Document Detail


Patient-controlled analgesia (PCA) following video-assisted thoracoscopic lobectomy: Comparison of epidural PCA and intravenous PCA.
MedLine Citation:
PMID:  23026166     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: To 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 METHODS: EPCA 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 T(6-7) or T(7-8) 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).
RESULTS: This 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).
CONCLUSION: Our 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.
Authors:
Jr-Chi Yie; Jen-Ting Yang; Chun-Yu Wu; Wei-Zen Sun; Ya-Jung Cheng
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Publication Detail:
Type:  Journal Article     Date:  2012-09-07
Journal Detail:
Title:  Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists     Volume:  50     ISSN:  1875-452X     ISO Abbreviation:  Acta Anaesthesiol Taiwan     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-10-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101214918     Medline TA:  Acta Anaesthesiol Taiwan     Country:  China (Republic : 1949- )    
Other Details:
Languages:  eng     Pagination:  92-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2012. Published by Elsevier B.V.
Affiliation:
Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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