Effect of postoperative analgesia with difference methods on immunity in patients after thoracic tumour surgery / 中国医师进修杂志

Objective To investigate the effect of postoperative analgesia with difference methods on immunity in patients after thoracic tumour surgery. Methods Forty ASA Ⅰ-Ⅱ patients aged 35-65 years old undergoing thoracic tumour surgery were randomized to receive either postoperative patient- controlled intravenous analgesia (PCIA) (group Ⅰ, 20 cases) or patient-controlled epidural analgesia (PCEA) (group E, 20 cases) for 48 h. Medicine compatibility in group Ⅰ: sulfentanyl 1μg/ml, tropisetron 0.05 mg/ml, the PCIA pump was set up to deliver a 5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h. Epidual catheter was placed at T4-5interspace before induction of anesthesia in group E. The PCEA solution contained 2 mg/ml ropivacaine. The PCEA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h after a loading dose of 0.33% ropivacame 6 ml. The VAS score, Ramsay sedation score and complications were reeorded. Blood samples were taken before induction (baseline) and at 2 h and 1st, 3rd and 7th day after surgery for determination of plasma concentrations of cortisol, interleukin 2 (IL-2) and the level of natural killer (NK) cells and eytokine-induced killer (CIK) cells. Results There was no significant difference in VAS score at 2 h after operation between two groups [(1.8±0.3) scores in group Ⅰ and (1.8±0.5)scores in group E].Ramsay sedation score at Ist, 3rd and 7th day after operation in group E were significantly lower than those in group Ⅰ (P<0.05), The plasma concentration of cortisol at 2 h and Ist, 3rd, 7th day after operation in group Ewere significantly lower than those in group Ⅰ (P<0.05), the levels of IL-2, NK cells and CIK cells in group E were significantly higher than those in group Ⅰ (P<0.05). Conclusions The efficacy of postoperative PCEA in improving immunity after thoracic tumour surgery is better than that of postoperative PCIA.

Is a Basal Infusion Required in Patient-controlled Analgesia Using Fentanyl after Orthopedic Surgery? / 대한마취과학회지

BACKGROUND: It has been suggested that addition of a basal infusion (BI) to patient-controlled analgesia (PCA) improves the continuity of analgesia for post-operative pain, by maintaining a minimum effective blood concentration of opioids between PCA demands. The aim of this study was to determine whether the addition of a BI to PCA using fentanyl would lead to improved pain control and patient satisfaction without increasing the side effects. METHODS: Seventy three patients, ASA class I or II, aged 22 - 72 years, following an orthopedic surgery under general anesthesia were studied. Patients were randomly allocated into two groups as follows: PCA group (n = 37), fentanyl 20 microgram demand dose with a lockout time of 6 min; PCA + BI group (n = 36), addition of fentanyl 20 microgram/h as a BI in the same regimen as the PCA group. RESULTS: Pain scores, patient satisfaction, sedation, and incidence of side effects were similar between the two groups. However, total consumption of fentanyl during the first 24 h after surgery was significantly increased in the PCA + BI group compared with those in the PCA group (1114 +/- 334 microgram vs. 841 +/- 409 microgram, P < 0.05). CONCLUSIONS: Despite the increased fentanyl consumption, the pain scores and patient satisfaction were not improved in the PCA + BI group. Addition of a BI at 20 microgram /h of fentanyl did not confer any advantage over a PCA alone and is not recommended when fentanyl PCA is used after orthopedic surgery.

Comparison of an Effective Dose of Intravenous Postoperative Patient-controlled Analgesia with Nalbuphine / 대한마취과학회지

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.

The Effects of Preincisional and Postincisional Low-Dose Ketamine in Addition to General Anesthesia on the Patient Controlled Analgesia for Postoperative Pain / 대한마취과학회지

BACKGROUND: Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, is known to inhibit "wind-up" and hence central hyperexcitability of dorsal horn neurons. However the results of clinical studies for its preemptive analgesic effect are controversial. The object of this study is to evaluate the effects of preincisional and postincisional low-dose ketamine on postoperative pain. METHODS: In a randomized, double-blind study, postoperative pain was assessed in 60 patients undergoing spinal fusion with general anesthesia who were allocated to three groups. Twenty patients were received 0.15 mg/kg of ketamine and the same volume of saline 5 min before and 15 min after surgical incision, respectively (group I). Patients in group II received 0.15 mg/kg of ketamine and the same volume of saline 15 min after and 5 min before surgical incision, respectively (n = 20), and in control group, patients received saline 5 min before and 15 min after surgical incision (n = 20). IV patient-controlled analgesia (PCA) with a morphine-ketorolac mixture was started in all patients at skin closure. Visual numerical scale (VNS) pain score, total analgesic consumption, and side effects were recorded at 1, 3, 6, 12, 24 and 48 h postoperatively. RESULTS: No significant intergroup differences were seen in the VNS pain scores, total analgesic consumption and incidence of side effects at 1, 3, 6, 12, 24 and 48 h postoperatively. CONCLUSIONS: This result indicates that postoperative pain cannot be decreased when ketamine in low doses is added to general anesthesia before and after surgical stimulation.

Can Different Analgesic Methods Affect Open Thoracotomy Outcomes? / 대한마취과학회지

BACKGROUND: Due to severe pain after open thoracotmy, the postoperative pain control is essential to decrease pulmonary complications, and improve a patient's recovery. This study compared the surgical outcome of patients who had undergone open thoracotomy, and been managed with two different analgesic methods. METHODS: A retrospective chart review was carried out regarding 81 patients who had undergone open thoracotomy due to lung cancer. 41 of these patients has received continuous thoracic epidural analgesia with 0.1% bupivacaine and 0.3 mg/ml morphine at a rate of 2 ml/hr for postthoracotomy pain control (CTEA group). The remaining 40 patients has received intravenous patient-controlled analgesia with 1% meperidine (IV-PCA group). We compared the effects of the postoperative pain control in the two groups and the outcomes, including the pulmonary complications and durations of hospital stay. RESULTS: There were no significant differences in demographic data between the two groups. Supplemental analgesic requirements and postoperative pulmonary complications were significantly lower in the CTEA group than in the IV-PCA group. There were no significant statistical differences between the two groups in the durations of their hospital stay. CONCLUSIONS: We conclude that the continuous thoracic epidural infusion provided better postthoracotomy analgesia and surgical outcomes than intravenous patient controlled analgesia.

Intravenous Infusion of Clonidine Potentiates Postoperative Analgesia Induced by Fentanyl / 대한마취과학회지

BACKGROUND: Clonidine, an alpha 2adrenergic agonist, has nonopiate antinociceptive properties which might be an alternative for postoperative analgesia free of undesirable effects from opioid. The aim of this study was to evaluate the postoperative analgesic effects of intravenous (IV) infusion of clonidine. METHODS: Seventy two healthy patients who undergoing cesarean section or gynecological surgery under general anesthesia were randomly divided into three groups as follows; the patients of group l received fentanyl (100 g bolus + 0.5ug/kg/hr) alone, the patients of group II received clonidine (100ug bolus + 10ug/kg/hr) and same dose of fentanyl, and the patients of group III received clonidine (200 g bolus + 20ug/kg/hr) and same dose of fentanyl. Pain score using a visual analogue scale (VAS), sedation score and any side effects were evaluated at 1, 6, 24 and 48 hours after starting the infusion. RESULT: Patients in group II and group III were more pain relieved during 48 hours and more sedated compared to group I at 1 hr, but there were no significant difference of side effects. CONCLUSION: Continuous IV infusion of clonidine potentiates postoperative analgesia induced by fentanyl.