[Postoperative peridural analgesia. Continuous versus patient-controlled administration of a low-dose mixture of sufentanil, clonidine and bupivacaine].
The purpose of our study was to find out whether patient-controlled epidural administration (PCEA) of a mixture containing a low-dose local anaesthetic, opioid and alpha 2-agonist provides as good or better postoperative analgesia as continuous epidural administration of the same analgetic solution.


METHODS
30 patients (ASA I-III), scheduled for major abdominal surgery, were randomly divided into 2 groups. 90 minutes after induction of general anaesthesia all patients received a continuous epidural infusion of 5 ml/h of the analgetic solution (50 micrograms sufentanil + 150 micrograms clonidine in 50 ml 0.125% bupivacaine) until the end of surgery. Immediately postoperatively the patients of group A received a continuous infusion of the study solution (5-8 ml/h), the patients of group B received a baseline continuous epidural infusion (3 ml/h), additionally they could self-administer 5 ml boli via a PCEA device. Measurements included the total dose of infused drug solution, pain at rest and on exercise by a visual analogue scale, cardiorespiratory data and side effects within the first 24 hours postoperatively. A standardised interview on analgesia and side effects was held 2 days after surgery.


RESULTS
The PCEA group demanded less epidural analgesics (gr. B: 112 +/- 33 ml vs. gr. A: 135 +/- 20 ml) p < 0.01). Both continuous epidural infusion and patient-controlled administration provided very good analgesia at rest (gr. A: VAS 0.4 +/- 0.4 and gr. B: VAS 0.4 +/- 0.5) (n.s.). On exercise continuous epidural infusion of analgesics resulted in significantly lower pain scores (gr. A: 1.9 +/- 1.1) than patient-controlled application (gr. B: 3.4 +/- 1.1) (p < 0.01). We did not notice severe side effects such as respiratory depression or drop of heart rate or blood pressure.


CONCLUSIONS
In patients at rest both continuous and patient-controlled epidural administration of analgesics provides excellent analgesia after major abdominal surgery. Contrariwise, patients on exercise who could use a PCA-device experienced more pain compared to those with a continuous epidural infusion technique. On the other hand the patients of the PCA-group consumed less epidural analgesics. We did not notice any severe side effects such as respiratory depression or cardiovascular instability during the study.
Hering
R
R
Klinik und Poliklinik für Anästhesiologie und spezielle Intensivmedizin, Rheinische Friedrich-Wilhelms-Universität Bonn.
Schumacher
T
T
Müller
H
H
D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D003000:Clonidine / Q000008:administration & dosage* / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D017409:Sufentanil / Q000008:administration & dosage* / Q000009:adverse effects; D013565:Sympatholytics / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D013565:Sympatholytics; D017409:Sufentanil; D003000:Clonidine; D002045:Bupivacaine
Postoperative Periduralanalgesie. Kontinuierliche gegenüber patientenkontrollierter Applikation einer niedrig dosierten Mischung aus Sufentanil, Clonidin und Bupivacain.