Efficacy of the Epidural Buprenorphine for Postoperative Pain Control after Upper Abdominal Surgery

상복부 수술후 진통을 위한 경막외 Buprenorphine의 효과

The use of buprenorphine by epidural route in the prevention of postoperative pain has been controversial. High lipid solubility of buprenorphine caused the same parenteral/epidural analgesic dose ratio, and the analgesic effect of epidural buprenorphine possibly due to systemic absorption, which revealed no advantages of epidural administration against parenteral injection. On the contrary, epidural buprenorphine had longer duration of action and fewer side effects than parenteral buprenorphine, which advocated the epidural use of buprenorphine. We studied the efficacy of epidural buprenorphine by comparing epidural buprenorphine with epidural morphine in terms of latency and the duration of analgesic action, and the incidence of side effects. 0.15mg and 0.3mg of epidural buprenorphine had shorter latency than 2mg of morphine. 0.3 mg of buprenorphine had longer duration of action than 4 mg of morphine. The incidence of nausea and vomiting were slightely higher in buprenorphine group than in morphine group. Voiding difficulty and pruritus were little in buprenorphine group, while the incidence of somnolence was markedly higher in buprenorphine group. Form our results we conclude that epidural buprenorphine may be useful in the treatment of postoperative pain, and but recognize both advantages and disadvantages as compared epidural morphine.

수술후 통증관리에 있어서 경막외 buprenorphine의 유용성을 알아보기 위하여 상복부 수술을 받은 환자에 있어서 morphine 2 mg 및 4 mg, buprenorphine 0.15 mg, 및 0.3 mg을 경막외로 각각 투여하여 혈압과 맥박의 변화, 작용발현기간, 작용 지속 시간, 부작용의 발생을 관찰하여 다음과 같은 결과를 얻었다. 1) 모든 군에서 혈압 및 맥박의 유의한 변동은 초래하지 않았다. 2) 작용 발현은 morphine 2 mg군에서는 약물 주입후 30분에, 나머지 군에서는 15분에 유의하게 나타났다. 3) 진통 지속 시간은 morphine 2 mg 군에서는 $10.79{\pm}3.64$시간이었고, morphine 4 mg군에서는 $21.13{\pm}4.36$시간, buprenorphine 0.15 mg군에서는 $15.19{\pm}3.12$시간, buprenorphine 0.3 mg군에서는 $33.94{\pm}3.97$시간이었다. 4) 부작용의 발생은 buprenorphine군에서 오심, 구토가 많았으며, 졸림증이 현저하게 많았고, 소양감과 배뇨 곤란은 morphine군에서 많았다. 이상의 결과로 수술후의 통증관리에 있어서 경막외로의 buprenorphine주입은 유용한 방법이며, 경막 외 morphine에 비해 장점과 단점을 아울러 포함하고 있다고 사료된다.