[Study of analgestic efficacy of ropivacaine-fentanyl patient-controlled epidural analgesia after upper abdominal gynecological surgery].
BACKGROUND
Most of the patients who undergo radical or subradical hysterectomy with paraaortic lymphadenectomy suffer from postoperative pain for upper abdominal incision. They also complain of postoperative nausea and vomiting (PONV) frequently, which are increased by opioids.


METHODS
Reducing total fentanyl dose to 0.6 mg, frequency of moving pain complaints increased gradually. Therefore, we introduced patient-controlled epidural analgesia (PCEA) for suppressing pain on moving. We investigated analgestic efficacy of 0.2% ropivacaine-fentanyl PCEA in twelve patients undergoing upper abdominal gynecological surgery. Postoperative analgesic effects were evaluated by visual analogue scale (VAS) at rest and on moving, times of bolus infusion, side effects, and degrees of satisfication by patient's self-assessments. Continuous epidural infusion of 0.6 mg fentanyl in 288 ml 0.2% ropivacaine was started at a rate of 4 ml x hr(-1) with a bolus dose of 2 ml.


RESULTS
VAS was maintained below 20 mm at rest but was elevated to the maximum of 45 mm on moving with few bolus requests. Ninty-two percents of the patients answered satisfied but fifty percents of them had PONV.


CONCLUSIONS
We conclude that ropivacaine-fentanyl PCEA is effective after upper abdominal gynecological surgery, and we can decrease the dose of fentanyl by explaining PCEA system more effectively to the patients for suppressing the pain on moving and PONV.
Amano
Eizo
E
Department of Anesthesiology, National Hospital Organization Osaka National Hospital, Osaka.
Akamatsu
Tetsuya
T
Sonoda
Shunji
S
Konishi
Aya
A
Shibuya
Hiromi
H
Hirata
Takahiko
T
D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D000077212:Ropivacaine; D014594:Uterine Neoplasms / Q000601:surgery
D000577:Amides; D004338:Drug Combinations; D000077212:Ropivacaine; D005283:Fentanyl