Kim Sujin, Park Ji-Hyoung, Jeon Yeong-Gwan, Cho Yun Hyung, So Jung Hyun, Song Seung Woo
Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju-si, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Wonju Severance Christian Hospital, Wonju-si, Republic of Korea.
Medicine (Baltimore). 2025 Mar 14;104(11):e41813. doi: 10.1097/MD.0000000000041813.
Fentanyl-based intravenous patient-controlled analgesia (IV PCA) is widely prescribed postoperatively. Basal infusion of fentanyl through IV PCA is associated with postoperative nausea and vomiting. However, the role of basal infusion in fentanyl-based IV PCA is not well-established.
This parallel-group, randomized controlled trial was conducted at a tertiary university medical center in the Republic of Korea from September 2022 to April 2023. Patient inclusion criteria were: age 20 to 65 years, intraperitoneal laparoscopic gynecologic surgery, patient-controlled analgesia (PCA) request from the surgical department, and written informed consent for PCA. Patients were allocated to basal infusion (BAS group) and bolus-only (BOL group) groups in a 1:1 ratio.A sum of 100 mL of analgesic mixture containing fentanyl 18.5 µg/kg, nefopam 120 mg, and ramosetron 0.3 mg was mixed in PCA pumps of both groups. For BAS group, basal infusion rate, bolus volume, and lock-out interval were 2 mL/hour, 1 mL, and 15 minutes, respectively. BOL group received no basal infusion; bolus volume and lock-out interval were 1 mL and 6 minutes, respectively.The primary outcome was postoperative nausea, measured using a self-response questionnaire 24 hours after operation and expressed as a 100-mm visual analog scale score. We also determined frequency of postoperative vomiting, quality of postoperative recovery (using Korean version of 15-item Quality of Recovery [QoR-15K] scale), and overall patient satisfaction with anesthetic service.
A sum of 82 of the 88 patients enrolled were included. The visual analog scale score for postoperative nausea was 31.4 ± 31.3 mm; the condition was more severe in the BAS group than in the BOL group (95% confidence interval of difference: 2.1-28.9 mm, P = .024). The QoR-15K score, patient satisfaction, and rescue opioid doses used were similar across groups.
Fentanyl-based IV PCA without basal infusion resulted in less postoperative nausea and vomiting than IV PCA with basal infusion and maintained adequate analgesia. Basal infusion can be omitted to reduce postoperative nausea using IV PCA by applying an appropriate lock-out interval. Further research comparing variable PCA settings is warranted.
基于芬太尼的静脉自控镇痛（IV PCA）在术后广泛应用。通过IV PCA进行芬太尼基础输注与术后恶心和呕吐相关。然而，基础输注在基于芬太尼的IV PCA中的作用尚未明确。
本平行组随机对照试验于2022年9月至2023年4月在韩国一所三级大学医学中心进行。患者纳入标准为：年龄20至65岁，接受腹腔镜妇科腹腔手术，外科提出自控镇痛（PCA）要求，并签署PCA书面知情同意书。患者按1:1比例分为基础输注组（BAS组）和仅推注组（BOL组）。两组PCA泵中均混合了100 mL含有芬太尼18.5 µg/kg、奈福泮120 mg和雷莫司琼0.3 mg的镇痛混合物。BAS组的基础输注速率、推注量和锁定间隔分别为2 mL/小时、1 mL和15分钟。BOL组不进行基础输注；推注量和锁定间隔分别为1 mL和6分钟。主要结局为术后恶心，于术后24小时使用自我应答问卷进行测量，并以100 mm视觉模拟量表评分表示。我们还确定了术后呕吐频率、术后恢复质量（使用韩国版15项恢复质量[QoR - 15K]量表）以及患者对麻醉服务的总体满意度。
88名入组患者中有82名被纳入。术后恶心的视觉模拟量表评分为31.4±31.3 mm；BAS组的情况比BOL组更严重（差异的95%置信区间：2.1 - 28.9 mm，P = 0.024）。各组的QoR - 15K评分、患者满意度和使用的挽救性阿片类药物剂量相似。
与有基础输注的IV PCA相比，无基础输注的基于芬太尼的IV PCA术后恶心和呕吐更少，且维持了足够的镇痛效果。通过应用适当的锁定间隔，可省略基础输注以减少IV PCA引起的术后恶心。有必要进一步开展比较不同PCA设置的研究。
