Is Intravenous Patient Controlled Analgesia Enough for Pain Control in Patients Who Underwent Thoracoscopy?

Abstract

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 µg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 µg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

“…Therefore, it is reasonable and justified to use the methods of regional anaesthesia with continuous drug infusions providing even and long-term analgaesic effects, enabling continuous and steady convalescence. Continuous epidural thoracic anaesthesia is considered the gold standard of analgaesia after thoracotomy and is routinely used after VATS in many centres [6,[9][10][11]. The results of meta-analyses and reviews have demonstrated that paravertebral anaesthesia is characterised by comparable (if not higher) efficacy and a more favourable safety profile [1,2].…”

“…Analysis of the literature revealed only five randomised and two observational clinical trials concerning the lung resections of comparable extents that can be compared with our findings. Four of those mentioned above focused exclusively on lobectomy [9,10,16,17], and three dealt with mixed procedures (lobectomies, segmentectomies, and wedge resections) [6,11,18]. Continuous paravertebral block and continuous epidural anaesthesia have been compared in only one of the cited studies [6].…”

The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl‐based intravenous patient‐controlled analgesia*

“…Intravenous patient-controlled analgesia (PCA) with opioids is an effective, safe method of postoperative analgesia. Video-assisted thoracoscopic surgery is associated with less postoperative pain than thoracotomy [3], and PCA with fentanyl is an alternative to invasive regional analgesia such as epidural or paravertebral block [4]. However, to be safe and acceptable, PCA in patients undergoing video-assisted thoracoscopic surgery should be accompanied by effective prophylaxis of nausea and vomiting.…”

Perioperative Management of Patients Undergoing Video-Assisted Thoracoscopic Sympathectomy: A Retrospective Clinical Research

“…(28,29) Çalışma hastalarımızda parasetamol ve diklofenak sodyum kombinasyonu ile erken postoperatif dönemde yeterli ağrı tedavisi sağ-lanabilmiştir. Ancak, ilgi çekici bir konu postoperatif dönemde devam eden ağrı yakınmalarının klipsleme yapılan hastalarda daha belirgin olmasıdır.…”