)
  • Jo, Ji Yon (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Lee, Mi Geum (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Lee, Hyo Min (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Choi, Yun Suk (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Yun, Hey Jeong (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Lee, Chul Joong (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Lee, Sang Chul (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine) ;
  • Kim, Yong Chul (Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine)
  • 투고 : 2006.09.29
  • 심사 : 2006.12.05
  • 발행 : 2006.12.30

초록

Complex regional pain syndrome (CRPS) is a syndrome of pain and sudomotor or vasomotor instabilities. The perioperative pain management in CRPS patients is very important, as surgery can aggravate preexisting symptoms, especially when performed around the lesion site. Despite the increasing interest in CRPS research, little is known about the optimal perioperative treatment strategy for CRPS patients. Herein, the case of a female CRPS patient, who underwent elective surgery at the lesion site, is reported. As a preemptive analgesia, the patient was satisfactorily managed with two weeks of patient-controlled epidural analgesia, initiated 2 days prior to surgery. The techniques for the prevention of perioperative pain, including preemptive analgesia, as well as its importance, are discussed.

키워드

참고문헌

  1. Rowbotham MC: Pharmacolgic management of complex regional pain syndrome. Clin J Pain 2006; 22: 425-9 https://doi.org/10.1097/01.ajp.0000194281.74379.01
  2. Bennett DS, Brookoff D: Complex regional pain syndromes (reflex sympathetic dystrophy and causalgia) and spinal cord stimulation. Pain Med 2006; 7: S64-96 https://doi.org/10.1111/j.1526-4637.2006.00124.x
  3. Kanoff RB: Intraspinal delivery of opiates hy an implantable, programmable pump in patients with chronic, intractable pain of nonmalignant origin. J Am Osteopath Assoc 1994; 94: 487-93
  4. Cramer G, Young BM, Schwarzentraub P, Oliva CM, Racz G: Preemptive analgesia in elective surgery in patients with complex regional pain syndrome: a case report. J Foot Ankle Surg 2000; 39:387-91 https://doi.org/10.1016/S1067-2516(00)80075-7
  5. Bach S, Noreng MF, Tjellden NU: Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain 1988; 33: 297-301 https://doi.org/10.1016/0304-3959(88)90288-6
  6. Jahangiri M, Jayatunga AP, Bradley JW, Dark CH: Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine. Ann R Coll Surg Engl 1994; 76: 324-6
  7. Kim YC: Complex regional pain syndrome. Korean J Pain 2004; 17:S104-8 https://doi.org/10.3344/kjp.2004.17.S.S104
  8. Lankford LL: Reflex sympathetic dystrophy in operative hand surgery. 3rd ed. New York, Churchill Livingstone. 1988, pp 633-63
  9. Gracely RH, Lynch SA, Bennett GJ: Painful neuropathy: altered central processing maintained dynamically by peripheral input. Pain 1992; 51: 175-94 https://doi.org/10.1016/0304-3959(92)90259-E
  10. Reuben SS: Preventing the development of complex regional pain syndrome after surgery. Anesthesiology 2004; 101: 1215-24 https://doi.org/10.1097/00000542-200411000-00023
  11. Rocco AG: Sympathetically maintained pain may be rekindled by surgery under general anesthesia (letter). Anesthesiology 1993; 79:865 https://doi.org/10.1097/00000542-199310000-00035
  12. Viel EJ, Pelissier J, Eledjam JJ: Sympathetically maintained pain after surgery may be prevented by regional anesthesia. Anesthesiology 1994; 81: 265-6 https://doi.org/10.1097/00000542-199407000-00040
  13. Katz J, McCartney CJ: Current status on pre-emptive analgesia. Curr Opin Anesthesiol 2002; 15: 435-41 https://doi.org/10.1097/00001503-200208000-00005
  14. Cousins MJ, Power I, Smith G: 1996 Labat lecture: pain-a persistent problem. Reg Anesth Pain Med 2000; 25: 6-21
  15. Woolf CJ, Chong MS: Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362-79
  16. Sveticic G, Gentilini A, Eichenberger U, Zandcrigo E, Sartori V, Luginbuhl M, et al: Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia. Anesthesiology 2004; 101: 1381-93 https://doi.org/10.1097/00000542-200412000-00019
  17. Yaksh TL: Spinal opiates: a review of their effect on spinal function with emphasis on pain processing. Acta Anaesthesiol Scand 1987; 85:S25-37
  18. Stoelting RK, Miller RD: Basics of anesthesia. 3rd ed. New York, Churchill Livingstone. 1994, p 450
  19. Meister GC, D'Angelo R, Owen M, Nelson KE, Gaver R: A comparison of epidural analgesia with 0.125% ropivacaine with fentanyl versus 0.125% bupivacaine with fentanyl during labor. Anesth Analg 2000; 90: 632-7 https://doi.org/10.1097/00000539-200003000-00024