Effect Of Epidural Patient-controlled Analgesia Research Articles

Patient-controlled analgesia (PCA) following video-assisted thoracoscopic lobectomy: Comparison of epidural PCA and intravenous PCA

ObjectivesTo compare the efficacy and side effects of epidural patient-controlled analgesia (EPCA) with those of intravenous patient-controlled analgesia (IVPCA) in fast-track video-assisted thoracoscopic (VATS) lobectomy. Patients and methodsEPCA or IVPCA was chosen by patients and was started immediately following tracheal extubation in the wake of completion of VATS lobectomy. EPCA analgesia was carried out with the PCA device programmed to deliver a bolus dose of 3 mL of 0.1% bupivacaine combined with 1.2 μg/mL fentanyl, and continuous epidural infusion at a rate of 4 mL/hour through an epidural catheter placed at the T6-7 or T7-8 level. IVPCA was made possible by a patient controlled infusion pump programmed to deliver 0.1% morphine with a loading dose of 3 mg, and the controlled bolus of 1 mg, at a lockout interval of 5 minutes. A rescue dose of 5 mg intravenous morphine was available for all patients in postoperative care unit. Pain management was assessed with visual analog scale at rest (VAS-R) and during motion (VAS-M); side effects including nausea, vomiting, pruritus, dizziness and sleepiness were recorded and analyzed from postoperative Day 1 (POD1) to Day 3 (POD3). ResultsThis study included 105 patients. Satisfactory pain control was achieved, although 9/70 patients in the EPCA group and 5/35 patients in the IVPCA group needed rescue morphine in the recovery room. The VAS-R was significantly higher on POD1 than on POD2 or POD3 in both groups (p < 0.001). The VAS-R and VAS-M were comparable in both groups on POD1 and POD3 but significant lower VAS-M was seen in the EPCA group on POD2 (p = 0.008). Higher incidence of dizziness was found in the IVPCA group on POD1 (p = 0.044) but the EPCA group had a higher incidence of pruritus on POD2 (p = 0.024) and POD3 (p = 0.03). ConclusionOur results indicated that the necessity of pain control was higher on POD1 for VATS lobectomy. Both EPCA and IVPCA can provide an adequate, continuous and effective means for postoperative pain management and a lower VAS-M was found in EPCA on POD2.

A Comparison of the Effect of Epidural Patient-Controlled Analgesia with Intravenous Patient-Controlled Analgesia on Pain Control after Posterior Lumbar Instrumented Fusion

Retrospective analysis to compare the effect and complication of epidural patient-controlled analgesia (epidural PCA) with intravenous patient-controlled analgesia (IV PCA) for the treatment of the post-operative pain after posterior lumbar instrumented fusion. Sixty patients who underwent posterior lumbar instrumented fusion for degenerative lumbar disease at our institution from September 2007 to January 2008 were enrolled in this study. Out of sixty patients, thirty patients received IV PCA group and thirty patients received epidural PCA group. The pain scale was measured by the visual analogue scale (VAS) score. There were no significant difference between IV PCA group and epidural PCA group on the PCA related complications (p=0.7168). Ten patients in IV PCA group and six patients in epidural PCA group showed PCA related complications. Also, there were no significant differences in reduction of VAS score between two groups on postoperative 2 hours (p=0.9618) and 6 hours (p=0.0744). However, postoperative 12 hours, 24 hours and 48 hours showed the significant differences as mean of reduction of VAS score (p=0.0069, 0.0165, 0.0058 respectively). The epidural PCA is more effective method to control the post-operative pain than IV PCA after 12 hours of spinal fusion operation. However, during the first twelve hours after operation, there were no differences between IV PCA and epidural PCA.

The Effect of Epidural Patient-Controlled Analgesia on the Frequency and Progress of Postoperative Side Effects

Background: Epidural PCA (patient controlled analgesia) is a well known postoperative pain control method. However its side effects are not well understood. This study will look into the frequency and progress of the side effects of the epidural PCA using bupivacaine and fentanyl mixture after gynecological surgery. Methods: About 100 female patients undergoing lower abdominal gynecologic surgery under the general anesthesia were studied regarding the side effects such as failure of pain control, nausea, vomit, sedation, pruritus, motor block and hypotension. Visual analogue scale (VAS) was used for the measurement of pain at rest and cough. The frequency and the progress of the side effects were also recorded at 2, 6, 12, 24, 36 and 48 hours after the surgery. The relationship between the insertion site of epidural PCA catheter and motor block, hypotension and the use of rescue drug were also analyzed. Results: VAS scores at cough were 12 to 21 point higher than at rest. Nausea and motor block were more severe than other side effects. The group having epidural PCA catheter inserted in the upper lumbar epidural space showed more severe motor block than the group having it inserted in the lower thoracic epidural space. Conclusions: The frequency of nausea and motor block were relatively higher than other side effects. So it is necessary to take a careful observation and an immediate treatment for these side effects in postoperative pain management using epidural PCA. Also the severity of motor block depends on the insertion site of epidural PCA catheter. Lower thoracic epidural space is considered to be a better insertion site than upper lumbar epidural space in reducing the motor block side effect.