[Patient-controlled analgesia (PCA) after urologic interventions].

Patient-controlled analgesia (PCA) is a well-accepted technique in postoperative pain management. We used PCA in three different protocols to find the optimum application form. Our study compared 100 patients with radical prostatectomy or transperitoneal tumor nephrectomy in three groups using piritramide. Group 1 (n = 16) received 1.2 mg/h continuously and a 3 mg bolus with a lock-out time of 90 min. Group 2 (n = 30) received 0.8 mg/h continuously and a 3 mg bolus with a lock-out time of 60 min. Group 3 (n = 54) received the same continuous infusion, but the lock-out time was only 30 min. After 24 hours we evaluated the quality of analgesia using VAS scale. The quantity of piritramide was equal in all groups (35.1 mg). An average of seven bolus applications were made during the observation period. In 27.6% of the patients (group 1: 30.4%; group 2: 35.0%; group 3: 23.1%) the bolus demand was refused by programme. The analgesia level was satisfactory in each group, with a VAS value of 27. There was no respiratory depression observed. In conclusion, on-demand analgesia proved to be a good and practicable method in postoperative pain management. Although the dosage of piritramide was not different in the three groups, we recommend the protocol of group 3 because of the lower refusal of bolus application. Therefore, this seems to be the best patient-adapted application form. Even though respiratory complications in the group 3 scheme are not expected, monitoring of respiration and vigilance are recommended.