Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer?

PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach. METHODS: Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured. RESULTS: Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03). CONCLUSION: Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.

The Use of Saline Bag for Cardiac Displacement Facilitates the Transgastric Transesophageal Echocardiographic View during Off-pump Coronary Artery Bypass Graft Surgery : A case report / 대한마취과학회지

During off-pump coronary artery bypass graft surgery (OPCAB), vigorous displacement and compression of the heart producing significant hemodynamic change are essential for optimal exposure of graft anastomoses. Intraoperative transesophageal echocardiography (TEE) is useful in determining hemodynamic compromise and prompting medical and mechanical support. However, in addition to the loss of contact between the heart and diaphragm during the displacement, swabs or snears underneath the heart interrupt the TEE signal transmission, resulting in a compromised transgastric (TG) TEE view. Therefore, TEE monitoring during OPCAB is usually limited to the mid-esophageal view. The authors placed a saline bag (a surgical glove filled with saline) underneath the heart to facilitate this anterior displacement of the heart, as well as avoid the signal interruption of the TG echocardiographic window. As a result, the optimal heart position with the minimal changes in LV regional wall motion, LV function and mitral regurgitation were found using the TG and other TEE views. The series of velocity-time integral of aortic valvular flow (VTI-Ao) in TG long axis view, in addition to SvO2, were then monitored as a surrogate marker of the cardiac output during a graft construction of the left circumflex artery. It was concluded that the use of a saline bag may be useful in avoiding compromise of the TG TEE view and determine the hemodynamic change using VTI-Ao during cardiac displacement for OPCAB.