ロピバカインとフェンタニル硬膜外投与の術後疼痛管理 : 肝機能に応じた鎮痛薬用量設定の必要性

概要

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Despite the generally adequate dosages that have been established for patient-controlled epidural analgesia (PCA) following upper abdominal surgery such as gastrectomy and hepatectomy, in our experience, patients who have undergone gastrectomy need a higher PCA dosage than those who have undergone hepatectomy. The aim of this study was to review the efficacy and dosages of PCA in the case of simultaneous epidural administration of ropivacaine and fentanyl following upper abdominal surgery, and the adverse reactions that appeared. The gastrectomy and hepatectomy patients numbered 51 and 55, respectively, with the hepatectomy comprising that for metastatic hepatic cancer (47 patients) and that for primary hepatic cancer (8 patients). The visual analog scale (VAS) and Prince Henry Scores (PHS) for the patients who underwent hepatectomy were signifiscantly lower than those for patients who underwent gastrectomy. Further, the analgesic effect of PCA, was weaker in patients with metastatic liver cancer than those with primary hepatic cancer, and Indocyanine green retention at 15 minutes (ICG-R) was significantly correlated with the VAS scores of hepatectomy patients. These results suggested that the dosage of PCA following upper abdominal surgery should be determined based on a hepatic function indicator such as ICG-R.
2008-02-10