title: Intravenous patient-controlled analgesia to manage the postoperative pain in patients undergoing craniotomy.
abstract: BACKGROUND
  This randomized controlled study evaluated the efficacy of intravenous patient-controlled analgesia (IV-PCA) with fentanyl and ketorolac for neurosurgical patients, and compared the effectiveness of IV-PCA with intermittent analgesics injection.
  
  
  METHODS
  The patients undergoing craniotomy were randomly assigned to two groups. Patients of group P (n = 53) received fentanyl (0.2 µg/kg/hr) and ketorolac (0.3 mg/kg/hr) via IV-PCA, and those of group N (n = 53) received intermittent fentanyl or ketorolac injection as needed. Pain was evaluated using a 0-10 visual analogue scale (VAS) at postoperative 1, 4, and 24 hr. The amount of infused analgesic drugs, Glasgow Coma Scale (GCS) score, systolic arterial pressure, heart rate, respiratory rate, and the incidence of nausea and miosis were measured at the same time points.
  
  
  RESULTS
  Although VAS of pain (VASp) was comparable at postoperative 1 hr (P = 0.168) between the two groups, the group P had significantly lower VASp at postoperative 4 hr (P = 0.007) and 24 hr (P = 0.017). In group P, less analgesic drugs were administered at postoperative 1 hr, and more analgesic drugs were administered at postoperative 24 hr. There were no differences between two groups with respect to nausea, GCS, systolic arterial pressure, and heart rate. IV-PCA did not further incur respiratory depression or miosis.
  
  
  CONCLUSIONS
  IV-PCA with fentanyl and ketorolac after craniotomy is more effective analgesic technique, without adverse events, than the intermittent administration of analgesics.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hyo-Seok
authors.initials: HS
authors.lastname: Na
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: An
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Lim
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Seong-Won
authors.initials: SW
authors.lastname: Min