[Intravenous versus thoracic-epidural patient-controlled analgesia following extended abdominal or thoracic surgery].
BACKGROUND
Intravenous patient-controlled analgesia (PCA-i.v.) has has markedly improved postoperative pain-relief. Alternatively, peridural anesthesia has been used successfully in high risk patients with the disadvantage of a more intense postoperative care. In this study we compared the applicability of intravenous vs. peridural patient-controlled analgesia on a general ward.


METHODS
In a prospective double blinded study 40 patients were randomized after extensive thoracic or abdominal surgery in two groups and received either intravenous PCA (n = 20) or epidural PCA (n = 20). Postoperative monitoring was performed on the general ward by specifically trained nurses. Physiological data, neurological status, the effects of the analgesia and complications were registered before and 48 hours after surgery. Pain intensity was determined by using the visual analog scale (VAS). For the evaluation of wellness and cognitive efficacy psychological tests were performed.


RESULTS
Our results show that epidural PCA without administration of a basal rate is a safe method and can be performed on a general ward. Relevant postoperative complications or negative side effects were not registered in both groups. Sufficient analgesia was achieved with both methods. Patients treated with PCA-PDK had a significantly better score regarding vigilance and subjective wellness when compared to patients in the PCA-i.v. group.


CONCLUSIONS
This study demonstrates that epidural PCA can be used on a general surgical ward as an alternative method compared to intravenous PCA. PCA-PDK may be advantageous over intravenous PCA since both techniques require similar intense monitoring and side effects in the PCA-PDK group appear to be less.
Stehr-Zirngibl
S
S
Klinik für Anästhesiologie und Intensivmedizin, Universität Regensburg.
Doblinger
L
L
Neumeier
S
S
Zirngibl
H
H
Taeger
K
K
D000005:Abdomen / Q000601:surgery; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D007275:Injections, Intravenous; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D017409:Sufentanil / Q000009:adverse effects / Q000627:therapeutic use; D019616:Thoracic Surgical Procedures
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine