Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

STUDY DESIGN: Prospective study. OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.

Comparison of the Effects of Sufentanil and Fentanyl Intravenous Patient Controlled Analgesia after Lumbar Fusion

OBJECTIVE: Postoperative pain is one of the major complaints of patients after lumbar fusion surgery. The authors evaluated the effects of intravenous patient controlled analgesia (IV-PCA) using fentanyl or sufentanil on postoperative pain management and pain-related complications. METHODS: Forty-two patients that had undergone surgery with lumbar instrumentation and fusion at single or double levels constituted the study cohort. Patients were equally and randomly allocated to a sufentanil group (group S) or a fentanyl group (group F) for patient controlled analgesia (PCA). Group S received sufentanil at a dose of 4 μg/kg IV-PCA and group F received fentanyl 24 μg/kg IV-PCA. A numeric rating scale (NRS) of postoperative pain was applied before surgery, and immediately and at 1, 6, and 24 hours (hrs) after surgery. Oswestry disability index (ODI) scores were obtained before surgery and one month after surgery. Opioid-related side effects were also evaluated. RESULTS: No significant intergroup difference was observed in NRS or ODI scores at any of the above-mentioned time points. Side effects were more frequent in group F. More specifically, nausea, vomiting rates were significantly higher (p=0.04), but pruritus, hypotension, and headache rates were non-significantly different in the two groups. CONCLUSION: Sufentanil displayed no analgesic advantage over fentanyl postoperatively. However, sufentanil should be considerable for patients at high risk of GI issues, because it had lower postoperative nausea and vomiting rates than fentanyl.

The effects of continuous infusion of ondansetron on postoperative nausea and vomiting in patients receiving IV-patient controlled analgesia following gynecological surgery / 대한마취과학회지

BACKGROUND: This study was designed to evaluate the effects of continuous infusion of ondansetron on postoperative nausea and vomiting (PONV) in patients receiving intravenous patient controlled analgesia (IV-PCA) following laparoscopic gynecological surgery. METHODS: Sixty ASA class I and II patients scheduled for gynecological laparoscopic surgery were randomly divided into the following 3 groups that received the specified dosages of ondansetron mixed with IV-PCA: placebo (group 1), ondansetron 8 mg (group 2), ondansetron 16 mg (group 3). The incidences of nausea, vomiting, visual analogue scale (VAS), and side effects were then recorded in the recovery room, 24 h, 48 h and 72 h postoperatively. RESULTS: There were no significant differences in the occurrence of nausea between group 1 and 2. However, the incidence of nausea in group 3 was significantly lower than in group 1 at 24 h and 48 h after surgery. In addition, significant differences in the occurrence of vomiting were observed among the three groups. However, with the exception of pruritus, no side effects were observed in any of the groups. CONCLUSIONS: IV-PCA mixed with 16 mg of ondansetron effectively prevented nausea at 24 h and 48 h after gynecologic laparoscopic surgery.

Intravenous Patient-controlled Analgesia using Remifentanil after Cardiac Surgery / 대한마취과학회지

BACKGOUND: For rapid onset and predictable elimination half life, remifentanil may be suitable for patients undergoing cardiac surgery with unstable vital sign and decreased metabolism. We evaluated the efficacy, safety and proper dosage of intravenous patient-controlled analgesia (IV PCA) using remifentanil in patients undergoing cardiac surgery. METHODS: Forty-nine patients scheduled for cardiac surgery with sternotomy were randomly allocated to three groups. Group F had IV PCA using fentanyl with basal rate of 0.3microgram/kg/h, bolus of 0.5microgram/kg and lockout time of 15 min. Group L had remifentanil IV PCA with basal rate of 4microgram/kg/h, and group S with basal rate of 1microgram/kg/h. Both of group L and group S had setting of bolus of 0.5microgram/kg and lockout time of 5 min. In 12, 24 and 36 hours after surgery, vital sign, arterial blood gas analysis, visual analog pain scale (VAS), sedation score, and incidences of side effects were evaluated. RESULTS: The VAS score of group L was significantly low until 24 hours after surgery compared with other groups (P < 0.001). In group L, sedation score and PaCO2 in 12 hours after surgery were significantly high compared with other groups (P < 0.05), but no treatments were needed. CONCLUSIONS: Remifentanil IV PCA with basal rate of 4microgram/kg/h showed lower VAS score compared with small dosage of remifentanil and fentanyl with basal rate of 0.3microgram/kg/h. In the safety and proper dosage, further evaluations were needed.

The Effect of Continuous Infusion of Ondansetron on Nausea and Vomiting during Intravenous Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: This study was designed to determine the effectiveness of the continuous infusion of ondansetron for the prevention of postoperative nausea and vomiting (PONV) in intravenous patient-controlled analgesia (PCA). METHODS: One hundred and sixty patients undergoing spinal surgery were randomized into four groups according to the method of ondansetron administration, placebo (n = 40, group 1), ondansetron 8 mg mixed to IV PCA (n = 40, group 2), ondansetron 4 mg IV before induction or after surgery in addition to 8 mg mixed to IV PCA (n = 40, group 3 or n = 40, group 4). The incidences of nausea, vomiting, and side effects were recorded for 48 hr postoperatively. RESULTS: The incidence of nausea in group 1 (43 %) was significantly higher than in the other groups (group 2; 18%, group 3; 15%, group 4; 18%) (P < 0.05), and vomiting was one in group 1. CONCLUSIONS: Continuous ondansetron infusion is effective at preventing PONV, but the effects of additional bolus injections to continuous infusion of ondansetron were not different from continuous infusion only.

A Comparison of the Effect of Fentanyl and Fentanyl-Nalbuphine for Postoperative Analgesia Using IV-PCA / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) is effectively used for postoperative pain control. Fentanyl has a strong analgesic effect but has some side effects. The purpose of this study was to compare the side effects and analgesic effects of fentanyl alone and combination with nalbuphine in patients using intravenous PCA. METHODS: Forty six ASA class 1 or 2 patients were randomly divided into two groups. Group F (n = 23) received fentanyl 1,200microgram in 100 ml of normal saline. Group NF (n = 23) received nalbupine 60 mg and fentanyl 600microgram in 100 ml of normal saline. All patients used the same background infusion rate (2 ml/hr), bolus dose (2 ml) and lockout interval (15 min) just after emergence from general anesthesia. The analgesic effect was evaluated by using a visual analogue scale (VAS) at 1 hr, 6 hr, 12 hr, 24 hr and 48 hr postoperatively. Side effects and satisfaction degree were also checked. RESULTS: No significant differences were observed between the two groups in terms of pain scores and satisfaction degrees. The side effects were similar in both groups except that sedation was significantly (P<0.05) lower in group NF. CONCLUSIONS: We conclude that nalbuphine with fentanyl in combination is a useful method for intravenous PCA. On comparing the incidence of side effects in the two groups, sedation was found to be lower for the combined regimen.

Comparative Study of Postoperative Analgesic Effect of IV-PCA According to Timing of Infusion in Patients with Total Abdominal Hysterectomy / 기본간호학회지

PURPOSE: This study was designed to verify preemptive effects of intravenous patient-controlled analgesia (IV-PCA) infusion on postoperative pain in women having a total abdominal hysterectomy. METHOD: The research design was a nonequivalent control group post test only design. The participants in this study were 50 women who were scheduled for a total abdominal hysterectomy at a University affiliated Hospital in Suwon, Korea. The subjects were divided into two groups. For the experimental group, IV-PCA infusion was started before the skin incision and for the control group, IV-PCA infusion was started after the skin was closed. Each group was evaluated in terms of pain score by the visual analogue scale (VAS) and the number of times they pushed the button for IV-PCA at postoperative hours 1, 2, 3, 6, 12, and 24. The data were collected from July 1 to December 10, 2001. Collected data was analyzed by SPSS/PC+ program. RESULT: 1. There was no difference between the two groups, over six points for the number of times the control button for IV-PCA was used. Group differences and interaction effect were not significant. 2. There was no significant difference in pain scores between the two groups, over seven time points. A significant interaction effect was observed between groups and measurement points in time. 3. There was a significant difference in the requirements for additional analgesia between the two groups, 32% of the control group received additional analgesia. CONCLUSION: Preemptive analgesics administration may have a better effect in relieving postoperative pain than the usual analgesic treatment which is started after surgery.

The Effect of Diclofenac Sodium on Uncontrolled Postoperative Back Pain by IV-PCA / 대한마취과학회지

BACKGROUND: Although postoperative back pain has been reported to occur, as a frequent complication of anesthesia and surgery, it is usually mild and self-limited. However, we experienced cases of uncontrolled postoperative back pain in patients even after IV-PCA administration. These patients' back pain was relieved by the traditional diclofenac sodium intramuscular injection, so we evaluated the efficacy of diclofenac sodium on uncontrolled postoperative back pain by IV-PCA. METHODS: We studied 16 patients who complained of postoperative back pain even with IV-PCA for postoperative pain control. When NRS pain score was above 5, the patients were treated with a diclofenac sodium 75 mg intramuscular injection. Postoperative back pain and operation site pain was measured by NRS before and after diclofenac sodium injection. RESULTS: There was a significant decrease in the pain score of postoperative back pain after diclofenac sodium injection without a dramatic improvement of operation site pain. CONCLUSIONS: Diclofenac sodium plays a useful role in the control of acute postoperative back pain.

The Effects of Intravenous Patient-Controlled Analgesia using Morphine or Nalbuphine to Postoperative Respiratory Depression / 대한마취과학회지

BACKGROUND: The aim of this study was to evaluate the effects of respiratory depression of IV-PCA using morphine which has potent respiratory depression or nalbuphine which has less potent respiratory depression among opioids. METHODS: Forty patients were divided into two groups; Group M was used morphine, and Group N was used nalbuphine as a drug for IV-PCA. When patient emerges from general anesthesia, Group M was given initial bolus of 0.1 ml/kg of 0.1% morphine solution and connected Basal Bolus PCA infusor R containing morphine 50 mg per 40 ml in normal saline. Group N, similarly Group M, was given initial bolus of 0.1 ml/kg of 0.1% nalbuphine solution, and connected PCA infusor containing nalbuphine 50 mg per 40 ml in normal saline. To compare respiratory depression, arterial blood gas analyses were done preoperatively and at 1, 6 and 12 hour after IV-PCA. Simultaneously, analgesic and side effects were evaluated. RESULTS: There were no remarkable respiratory depression such as hypercarbia(PaCO2 > 50 mmHg), hypoxemia(PaO2 < 60 mmHg) and slow respiratory rate in both groups. Analgesic and side effects were similar in both groups. CONCLUSIONS: We conclude that IV-PCA using morphine or nalbuphine is relatively effective and safe method for the postoperative pain control. Ordinarily, IV-PCA dose not induce respiratory depression unless overdose in careless or mistaken mishaps are developed.

A Comparison of the Effect of Intravenous Patient - Controlled Analgesia vs. Intramuscular P.R.N Opioid Regimen on Heart Rate, Blood Pressure, Rate Pressure Product, and Visual Analogue Scale following Abdominal Hysterctomy / 대한마취과학회지

Previous studies have shown that patient-controlled analgesia(PCA) provides effective pain control in the postoperative patient. To compare the effect of pain relief on postoperative sympathetic responses and myocardial oxygen consumption, 40 healthy female patients undergoing abdominal hysterectomy were chosen randomly. They underwent pain management with either intravenous patient-controlled analgesia(IV PCA) or intermittent intramuscular opioid(IM P.R.N) regimen. Pain intensity(VAS), heart rate, blood pressure, and rate pressure product(RPP) were measured at predetermined time intervals for postoperative 72 hours after measurement of preoperative baseline values. Comparisons were then made between the two groups and among individuals within each group. IV-PCA improved postoperative pain relief(P<0.05), but did not suppress efficiently the heart rate, blood pressure, and RPP indicating sympathetic responses and myocardial oxygen consumption when compared with M P.R.N regimen. These variables were increased immediately and/or 30 minutes following the operation in both groups when compared with preoperative baseline value (P<0.05). These results suggest that improved pain relief per se by IV PCA had no mjor influence on the suppression of sympathetic responses and myocardial oxygen consumption and these responses were exaggerated during first 30 minutes after abdominal hysterectomy.