술중 투여된 Ketorolac의 술후 통증조절을 위한 Fentanyl의 절감효과

• Published in: Korean journal of anesthesiology Vol. 33; no. 6; pp. 1142 - 1147
• Main Authors: 오완수, Wan Soo Oh, 길호영, Ho Yeong Kil
• Format: Journal Article
• Language: Korean
• Published: 대한마취통증의학회(구 대한마취과학회) 30-12-1997
• Subjects: Analgesia; fentanyl; ketorolac; patient-controlled; postoperative. Analgesics
• ISSN: 2005-6419; 2005-7563

Background : Ketorolac is a nonsteroidal anti-inflammatory analgesic that has analgesic propertiescomparable to morphine. Also, ketorolac alleviated moderate to severe pain in the postoperativeperiod while diminishing the incidence of side effects such as respiratory depression, nausea, and vomiting typically associated with opioids. The purpose of this study was to evaluate whether intraoperative ketorolac would act synergistically with fentanyl to decrease postoperative analgesic requirement using patient controlled analgesia device. Methods : Forty ASA physical status I or II adult(20∼55 years) patients undergoing spine fusion was randomly allocated into two groups according to use of intraoperative ketorolac(n=20 for each group). Group I received propofol-N2O-O2 general anesthesia without intraoperative ketorolac, and group II received continuous infusion of ketorolac(50 mg/hr) during operation under the same anesthesia as group I. Recovery profiles including orientation time and recovery of respiration were checked. All patients had access to intravenous fentanyl via patient controlled analgesia for post-operative pain control. Evaluation included PCA fentanyl used, pain assessment(verbal rating scale), intra- and postoperative prothrombin time, thromboplastin time, platelet count for bleeding tendency. Results : Demographic data revealed that the two groups showed no difference in operation time, anesthesia time, amount of propofol used. Total amount of ketorolac infused during operation was 110±31 mg in goup 2(Table 1). Recovery profiles showed no difference between two groups (Table 2). In changes of platelet, group 2 showed significant decrease in platelet count at post-operative 24 and 48 hours compared with control, but there was no clinical significance and no difference between two groups(Fig. 1). Changes in prothrombin time, thromboplastin time showed no significant differences within and between two groups(Fig. 2). Group 2 used less fentanyl(average 427±241ug) than did the group 1(705±222ug), showed 41% fentanyl sparing effect during postoperative 24 hours(Table 3). Verbal rating scale(VRS) was significantly less in group 2 during first postoperative 24 hours(Fig. 3). Conclusions : It is concluded that intraoperative continuous ketorolac infusion(50 mg/hr) showed significant fentanyl sparing effect for postoperative pain control(P＜0.05) without any increased bleeding tendency or side effects. (Korean J Anesthesiol 1997; 33: 1142∼1147)