Comparison of hydromorphone and fentanyl administered by lumbar epidural as patient-controlled analgesia after total knee arthroplasty

BACKGROUND:Hydromorphone is a semi-synthetic opioid that has recently been used for the control of acute and chronic pain.It has been reported that epidural infusion of hydromorphone provides rapid onset of analgesia and a lower incidence of side effects than morphine.However, comparative studies of hydromorphone and lipophilic opioids such as fentanyl are rare.Therefore, we compared the analgesic effects and side effects of hydromorphone infused epidurally with fentanyl in patients who underwent total knee arthroplasty. METHODS:In a randomized, double-blind manner, 79 patients (ASA I-III, aged 60?75) underwent total knee arthroplasty and were provided with patient-controlled epidural analgesia (PCEA) using a lumbar spinal/epidural-combined technique. Group HR (n = 39) received epidurally administered hydromorphone (4microg/ml) with 0.1% ropivacaine, while group FR (n = 40) received epidural fentanyl (2microg/ml) with 0.1% ropivacaine for 24 h after surgery at a rate of 5 ml/h. The visual analogue scale (VAS) was used to evaluate pain and the incidence of side effects such as nausea/vomiting, pruritis, dizziness, and respiratory depression were recorded at 4, 8, 12, 24 h after surgery. RESULTS:Group HR showed a lower VAS than group FR at 4, 12 and 24 h after surgery, but a higher incidence of nausea and vomiting at 8 h after surgery, and a higher incidence of pruritis at 8 and 12 h after surgery. None of the patients showed respiratory depression. CONCLUSIONS:Lumbar epidural infusion of hydromorphone more effectively controlled acute pain after total knee arthroplasty when compared with fentanyl, but some adverse effects such as nausea and vomiting appeared to occur more frequently.

Comparison of hydromorphone and fentanyl administered by lumbar epidural as patient-controlled analgesia after total knee arthroplasty

BACKGROUND:Hydromorphone is a semi-synthetic opioid that has recently been used for the control of acute and chronic pain.It has been reported that epidural infusion of hydromorphone provides rapid onset of analgesia and a lower incidence of side effects than morphine.However, comparative studies of hydromorphone and lipophilic opioids such as fentanyl are rare.Therefore, we compared the analgesic effects and side effects of hydromorphone infused epidurally with fentanyl in patients who underwent total knee arthroplasty. METHODS:In a randomized, double-blind manner, 79 patients (ASA I-III, aged 60?75) underwent total knee arthroplasty and were provided with patient-controlled epidural analgesia (PCEA) using a lumbar spinal/epidural-combined technique. Group HR (n = 39) received epidurally administered hydromorphone (4microg/ml) with 0.1% ropivacaine, while group FR (n = 40) received epidural fentanyl (2microg/ml) with 0.1% ropivacaine for 24 h after surgery at a rate of 5 ml/h. The visual analogue scale (VAS) was used to evaluate pain and the incidence of side effects such as nausea/vomiting, pruritis, dizziness, and respiratory depression were recorded at 4, 8, 12, 24 h after surgery. RESULTS:Group HR showed a lower VAS than group FR at 4, 12 and 24 h after surgery, but a higher incidence of nausea and vomiting at 8 h after surgery, and a higher incidence of pruritis at 8 and 12 h after surgery. None of the patients showed respiratory depression. CONCLUSIONS:Lumbar epidural infusion of hydromorphone more effectively controlled acute pain after total knee arthroplasty when compared with fentanyl, but some adverse effects such as nausea and vomiting appeared to occur more frequently.

The treatment of the pulmonary embolism with tissue plasminogen activator: A case report / 대한마취과학회지

Pulmonary embolism can occur in various situations and it can result in severe hemodynamic instability, including cardiac arrest. Because of its fatality, diagnosis and treatment should be immediate and proper. We report a case of pulmonary embolism just after combined spinal epidural anesthesia. We diagnosed pulmonary embolism by echocardiogram, spiral CT and pulmonary angiography. Besides immediate use of heparin, tissue plasminogen activator therapy was started with 10 mg bolus and 90 mg intravenous infusion during 2 hours. Despite the therapy, pulmonary embolism was not resolved and the patient was expired.