title: Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy.
abstract: 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.
authors.affiliation: Department of Surgery, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishimura
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Higashi
authors.forename: Dai
authors.initials: D
authors.lastname: Kitagawa
authors.forename: Junko
authors.initials: J
authors.lastname: Tanaka
authors.forename: Riichiroh
authors.initials: R
authors.lastname: Maruyama
authors.forename: Hidenori
authors.initials: H
authors.lastname: Katoh
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Shimazoe
authors.forename: Kouta
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ayabe
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008619:Mepivacaine; D010423:Pentazocine; D005283:Fentanyl