Behera B K, Puri G D, Ghai B
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India.
J Postgrad Med. 2008 Apr-Jun;54(2):86-90. doi: 10.4103/0022-3859.40772.
Intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) were studied in terms of analgesic efficacy, respiratory function and side effects after thoracic surgery for 24h. PCEA using fentanyl and bupivacaine as compared to IVPCA using morphine provides better pain relief both at rest and during coughing and is associated with fewer side effects.
To compare IVPCA and PCEA in terms of analgesic efficacy, respiratory function and side effects after thoracic surgery.
Tertiary care teaching hospital. Prospective, randomized and open study.
Thirty ASA-I or II patients undergoing thoracotomy were assigned randomly to receive either IVPCA using morphine or PCEA using fentanyl and bupivacaine combination postoperatively. No background infusion was administered in either group. Postoperative evaluation included pain intensity both at rest and during coughing, degree of sedation, arterial blood gas, forced vital capacity (FVC), peak expiratory flow rate (PEFR), presence of side effects such as nausea/vomiting and pruritus at 0, 2, 8, 12 and 24h. The primary outcome of the study was the percentage of patients with analgesia failure defined as VAS>30 despite three consecutive PCA boluses requiring rescue analgesia with intravenous fentanyl.
Data were analyzed using t -test, chi2 test and Mann-Whitney test.
Significantly less number of patients required rescue analgesia in PCEA group ( P< 0.05). Pain relief was better both at rest and during coughing ( P< 0.05) in PCEA group as compared to IVPCA. Patients in the PCEA group were less sedated and had fewer incidences of side effects, i.e. nausea/vomiting and pruritus. Postoperative FVC and PEFR were reduced significantly compared to baseline only in IVPCA group ( P< 0.05).
After thoracic surgery, PCEA using fentanyl and bupivacaine as compared to IVPCA using morphine provides better pain relief both at rest and during coughing and associated with fewer side effects.
对静脉自控镇痛（IVPCA）和患者自控硬膜外镇痛（PCEA）在胸外科手术后24小时的镇痛效果、呼吸功能及副作用进行了研究。与使用吗啡的IVPCA相比，使用芬太尼和布比卡因的PCEA在静息和咳嗽时均能提供更好的疼痛缓解，且副作用更少。
比较IVPCA和PCEA在胸外科手术后的镇痛效果、呼吸功能及副作用。
三级护理教学医院。前瞻性、随机、开放研究。
30例接受开胸手术的ASA-I或II级患者术后随机分为两组，分别接受使用吗啡的IVPCA或使用芬太尼和布比卡因联合的PCEA。两组均不给予背景输注。术后评估包括静息和咳嗽时的疼痛强度、镇静程度、动脉血气、用力肺活量（FVC）、呼气峰值流速（PEFR），以及在0、2、8、12和24小时时恶心/呕吐和瘙痒等副作用的发生情况。该研究的主要结局是尽管连续三次PCA推注后疼痛视觉模拟评分（VAS）>30，仍需要静脉注射芬太尼进行补救镇痛的镇痛失败患者百分比。
数据采用t检验、卡方检验和曼-惠特尼检验进行分析。
PCEA组需要补救镇痛的患者数量明显较少（P<0.05）。与IVPCA相比，PCEA组在静息和咳嗽时的疼痛缓解更好（P<0.05）。PCEA组患者的镇静程度较轻，副作用（即恶心/呕吐和瘙痒）的发生率较低。仅IVPCA组术后FVC和PEFR较基线水平显著降低（P<0.05）。
胸外科手术后，与使用吗啡的IVPCA相比，使用芬太尼和布比卡因的PCEA在静息和咳嗽时均能提供更好的疼痛缓解，且副作用更少。
