title: [Patient-controlled epidural analgesia combined with patient-controlled intravenous analgesia for postoperative analgesia after Miles' operation for rectal cancer].
abstract: A 69-year-old woman (156 cm, 53 kg) underwent a Miles' operation, total hysterectomy, resection of vagina, and thigh flap to vulva for rectal cancer. Before general anesthesia, an epidural catheter was inserted at T11-12 interspace, and 1.5% mepivacaine 7ml was administered. Sensory block level spread from T4 to L1. Anesthesia was induced with propofol and maintained with sevoflurane in air oxygen mixture. Operation was performed uneventfully. After the operation, postoperative analgesia was achieved with patient-controlled epidural analgesia (PCEA). The epidural solution of 0.06% ropivacaine with 4 microg x ml(-1) fentanyl and 20 microg x ml(-1) was connected to a PCA pump (i-Fuser, JMS, Japan) that was programmed as an 8 ml initial bolus, 4 ml x hr(-1) basal infusion, 2 ml bolus dose, and 10-min lockout interval. Although abdominal pain was well controlled by PCEA, intractable pain in the pelvic nerve region existed. Patient-controlled intravenous analgesia (IV-PCA) with fentanyl, ketamine, and lidocaine was added to PCEA. Then excellent pain relief was obtained without any side effects such as nausea, vomiting, drowsiness, and respiratory depression. It could be useful to use IV-PCA together with PCEA when wide spread postoperative analgesia is necessary.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Chuo 409-3898.
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Kumakura
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Ishiyama
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Iijima
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugawara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsukawa
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000768:Anesthesia, General; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage; D008012:Lidocaine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy*; D012004:Rectal Neoplasms / Q000601:surgery*; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D007649:Ketamine; D000077212:Ropivacaine; D008012:Lidocaine; D005283:Fentanyl