Remifentanil을 이용한 전신마취하에 시행된 복강경 담낭절제술에서 0.25% Levobupivacaine의 트로카 부위침윤과 복강 내 점적주입이 수술 후 진통에 미치는 효과

• Published in: The Korean journal of pain Vol. 21; no. 1; pp. 44 - 50
• Main Authors: 이철, Cheol Lee, 송윤강, Yoon Kang Song
• Format: Journal Article
• Language: Korean
• Published: 대한통증학회 30-04-2008
• Subjects: Laparoscopic cholecystectomy; Levobupivacaine; postoperative pain; remifentanil; 마취과학; remifentanil; levobupivacaine; postoperative pain; laparoscopic cholecystectomy
• ISSN: 2005-9159; 1226-2579; 2093-0569

Background: The use of regional local anesthetics or opioids during laparoscopic cholecystectomy (LC), in combination with general anesthesia, has been investigated in several interventional studies. Methods: We studied a total of 240 (n = 60, each) patients who were undergoing LC, and they received local infiltration and intraperitoneal instillation with normal saline or 0.25% levobupivacaine 60 ml. Group R (S) received infiltration of normal saline 20 ml before incision and at the end of surgery and then 40 ml intraperitoneal instillation after removal of the gall bladder under remifentanil-based anesthesia. Group R (L) received 0.25% levobupivacaine instead of normal saline in the same method like group R (S). Group S (S) received the same method as group R (S) under sevoflurane based anesthesia in place of remifentanil. Group S (L) received 0.25% levobupivacaine instead of normal saline with the same method as group S (S). Pain was assessed on a visual analog scale at 1, 6, 12 and 24 hours after operation. Results: The pain intensity of Group R (L) was significantly lower than that of group R (S), and the the incisional pain of group S (L) was significantly lower than that of group S (S) in the first six hours. The time delay to first operative analgesics in group R (S) and group S (S) was significantly shorter than that of group R (L) and group S (L). Conclusions: Infiltration and instillation of levobupivacaine reduced the postoperative pain and remifentanil did not increase the pain severity and opioid requirement when performing the LC.