Korean J Pain.  2018 Jul;31(3):191-198. 10.3344/kjp.2018.31.3.191.

Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia for laparoscopic radical prostatectomy

• Hwang BY
• Kwon JY
• Jeon SE
• Kim ES
• Kim HJ
• Lee HJ
• An J

• KMID: 2417957
• DOI: http://doi.org/10.3344/kjp.2018.31.3.191

Abstract

BACKGROUND
Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared.
METHODS
Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h.
RESULTS
EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group.
CONCLUSIONS
Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.

Keyword

Epidural injection; Intravenous administration; Laparoscopes; Morphine; Oxycodone; Pain measurement; Patient-controlled analgesia; Postoperative pain; Prostatectomy; Ropivacaine; Thoracic vertebrae

MeSH Terms

Administration, Intravenous
Analgesia*
Analgesia, Epidural*
Analgesia, Patient-Controlled
Analgesics
Anesthesia, Epidural
Humans
Injections, Epidural
Laparoscopes
Laparoscopy
Methods
Morphine
Nefopam
Oxycodone
Pain Measurement
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Patient Satisfaction
Pica
Prostatectomy*
Thoracic Vertebrae
Analgesics
Morphine
Nefopam
Oxycodone

Figure

• 

  Fig. 1 Study flow chart with individual causes of study interruptions and dropouts. The flow chart of this study was according to the CONSORT Statement.

• 

  Fig. 2 Blood pressure during laparoscopic radical prostatectomy. 2a. Systolic blood pressure (SBP), 2b. Diastolic blood pressure (DBP), 2c. Mean blood pressure (MBP). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) of the PCEA group are lower than those of the PCIA group. B: baseline, I0: intubation time, I1: incision time, I2: insufflation time, I3: prostatectomy time, I4: anastomosis time, D: deflation. *P < 0.05 compared with PCIA group.

• 

  Fig. 3 Numeric rating scale (NRS) of pain intensity and accumulated PCA count at 1, 6, 24 and 48 h after the operation. (A) Numeric rating scale (NRS) of pain intensity at 1, 6, 24 and 48 h after the operation. Both groups show a decrease in pain as the time passed. In all period, lower NRS are recorded in Patient-controlled epidural analgesia (PCEA) group than patient-controlled intravascular analgesia (PCIA). Values are expressed as mean ± SD. *P < 0.05 compared with PCIA group. (B) Accumulated PCA count at 1, 6, 24 and 48 h after the operation. Lower accumulated patient-controlled analgesia (PCA) counts are recorded in the patient-controlled epidural analgesia (PCEA) group than the patient-controlled intravascular analgesia (PCIA). Values are expressed as mean ± SD. ed with PCIA group. Data are expressed as mean ± SD.

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