Yie Jr-Chi, Yang Jen-Ting, Wu Chun-Yu, Sun Wei-Zen, Cheng Ya-Jung
Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Acta Anaesthesiol Taiwan. 2012 Sep;50(3):92-5. doi: 10.1016/j.aat.2012.08.004. Epub 2012 Sep 7.
To compare the efficacy and side effects of epidural patient-controlled analgesia (EPCA) with those of intravenous patient-controlled analgesia (IVPCA) in fast-track video-assisted thoracoscopic (VATS) lobectomy.
EPCA or IVPCA was chosen by patients and was started immediately following tracheal extubation in the wake of completion of VATS lobectomy. EPCA analgesia was carried out with the PCA device programmed to deliver a bolus dose of 3 mL of 0.1% bupivacaine combined with 1.2 μg/mL fentanyl, and continuous epidural infusion at a rate of 4 mL/hour through an epidural catheter placed at the T(6-7) or T(7-8) level. IVPCA was made possible by a patient controlled infusion pump programmed to deliver 0.1% morphine with a loading dose of 3 mg, and the controlled bolus of 1 mg, at a lockout interval of 5 minutes. A rescue dose of 5 mg intravenous morphine was available for all patients in postoperative care unit. Pain management was assessed with visual analog scale at rest (VAS-R) and during motion (VAS-M); side effects including nausea, vomiting, pruritus, dizziness and sleepiness were recorded and analyzed from postoperative Day 1 (POD1) to Day 3 (POD3).
This study included 105 patients. Satisfactory pain control was achieved, although 9/70 patients in the EPCA group and 5/35 patients in the IVPCA group needed rescue morphine in the recovery room. The VAS-R was significantly higher on POD1 than on POD2 or POD3 in both groups (p < 0.001). The VAS-R and VAS-M were comparable in both groups on POD1 and POD3 but significant lower VAS-M was seen in the EPCA group on POD2 (p = 0.008). Higher incidence of dizziness was found in the IVPCA group on POD1 (p = 0.044) but the EPCA group had a higher incidence of pruritus on POD2 (p = 0.024) and POD3 (p = 0.03).
Our results indicated that the necessity of pain control was higher on POD1 for VATS lobectomy. Both EPCA and IVPCA can provide an adequate, continuous and effective means for postoperative pain management and a lower VAS-M was found in EPCA on POD2.
比较在快速康复电视辅助胸腔镜（VATS）肺叶切除术中，硬膜外自控镇痛（EPCA）与静脉自控镇痛（IVPCA）的疗效和副作用。
患者可选择EPCA或IVPCA，并在VATS肺叶切除术后气管插管拔除后立即开始使用。EPCA镇痛通过PCA设备进行，设定推注剂量为3毫升0.1%布比卡因加1.2微克/毫升芬太尼，并通过置于T（6 - 7）或T（7 - 8）水平的硬膜外导管以4毫升/小时的速率持续硬膜外输注。IVPCA通过患者自控输注泵实现，设定输注0.1%吗啡，负荷剂量为3毫克，控制推注剂量为1毫克，锁定时间间隔为5分钟。术后护理单元的所有患者均可使用5毫克静脉注射吗啡的补救剂量。采用视觉模拟评分法评估静息时（VAS - R）和活动时（VAS - M）的疼痛管理情况；记录并分析术后第1天（POD1）至第3天（POD3）的副作用，包括恶心、呕吐、瘙痒、头晕和嗜睡。
本研究纳入105例患者。尽管EPCA组70例患者中有9例、IVPCA组35例患者中有5例在恢复室需要补救吗啡，但均实现了满意的疼痛控制。两组患者术后第1天的VAS - R均显著高于第2天或第3天（p < 0.001）。两组患者术后第1天和第3天的VAS - R和VAS - M相当，但EPCA组术后第2天的VAS - M显著更低（p = 0.008）。IVPCA组术后第1天头晕发生率更高（p = 0.044），但EPCA组术后第2天（p = 0.024）和第3天（p = 0.03）瘙痒发生率更高。
我们的结果表明，VATS肺叶切除术后第1天对疼痛控制的需求更高。EPCA和IVPCA均能为术后疼痛管理提供充分、持续且有效的方法，且EPCA组术后第2天的VAS - M更低。
