Effect of patient-controlled epidural analgesia for pain relief after thymectomy in patients with myasthenia gravis.

OBJECTIVE: To evaluate the effect of patient-controlled epidural analgesia (PCEA) with ropivacaine or bupivacaine in relieving pain after thymectomy in patients with myasthenia gravis. METHODS: Twenty adult ASA I-II patients with myasthenia gravis were randomized to receive either 0.125% ropivacaine (Group R, n=10) or 0.125% bupivacaine (Group B, n=10) with a PCEA device after transsternal thymectomy. PCEA (continuous infusion at 1 ml/h, bolus dose of 4 ml and lockout time of 30 min) was implemented via an epidural catheter inserted in the T3-4 intervertebral space. The vital signs and visual analogue scale (VAS), together with cumulative consumption (CC) of ropivacaine or bupivacaine were recorded within 48 h postoperatively. RESULTS: The vital signs, including systolic and diastolic blood pressure, heart rate, SpO2, pH and PaCO2, did not show any significant differences between the 2 groups. The CC of the local anesthetic was significantly higher in group R than that in group B at 24 and 48 h postoperatively, but VAS were not significantly different between the 2 groups which was less than 4 in both groups. CONCLUSIONS: PCEA with low concentration of ropivacaine or bupivacaine may provide effective and safe analgesia after transsternal thymectomy.

[Effect of preemptive analgesia with flurbiprofen axetil on patient-controlled intravenous analgesia with tramadol in patients undergoing postburn plastic surgery].

OBJECTIVE: To observe the preemptive analgesic effect of flurbiprofen axetil for post-operative pain relief. METHODS: Sixty ASA class I or II patients undergoing postburn plastic surgery were randomly assigned into two groups to receive intravenous administration of 100 mg flurbiprofen axetil (group F, n=30) and 10 ml intravenous saline (group C, n=30) 30 min before surgery. After the operation, all the patients received patient-controlled intravenous analgesia (PCIA) with tramadol for pain relief. The postoperative analgesic effect was assessed by visual analog scales (VAS) at 1, 2, 4, 8, 12 and 24 h after surgery, with tramadol requirements and the adverse effects were recorded. RESULT: At 1, 2, 4, and 8 h after the operation, the patients in group F showed significantly lowered VAS scores as compared with the patients in group C (P<0.05). The requirement of tramadol was also significantly less in group F than in group C (182.9-/+37.4 vs 227.3-/+49.8 mg, P<0.05). No significant difference was found in the adverse effects between the two groups. CONCLUSION: Flurbiprofen axetil can produce preemptive analgesia and reduce the tramadol dose during postoperative PCIA in patients undergoing postburn plastic operations.