Low Dose Spinal Anesthesia for Ambulatory Surgery of Varicose Vein

하지정맥류의 외래수술을 위한 저용량 척추마취

  • Yang, Jin-Sung (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Sooncheonhyang University College of Medicine) ;
  • Park, Young-Woo (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang Gumi University Hospital, Sooncheonhyang University College of Medicine) ;
  • Lee, Jae-Wook (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang Gumi University Hospital, Sooncheonhyang University College of Medicine) ;
  • Won, Yong-Soon (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Sooncheonhyang University College of Medicine) ;
  • Shin, Hwa-Kyun (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Sooncheonhyang University College of Medicine) ;
  • Lee, Dong-Gi (Department of Anesthesiology and Pain Medicine, Sooncheonhyang Gumi University Hospital, Sooncheonhyang University College of Medicine)
  • 양진성 (순천향대학교 의과대학 부천병원 흉부외과학교실) ;
  • 박영우 (순천향대학교 의과대학 구미병원 흉부외과학교실) ;
  • 이재욱 (순천향대학교 의과대학 구미병원 흉부외과학교실) ;
  • 원용순 (순천향대학교 의과대학 부천병원 흉부외과학교실) ;
  • 신화균 (순천향대학교 의과대학 부천병원 흉부외과학교실) ;
  • 이동기 (순천향대학교 의과대학 구미병원 마취통증의학교실)
  • Published : 2009.04.05

Abstract

Background: Bupivacaine with fentanyl might be suitable as the spinal anesthesia for performing ambulatory surgery to treat varicose vein. Material and Method: Thirty patients who underwent spinal anesthesia for a varicose vein operation were enrolled in this study. They were classified into 2 groups of either fentanyl 25ug mixed with bupivacaine 4mg (group FB4) or bupivacaine 8mg (group B8). We compared the groups for the success of the analgesia, the recovery time from sensory and motor block, the side effects and the postoperative complications. Result: The groups did not differ significantly regarding the success of analgesia (13 of 15 [group FB4], 15 of 15 [group B8]). None of the patients were converted to general anesthesia due to surgical pain. None of the patients required medication for hypotension and/or bradycardia. The operative and nonoperative side effects of motor block (tested for by using a modified Bromage scale) was significantly lower in group FB4 than that in group B8, as checked at 2 hours after spinal anesthesia (p<0.05). Recovery from spinal block was significantly quicker in group FB4 than that in group B8 (p<0.05). The first voluntary micturition time did not differ significantly (6.5 hours v 4.5 hours [p=0.143]) between the groups, but a nelatone catheter was inserted into 2 of the group B8 patients due to dysuria. Conclusion: Adequate intraoperative analgesia and hemodynamic stability and faster mobilization were achieved using bupivacaine 4mg with fentanyl 25ug. Low dose spinal anesthesia with fentanyl is suitable for performing ambulatory surgery to treat varicose vein.

배경: 하지정맥류의 외래수술을 위한 마취로 Bupivacaine에 fentanyl을 첨가하여 시행한 척추마취가 적당한지 알아보고자 하였다. 대상 및 방법: 척추마취를 이용하여 하지정맥류 수술을 받은 30명을 대상으로 하였다. 척추마취제로 bupivacaine 4mg과 fentanyl 25ug을 사용한 군(FB4군)과 bupivacaine 8mg을 사용한 군(B8군)으로 분류하였다. 두 군 간 적정한 마취유지, 수술중 심혈관계 합병증, 감각 및 운동차단회복시간, 수술 후 합병증을 비교 분석하였다. 결과: 마취성공은 두 군 간 통계적으로 차이가 없었다(13 of 15 [FB4군], 15 of 15 [B8군]). 두 군 모두 수술 중 통증 때문에 전신마취로 전환은 없었다. 수술 중 치료가 필요한 심혈관계 합병증은 두 군 모두에서 없었다. Modified Bromage scale로 측정한 척추마취 후 두 시간째 수술측과 비수술측 운동차단정도는 FB4군에서 통계적으로 유의하게 낮았다(p<0.05). 척추마취로부터 감각 및 운동차단회복은 FB4군이 B8군보다 유의하게 빨랐다(p<0.05). 맘대로소변보기는 통계적으로 유의한 차이는 없었으나(6.5시간 대 4.5시간 [p=0.143]) 배뇨 장애로 넬라톤 카테터를 삽입한 경우는 B8군에서는 2예 있었고 FB4군에서는 없었다. 결론: bupivacaine 4mg과 fentanyl 25ug을 이용한 척추마취는 수술 중 심혈관계의 안정성이 유지되고 적당한 감각차단이 이루어지고 수술 후 운동차단 시간을 감소시켜 빠른 보행이 가능하여 하지정맥류 외래수술에 적당한 마취방법이라고 생각된다.

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