척추 마취하에서 항문 수술후 조기 활동이 방광 저류와 경막 관통성 두통 발생에 미치는 영향에 관한 무작위 표본 연구
The Effects of Early Ambulation on Urinary Retention and Postdural Puncture Headache Following Anal Operations : A Prospective Randomized Study
김선한, 김동희, 문홍영, 구범환, 이일옥,
소속 상세정보
김선한 ( Kim Seon-Hahn )
고려대학교 의과대학 외과학교실
김동희 ( Kim Dong-Hee )
고려대학교 의과대학 외과학교실
문홍영 ( Moon Hong-Young )
고려대학교 의과대학 외과학교실
구범환 ( Koo Bum-Hwan )
고려대학교 의과대학 외과학교실
이일옥 ( Lee Il-Ok )
고려대학교 의과대학 마취통증의학교실
KMID : 0356719990150030179
Abstract
Introduction: Urinary retention (UR) is one most common complication of anal surgery and its cause is multifactorial. Postdural puncture headache (PDPH) is caused by cerebrospinal fluid leakage after spinal anesthesia, therefore it may be aggravated by early ambulation.
Purpose: To determine whether early ambulation (EA) vs. bed rest (BR) reduces the incidence of UR after anal surgery under spinal anesthesia, without causing PDPH.
Methods: In this prospective, randomized study, 107 patients undergoing anal surgery under spinal anesthesia were randomly assigned in the EA group (n=54) or the BR group (n=53). UR was defined as a voiding difficulty that needs catheterization. In the BR group, the patients were positioned flat in bed on the operation day. Anesthetic techniques (tetracaine injection using 24-gauge needle in sitting position, bupivacaine local infiltration) and postoperative pain
therapy (intramuscular demerol injection every 6 hours, oral nonsteriodal antiinflammatory drug plus acetaminophen) were standardized. Perioperative intravenous fluids were restricted.
Results: Urinary retention and PDPH occurred in 32 (29.9%) and 7 (6.5%) patients, respectively. UR was significantly reduced in the EA group (10/54=18.5%) vs. the BR group(22/53=41.5%) (p=0.017, Chi-square). The incidence of PDPH, however, was not different between the two groups (5.6% in the EA vs. 7.5% in the BR group).
Conclusion: Early ambulation has important implication on reducing the incidence of urinary retention after anal
surgery under spinal anesthesia, without causing PDPH.
키워드
항문 수술;척추 마취;조기 활동;방광 저류;두통
Anal surgery;Spinal anesthesia;Early ambulation;Urinary retention;Headache
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