전자궁 적출술 시 0.6% Ropivacaine을 이용한 경막외 마취

Abstract

Ropivacaine closely resembles bupivacaine with propyl group substituted for butyl group at the same position. Ropivacaine is 100% S-isomer with more safety but less cardiotoxicity than bupivacaine. Because of this, ropivacaine can be safely used in epidural anesthesia. However, ropivacaine caused a motor block lasting more than 5 hours in some patients. Therefore this study was undertaken to find an optimal concentration of ropivacaine with the effective analgesic and muscle relaxation but rapid recovery from the motor block. Fifty one patients scheduled for total hysterectomy were randomly selected and divided into 3 groups. The patients were placed in sitting position and epidural space was confirmed by loss of resistance with air. Epidural catheter was placed at the L2-3 or L3-4 interspace using median approach with a 18 G Tuohy needle. About 15 min prior to skin incision, groupⅠ received 20 ml of 0.75% ropivacaine, groupⅡ received 25 ml of 0.6% ropivacaine plus 100 ㎍ fentanyl, and groupⅢ received 20 ml of 0.6% ropivacaine plus 100 ㎍ of fentanyl. During operation, sensory block was assessed by cold test every 5 min and motor block by Bromage scale. There were no significant differences between the group Ⅰ, Ⅱ and Ⅲ in analgesic and muscle relaxation effect, but there was a significant difference in the recovery from motor block in the group Ⅲ. 20 ml of 0.6 % ropivacaine and 100 ㎍ of fentanyl were found to the optimum concentration for the epidural anesthesia in total hysterectomy.