Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.
Medicine (Baltimore). 2024 Feb 23;103(8):e37122. doi: 10.1097/MD.0000000000037122.
Administering opioids via intravenous patient-controlled analgesia is a prevalent approach for managing postoperative pain. Nevertheless, due to concerns about opioid-related side effects and the potential for opioid tolerance, there is a growing emphasis on adopting opioid-sparing techniques for postoperative pain management. We aimed to investigate the effect of adding a basal rate infusion in fentanyl-based IVA following a cesarean section (CS).
Forty-eight patients, who received pain management through IVA after CS, were assigned randomly into 3 groups based on the background rate setting: Group 0 (0 mcg/hour, n = 16), Group 1 (15 mcg/hour, n = 16), and Group 2 (30 mcg/hour, n = 16). We assessed the impact of the basal infusion rate on opioid consumption and the visual analog scale (VAS) scores during the first 48 hours post-CS and also investigated opioid-induced side effects and the requirement for rescue analgesics in the ward during the first 48 hours after CS.
In the initial 24 hours following CS, fentanyl consumption significantly increased in Group 2 compared with Group 0 and Group 1 (P = .037). At 24 hours, VAS scores both at rest and during movement, tended to decrease, as the basal rate increased; however, no significant differences were observed between the groups (P = .218 and 0.827, respectively). Between the first 24- and 48-hours post-CS, fentanyl consumption showed a marked increase in both Group 1 and Group 2 compared to Group 0 (P < .001). At 48 hours, the VAS scores at rest displayed a trend toward reduction; however, no significant differences between groups were evident (P = .165). Although the incidence of opioid-induced complications was noted, no statistically significant differences were recorded between groups during the initial 24 hours and subsequent 24 to 48 hours period (P = .556 and P = .345, respectively).
The inclusion of a basal fentanyl infusion in the IVA protocol did not provide any advantages over an IVA devoid of a basal rate infusion in managing acute pain following CS.
通过静脉患者自控镇痛（IVPA）给予阿片类药物是管理术后疼痛的一种常用方法。然而，由于担心阿片类药物相关的副作用和阿片类药物耐受的可能性，人们越来越强调采用阿片类药物节约技术来管理术后疼痛。我们旨在研究在剖宫产（CS）后添加芬太尼基础输注对基于芬太尼的 IVA 的影响。
48 名接受 CS 后 IVA 镇痛的患者，根据背景率设置随机分为 3 组：组 0（0 mcg/hour，n = 16）、组 1（15 mcg/hour，n = 16）和组 2（30 mcg/hour，n = 16）。我们评估了基础输注率对 CS 后前 48 小时内阿片类药物消耗和视觉模拟评分（VAS）的影响，并研究了 CS 后前 48 小时内病房内阿片类药物引起的副作用和需要解救性镇痛药物的情况。
CS 后前 24 小时，组 2 的芬太尼消耗量明显高于组 0 和组 1（P = 0.037）。在 24 小时时，随着基础率的增加，休息和运动时的 VAS 评分均有下降的趋势，但组间无显著差异（分别为 P = 0.218 和 0.827）。CS 后 24 至 48 小时期间，组 1 和组 2 的芬太尼消耗量与组 0 相比均明显增加（P < 0.001）。48 小时时，休息时的 VAS 评分呈下降趋势，但组间无显著差异（P = 0.165）。尽管观察到阿片类药物相关并发症的发生率，但在最初的 24 小时和随后的 24 至 48 小时期间，各组之间无统计学差异（分别为 P = 0.556 和 P = 0.345）。
在 CS 后管理急性疼痛时，IVA 方案中添加芬太尼基础输注并不能提供优于无基础输注的 IVA 的优势。
