Rockemann M G, Seeling W, Goertz A W, Konietzko I, Steffen P, Georgieff M
Universitätsklinik für Anästhesiologie, Ulm.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 Jul;32(7):414-9. doi: 10.1055/s-2007-995082.
Improvement of the quality of analgesia, reduction of side effects and costs by application of epidural (PCEA) in comparison to intravenous patient-controlled analgesia (PCA) in postoperative pain treatment.
62 patients with upper abdominal surgery took part in this randomised prospective study which was approved by the local ethics committee. Epidural catheters were inserted at T 8/9 (group PCEA). General anaesthesia was performed with propofol, sufentanil 2 micrograms/kg, pancuronium, enflurane and O2:N2O = 1:2. Postoperative analgesia consisted of epidural bupivacaine 0.25% + sufentanil 2 micrograms/ml (BS). (bolus 0.05 ml/kg, lockout 10 min) in group PCEA, or of intravenous morphine (bolus 2 mg. lockout 10 min) in group PCA. The following parameters were recorded until the evening of postoperative day 4: pain intensity at rest (VASR, 1-10) and on coughing (VASH, 1-10), blood pressure, heart rate, blood gas analysis, ability to ambulate, pruritus, nausea/vomiting (PONV), patient satisfaction (0-4), time and expenses for postoperative pain treatment.
Median VASR (1 vs 2) and VASH (3 vs 4.5) were lower, cough intensity (2 vs 1) and patient satisfaction score (4 vs 3) were higher in PCEA compared to PCA. Ability to ambulate, pruritus, PONV, haemodynamics, paO2 and paCO2 were comparable. Postoperative pain treatment with PCEA was more time-consuming (407 vs 299 min) and expensive (71 vs 40 S/day) than PCA.
PCEA in comparison to PCA after major abdominal surgery provides superior analgesia with comparable side effects at approximately 80% higher costs.
在术后疼痛治疗中，通过应用硬膜外自控镇痛（PCEA）与静脉自控镇痛（PCA）相比较，提高镇痛质量，减少副作用及费用。
62例上腹部手术患者参与了这项由当地伦理委员会批准的随机前瞻性研究。在T8/9置入硬膜外导管（PCEA组）。采用丙泊酚、舒芬太尼2微克/千克、潘库溴铵、恩氟烷及O2:N2O = 1:2进行全身麻醉。术后镇痛方面，PCEA组采用硬膜外0.25%布比卡因+舒芬太尼2微克/毫升（BS）（负荷量0.05毫升/千克，锁定时间10分钟），PCA组采用静脉注射吗啡（负荷量2毫克，锁定时间10分钟）。记录以下参数直至术后第4天晚上：静息时疼痛强度（VASR，1 - 10）及咳嗽时疼痛强度（VASH，1 - 10）、血压、心率、血气分析、行走能力、瘙痒、恶心/呕吐（PONV）、患者满意度（0 - 4）、术后疼痛治疗的时间及费用。
与PCA组相比，PCEA组的VASR中位数（1对2）和VASH中位数（3对4.5）更低，咳嗽强度（2对1）和患者满意度评分（4对3）更高。行走能力、瘙痒、PONV、血流动力学、动脉血氧分压和动脉血二氧化碳分压相当。与PCA相比，PCEA进行术后疼痛治疗耗时更长（407对299分钟）且费用更高（71对40瑞士法郎/天）。
与腹部大手术后的PCA相比，PCEA提供了更优的镇痛效果，副作用相当，但费用高出约80%。
