Moslemi Farnaz, Rasooli Sousan, Baybordi Ali, Golzari Samad E J
Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran.
Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Anesth Pain Med. 2015 Oct 17;5(5):e29540. doi: 10.5812/aapm.29540. eCollection 2015 Oct.
Postoperative pain after major open gynecologic surgeries requires appropriate pain management.
This study aimed at comparing perioperative patient controlled epidural analgesia (PCEA) and patient controlled intravenous analgesia (PCA) after gynecologic oncology surgeries.
In this clinical trial study, 90 patients with American society of anesthesiologists (ASA) class I or II scheduled for gynecologic oncologic surgeries were randomly allocated to two groups (45 patients each group) to receive: patient-controlled epidural analgesia with bupivacaine and fentanyl (PCEA group), or patient controlled intravenous analgesia (IV PCA group) with fentanyl, pethidine and ondansetron. Postoperative pain was assessed over 48 hours using the visual analog scale (VAS). The frequency of rescue analgesia was recorded. Occurrence of any concomitant events such as nausea, vomiting, ileus, purities, sedation and respiratory complications were recorded postoperatively.
There were no statistically significant differences in demographic data including; age, weight, ASA physical status, duration of surgery, intraoperative bleeding, and the amount of blood transfusion (P > 0.05), between the two studied groups. Severity of postoperative pain was not significantly different between the two groups (P > 0.05); however, after first patient mobilization, pain was significantly lower in the epidural group than the IV group (P < 0.001). There was no significant difference between the two groups regarding the incidence of complications such as nausea, vomiting, purities or ileus (P > 0.05). Nevertheless, the incidence and severity of sedation was significantly higher in the IV group (P < 0.001). Respiratory depression was higher in the IV group than the epidural group; this difference, however, was not significant (P = 0.11). In the epidural group, only 10 patients (22.2%) had mild and transient lower extremities parenthesis.
Both intravenous and epidural analgesic techniques with combination of analgesics provide proper postoperative pain control after major gynecologic cancer surgeries without any significant complications. Regarding lower sedative and respiratory depressant effects of epidural analgesia, it seems that this method is a safer technique for postoperative pain relief in these patients.
大型妇科开放性手术后的疼痛需要适当的疼痛管理。
本研究旨在比较妇科肿瘤手术后围手术期患者自控硬膜外镇痛（PCEA）和患者自控静脉镇痛（PCA）的效果。
在这项临床试验研究中，90例美国麻醉医师协会（ASA）分级为I或II级、计划进行妇科肿瘤手术的患者被随机分为两组（每组45例），分别接受：布比卡因和芬太尼的患者自控硬膜外镇痛（PCEA组），或芬太尼、哌替啶和昂丹司琼的患者自控静脉镇痛（IV PCA组）。术后48小时内使用视觉模拟量表（VAS）评估疼痛程度。记录补救性镇痛的频率。术后记录恶心、呕吐、肠梗阻、发热、镇静和呼吸并发症等任何伴随事件的发生情况。
两组患者的人口统计学数据，包括年龄、体重、ASA身体状况、手术时间、术中出血和输血量，差异均无统计学意义（P>0.05）。两组术后疼痛严重程度差异无统计学意义（P>0.05）；然而，首次患者活动后，硬膜外组的疼痛明显低于静脉组（P<0.001）。两组在恶心、呕吐、发热或肠梗阻等并发症发生率方面差异无统计学意义（P>0.05）。然而，静脉组的镇静发生率和严重程度明显更高（P<0.001）。静脉组的呼吸抑制高于硬膜外组；然而，这种差异不显著（P=0.11）。在硬膜外组，只有10例患者（22.2%）出现轻度和短暂的下肢感觉异常。
静脉和硬膜外镇痛技术联合使用镇痛药在大型妇科癌症手术后均能提供适当的术后疼痛控制，且无任何严重并发症。鉴于硬膜外镇痛的镇静和呼吸抑制作用较低，似乎这种方法是这些患者术后疼痛缓解的更安全技术。
