Yamauchi Masanori, Asano Makoto, Watanabe Masanori, Iwasaki Soushi, Furuse Shingo, Namiki Akiyoshi
Department of Anesthesia, Oji General Hospital, Tomakomai, 053-8506.
Masui. 2004 Jan;53(1):29-33.
Although patient-controlled epidural analgesia (PCEA) is widely known to provide good pain control after abdominal surgery, it has not been popular in Japan. We evaluated the effects of PCEA with background infusion after major abdominal surgery.
Ninety patients scheduled for abdominal surgery were randomly allocated to two groups by treatment with postoperative epidural analgesia: infuser group (n = 48); continuous infusion 5 ml.hr-1 or PCEA group (n = 42); background infusion 5 ml.hr-1, PCEA 3 ml and lock out 30 min. Microject (Sorenson Medical Co, U.S.A.) was used for PCEA machine. 0.2% ropivacaine 100 ml with fentanyl 500 micrograms was administered into the epidural space in both groups.
Postoperative visual analogue scale (VAS) at rest and coughing were about 10 mm and 40 mm in both group, respectively, and there were no significant differences between the groups. NSAIDs were effective for rescue analgesia in infuser group to improve postoperative pain as PCEA. Vomiting and sedation were more frequent in infuser group than in PCEA group. Empty battery and machine troubles of unknown origin were observed in 2 and 4 patients, respectively in PCEA group.
PCEA with background infusion could improve the management of postoperative pain, and adequate program of PCEA is important to reduce postoperative pain and its side effects.
尽管患者自控硬膜外镇痛（PCEA）在腹部手术后能提供良好的疼痛控制已广为人知，但在日本尚未普及。我们评估了腹部大手术后背景输注PCEA的效果。
90例计划行腹部手术的患者通过术后硬膜外镇痛治疗随机分为两组：输注泵组（n = 48）；持续输注5毫升/小时；或PCEA组（n = 42）；背景输注5毫升/小时，PCEA 3毫升，锁定时间30分钟。PCEA机器使用Microject（美国Sorenson Medical公司）。两组均将含500微克芬太尼的0.2%罗哌卡因100毫升注入硬膜外间隙。
两组术后静息和咳嗽时的视觉模拟评分（VAS）分别约为10毫米和40毫米，两组间无显著差异。在输注泵组，非甾体抗炎药对补救性镇痛有效，可改善术后疼痛，效果与PCEA相当。输注泵组呕吐和镇静比PCEA组更频繁。PCEA组分别有2例和4例出现电池耗尽和不明原因的机器故障。
背景输注PCEA可改善术后疼痛管理，合适的PCEA方案对于减轻术后疼痛及其副作用很重要。
