[Postoperative analgesia with buprenorphine : A comparative study of epidural, patient-controlled intravenous and conventional subcutaneous administration.].
Thirty patients who had undergone elective anterolateral thoracotomy were studied in the surgical intensive care unit to compare the analgesic effectiveness of i.v. self-administered buprenorphine (group A) with that of epidural administration (group B) and of s.c. administration by a nurse of 0.3 mg buprenorphine every 3-4 h (group C, controls). Every 2 h the patients were asked to record their subjektive pain level as a percentage on an analogue scale: zero was to be used for no pain and 100% for the most severe pain they could imagine. the mean of all analogue scores for pain in the first 36 h was 19.4+/-3.1 for group A; 18.4+/-2.3 for group B and 42.0+/-7.4 for group C (P<0.025). When the mean scores were referred to time, it seemed that groups A and B suffered a little more pain immediately after the operation; however, after 4 h the mean scores for these groups were far lower than that for the control group. The amount of buprenorphine used during the first 36 h was 0.036+/-0.006 mg/h per m(2) in group A, 0.021+/-0.002 mg/h per m(2) in group B and 0.038+0.004 mg/h in the control group. The mean interval between two injections was 9.47+/-1.4 h in group A, 2.47+0.5 h in group B, and 5.18+0.7 h in group C. It can be concluded that, at least in patients in an intensive care unit, scheduled administration of pain killers is unacceptable now. The self-administration device has shown the possibility of on-demand i.v. administration, which is no more dangerous than scheduled s.c. administration. Nurses should be instructed to provide analgesic medication on demand. Epidural administration of buprenorphine is superior to self-administration in terms of the amount of drugs used and the dosing intervals. In the quality of analgesia epidural administration and self-administration are equal and superior to the control procedure.
Fähnrich
J
J
Institut für Anaesthesiologie, Universitätsspital, Zürich, Schweiz.
Castelano
C
C
Sturzenegger
E
E
Stoll
B
B
Uehlinger
P
P
Geroulanos
S
S