Kajiyama Seiji, Sanuki Michiyoshi, Kinoshita Hiroyuki, Fujii Kiyoshi
Department of Anesthesia and Intensive Care, Hiroshima City Asa Hospital, Hiroshima 731-0293.
Masui. 2003 Apr;52(4):383-8.
We have been offering active postoperative analgesia service (PAS). In order to further enhance the quality of PAS, we reviewed 1500 cases of postoperative continuous epidural analgesia (PCEA).
Postoperative patients received epidural administration of a mixed analgesic solution employing bupivacaine, morphine, or fentanyl using a portable disposable infuser pump (PDIP) for at least 72 hours. Analgesic effects were assessed by using Prince Henry's scoring and the demand for additional analgesics. The frequency and causes of discontinued infusion were also evaluated.
83.9% of cases showed no complications. However, in 4.7% of cases infusion was discontinued because of side effects (nausea, vomiting, pruritus, lower limb motor block, and hypotension, etc.), in 4.1% because of dislodgment of the epidural catheter, in 3.4% because of disconnection, in 2.0% because the patient removing the catheter, and in 0.8% because of the condition of the catheter insertion site.
These results indicate that to improve our method of PCEA with PDIP, we must re-assess our regimen used for continuous epidural infusion for postoperative pain relief, and develop measures to prevent side effects and complications.
我们一直在提供术后主动镇痛服务（PAS）。为了进一步提高PAS的质量，我们回顾了1500例术后连续硬膜外镇痛（PCEA）病例。
术后患者使用便携式一次性输注泵（PDIP）硬膜外注射包含布比卡因、吗啡或芬太尼的混合镇痛溶液，持续至少72小时。通过使用亨利王子评分法和额外镇痛药物的需求来评估镇痛效果。还评估了停止输注的频率和原因。
83.9%的病例未出现并发症。然而，4.7%的病例因副作用（恶心、呕吐、瘙痒、下肢运动阻滞和低血压等）而停止输注，4.1%是因为硬膜外导管移位，3.4%是因为断开连接，2.0%是因为患者自行拔除导管，0.8%是因为导管插入部位的情况。
这些结果表明，为了改进我们使用PDIP进行PCEA的方法，我们必须重新评估用于术后疼痛缓解的连续硬膜外输注方案，并制定预防副作用和并发症的措施。
