Comparison of patient-assisted epidural analgesia with continuous-infusion epidural analgesia for postoperative patients.
OBJECTIVE
Patient-assisted epidural analgesia, a mode of epidural analgesic delivery in which self-administered epidural boluses supplement a baseline continuous epidural infusion, was compared to continuous epidural infusion in 62 postsurgical patients.


METHODS
Patients were randomly assigned to receive continuous epidural infusion (n = 31) or patient-assisted epidural analgesia (n = 31) consisting of fentanyl 10 mcg/mL and bupivacaine 1 mg/mL for the first 2 days after the operation. Variables examined included the adequacy of analgesia, amount of epidural infusion solution used, use of supplemental opioids, as well as incidence of side effects including nausea, pruritus, sedation, urinary retention, and respiratory depression.


RESULTS
Visual analog pain scores on days 1 and 2 after the operation, mean total epidural fentanyl consumption, and use of supplemental opioids were all significantly (P < .05) lower in the patient-assisted epidural group than in the continuous infusion group. There was no significant difference in the incidence of side effects between groups. The effects of age and operation type were not significant.


CONCLUSIONS
Patient-assisted epidural analgesia can provide superior pain control as compared to continuous epidural infusions while also reducing opioid dosages. Despite the reduction in total analgesic administered no reduction in side effects was seen with this mode of administration.
Lubenow
T R
TR
Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
Tanck
E N
EN
Hopkins
E M
EM
McCarthy
R J
RJ
Ivankovich
A D
AD
D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
D005283:Fentanyl; D002045:Bupivacaine