Chen Lee-May, Weinberg Vivian K, Chen Christine, Powell C Bethan, Chen Lee-Lynn, Chan John K, Burkhardt Daniel H
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Gynecol Oncol. 2009 Dec;115(3):357-61. doi: 10.1016/j.ygyno.2009.08.015. Epub 2009 Sep 23.
Our aim was to compare perioperative patient controlled epidural analgesia (PCEA) versus patient controlled intravenous analgesia (PCA) after gynecologic oncology laparotomy.
This was a prospective cohort study where perioperative pain management was decided through patient-centered discussion by anesthesia and surgical teams. The study was designed to accrue 224 patients, to test for equivalence in pain control on postoperative day 1, defined as less than a 10% difference in the proportion of patients with a visual analog scale pain score of <2 (0-10 scale).
Two hundred forty patients were enrolled, with 205 patients evaluable for outcomes: 98 received PCA, while 107 received a thoracic level PCEA. Utilization of PCEA was associated with longer anesthesia time pre-op (means: 60 vs. 44 min, p<0.0001), as well as more likely use of pressors during surgery (78% vs. 57%, p=0.002). Pain control was comparable between groups on postoperative day 1 (mean VAS: 2.4 vs. 2.5, p=0.56), but patients with PCEA tended to require more supplemental pain medications. Time to first ambulation was longer in the PCEA patients (means: 49 vs. 36 h post-op, p=0.03), with no difference in time to tolerating regular diet (means: 89 vs. 77 h post-op, 0.17) and no difference in readiness for discharge (means: 144 vs. 145 h post-op, p=0.95).
In this nonrandomized prospective study, selection of a PCEA for perioperative pain management did not improve pain management for patients undergoing gynecologic oncology surgery.
我们的目的是比较妇科肿瘤剖腹手术后围手术期患者自控硬膜外镇痛（PCEA）与患者自控静脉镇痛（PCA）的效果。
这是一项前瞻性队列研究，围手术期疼痛管理通过麻醉和手术团队以患者为中心的讨论来决定。该研究旨在招募224名患者，以测试术后第1天疼痛控制的等效性，定义为视觉模拟量表疼痛评分<2（0-10分）的患者比例差异小于10%。
共纳入240名患者，其中205名患者可评估结局：98名接受PCA，107名接受胸段PCEA。使用PCEA与术前麻醉时间较长有关（平均值：60分钟对44分钟，p<0.0001），以及手术期间更有可能使用升压药（78%对57%，p=0.002）。两组术后第1天的疼痛控制相当（平均VAS：2.4对2.5，p=0.56），但PCEA患者往往需要更多的补充性镇痛药。PCEA患者首次下床活动的时间更长（平均值：术后49小时对36小时，p=0.03），耐受常规饮食的时间没有差异（平均值：术后89小时对77小时，p=0.17），出院准备情况也没有差异（平均值：术后144小时对145小时，p=0.95）。
在这项非随机前瞻性研究中，选择PCEA进行围手术期疼痛管理并不能改善妇科肿瘤手术患者的疼痛管理。
