Koh Jae Chul, Song Young, Kim So Yeon, Park Sooyeun, Ko Seo Hee, Han Dong Woo
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
J Pain Res. 2017 Apr 12;10:897-904. doi: 10.2147/JPR.S133235. eCollection 2017.
In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA) for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA)-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20-39 years) and elderly (age ≥70 years) patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6-48 hours postsurgery. While younger patients exhibited greater incidence of numbness, motor weakness, and discontinuation of PCA postsurgery, elderly patients exhibited greater incidence of hypotension, nausea/vomiting, rescue analgesia, and antiemetic administration. Upon multivariate analysis, low fentanyl dosage and history of smoking were found to be associated with an increased need for rescue analgesia among younger patients, while physical status classification III/IV and thoracic surgery were associated with a decreased need for rescue analgesia among the elderly. Discontinuation of PCA was more frequent among younger patients than the elderly (18.5% vs 13.5%, =0.001). Reasons for discontinuation of PCA among young and elderly patients, respectively, were nausea and vomiting (6.8% vs 26.6%), numbness or motor weakness (67.8% vs 11.5%), urinary retention (7.4% vs 8.7%), dizziness (2.2% vs 5.2%), and hypotension (3.1% vs 20.3%). In conclusion, PCEA was more frequently associated with numbness, motor weakness, and discontinuation of PCA in younger patients and with hypotension, nausea/vomiting, and a greater need for rescue analgesics/antiemetics among elderly patients. Therefore, in order to minimize the adverse effects of PCEA and enhance pain relief, different PCEA regimens and administration/prevention strategies should be considered for young and elderly patients.
在这项回顾性研究中，我们回顾了2435例在全身麻醉或脊髓麻醉下行择期手术后接受芬太尼和罗哌卡因自控硬膜外镇痛（PCEA）以缓解疼痛的患者的数据。评估了年轻（20 - 39岁）和老年（年龄≥70岁）患者术后疼痛、自控镇痛（PCA）相关不良反应发生率以及术后48小时内需要使用补救镇痛药的危险因素。尽管两组患者术后6小时内的疼痛强度无显著差异，但与老年患者相比，年轻患者在术后6 - 48小时的疼痛强度更大。年轻患者术后出现麻木、运动无力和PCA停用的发生率更高，而老年患者出现低血压、恶心/呕吐、补救镇痛和使用止吐药的发生率更高。多因素分析显示，低芬太尼剂量和吸烟史与年轻患者对补救镇痛的需求增加有关，而身体状况分级III/IV和胸科手术与老年患者对补救镇痛的需求减少有关。年轻患者PCA停用的频率高于老年患者（18.5%对13.5%，P = 0.001）。年轻和老年患者PCA停用的原因分别为恶心和呕吐（6.8%对26.6%）、麻木或运动无力（67.8%对11.5%）、尿潴留（7.4%对8.7%）、头晕（2.2%对5.2%）和低血压（3.1%对20.3%）。总之，PCEA在年轻患者中更常与麻木、运动无力和PCA停用相关，而在老年患者中与低血压、恶心/呕吐以及对补救镇痛药/止吐药的更大需求相关。因此，为了尽量减少PCEA的不良反应并增强疼痛缓解效果，应针对年轻和老年患者考虑不同的PCEA方案以及给药/预防策略。
