Equivalence of postoperative analgesia with patient-controlled intravenous or epidural alfentanil.
The analgesia and the frequency and severity of oxyhemoglobin desaturation related to alfentanil administration were compared in 32 patients randomly selected to receive patient-controlled analgesia (PCA) by either the epidural (EPI) or intravenous (i.v.) route for a mean period of 16 h after major abdominal surgery. Bolus increments of 250 micrograms of alfentanil with a lockout interval of 5 min for i.v. and of 10 min for EPI route were administered by a programmable pump. Oxygen saturation (SpO2) was monitored for 16 h, using a pulse oximeter; data were collected continuously and stored every 30 s via an interface connected to a computer. For the purpose of analysis, SpO2 was divided into six categories: 95%-100%, 90%-94%, 85%-89%, 80%-84%, 75%-79%, and 70%-74%. Both routes provided similar degrees of analgesia at rest and on coughing. Maximum pain relief was obtained earlier in the i.v. group (P < 0.01). The total consumption of alfentanil was 13,141 +/- 3471 micrograms (mean +/- SD) in the i.v. group and 8000 +/- 4213 micrograms in the EPI group (P < 0.001). The effects on SpO2 were not statistically different between the two groups. Cumulative time spent in each saturation category was similar for the EPI and i.v. groups. Severe desaturation episodes, defined as SpO2 < or = 85% for at least 60 s, occurred in 69% of patients in the EPI group and 56% in the i.v. group.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Anesthesiology, Hôpital Ambroise Paré, Boulogne-sur-Seine, France.
M
M
Chauvin
J M
JM
Hongnat
E
E
Mourgeon
C
C
Lebrault
F
F
Bellenfant
P
P
Alfonsi
D000005:Abdomen / Q000601:surgery; D015760:Alfentanil; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000771:Anesthesia, Intravenous; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010108:Oxyhemoglobins / Q000378:metabolism; D010149:Postoperative Pain / Q000517:prevention & control*
D010108:Oxyhemoglobins; D015760:Alfentanil