-Abstract-
Recent studios have shown that narcotic drags pro4uc3 an unusually intense,
prolonged a n4 segmental analgesic action in man whoa injected into the spinal
subarachnoid or epidural space (Wang et al, 1979; Behar et al, 1979; Cousins et al, 1979;
Majora et at, 1980, Johnston and McCaughey, 1980).
Since 1960, many investigators claimed that low molecular weight(LMW) dextran
increased the clinical duration of lidocaine(Loder, 1950; Loder, 1962), tetracaine (Chinn
and Wirjoatmadja, 1967) and bupivacaine(Kaplan et at, 197i) in man but the mechanism
of the action of dextran was unclear. But Curtiss and Scurlock(1979) , and Buckled and
Pink(1979) claimed that LMW dextran has no effect on the duration of action of
bupivacaine in animal studies.
The present study was performed to evaluate the clinical efficacy of analgesia by the
thoracic epidural injection of morphine and bupivacaine mixture for the relief of pain due
to fractured or contused ribs, to evaluate the duration of analgesic effect by the use of
the above mixture in a hypertonic solution(dextran 70 or 50% dextrose in water) and to
observe the possibility of improvement in the lung function after the pain block. The
complications following the pain block were also observed.
The 50 single thoracic epidural injections of the mixture were divided into three
groups :
Group 1(n=15) served as a control group and drags used for the relief of pain were as
follows(Mean±5.D.) : morphine(2.13±1.64 ㎎), 0.5% bupivacaine(3.10±1.04 ㎖)
and 0.9% saline(3.64±1.11 ㎖).
Group 2(n=16) serves as an experimental group and drugs were as follows(Mean±
5.D.) : morphine(2.13±0.72 ㎎), 0.5% bupivacaine(3.06±0.77 ㎖) and dextran 70
(3.75±1.29 ㎖).
Group 3 (n=19) served as an experimental group and drags were a9 follows(Mean±
S.D.) : morphine(2.42±0.51 ㎎), 0.5% bupivacaine(3.21±0.71 ㎖) and 50%
dextrose in water(3.58±1.11 ㎖).
The results are were follows :
1) The Dumber of patients who obtained excellent and good analgesic effects
following the block were greater in the experimental Croup 2(94%) and Group 3 (90%)
than theme of the control Group 1 (80%).
2) The duration of pain relief which lasted more than 3 daya after the epidural block
was longer in the experimental Group 2 (81%) and Group 3 (75%) than those of the
control Croup 1 (67%) .
3) The pulmonary reserve(FVC%+FEV 1.0%) of 27 cases who were treated by the
pain block between 1 and 31 drys following the chest injury was increased to about
13% than those before the block, and that of 13 cases between 32 and 82 days
following the chest injury was decreased to about 4% than those before the block.
4) Of the complications following the pain block, there were 5 cased(10%) of nausea
within 2 hours following the block, 4 cases(8%) of vomiting after 2 hours following the
block, 10 cases(20%) of pruritus after 3∼4 hours following the block, 17 cases(34%) of
transient urinary retention which tasted 8 to 19 hours, 3 cases(6%) of headache within 2
hoers following the block and 2 cases(4%) of dural puncture.
In conclusion, it is suggested that the clinical duration of analgesic effect produced by
morphine and bupivacaine mixture can be prolonged by addition of the hypertonic
solution to the mixture.
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