초록

측두하악장애 및 구강안면통증 환자들 중 근막통증에 의한 기능제한이나 통증을 호소하는 경우를 흔히 볼 수 있다. 근막통증환자를 치료할 때 여러 가지 물리치료가 유용하지만, 즉각적인 통증완화효과를 나타내는 발통점주사요법이 근막통증의 치료로서 널리 적용되고 있다. 발통점주사요법에 흔히 사용하는 화학약제로 생리식염수, 국소마취제, 스테로이드 등이 있으며, 국소마취제는 근육에 대한 부작용이 보고되어 있어 사용상 주의가 필요하다. 이 연구는 상품화된 lidocaine과, dexamethasone 주사제의 혼합용액을 근육내 주사한 후 조직학적 변화를 관찰함으로써 근육에 대한 위해성 여부를 평가하고자 하였다. 또한 용액의 농도에 따라 각각 조직학적 변화를 관찰함으로써 위해성이 없는 적정한 농도를 제시하고자 하였다. 이 연구에서는 생후 9주된 BALB/c 생쥐 (자성) 63마리를 7군으로 분류하여, 앞정강근 (전경골근, tibialis cranialis) 에 각각 생리식염수, dexamethasone, 2.0% lidocaine, 생리식염수와 혼합한 1.0% lidocaine, 생리식염수와 혼합한 1.5% lidocaine, dexamethasone과 혼합한 1.0% lidocaine, dexamethasone과 혼합한 1.5% lidocaine을 주사하였다. 그 후 1일, 7일, 14일째에 희생시켜 실험부위를 절취한 후 조직절편을 만들어 HE염색과 Van-Gieson염색을 거쳐 광학현미경으로 관찰하여 다음의 결론을 얻었다. Lidocaine과 dexamethasone의 혼합용액을 근육내 주사하였을 때, lidocaine의 농도가 1.5% 이하인 경우 조직학적으로 유해하지 않았으며, 통증완화효과와 항염증작용을 동시에 기대할 수 있을 것으로 생각된다. 향후 상기 혼합용액을 발통점주사요법의 약제로 사용할 경우, 인체에서도 동일한 결과가 나올 것인가에 대해서는 추가적인 연구가 필요하다.

Abstract

A trigger point injection (TPI) has been reported to have an immediate analgesic effect, and to be one of the most widely employed treatment methods of myofascial pain. There are normal saline, local anesthetics, and steroids as the solutions frequently used in TPI. They can be used separately or in combination. Local anaesthetics have myotoxicity in proportion to its concentration. The purpose of this study was to evaluate microstructural changes in point of the myotoxic effects of the combined solution of lidocaine and dexamethasone (a local anesthetic and a steroid) after being injected into the muscle of BALB/c mice. And this study tested solutions with various concentration separately and in combination, to find out proper concentration of solution without muscular tissue damage. This study shows that lidocaine and dexamethasone combination is not histologically myotoxic in case of the concentration of lidocaine less than 1.5%. Also it is suggested from this study that this combined solution will have an analgesic and anti-inflammatory effect. Hereafter continuous study should be performed to reveal that these results can be applied to human when lidocaine and dexamethasone combination is used as an injection modality of TrP treatment.

주제어

#근막통증   #발통점주사요법  

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