Effect of PCIA versus PCEA on platelet activation in patients undergoing radical colon cancer operation / 中华麻醉学杂志

ABSTRACT

Objective To compare the effects of patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) on platelet activation in patients undergoing radical colon cancer operation.Methods Sixty-four ASA Ⅰ or Ⅱ patients,aged 43-65 yr,weighing 45-68 kg,undergoing radical operation for colon cancer,were randomly divided into 2 groups ( n =32 each)PCIA group and PCEA group.PCA pumps were connected at the end of operation.The PCIA solution c6ntained sufentanil 3 μg/kg,tropisetron 5 mg and vitamin B6 100 mg in 130 ml of normal saline.The PCIA pump was set up to deliver a 1.8 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.The PCEA solution contained sufentanil 0.5 μg/kg and 0.125％ ropivacaine in 300 ml of normal saline.The PCEA pump was set up to deliver a 2.5 ml bolus dose with a 20-min lockout interval and background infusion at 5 ml/h after a loading dose of 5 ml. VAS was maintained ≤ 3 after operation.Venous blood samples were taken before anesthesia,at 60 min after beginning of operation,and at the end of operation to determine the concentrations of plasma insulin and cortisol and blood glucose.Venous blood samples were taken at 30 min before operation,1 h after beginning of operation,and at 30 min and 4,12,24 and 48 h after operation (T0-6) to measure the concentration of serum platelet α-granzyme membrane protein-140 (GMP-140).The side effects were recorded after operation.Results Thirty and 29 patients completed the study in groups PCEA and PCIA respectively.There was no significant difference in the concentrations of plasma insulin and cortisol and blood glucose at each time point between the two groups ( P ＞ 0.05 ).The concentration of serum GMP-140 was significantly higher at T1-6 than the baseline value at T0 (P ＜ 0.05).The concentration of serum GMP-140 and incidence of nausea and vomiting were significantly lower at T3-6 in group PCEA than in group PCIA (P ＜ 0.05).One case happened pruritus in group PCIA,and respiratory depression and local anesthetic intoxication were not observed in the two groups.Conclusion PCEA has better inhibitory effect on the overactivation of platelet than PCIA,which may be helpful for preventing metastases of cancer ceils or postoperative thrombosis,and it is more suitable for postoperative analgesia in patients undergoing radical colon cancer operation.