Effect Of Intravenous Patient-controlled Analgesia Research Articles

Comparison of the Postoperative Analgesia Effects of Patient-Controlled Analgesia and Epidural Catheter After Posterior Instrumentation Surgery

Objective: To prospectively assess the effects of intravenous patient-controlled analgesia (IV PCA) and epidural patient-controlled analgesia (epidural PCA) on postoperative pain management following posterior instrumentation surgery.
 Materials and Methods: The study involved the ASA 1-2 group, 60 patients who underwent elective thoracic or lumbar posterior instrumentation surgery at our tertiary centre for spinal stenosis. Two groups of patients were created: Group 1 (n = 30), IV PCA group, and Group 2 (n=30), epidural PCA group. IV PCA was applied by fentanyl. Epidural PCA was maintained by lading to epidural space by the neurosurgeon. Bupivacaine was administered to Group 2 patients in the recovery room. Following surgery, patients in both groups were assessed for pain using the visual analogue scale (VAS) and for motor block using the Bromage scale. Additionally, hemodynamic parameters, side effects, and patient satisfaction were noted. Following 48 hours, patients' overall rescue analgesia, opioid, and local anaesthetic requirements were recorded. 
 Results: Postoperative VAS scores of Group 2 at the 1st, 2nd, 4th, 8th and 16th hours were lower than Group 1 and these differences was statistically significant. Postoperative patient satisfaction scores at 1st, 2nd, 4th, 8th, 12th, 16th, 20th, 24th, 30th, 36th, 42nd and 48th hours were significantly different between the groups and the patient satisfaction scores of Group 2 were higher than the Group 1. Side effects were similar in both groups. Group 1 required statistically significantly higher number of rescue analgesia. 
 Conclusion: This study shows that epidural PCA is more comfortable than IV PCA with low VAS and high patient satisfaction scores. As a conclusion, epidural PCA is a safe, highly efficient method for patients with posterior instrumentation surgery.

Comparative Study Between Intravenous Patient-Controlled Analgesia Morphine and Computerized Ambulatory Delivery Device Epidural Morphine for Post Operative Analgesia for Nuss Procedure in Pectus Excavatum: A Retrospective Analysis.

Pectus deformities are commonly seen in chest wall deformities among the pediatric age group. Pectus deformities occur due to defective growth of the sternum and its surrounding cartilage. The Nuss procedure is the technique of choice for correcting the deformity surgically which includes placing a convex bar under the sternum without resection or injury to costal cartilages. Adequate pain control is utmost to improve wound healing, patient satisfaction, short hospital stays, and decrease the financial burden on attendants. Therefore, it is necessary to investigate which analgesic method is more advantageous for the Nuss procedure. To compare the analgesic effects of intravenous patient-controlled analgesia (IVPCA) morphine versus computerized ambulatory delivery device (CADD) epidural morphine on acute post-operative pain management in Nuss procedures. A retrospective study was done at Rajiv Gandhi Cancer and Research Hospital, New Delhi from 2015 to 2020 to assess the efficacy and safety between IVPCA morphine and CADD epidural for post-operative analgesia following pectus excavatum repair. A total of 34 cases of Nuss procedures were taken with 17 cases in each group. Group 1 (intravenous PCA morphine) was given 39 ml normal saline + 6 ml morphine (total 45 ml, 2 mg/ml morphine), set at demand dose 0.5 ml, i.e. 1 mg, lockout interval 7 minutes, doses per hour was six and Group 2 (CADD epidural morphine) was given 42 ml normal saline + 3 ml morphine (1 mg/ml morphine) with continuous infusion at the rate of 0.5 ml/hr. Demand dose 0, lockout interval nil. Visual analog pain scores using a scale of 0-10 and Ramsay Sedation Score (RSS) scores were obtained on arrival at the post-anesthesia care unit, at 12, 24, 48, and 72 hours throughout the subsequent hospital stay. This study yielded positive information about our experience with the pectus post-operative pain management. The mean visual analogscale (VAS) score was lower in Group 1 compared to Group 2 but significantly different at 12 and 72 hours only. The mean RSS score was comparable between groups. The mean hospital stay (days) and requirement of rescue analgesia doses were 3.47±0.51 and 0.12±0.33 in Group 1 and 4.76±0.44, 0.59±1.12 in Group 2. Both IVPCA morphine and CADD morphine were effective in controlling post-surgical pain in the Nuss procedure, but IVPCA morphine was better as compared to CADD morphine in this regard because it was noninvasive, safe, and cost-effectivewith non-significant complications.

Randomized controlled study comparing the analgesic effects of intravenous patient-controlled analgesia and patient-controlled epidural analgesia after open major surgery for pancreatobiliary cancer.

This randomized clinical trial was performed to compare pain scales between intravenous patient-controlled analgesia (IV-PCA) and patient-controlled epidural analgesia (PCEA) in patients undergoing open surgical resection of major pancreatobiliary malignancies. One hundred ten patients were randomly assigned to the PCEA or IV-PCA group. We compared the numeric rating scale pain score during ambulation on postoperative day (PD) 2 and at rest (at 06:00, 12:00, and 18:00) from PD 1 to 7, the serum level of troponin I on PD 1, and the incidence of postoperative complicationsbetween the two groups. There were no significant differences in the pain scores during ambulation on PD 2, at rest up to PD 7, serum troponin I level, and postoperative complication rates. The incidences of nausea (20.4% vs. 6.3%; p = 0.039) and drowsiness (20.4% vs. 0%; p = 0.001) were higher in the IV-PCA group and the rate of dysuria (0% vs. 14.6%; p = 0.004) was higher in the PCEA group. PCEA showed no superiority over IV-PCA in terms of postoperative pain relief or morbidity after major open surgery for pancreatobiliary malignancies. The method of analgesia should be considered based the characteristics of the patient, surgeon, anesthesiologist, and institute.

Anesthetic Depth Monitoring Decreased the Incidence of Postoperative Delirium Assessed in Nursing Delirium Screening Scale in Elective Non-Cardiac Surgical Patients Receiving Intravenous Patient-Controlled Analgesia

Background To identify the impact of processed electroencephalogram (pEEG)-guided anesthesia on postoperative delirium (POD) assessed by NuDESC, postoperative analgesic requirements, and the incidence of postoperative nausea/vomiting (PONV) in the elective non-cardiac surgical patients with intravenous patient-controlled analgesia (IVPCA) in the wards. Methods In this retrospective observational study, the anesthesiologists were free to use M-Entropy™, an pEEG device, to monitor the depth of anesthesia intraoperatively during the period (September 2015 ~ February 2018). Acute pain service team assessed the analgesic/side effects of IVPCA and POD at least twice daily for 3 days postoperatively. POD was screened by Nursing Delirium Screening Scale (NuDESC) (0-10). Pain severity was measured by an 11-point verbal numerical rating scale (0–10). Results A total of 1178 patients (≧60 years) were enrolled and divided to Entropy (749 patients) vs. non-Entropy group (429 patients). Multivariate logistic analysis showed that age (≧70), surgical types (non-joint), intraoperative highest minimum alveolar concentration (MAC) (<0.9MAC) and the POD incidence were independent predictors for group differences (multiple odds ratio and 95% confidence interval: 5.99, 4.34-8.29; 2.01, 1.49-2.72; 6.84, 4.38-10.67; 0.09, 0.04-0.19). The POD incidence in Entropy group (2.2%, 17 patients) was significantly lower than that in non-Entropy group (6.7%, 29 patients) (p <0.001). However, pEEG-guided anesthesia did not affect the phenomenological characteristics of POD. In addition, intraoperative pEEG-guided anesthesia did not reduce total morphine dose of IVPCA, the incidence of PONV and pain severity. Conclusions Processed EEG-guided anesthesia decreased POD incidence assessed in NuDESC in IVPCA patients undergoing elective non-cardiac surgery returning to the common ward. In addition, it did not reduce postoperative pain severity, postoperative analgesic requirements and PONV incidence. More researches are needed to investigate the effects of pEEG-guided anesthesia on POD and other postoperative conditions.

Randomized controlled study comparing the analgesic effects of intravenous patient-controlled analgesia and patient-controlled epidural analgesia after open major surgery for pancreatobiliary cancer

Randomized controlled study comparing the analgesic effects of intravenous patient-controlled analgesia and patient-controlled epidural analgesia after open major surgery for pancreatobiliary cancer

Randomized Controlled Study Comparing the Analgesic Effects of Intravenous Patient-Controlled Analgesia and Patient-controlled Epidural Analgesia after Open Major Surgery for Pancreatobiliary Cancer

Introduction: Postoperative pain relief is one of the most important components of Enhanced Recovery After Surgery (ERAS) programs. This study was performed to compare outcomes, including pain control, between IV-PCA and PCEA in patients undergoing open surgical resection of major pancreatobiliary malignancies. Methods: A total of 110 patients scheduled for open resection of pancreatobiliary cancers between January 2018 and February 2020 were enrolled in this randomized controlled trial, and were randomly assigned to the PCEA or IV-PCA group (each consisting of 55 patients). The primary endpoint was the numeric rating scale (NRS) pain score (minimum, 0; maximum, 10) during ambulation on postoperative day (PD) 2. The secondary endpoints were the NRS pain scores at rest (at 06:00, 12:00, and 18:00) from PD 1 to 7, the serum level of troponin I on PD 1, and the incidence of postoperative complications. Results: There were no significant differences in NRS pain scores between the two groups during ambulation on PD 2, or at rest up to PD 7. There were no group differences in the serum troponin I level on PD 1, or in the rates of postoperative complications. The incidences of nausea and sleeping tendency were higher in the IV-PCA group and the rate of dysuria was higher in the PCEA group. Conclusions: PCEA showed no superiority over IV-PCA in terms of postoperative pain relief or morbidity after major open surgery for pancreatobiliary malignancies. The method of analgesia should be considered based the characteristics of the patient, surgeon, anesthesiologist, and institute.

Side Effects of Intravenous Patient-Controlled Analgesia with Remifentanil Compared with Intermittent Epidural Bolus for Labour Analgesia - A Randomized Controlled Trial.

Epidural analgesia is considered a gold standard in obstetric anaesthesia and analgesia. However, in situation when it is contraindicated, unwanted by the patient or simply unavailable, remifentanil can be an excellent alternative. The goal of our study is to analyse the side effects of intravenous patient-controlled analgesia (IV PCA) with remifentanil compared with epidural analgesia during delivery. This study included 155 pregnant women in term for birth, divided into 2 groups: a remifentanil group (RG), and an epidural group (EG). Patients in the RG received intravenous PCA with remifentanil, while patients in the ЕG received epidural analgesia with programmed intermittent bolus dosing. Our primary outcome was maternal safety; the secondary outcome was neonatal safety. The results present a significantly lower SaO2 value of the parturients in the RG (96.95 ± 1.4 vs 98.22 ± 0.6), and a significantly higher respiratory rate per minute in the EG at all time points after the onset of analgesia (20.85 ± 1.4 vs 18.67 ± 0.9). There was more frequent sedation, nausea and vomiting in the RG, while in the EG there was a more elevated temperature, itching and irregularities in the CTG record. Regarding the newborn, there was no significant difference between the two groups in the Apgar scores, pH, pCO2, pO2, and bicarbonate, while there was a significantly lower value of the base excess in the RG group. PCA with remifentanil is safe for the mother, foetus and the newborn, with minimal side effects. Continuous respiratory monitoring, oxygen supply and following of all consensus recommendations are mandatory.

Patient-controlled Analgesia With Propacetamol-Fentanyl Mixture for Prevention of Postoperative Nausea and Vomiting in High-risk Patients Undergoing Spine Surgery: A Randomized Controlled Trial.

This randomized trial evaluated the effect of intravenous patient-controlled analgesia (IV-PCA) based on fentanyl mixed with either propacetamol or an equivalent volume of normal saline on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing spinal surgery. One hundred eight nonsmoking female patients were randomly and evenly allocated to receive IV-PCA with either propacetamol (4 g) or normal saline mixed to fentanyl (20 μg/kg). Primary study outcome was PONV incidence at 24 hours postsurgery. Secondary outcomes were nausea severity, pain intensity (100-mm visual analog scale), use of rescue antiemetics and analgesics, patient satisfaction, and adverse events at 6, 12, and 24 hours postsurgery. Postsurgery, the propacetamol versus normal saline group had lower PONV incidence at 24 hours (41% vs. 66%, P=0.011); pain intensity at rest and rescue analgesic requirements at 6 to 12 hours (30±15 vs. 41±19, P=0.008; and 25% vs. 49%, P=0.036, respectively) and at 12 to 24 hours (25±15 vs. 35±17, P=0.008; and 19% vs. 42%, P=0.044, respectively); and higher patient satisfaction score (6.4±1.4 vs. 5.7±1.8, P=0.028). In patients undergoing spinal surgery and at risk of developing PONV, continuous IV-PCA based on propacetamol mixed to fentanyl, relative to fentanyl alone, effectively reduced the incidence of PONV, pain intensity at rest, and additional use of rescue analgesics with higher patient satisfaction.

Efficacy of subpleural continuous infusion of local anesthetics after thoracoscopic pulmonary resection for primary lung cancer compared to intravenous patient-controlled analgesia.

This study compared the efficacy and side effects of intravenous patient-controlled analgesia (IV-PCA) with those of a subpleural continuous infusion of local anesthetic (ON-Q system) in patients undergoing thoracoscopic pulmonary resection for primary lung cancer. We retrospectively reviewed 66 patients who underwent thoracoscopic pulmonary resection for primary lung cancer from January 2014 to August 2015 (36 in the IV-PCA group and 30 in the ON-Q group). The numeric pain intensity scale (NPIS), additional IV injections for pain control, side effects, and early discontinuation of the pain control device were compared. There were no differences in the general characteristics of the two groups. The NPIS scores gradually decreased with time (P<0.001), but the two groups had differences in pattern of NPIS scores (P=0.111). There were no differences in the highest NPIS score during admission (4.75±2.35 vs. 5.27±1.87, P=0.334) or the number of additional IV injections for pain control in the same period (0.72±0.94 for IV-PCA vs. 0.83±0.65 for ON-Q; P=0.575). Side effects such as nausea, dizziness, and drowsiness were significantly more frequent with IV-PCA (36.1% vs. 10.0%, P=0.014), and early discontinuation of the pain control device was more frequent in the IV-PCA group (33.3% vs. 6.7%, P=0.008). The ON-Q system was equivalent to the IV-PCA for postoperative pain control after thoracoscopic pulmonary resection for primary lung cancer, and it also had fewer effects and early discontinuations.

Evaluation of Postoperative Pain Control and Quality of Recovery in Patients Using Intravenous Patient-Controlled Analgesia with Fentanyl: A Prospective Randomized Study.

Opioids are increasingly used to control postoperative pain via intravenous patient-controlled analgesia, with several advantages. The present study evaluated the effects of intravenous patient-controlled analgesia with different doses of fentanyl on postoperative pain and on the quality of physical/emotional recovery from surgery and anesthesia. We retrospectively reviewed data from 288 patients, and evaluated whether intravenous patient-controlled analgesia with fentanyl correlated with the degree of postoperative pain. We then prospectively studied 47 patients who underwent elective laparoscopic cholecystectomy. The patients were randomized into 2 groups (15 or 30 μg/mL of fentanyl), and postoperative pain control was compared using a visual analog scale score. Furthermore, the Japanese 40-item quality of recovery (QoR-40J) score (global and dimensional) and Hospital Anxiety and Depression Scale (HADS) were used to assess the quality of recovery from surgery and anesthesia. Of 288 patients, 20% complained of intolerable pain and 18% experienced postoperative nausea and vomiting. In the prospective study, the visual analog scale pain score was lower in the Fentanyl 30 group than in the Fentanyl 15 group (p<0.05) on postoperative day 1. Dimensional QoR-40J pain subscales correlated with both the emotional state subscales (postoperative day 1, p<0.05; day 2, p<0.05) and global QoR-40 scores on both postoperative days (day 1, p<0.05; day 2, p<0.05). The postoperative pain as well as the physical and emotional quality of recovery in the patients who underwent laparoscopic cholecystectomy could be alleviated by sufficient doses of opioids.

A comparison on the effect of remifentanil patient-controlled analgesia versus fentanyl via any delivery method on maternal satisfaction and pain reduction during labor: a systematic review protocol

REVIEW QUESTION/OBJECTIVE In participants who are in active first and second stages of labor, what is the effect of intravenous patient-controlled analgesia with remifentanil on the level of maternal satisfaction and pain reduction from baseline compared to intravenous fentanyl? INCLUSION CRITERIA Types of participants This review will consider studies that include participants of 18 years and older who are either nulliparous or multiparous, who are of normal term, singleton gestation and deliver in an acute care setting or delivery center. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the use of intravenous remifentanil in comparison to intravenous fentanyl during first and second stages of labor. Types of outcomes This review will consider studies that include the following outcomes measures: level of maternal satisfaction based on subjective rating using a Likert scale or equivalent after delivery and pain score reduction from baseline at various points during labor assessed using a visual analogue scale.

Patient–machine interactions of intravenous patient-controlled analgesia in bilateral versus unilateral total knee arthroplasty: A retrospective study

BackgroundContinuous passive motion after a major knee surgery optimizes functional prognosis, but causes severe pain. In this study, we assessed the effect of intravenous patient-controlled analgesia (IVPCA) on postoperative pain management in unilateral and bilateral total knee arthroplasty (TKA). MethodsData were collected retrospectively from a single medical center from March 2003 to October 2007. All patients who had undergone TKA were given general anesthesia, and the type of surgery that each patient received was planned according to individual needs. A total of 223 patients qualified for this study, with 174 patients in the unilateral TKA group. Data on patient demography, pain scores, and side effect scores were collected. Total dose consumption, demand, delivery doses, demand-to-delivery ratio, and infusion rate were collected from PCA machines and analyzed. ResultsThe patient pain score and patient satisfaction showed no significant difference between the unilateral and bilateral TKA groups. The incidence of sedation (p < 0.001), nausea (p = 0.013), and vomiting (p = 0.044) during the postoperative 24–48-hour period was higher in the bilateral TKA group. Compared with the patients in the unilateral group, those in the bilateral group showed significantly greater dose consumption during the postoperative 6–12-, 12–18-, and 18–24-hour periods. They also showed more demand for medication during the postoperative 12–18- and 18–24-hour periods and received more bolus doses during the postoperative 12–18-, 18–24-, and 30–36-hour periods. In addition, there was also a significantly higher demand-to-delivery ratio for patients in the bilateral group during the postoperative 6–12-, 12–18-hour periods. ConclusionIn this study, we successfully demonstrated that our IVPCA protocol can provide adequate analgesia for patients after both bilateral and unilateral TKA. However, sedation, nausea, and vomiting occurred more frequently during the postoperative 24–48-hour period in patients who underwent bilateral than unilateral TKA. This may due of the increased number of bolus doses administered to the patients in the bilateral TKA group during the postoperative 12–18, 18–24, and 30–36-hour periods. Therefore, the initial infusion rates for patients undergoing bilateral TKA could be set at a lower threshold in order to reduce the incidence of these side effects.

Randomized, controlled trial of multimodal shoulder injection or intravenous patient-controlled analgesia after arthroscopic rotator cuff repair

The aim of this study was to compare the effect of postoperative pain control and adverse effects of intravenous patient-controlled analgesia (IV PCA) and multimodal shoulder injection after arthroscopic rotator cuff repair. Seventy patients scheduled for elective arthroscopic rotator cuff repair were prospectively randomized to receive either IV PCA or multimodal shoulder injections. Postoperative pain, nausea, vomiting, and other adverse effects were assessed at 2, 6, 12, 24, and 48 h after surgery. Use of rescue analgesics and antiemetics, level of satisfaction, and cost for both modalities were recorded. Pain was better controlled in the multimodal shoulder injection group at 2 h postoperatively (P = 0.001). However, the use of additional analgesics was greater in the multimodal shoulder injection group during 12-48 h after surgery (P < 0.001). The incidence of nausea within 12-24 h after surgery in the multimodal shoulder injection group (5.7 %) was less significant compared with that in the IV PCA group (31.4 %, P = 0.012), but no difference in overall incidence of the use of rescue antiemetics was observed between the groups (n.s.). No differences in adverse effects were noted between the groups. Patient satisfaction also showed no differences (n.s.). Costs required for both modalities were $20.3 for the multimodal shoulder injection and $157.8 for the IV PCA. Multimodal shoulder injection is a safe and effective modality for management of pain after arthroscopic rotator cuff repair. Considering the expense and need of special devices for IV PCA, multimodal shoulder injection may be an effective and safe alternative to IV PCA for postoperative analgesia after arthroscopic rotator cuff repair.

Effects of intravenous patient-controlled analgesia with buprenorphine and morphine alone and in combination during the first 12 postoperative hours: A randomized, double-blind, four-arm trial in adults undergoing abdominal surgery

Background: Intense pain in the first 12 hours after major abdominal surgery requires the use of large amounts of analgesics, mainly opioids, which may produce undesirable effects. Buprenorphine (BUP) is not typically used intravenously in this setting, particularly in combination with morphine (MO), due to concerns that BUP might inhibit the analgesic effect of MO. Objective: This study compared the analgesic effect of BUP and MO separately and in combination for postoperative pain control in patients undergoing abdominal surgery. Methods: In this double-blind study, adult patients were randomized to receive 1 of 4 regimens for 12 hours: a basal BUP infusion (BUP-i) of 0.4 µg/kg/h + BUP boluses (BUP-b) of 0.15 µg/kg each; a basal MO infusion (MO-i) of 10 µg/kg/h + MO boluses (MO-b) of 5 µg/kg each; a basal BUP-i of 0.4 µg/kg/h + MO-b of 5 µg/kg each; or a basal MO-i of 10 µg/kg/h + BUP-b of 0.15 µg/kg each. Bolus doses were delivered by intravenous patient-controlled anesthesia, with a bolus lockout time of 7 minutes. Diclofenac 75 mg IM q6h was available as rescue pain medication. Every 15 minutes during the first 2 postoperative hours and hourly thereafter, patients used visual analog scales to rate their pain (from 0 = totally free of pain to 10 = unbearable pain), level of sedation (from 1 = totally awake to 10 = heavily sedated), and satisfaction with treatment (from 1 = totally unsatisfied to 10 = fully satisfied). Blood pressure, heart rate, respiration rate, and arterial blood oxygen saturation (SpO 2) were monitored, and adverse effects reported by patients or noted by clinicians were recorded at the same times. Study end points included total opioid consumption (infusion + boluses), demand:delivery ratio, and use of rescue medication. Results: One hundred twenty patients (63 men, 57 women; age range, 21-80 years; weight range, 40-120 kg) were included in the study. Seventy-four percent had other mild, treated diseases (American Society of Anesthesiologists physical class 2). Pain visual analog scale ratings were comparably high in all groups during the first 2 postoperative hours. Pain intensity ratings at 3 to 12 hours were significantly lower in those who received BUP-i + BUP-b compared with the other treatment groups ( P = 0.018). The drug requirement during the postoperative period decreased significantly in all groups ( P = 0.01); however, there was a significant difference between groups in the demand:delivery ratio at 3 to 12 hours (group * psydrug interaction, P = 0.026). The numerically lowest demand:delivery ratio was seen with BUP-i + BUP-b. BUP-i was associated with a significantly lower heart rate compared with the other groups ( P = 0.027); there were no drug-related differences in respiration rate, SpO 2, or sedation. Patients' level of satisfaction with treatment was significantly higher in the group that received BUP-i + BUP-b compared with the other 3 groups ( P < 0.001). Postoperative nausea and vomiting were mild and occurred at a similar incidence in all groups, as did rescue diclofenac use. Conclusions: In these patients undergoing abdominal surgery, the BUP-i + BUP-b regimen controlled postoperative pain as well as did MO-i + MO-b or the combinations of BUP and MO. BUP neither inhibited the analgesia provided by MO nor induced undesired sedation or hemodynamic or respiratory effects.

Effects of Intravenous Patient-Controlled Analgesia With Morphine, Continuous Epidural Analgesia, and Continuous Femoral Nerve Sheath Block on Rehabilitation After Unilateral Total-Hip Arthroplasty

Effects of Intravenous Patient-Controlled Analgesia With Morphine, Continuous Epidural Analgesia, and Continuous Femoral Nerve Sheath Block on Rehabilitation After Unilateral Total-Hip Arthroplasty

Effects of Intravenous Patient-Controlled Analgesia With Morphine, Continuous Epidural Analgesia, and Continuous Femoral Nerve Sheath Block on Rehabilitation After Unilateral Total-Hip Arthroplasty

Regional analgesic techniques allow better postoperative rehabilitation and shorter hospital stay after major knee surgery. The authors tested the hypothesis that similar results could be obtained after total-hip arthroplasty. Forty-five patients scheduled for THA under general anesthesia were randomly divided into 3 groups. Postoperative analgesia was provided during the first 48 hours, with intravenous patient-controlled analgesia (IV PCA) induced by morphine (dose, 1.5 mg; lockout interval, 8 min) in group IV, continuous femoral nerve sheath block in group FNB, and continuous epidural analgesia in group EPI. The day after surgery, the 3 groups started identical physical therapy regimens. Pain scores at rest and on movement, supplemental analgesia, side effects, daily degree of maximal hip flexion and abduction, day of first walk, and duration of hospital stay were recorded. Population data, quality of pain relief, postoperative hip rehabilitation, and duration of hospital stay were comparable in the 3 groups. When compared with the two other techniques, continuous FNB was associated with a lower incidence of side effects (no nausea/vomiting, urinary retention, arterial hypotension, or catheter problem during the first 48 hours in 20%, 60%, and 13% of patients in groups IV, FNB, and EPI, respectively). This study suggests that IV PCA with morphine, continuous FNB, and continuous epidural analgesia provide similar pain relief and allow comparable hip rehabilitation and duration of hospital stay after total-hip arthroplasty (THA). As continuous FNB is associated with less side effects, it appears to offer the best option of the three.

Comparison of Analgesic Effect and Satisfaction for Intravenous Patient-Controlled Analgesia and Epidural Patient-Controlled Analgesia in Patients Undergoing Cesarean Section with Spinal Anesthesia

Background: In many cases, spinal anesthesia is performed in cesarean section. Many women want postoperative pain control. The purpose of this study was to compare the effects of intravenous patient-controlled analgesia (IV-PCA) and epidural patient-controlled analgesia (Epi-PCA) in patients undergoing cesarean section with spinal anesthesia. Methods: Forty healthy women were randomly assigned to receive IV-PCA or Epi-PCA after cesarean section with spinal anesthesia. The IV-PCA group received ketorolac 30 mg and butorphanol 0.5 mg intravenously when the peritoneum was sutured, followed by IV-PCA with 0.15% ketorolac and 0.005% butorphanol 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The Epi-PCA group received 0.01% morphine 10 ml via an epidural catheter when the peritoneum was sutured, followed by Epi-PCA with 0.004% morphine and 0.1% bupivacaine 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The degree of pain was subjectively evaluated using a visual analogue scale (VAS). Patients were evaluated at 2, 6, 12, 24 and 48 hours after operation. Statistical analyses were performed using T-test, Mann White U test and the Chi-square test. Results: VAS was not significantly different at any time, and the incidences of pruritus and sensory and motor changes of the lower extremities were significantly higher in Epi-PCA than IV-PCA. Conclusions: Although VAS in the two groups was not significantly different, we conclude that IV-PCA is more beneficial than Epi-PCA in patients undergoing cesarean section with spinal anesthesia, because of the side effects of Epi-PCA.

Effects of Intravenous Patient-Controlled Analgesia with Morphine, Continuous Epidural Analgesia, and Continuous Three-in-One Block on Postoperative Pain and Knee Rehabilitation After Unilateral Total Knee Arthroplasty

In this study, we assessed the influence of three analgesic techniques on postoperative knee rehabilitation after total knee arthroplasty (TKA). Forty-five patients scheduled for elective TKA under general anesthesia were randomly divided into three groups. Postoperative analgesia was provided with i.v. patient-controlled analgesia (PCA) with morphine in Group A, continuous 3-in-1 block in Group B, and epidural analgesia in Group C. Immediately after surgery, the three groups started identical physical therapy regimens. Pain scores, supplemental analgesia, side effects, degree of maximal knee flexion, day of first walk, and duration of hospital stay were recorded. Patients in Groups B and C reported significantly lower pain scores than those in Group A. Supplemental analgesia was comparable in the three groups. Compared with Groups A and C, a significantly lower incidence of side effects was noted in Group B. Significantly better knee flexion (until 6 wk after surgery), faster ambulation, and shorter hospital stay were noted in Groups B and C. However, these benefits did not affect outcome at 3 mo. We conclude that, after TKA, continuous 3-in-1 block and epidural analgesia provide better pain relief and faster knee rehabilitation than i.v. PCA with morphine. Because it induces fewer side effects, continuous 3-in-1 block should be considered the technique of choice. In this study, we determined that, after total knee arthroplasty, loco-regional analgesic techniques (epidural analgesia or continuous 3-in-1 block) provide better pain relief and faster postoperative knee rehabilitation than i.v. patient-controlled analgesia with morphine. Because it causes fewer side effects than epidural analgesia, continuous 3-in-1 block is the technique of choice.

Effects of Intravenous Patient-Controlled Analgesia with Morphine, Continuous Epidural Analgesia, and Continuous Three-in-One Block on Postoperative Pain and Knee Rehabilitation After Unilateral Total Knee Arthroplasty

In this study, we assessed the influence of three analgesic techniques on postoperative knee rehabilitation after total knee arthroplasty (TKA).Forty-five patients scheduled for elective TKA under general anesthesia were randomly divided into three groups. Postoperative analgesia was provided with IV patient-controlled analgesia (PCA) with morphine in Group A, continuous 3-in-1 block in Group B, and epidural analgesia in Group C. Immediately after surgery, the three groups started identical physical therapy regimens. Pain scores, supplemental analgesia, side effects, degree of maximal knee flexion, day of first walk, and duration of hospital stay were recorded. Patients in Groups B and C reported significantly lower pain scores than those in Group A. Supplemental analgesia was comparable in the three groups. Compared with Groups A and C, a significantly lower incidence of side effects was noted in Group B. Significantly better knee flexion (until 6 wk after surgery), faster ambulation, and shorter hospital stay were noted in Groups B and C. However, these benefits did not affect outcome at 3 mo. We conclude that, after TKA, continuous 3-in-1 block and epidural analgesia provide better pain relief and faster knee rehabilitation than IV PCA with morphine. Because it induces fewer side effects, continuous 3-in-1 block should be considered the technique of choice. Implications: In this study, we determined that, after total knee arthroplasty, loco-regional analgesic techniques (epidural analgesia or continuous 3-in-1 block) provide better pain relief and faster postoperative knee rehabilitation than IV patient-controlled analgesia with morphine. Because it causes fewer side effects than epidural analgesia, continuous 3-in-1 block is the technique of choice. (Anesth Analg 1998;87:88-92)

The Effects of Intravenous Patient-Controlled Analgesia using Morphine or Nalbuphine to Postoperative Respiratory Depression

The Effects of Intravenous Patient-Controlled Analgesia using Morphine or Nalbuphine to Postoperative Respiratory Depression