Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy.
OBJECTIVE
Patient-controlled epidural analgesia (PCEA) was developed for use after surgery for thoracic esophageal cancer to relieve wound pain, introduce early rehabilitation, and provide an uneventful postoperative recovery.


METHODS
This retrospective study investigated 22 patients who underwent esophageal surgery to determine the efficacy of postoperative management with PCEA. In the PCEA group (n = 12), patients had two epidural catheters inserted to cover both the thoracic and abdominal incision with a patient-controlled bolus capability.


RESULTS
Postoperative mechanical ventilation was administered in all cases in the control group (n = 10). On the other hand, this was only necessary in two patients in the PCEA group. The amount of time the patients stayed in the intensive care unit and the hospital was significantly shorter in the PCEA group than in the control group (P < 0.001 and P < 0.01, respectively). Respiratory complications occurred in four patients in the control group, and none in the PCEA group. The mean number of supplemental analgesics administered for breakthrough pain until the 7th postoperative day was 5.5 in the control group, and 1.3 in the PCEA group (P < 0.001).


CONCLUSIONS
Early rehabilitation is facilitated with intensive PCEA, while it also improves postoperative management and reduces hospitalization after esophageal surgery.
Saeki
Hiroshi
H
Department of Surgery, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan.
Ishimura
Hiroshi
H
Higashi
Hidefumi
H
Kitagawa
Dai
D
Tanaka
Junko
J
Maruyama
Riichiroh
R
Katoh
Hidenori
H
Shimazoe
Hirofumi
H
Yamauchi
Kouta
K
Ayabe
Hitoshi
H
Kakeji
Yoshihiro
Y
Morita
Masaru
M
Maehara
Yoshihiko
Y
D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000534:rehabilitation*; D010423:Pentazocine / Q000008:administration & dosage; D011183:Postoperative Complications; D012121:Respiration, Artificial; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008619:Mepivacaine; D010423:Pentazocine; D005283:Fentanyl