A comparison of intravenous-based and epidural-based techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy.
OBJECTIVE
We wished to compare the effectiveness of intravenous-based (IV) and epidural-based (EPI) techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. Effectiveness was compared in terms of reduction of postoperative pain and adverse events, and achieving a high level of patient satisfaction.


METHODS
Thirty American Society of Anesthesiologists (ASA) physical status I-II patients aged more than 65 years, scheduled for laparoscopic cholecystectomy, were enrolled in this study. The patients in the IV group (n = 15) received modified neurolept anesthesia with droperidol 0.2 mgxkg(-1) and pentazocine 0.15-0.3 mgxkg(-1) (maximum dose of 1.0 mgxkg(-1)) and 60% nitrous oxide in oxygen, followed by postoperative intravenous infusion of 20 microgxml(-1) buprenorphine, provided with a patient-controlled analgesia pump programmed to deliver a bolus of 0.5 ml with a lockout interval of 15 min and a background infusion of 0.5 mlxh(-1). The patients in the EPI group (n = 15) had combined epidural analgesia and general anesthesia with sevoflurane and 60% nitrous oxide in oxygen, followed by the epidural infusion of a 0.125% bupivacaine and 5 microg x ml(-1) buprenorphine mixture by means of an on-demand analgesic system (bolus of 2 ml, lockout interval of 60 min, and background infusion of 2 mlxh(-1)).


RESULTS
The quality of postoperative analgesia was similar in the two groups. The incidences of intraoperative hypotension and bradycardia and postoperative hypotension were significantly lower in the IV group than in the EPI group (P < 0.05). A significantly higher level of patient satisfaction was found in the IV group compared with that in the EPI group (P < 0.05). The major contributor to dissatisfaction in the EPI group was anxiety or discomfort associated with the epidural procedures.


CONCLUSIONS
Modified neurolept anesthesia with pentazocine and postoperative i.v. analgesia with buprenorphine were superior to epidural-based techniques, in terms of hemodynamic stability and patient satisfaction, in elderly patients undergoing laparoscopic cholecystectomy.
Nishikawa
Kohki
K
Department of Anesthesia, Muroran City General Hospital, 3-8-1 Yamate-cho, Muroran, 051-8512, Japan.
Kimura
Saori
S
Shimodate
Yuki
Y
Igarashi
Motohiko
M
Namiki
Akiyoshi
A
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004329:Droperidol / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D009609:Nitrous Oxide / Q000008:administration & dosage / Q000009:adverse effects; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D010423:Pentazocine / Q000008:administration & dosage / Q000009:adverse effects; D000077149:Sevoflurane; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D008738:Methyl Ethers; D000077149:Sevoflurane; D002047:Buprenorphine; D009609:Nitrous Oxide; D004329:Droperidol; D010423:Pentazocine; D002045:Bupivacaine