[Possible predictors of discontinuation of basal-flow of postoperative patient-controlled analgesia].
BACKGROUND
The purpose of this study was to identify possible predictors of discontinuation of basal-flow of postoperative patient-controlled analgesia.


METHODS
We reviewed postoperative pain assessment records by the postoperative pain service team from April 2010 to July 2011 in which surgical patients were provided with intravenous or epidural patient-controlled analgesia (IV-PCA or Epi-PCA). From these data, we extracted cases with discontinuation of basal-flow of PCA, and candidate variables such as patients' characteristics, preoperative and intraoperative variables were assessed. Predictors with significant univariate association (P < 0.20) with the primary outcome were used to construct multivariable logistic regression models.


RESULTS
We enrolled 685 patients for IV-PCA and 606 for Epi-PCA and obtained discontinuation groups (105 and 73 cases, respectively) with this cohort data. Results of multivariate analysis showed female, non-laparotomy, low body weight, and non-droperidol as independent risk factors for IV-PCA and low body weight, no-co-existing disease, and gastrointestinal surgery for Epi-PCA. There were no significant differences in pain intensity between discontinuation and non-discontinuation cases. The primary cause of discontinuation was PONV for IV-PCA and hypotension for Epi-PCA, respectively.


CONCLUSIONS
We should apply IV-PCA for female slender surgical patients undergoing non-laparotomy with great caution and provide prevention for PON. We should pay attention to incidence of postoperative hypotenion when we administer Epi-PCA to slender gastrointestinal surgical patients without co-existing disease.
Department of Anesthesiology, Nara Medical University, Kashihara 634-8522.
Maki
M
Masada
Satoki
S
Inoue
Tomomi
T
Nishimura
Aki
A
Okamoto
Yu
Y
Tanaka
Masahiko
M
Kawaguchi
Hitoshi
H
Furuya
D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis