The Effect of Perioperative Analgesic Methods on the Postoperative Changes of White Blood Cells in Patients Undergoing Knee Replacement Surgery / 대한마취과학회지

BACKGROUND: Postoperative pain is a major contributing factor to immune dysfunction related to changes of peripheral neutrophils, lymphocytes and monocytes. The aim of this study is to compare alterations in peripheral white blood cells perioperatively in patients under intravenous patient controlled analgesia (IVPCA) with intra-articular patient controlled analgesia (IAPCA) after general or spinal anesthesia, or epidural patient controlled analgesia (EPCA) after combined spinal epidural anesthesia for knee replacement surgery. METHODS: Thirty-three patients with IVPCA and IAPCA after general anesthesia (group 1), 33 patients with IVPCA and IAPCA after spinal anesthesia (group 2), and 34 patients with EPCA after combined spinal epidural anesthesia (group 3) were reviewed. The number of peripheral neutrophils, lymphocytes and monocytes were counted preoperatively, immediate postoperatively, on the first, third and fifth postoperative day. RESULTS: There were significant increases in neutrophils, decreases in lymphocytes, and increases in monocytes postoperatively in all the groups. However, there were no differences among the groups in three subtypes of white blood cells, except significantly low value of monocytes in the group 1 compared to that of group 2 immediate postoperatively. CONCLUSIONS: The technique of anesthesia and postoperative pain control did not influence to the changes of subtypes of circulating white blood cells in patients underwent knee replacement surgery.

The Effects of High Thoracic Epidural Patient Controlled Analgesia after Open Heart Surgery / 대한마취과학회지

BACKGROUND: Postoperative pain may be severe after open heart surgery (OHS). High thoracic epidural analgesia may reduce postoperative pain and improve the pulmonary function. We investigated the effect of epidural analgesia after median sternotomy METHODS: Fifty-six patients were randomized to epidural patient controlled analgesia (PCA) or conventional analgesia (control). Patients received OHS with standardized general anesthetic technique. The day before surgery, patients allocated to the PCA group had an epidural catheter inserted at level T4-5. Proper placement was tested with small dose of lidocaine and epinephrine. Epidural catheter was removed 3 days after surgery. Patients in control group received conventional nurse controlled analgesia. Postoperative assessment included daily visual analog scoring (VAS) and pulmonary function test 3 days after surgery. Complication and patients satisfaction were also evaluated. RESULTS: The VAS scores did not significantly differ between the groups, except 12 hours after surgery during coughing. Patients with PCA awoke and were extubated significantly earlier than patients in control group. Significantly higher forced expiratory volume in 1s and peak expiratory flow rate were seen in PCA group than in control group. No significant thoracic epidural related complications occurred. CONCLUSIONS: Thoracic epidural PCA provided better analgesia and allowed earlier extubation. Thoracic epidural PCA yields a slight, but significant, improvement in pulmonary function.

Outcome of Total Knee Arthroplasty Depending on Post-operative Pain Control Methods / 대한마취과학회지

BACKGROUND: Rehabilitation physical therapy after a total knee arthroplasy (TKA) is important for the functional prognosis of the surgery and the methods of postoperative analgesic control could have influence on physical therapy. Therefore we compared surgical outcome of TKA patients receiving intravenous patient-controlled analgesia (IPCA) and epidural patient-controlled analgesia (EPCA) for pain control. METHODS: Forty four patients scheduled for a TKA were randomly allocated into two groups. The IPCA group received intravenous PCA (fentanyl 30mu g/ml, ketorolac 3 mg/ml, 0.5 ml/15 min/0.5 ml) after general anesthesia and the EPCA group received epidural PCA (0.1% bupivacaine, fentanyl 3 microgram/ml, 3 ml/15 min/3 ml) after combined spinal epidural anesthesia for an operation. Pain score and side effects were checked at 6, 24, 48, and 72 hours after the operation. Range of motion (ROM) was evaluated at discharge, 1 and 3 months after the operation. RESULTS: The EPCA group showed better analgesia and ROM than the IPCA group but the advantage on ROM did not last up to the 3 month follow up. Nausea/vomiting and sedation was more in the IPCA group, and backache, paresthesia and motor eakness of the lower limbs were more in the EPCA group. However, all side effects were tolerable for the patients. There was 31.8% of epidural catheter dislodgement or occlusion. CONCLUSIONS: Better analgesia with epidural PCA resulted in a better functional prognosis, but more effort would be needed to manage an epidural catheter.

The Comparison of Ropivacaine and Bupivacaine in Epidural Patient Controlled Analgesia (PCA) / 대한마취과학회지

BACKGROUND: Local anesthetics combined with an opiate are frequently used as a postoperative epidural PCA regimen. Ropivacaine is known to have a selective blockade of the sensory nerve without motor blockade. This study is designed to show advantages of ropivacaine over bupivacaine. METHODS: Patients undergoing elective abdominal and orthopedic surgeries were randomly selected and divided into two groups, B and R. The patients in group B and R received 0.2% bupivacaine and 0.2% ropivacaine respectively through an epidural catheter using a PCA pump. Both local anesthetic solutions were mixed with 4 microgram/ml of fentanyl. The PCA pumps of both groups were set in the same manner. A basal rate of 2 ml/hr was infused from 1hour after the onset of surgery. This basal rate was continued postoperatively. A bolus dose and lock out time were set at 2 ml and 20 minutes respectively. The Visual analogue pain scale (VAS), demand dose, complication and additional intramuscular analgesic requirements were checked up to 24 hours after surgery in 6-hour interval. RESULTS: The VAS was significantly lower in group R than in group B at 6, 12, 18 and 24 hours after the surgery (P < 0.05). Total additional bolus doses of the PCA pump were not significantly different in either group at 6, 12, 18 and 24 hours after surgery. The patients in group R showed more satisfaction and less additional intramuscular injections. CONCLUSIONS: 0.2% Ropivacaine, mixed with 4microgram/ml of fentanyl, was more effective than bupivacaine, mixed with the same concentration of fentanyl, in controlling postoperative pain using an epidural PCA pump.

The Efficacy of Bupivacaine Combined with Midazolam Tramadol or Fentanyl on Patient-controlled Epidural Analgesia / 临床麻醉学杂志

Objective: To compare the efficacy of bupivacaine alone or combined with fentanyl, midazolam or tramadolduring PCEA. Methods:Sixty patients scheduled for abdominal hysterectomy under combined epidural and spinal anesthesiawere randomly divided into four groups. Group A received 0. 125 % bupivcaine, group B 0. 125 % bupivacaine + fentanyl(2.5tg/ml), group C 0.125 % bupivacaine + midazolam(0.5mg/ml), group D 0. 125 % bupivacaine + tramdol(3mg/ml).PCEA parameters were a loading dose of 6mi, a bolus dose of 3mi, a lockout interval of 30 min and continuous infusion of2ml/h. The total drug dosage was recorded for up to 24h after operation. The number of PCEA demand, visual analogue painscales(VAS), sedation scales, the incidence of nausea and vomiting, respiratory rate (RR) and mean arterial pressure (MAP)were measured at 4h, 8h, 12h and 24h postoperatively. Results: The total drug dosage, number of button pressed and VAS ingroup A were significantly higher than those in the other groups( P < 0.01 ), which was the least in group D. The sedationscales were the highest in group C. There was a higher incidence of nausea and vomiting in group B. Conclusions: Bupivacainecombined with fentanyl, midazolam or tramadol used for PCEA produces higherquality of pain relief than bupuvacaine alone.