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항문질환의 수술에서 음부신경마취와 요정체 문제

The Effects of Pudendal Block in Voiding Complication after Anal Surgery

대한대장항문학회지 2000년 16권 6호 p.365 ~ 370
김재황 ( Kim Jae-Hwang ) - 영남대학교 의과대학 외과학교실

장선모 ( Jang Seon-Mo ) - 영남대학교 의과대학 외과학교실
심민철 ( Shim Min-Chul ) - 영남대학교 의과대학 외과학교실
지대림 ( Jee Dae-Lim ) - 영남대학교 의과대학 마취통증의학과교실

Abstract


Urinary retention in common benign anal surgery is a burden to ambulatory surgery.

Purpose: To reduce voiding complication pudendal nerve block (PB) was applied in hemorrhoids surgery.

Methods: We compared PB with spinal anesthesia (SA) for anal surgery. In this prospective study, 163 patients undergoing elective hemorrhoids surgery by single surgeon were randomized to receive either PB with 0.5% bupivacaine (n=81) with 1:20,000 epinephrine or SA with 0.5% bupivacaine (n=83).

Results:There were no statistically significant differences in patient demographics, total amount of administered fluid, time to onset of block, or intraoperative pain. All patients had a successful block for surgery however, puborectalis muscle relaxation with PB was not complete. The time from injection of the anesthetics to first development of pain was longer in the patients who received PB (9.1 vs 3.1h; P<0.001). Urinary catheterization needed in only 6 patients in PB group compared with 57 cases in SA group (p<0.001). Degree of pain was significantly low in PB (2.7 vs 5.2 with VAS; p<0.001) Injected analgesics was significantly reduced in PB (16/81 vs 45/82; p<0.001)

Conclusion: Our results suggest that PB with bupivacaine results in fewer postoperative voiding complications and less pain compared with traditional SA in hemorrhoidectomy.

키워드

요정체;음부신경마취;척추마취;치핵
Urinary retention;Pudendal nerve block;Spinal anesthesia;Hemorrhoids;Bupivacaine
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