Number Of PCA Research Articles

Effectiveness of multimodal preemptive analgesia in major pediatric abdominal cancer surgery

Objective: evaluate efficacy of combining multimodal analgesia and local anesthetic infiltration compared with caudal analgesia among pediatric patients undergoing major abdominal pediatric cancer surgeryMethodology: This randomized controlled pilot study was carried out at postoperative care unit of our institution. This pilot study enrolled 90 children ASA I and II with cancer scheduled for major abdominal surgery through a midline incision. Intervention: patients were randomly divided into three equal groups. The morphine group received IV morphine at a dose of 0.1 mg/kg after induction of anesthesia. The caudal group underwent caudal block. The multimodal group received paracetamol, ketorolac and ketamine infusion, with local wound infiltration of levobupivacaine before skin incision and at the end of surgery. After surgery, all patients were maintained on PCA morphine postoperatively. Primary outcome measure was total postoperative morphine consumption. The secondary endpoints were VAS score for pain, the time to first PCA bolus, and the number of PCA doses.Results: that there were no between-group differences in the baseline characteristics of the participants. The three analgesic modalities provided adequate pain relief for up to 24 h. The multimodal and caudal groups did not significantly differ in terms of total morphine consumption (p = 0.521), time to first analgesic bolus (p = 0.136), or the number of total and active PCA boluses (p = 0.260 and p = 0.904, respectively). Both groups were superior to the morphine group regarding morphine consumption, time to first analgesic bolus, and the number of total and active PCA bolusesConclusion: Preemptive multimodal analgesia and caudal block offered comparable efficacy in the target population.Trial registration: clinicaltrial.gov with no. NCT03580980.Citation: Ghobrial HZ, Shaker EH. Effectiveness of multimodal preemptive analgesia in major pediatric abdominal cancer surgery. Anaesth pain & intensiv care 2019;23(3):256-262Received & Reviewed: 16, 21 August 2019. Accepted: 28 August 2019

PS02.227: A NEW POSTOPERATIVE PAIN MANAGEMENT LEADS TO ENHANCED RECOVERY AFTER ESOPHAGECTOMY: A PROPENSITY SCORE-MATCHED ANALYSIS

Abstract Background Opioid use is reportedly associated with delayed recovery after surgery because of gastrointestinal motility disorder and postoperative nausea and vomiting despite of acceptable efficacy for pain control.The aim of this study was to investigated the efficacy of postoperative scheduled intravenous acetaminophen to reduce the opioid use and enhanced recovery after esophagectomy. Methods Of 93 and 57 consecutive patients who underwent esophagectomy for esophageal cancer before and after introduction of postoperative scheduled intravenous acetaminophen, propensity score-matched population was created and short-term clinical outcomes were compared. Results Significant defervescence was demonstrated in Acetaminophen group (A-group) compared with control group (C-group) during the perioperative period (P < 0.05), whereas no significant difference was observed in postoperative inflammatory parameters. The incidence of postoperative complications was similar between the groups. The number of PCA pushes and the frequency of use of other non-opioid analgesics was significantly reduced in the A-group (P < 0.05). Both daily and cumulative opioid use was significantly reduced in the A-group (P < 0.05). The time to first flatus and defecation significantly decreased in the A-group (P = 0.001 and P = 0.035, respectively). The day of first walking after surgery significantly decreased in the A-group (1.0 vs. 2.0 days, P < 0.001). The ICU stay (3.05 vs. 3.62 days, P = 0.003) and the hospital stay (21.6 vs.26.8 days, P = 0.074) tended to be decreased in the A-group. Conclusion Scheduled postoperative intravenous acetaminophen after esophagectomy may reduce the use of opioids and might be associated with enhanced GI motility and decreased incidence of PONV. Scheduled intravenous acetaminophen may be a feasible new pain management option in ERAS protocol after esophagectomy. Disclosure All authors have declared no conflicts of interest.

Efficacy and safety of sulfentanyl(China) for patient-contrulled intravenous analgesia (PICA) in surgical patients with general anesthesia: a multiple-center, randomized, double-blind, parallel study

Objective To evaluate efficacy and safety of sulfentanyl (China) for PICA in surgical patients with general anes-thesia in a multiple-center, randomized, double-blind, parallel study. Methods 200 ASA grade Ⅰ -Ⅱ patients aged 18-55 undergo-ing surgery with general aneathesia enrolled from 3 hospitals were randomly and double-blindly divided into 2 groups: sulfentanyl (China, n=100) versus sulfentanyl(German, n=100). Sulfentanyl(China 0.1 μg/kg or German)was given before the end of surgery. VAS scores less than 3 after patient awake and PCA started after extubation(200 μg sulfentanyl was diluted with 50 ml saline solution, background dose 0.5 ml/h,bolus of 0.5 ml with lockout interval 15 min, continuous infusion 48 h). Vital signs including BP, HR, PR, SpO2 and side effects such as nausea, vomiting, urine retention, pruritus, breath depression, etc. And VAS scores with patients in quiet and cough were recorded at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. The total number of PCA, the total effective number of PCA, and the ratio of both and other analgesics as well as the satisfactory degree of patients and the cumulative suffen-tanyl consumption were recorded at 24 h. Results There were no significant difference of BP, HR, PR, SpO2 and the adverse effect and VAS scores in quiet and cough between two groups at the beginning of infusion at 0, 1, 4, 12, 24, 48 h. There were no signifi-cant difference of the total number of PCA, the total effective number of PCA and other analgesics as well as the satisfactory degree of patients and the total dosage of sulfentanyl at 24 h. Conclusion The sulfentanyl (China) had satisfactory effects of postoperative analgesia and had no significant side effects compared with sulfentanyl (German). The efficacy and the side effects of both drugs had no significant difference. Key words: Sulfentanyl; PICA

Sufentanil composite of different concentrations of ropivaeaine for obstetric epidural analgesia effect of clinical observation

Objective To compare the different concentrations of 0.125 percent compound sufentanil ropivacaine for cesarean section patient controlled epidural analgesia (PCEA) clinical efficacy and adverse reactions. Methods 60 cases of combined spinal-epidural anesthesia downlink maternal cesarean section were randomly divided into three groups (n=20). Sufentanil 0.2 μg/ml respectively 0.125% ropivacaine (A) group, 0.4 μg/ml sufentanil 0.125% ropivacaine (B) group, 0.6 μg/ml respectively aufentanil 0.125% ropivacaine (C) group. Postop-erative PCEA line that is loading dose (5ml)+continuous dose (3ml/h) + PCA dose (1ml/times), lockout time 15min.Observation: (1) Records of the time 0～3, 3～6, 6～12, 12～24 h postoperative incision pain, uter-ine pain VAS score, squeeze the number of PCA. (2) Records 24h with the incidence of adverse reactions: nausea, vomiting, itching, motor block, drowsiness, respiratory depression.Results Obstetric after PCEA, 24h in patients with Sufentanil concentration increased, incision pain VAS score and contraction VAS pain score decreased, which B Group, C group and Cween the two VAS score was no significant difference (P>0.05). Surgery 3～6h, 6～12h and 24h push PCA total number, B Group, C group were significantly lower than that A group (P 0.05). PCEA24h with adverse reactions in the nausea, the incidence of pruritus with sufentanil increased concentration increases, C group and B Group, A group were significantly different (P 0.05). Three groups of vomiting, motor block, lethargy no significant difference (P>0.05), no respiratory depression. Conclusion The cesarean section PCEA, 0.4 μg/ml composite sufentanil 0.125% ropivacaine can get better analgesic effect and less side effects. Key words: Epidural analgesia; Concentration; Sufentanil; Cesarean section