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Korean J Crit Care Med > Volume 22(2); 2007 > Article
Korean Journal of Critical Care Medicine 2007;22(2): 77-82.
개흉술 후 경막외 Morphine 투여 방법에 따른 환자의 중환자실 체류기간 비교
충남대학교 의과대학 마취통증의학교실, *흉부외과학교실
Post-thoracotomy Analgesia & ICU Length of Stay: Comparison of Thoracic Epidrual Morphine Infusion and Lumbar Epidural Plus Intravenous Morphine Infusion
Seok Hwa Yoon, Jung Hyun Lee, Hee Suk Yoon, Yoon Hee Kim, Myung Hoon Na, Seung Pyung Lim
1Department of Anesthsiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. seohwy@cnu.ac.kr
2Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University, Daejeon, Korea.
BACKGROUND: Length of stay in ICU after thoracotomy is related to postoperative pulmonary function and complication which are affected by postoperative pain. For the post-thoracotomy pain control, epidural morphine is commonly used. Although total dose-requirement for analgesia of lumbar epidural morphine is more than the thoracic, lumbar epidural morphine could be substituted the thoracic. Our study compared the effect of patient controlled analgesia using thoracic epidural morphine (TEA group) and lumbar epidural analgesia with patient controlled intravenous analgesia using morphine (LEA+IV group). METHODS: Sixty patients were randomly assigned into one of the two groups. The epidural taps were done before the induction. In all the patients morphine 0.2 mg/ml was administered via the epidural catheter at the end of surgery. In TEA group, basal infusion rate was 0.1 mg/hr and bolus dose was 0.02 mg. In LEA+IV group, basal infusion rate of epidural morphine was 0.1 mg/hr, patient controlled intravenous analgesia with morphine started when patients arrived at ICU, and basal infusion rate of intravenous morphine was 1.0 mg/hr and bolus dose was 0.8 mg. Pain score, side effect, postoperative length of stay in ICU and hospital were observed. RESULTS: There were no significant differences between two groups in pain score, side effects, length of stay in ICU and hospital. CONCLUSIONS: Lumbar epidural analgesia with patient controlled intravenous analgesia using morphine showed similar postoperative analgesia and length of stay in ICU and hospital compared to thoracic epidural analgesia with morphine, so that can substitute the thoracic epidural analgesia.
Key Words: Analgesia; Epidural; Lumbar; Morphine; Thoracic; Thoracotomy
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