Korean J Pain.  2013 Jan;26(1):39-45. 10.3344/kjp.2013.26.1.39.

Patient-controlled Epidural Analgesia with Ropivacaine and Fentanyl: Experience with 2,276 Surgical Patients

• Kim SH
• Yoon KB
• Yoon DM
• Kim CM
• Shin YS

• KMID: 1779022
• DOI: http://doi.org/10.3344/kjp.2013.26.1.39

Abstract

BACKGROUND
Good postoperative pain control is an important part of adequate postoperative care. Patient-controlled epidural analgesia (PCEA) provided better postoperative analgesia compared to other conventional analgesic methods, but several risks have been observed as well. We therefore surveyed the efficacy and safety of PCEA in this retrospective observational study.
METHODS
We analyzed collected data on 2,276 elective surgical patients who received PCEA with ropivacaine and fentanyl. Patients were assessed by a PCA service team in the post-anesthesia care unit (PACU), at 1-6 h, 6-24 h, and 24-48 h postoperatively for adequate pain control. The presence of PCEA-related adverse events was also assessed.
RESULTS
Numerical pain score (median [interquartile range]) were 3 [1-4], 5 [4-7], 4 [3-5], and 3 [3-5] in the PACU, at 1-6 h, 6-24 h, and 24-48 h postoperatively. Median pain scores in patients underwent major abdominal or thoracic surgery were higher than other surgical procedure in the PACU, at 1-6 h after surgery. Nausea and vomiting (20%) and numbness and motor weakness (15%) were revealed as major PCEA-related adverse events during the postoperative 48 h period. There were 329 patients (14%) for whom PCEA was ceased within 48 h following surgery.
CONCLUSIONS
Our data suggest that the use of PCEA provides proper analgesia in the postoperative 48 h period after a wide variety of surgical procedures and that is associated with few serious complications. However, more careful pain management and sustainable PCEA monitoring considering the type of surgical procedure undergone is needed in patients with PCEA.

Keyword

efficacy; epidural analgesia; patient-controlled analgesia; postoperative pain; safety

MeSH Terms

Amides
Analgesia
Analgesia, Epidural
Analgesia, Patient-Controlled
Fentanyl
Humans
Hypesthesia
Nausea
Pain Management
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Postoperative Care
Retrospective Studies
Thoracic Surgery
Vomiting
Amides
Fentanyl

Figure

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  Fig. 1 Study profile.

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  Fig. 2 Comparison between numerical pain scores according to the type of surgery at postoperative assessment intervals. The box plot displays 10th, 25th, median (fat bars), 75th, and 90th percentiles of values. PACU: post-anesthesia care unit. *P < 0.05 using the Friedman test with post-hoc testing using the Wilcoxon rank-sum test with Bonferroni correction.

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  Fig. 3 Comparison between numerical pain scores according to the type of anesthesia (general vs. regional) at postoperative assessment intervals for each surgery type. The box plot displays 10th, 25th, median (fat bars), 75th, and 90th percentiles of values. PACU: post-anesthesia care unit. *P < 0.05 vs. regional anesthesia using the Friedman test.

Reference

1. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001; 87:62–72. PMID: 11460814.

2. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97:534–540. PMID: 12873949.

3. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003; 290:2455–2463. PMID: 14612482.

4. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995; 82:1474–1506. PMID: 7793661.

5. Kim DH. Effective continuous infusion and bolus doses for patient-controlled epidural analgesia using ropivacaine. J Korean Pain Soc. 2002; 15:75–79.

6. Pöpping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki-Zahn EM. Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth. 2008; 101:832–840. PMID: 18945716.

7. Chen PP, Chui PT, Ma M, Gin T. A prospective survey of patients after cessation of patient-controlled analgesia. Anesth Analg. 2001; 92:224–227. PMID: 11133632.

8. Liu SS, Allen HW, Olsson GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: prospective experience with 1,030 surgical patients. Anesthesiology. 1998; 88:688–695. PMID: 9523813.

9. Scott DA, Beilby DS, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1,014 patients. Anesthesiology. 1995; 83:727–737. PMID: 7574052.

10. de Leon-Casasola OA, Parker B, Lema MJ, Harrison P, Massey J. Postoperative epidural bupivacaine-morphine therapy. Experience with 4,227 surgical cancer patients. Anesthesiology. 1994; 81:368–375. PMID: 8053587.

11. Cha YD, Song JH, Song JH, Kim TJ, Lee HS, Lee CS, et al. Is initial loading dose necessary for continuous epidural analgesia after brief surgery? J Korean Pain Soc. 2000; 13:44–48.

12. Brennum J, Arendt-Nielsen L, Secher NH, Jensen TS, Bjerring P. Quantitative sensory examination in human epidural anaesthesia and analgesia: effects of lidocaine. Pain. 1992; 51:27–34. PMID: 1454401.

13. Liu SS, Moore JM, Luo AM, Trautman WJ, Carpenter RL. Comparison of three solutions of ropivacaine/fentanyl for postoperative patient-controlled epidural analgesia. Anesthesiology. 1999; 90:727–733. PMID: 10078673.

14. Moon DE, Shim JY, Lim YG, Kim YS, Kim BC, Kim SN. Neurologic complications following epidural analgesia. J Korean Pain Soc. 1997; 10:291–295.

15. Talu GK, Erdine S. Complications of epidural neuroplasty: a retrospective evaluation. Neuromodulation. 2003; 6:237–247. PMID: 22151070.

16. Visser WA, Lee RA, Gielen MJ. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Anesth Analg. 2008; 107:708–721. PMID: 18633056.

17. Burstal R, Wegener F, Hayes C, Lantry G. Epidural analgesia: prospective audit of 1062 patients. Anaesth Intensive Care. 1998; 26:165–172. PMID: 9564395.

18. Wigfull J, Welchew E. Survey of 1057 patients receiving postoperative patient-controlled epidural analgesia. Anaesthesia. 2001; 56:70–75. PMID: 11167440.

19. Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth. 2001; 87:36–46. PMID: 11460812.