Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2009 Oct;24(5):930-5. doi: 10.3346/jkms.2009.24.5.930. Epub 2009 Sep 23.
This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.
本前瞻性随机研究旨在评估两种常见镇痛技术，胸段硬膜外患者自控镇痛（Epidural PCA）和静脉患者自控镇痛（IV PCA），在接受电视辅助胸腔镜手术（VATS）肺叶切除术患者中的疗效。52 例计划接受 VATS 肺叶切除术的患者被随机分为两组：硬膜外 PCA 组接受罗哌卡因 0.2%+芬太尼 5 μg/mL 混合液硬膜外输注，速率为 4 mL/hr；静脉 PCA 组接受酮咯酸 0.2 mg/kg+芬太尼 15 μg/mL 混合液静脉输注，速率为 1 mL/hr。术后 5 天，采用视觉模拟评分法（VAS）记录静息时和运动时的疼痛评分（VAS-R 和 VAS-M，0-10）。此外，我们还测量了每日吗啡消耗量、用力肺活量（FVC）、1 秒用力呼气量（FEV1）、满意度评分和不良反应发生率。52 例患者中有 37 例完成了研究（硬膜外 PCA 组 18 例，静脉 PCA 组 19 例）。两组间疼痛评分、镇痛需求、肺功能、满意度评分和不良反应发生率无差异。这表明 IV PCA 和 Epidural PCA 在控制 VATS 肺叶切除术后疼痛方面同样有效，提示 IV PCA 可替代 Epidural PCA。
