Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery

Werawatganon, Thewarug; Charuluxananan, Somrat

doi:10.1002/14651858.cd004088.pub3

Cited by 116 publications

(51 citation statements)

References 34 publications

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“…1 This is the case for cardiac surgery, after which movement-evoked pain is likely to occur (due to deep breathing, coughing, central venous pressure measurement, and mobilization for nursing or physiotherapy) and may affect rehabilitation. 2,3 The use of epidural postoperative analgesia, despite its promising analgesic effects on movement-evoked pain, 4 is still a matter of debate because of safety issues after cardiac surgery. 5,6 Of the possible local anesthetic techniques, single-injection peristernal techniques have a short-term effect, 7,8 whereas longlasting peripheral blocks with continuous infusion of a local anesthetic solution in the operative site have shown promising results.…”

mentioning

confidence: 99%

The Analgesic Effects of a Bilateral Sternal Infusion of Ropivacaine After Cardiac Surgery

Eljezi¹,

Dualé

Azarnoush³

et al. 2012

Regional Anesthesia and Pain Medicine

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confidence: 99%

The Analgesic Effects of a Bilateral Sternal Infusion of Ropivacaine After Cardiac Surgery

Eljezi¹,

Dualé

Azarnoush³

et al. 2012

Regional Anesthesia and Pain Medicine

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“…In contrast, according to Zutshi et al 29 , TEA does not improve the quality of life compared to IV-PCA. Results of a meta-analysis published by Werawatganon et al 31 show that there was no signifi cant diff erence in patient satisfaction with analgesia after intra-abdominal operations between patients receiving opioid IV-PCA and EA. Although the results of diff erent studies vary, eff ective analgesia provided with TEA certainly increases patient satisfaction and improves the quality of life.…”

Section: Discussionmentioning

confidence: 96%

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Radovanović

Skoric-Jokic³

et al. 2017

acc

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SUMMARY -Th e aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. Th is prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. Th e secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side eff ects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p<0.001) and resumption of dietary intake was achieved earlier (p<0.001) in TEA group. Intensity of pain during the first 3 postoperative days was significantly lower at rest, on coughing and during mobilization (p<0.001), and mobilization was much more effi cient (p<0.005) in TEA than in IV-PCA group. Satisfaction scores were better in TEA group (p<0.001). Nausea, sedation and postoperative delirium occurred less frequently in TEA group (p<0.05, p<0.001 and p<0.05, respectively). TEA demonstrated significantly better eff ectiveness than IV-PCA after open colorectal cancer surgery and had a positive impact on bowel function, dietary intake, patient satisfaction and early mobilization. Th e results of this study demonstrated the importance of implementation of TEA as a preferred method for postoperative pain control after major open colorectal surgery.

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“…It is well known that continuous epidural analgesia is superior to opioid IVPCA in relieving postoperative pain in patients undergoing abdominal surgery6 including gastrectomy 18. Also, ITM-IVPCA has been reported to reduce postoperative opioid consumption and improve analgesic effect over IVPCA alone 1,19.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, epidural analgesia remained the preferred analgesic technique in patients undergoing major abdominal surgery because it provides good pain control,6 improved respiratory function,7 and decreased chest-related morbidity 8. For epidural analgesia in patients undergoing conventional open gastrectomy, an epidural catheter is recommended to be placed at the level of the thoracic spine.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy

et al. 2014

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PurposeEpidural analgesia has been the preferred analgesic technique after major abdominal surgery. On the other hand, the combined use of intrathecal morphine (ITM) and intravenous patient controlled analgesia (IVPCA) has been shown to be a viable alternative approach for analgesia. We hypothesized that ITM combined with IVPCA is as effective as patient controlled thoracic epidural analgesia (PCTEA) with respect to postoperative pain control after conventional open gastrectomy.Materials and MethodsSixty-four patients undergoing conventional open gastrectomy due to gastric cancer were randomly allocated into the intrathecal morphine combined with intravenous patient-controlled analgesia (IT) group or patient-controlled thoracic epidural analgesia (EP) group. The IT group received preoperative 0.3 mg of ITM, followed by postoperative IVPCA. The EP group preoperatively underwent epidural catheterization, followed by postoperative PCTEA. Visual analog scale (VAS) scores were assessed until 48 hrs after surgery. Adverse effects related to analgesia, profiles associated with recovery from surgery, and postoperative complications within 30 days after surgery were also evaluated.ResultsThis study failed to demonstrate the non-inferiority of ITM-IVPCA (n=29) to PCTEA (n=30) with respect to VAS 24 hrs after surgery. Furthermore, the IT group consumed more fentanyl than the EP group did (1247.2±263.7 µg vs. 1048.9±71.7 µg, p<0.001). The IT group took a longer time to ambulate than the EP group (p=0.021) and had higher incidences of postoperative ileus (p=0.012) and pulmonary complications (p=0.05) compared with the EP group.ConclusionITM-IVPCA is not as effective as PCTEA in patients undergoing gastrectomy, with respect to pain control, ambulation, postoperative ileus and pulmonary complications.

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Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery

Cited by 116 publications

References 34 publications

The Analgesic Effects of a Bilateral Sternal Infusion of Ropivacaine After Cardiac Surgery

The Analgesic Effects of a Bilateral Sternal Infusion of Ropivacaine After Cardiac Surgery

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Efficacy of Intrathecal Morphine Combined with Intravenous Analgesia versus Thoracic Epidural Analgesia after Gastrectomy

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