Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Anesth. 2010 Apr;24(2):187-91. doi: 10.1007/s00540-010-0878-5. Epub 2010 Mar 2.
Excessive pain may interrupt early rehabilitation after cardiac surgery. The purpose of this study was to evaluate the efficacy of a longer patient-controlled analgesia (PCA) regimen for early ambulation after cardiac surgery.
This study was designed to be a retrospective, single-institutional (focusing on an urban, university-affiliated hospital), pre-post intervention survey. Fifty-nine patients undergoing elective cardiac surgery were included. A long pain management regimen (subcutaneous fentanyl PCA for up to 120 h) protocol was implemented for the postoperative care for adult cardiac surgery patients. Before implementing this extended protocol, the same PCA regimen was used for up to 40 h. Perioperative and postoperative management was similar for all patients. The number of days required to walk more than 100 m without assistance was recorded. Additional usage of analgesic drugs and pain intensity on movement were documented up to POD 5.
Time required to walk more than 100 m without assistance was significantly shorter in the 120 h PCA group. Need for another analgesic regimen and pain score during the ambulation phase were significantly lower in the 120 h PCA than in the 40 h PCA group. Frequency of side effects was similar for both groups.
Pain management using a PCA system can be recommended for patients during the ambulation period after cardiac surgery. Subcutaneous PCA with fentanyl is a safe and effective analgesic regimen for this purpose.
过度疼痛可能会中断心脏手术后的早期康复。本研究旨在评估延长患者自控镇痛（PCA）方案在心脏手术后早期活动中的疗效。
本研究设计为回顾性、单机构（侧重于城市、大学附属医院）、前后干预调查。纳入 59 例行择期心脏手术的患者。为成人心脏手术患者术后护理实施了一种长痛管理方案（皮下芬太尼 PCA 长达 120 小时）方案。在实施此扩展方案之前，相同的 PCA 方案最多使用 40 小时。所有患者的围手术期和术后管理均相似。记录无需辅助行走超过 100 米所需的天数。直至术后第 5 天，记录了额外使用镇痛药和运动时疼痛强度的情况。
无需辅助行走超过 100 米的时间在 120 小时 PCA 组明显缩短。在 120 小时 PCA 组中，需要另一种镇痛方案和在活动阶段的疼痛评分明显低于 40 小时 PCA 组。两组的副作用发生率相似。
心脏手术后活动期间使用 PCA 系统进行疼痛管理可以为患者推荐。皮下芬太尼 PCA 是一种安全有效的镇痛方案。
