Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia for laparoscopic radical prostatectomy
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared.Methods: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. Results: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group.Conclusions: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP. (Korean J Pain 2018; 31: 191-8)
Abstract
Background: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared.Methods: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. Results: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group.Conclusions: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP. (Korean J Pain 2018; 31: 191-8)
참고문헌 (19)
- Siegel R, "Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths", CA Cancer J Clin, 61, pp.212~236 (2011)[DOI]
- Laufenberg-Feldmann R, "Prevalence of pain 6 months after surgery: a prospective observational study", BMC Anesthesiol, 16, pp.91~ (2016)[DOI]
- Chen K, "Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer", World J Gastroenterol, 19, pp.5365~5376 (2013)[DOI]
- Bisgaard T, "Characteristics and prediction of early pain after laparoscopic cholecystectomy", Pain, 90, pp.261~269 (2001)[DOI]
- Hudcova J, "Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain", Cochrane Database Syst Rev (2006)
- Capdevila X, "Effectiveness of epidural analgesia, continuous surgical site analgesia, and patient-controlled analgesic morphine for postoperative pain management and hyperalgesia, rehabilitation, and health-related quality of life after open nephrectomy: a prospective, randomized, controlled study", Anesth Analg, 124, pp.336~345 (2017)[DOI]
- Oh YJ, "Randomized controlled comparison of combined general and epidural anesthesia versus general anesthesia on diaphragmatic function after laparoscopic prostatectomy", Minerva Anestesiol, 79, pp.1371~1380 (2013)
- Webster TM, "Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain", J Urol, 174, pp.912~914 (2005)[DOI]
- Joshi GP, "Optimal pain management for radical prostatectomy surgery: what is the evidence?", BMC Anesthesiol, 15, pp.159~ (2015)[DOI]
- Mir MC, "Effectiveness of epidural versus alternate analgesia for pain relief after radical prostatectomy and correlation with biochemical recurrence in men with prostate cancer", Res Rep Urol, 5, pp.139~145 (2013)
- Wheatley RG, "Safety and efficacy of postoperative epidural analgesia", Br J Anaesth, 87, pp.47~61 (2001)[DOI]
- Carvalho B, "Implementation of programmed intermittent epidural bolus for the maintenance of labor analgesia", Anesth Analg, 123, pp.965~971 (2016)[DOI]
- Doyle E, "Comparison of patient-controlled analgesia with and without a background infusion after lower abdominal surgery in children", Br J Anaesth, 71, pp.670~673 (1993)[DOI]
- Hwang BY, "A randomized clinical trial of nefopam versus ketorolac combined with oxycodone in patient-controlled analgesia after gynecologic surgery", Int J Med Sci, 12, pp.644~649 (2015)[DOI]
- Royse CE, "An audit of morphine versus fentanyl as an adjunct to ropivacaine 0.2% for high thoracic epidural analgesia", Anaesth Intensive Care, 33, pp.639~644 (2005)
- Delvecchio L, "Comparing the efficacy and safety of continuous epidural analgesia in abdominal and urological surgery between two opioids with different kinetic properties: morphine and sufentanyl", Minerva Anestesiol, 74, pp.69~76 (2008)
- Agarwal A, "The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium", Anesth Analg, 99, pp.1684~1688 (2004)
- Hendolin H, "Effect of epidural versus general anaesthesia on peroperative blood loss during retropubic prostatectomy", Int Urol Nephrol, 14, pp.399~405 (1982)[DOI]
- Baumunk D, "Impact of thoracic epidural analgesia on blood loss in radical retropubic prostatectomy", Urol Int, 93, pp.193~201 (2014)[DOI]