Abstract | BACKGROUND: METHODS: We retrospectively retrieved data from 859 patients (mean age 64+/-7 years) who received continuous epidural medication, either morphine or fentanyl- bupivacaine PCA, or intravenous morphine PCA for postoperative pain control after major elective surgery from 1999 to 2000. Pain was assessed postoperatively using a verbal analogue pain scale (VAS, 0-10) during rest, mobilization, and coughing. Adverse effects including nausea, vomiting, pruritus, urinary retention, sedation, motor block, and respiratory depression (< 8 breaths per minute) were recorded. On the third postoperative day, the overall quality of pain control was evaluated using a pain relief scale (PRS, 1-4). RESULTS: There were 201 patients who had epidural morphine PCA, 427 patients who had fentanyl- bupivacaine PCA, and 231 patients who had intravenous morphine PCA. Most patients (> 86%) who received epidural or intravenous PCA, either morphine or fentanyl combined with bupivacaine, experienced good pain relief (VAS, 0-3) during rest, mobilization, and coughing. Nonetheless, patients who received epidural morphine or fentanyl- bupivacaine had greater satisfaction with overall pain relief (PRS = 4) than did those who received intravenous morphine (p<0.05). Nausea and vomiting were most common in the epidural morphine group (p<0.05). Pruritus occurred least often in patients who received epidural fentanyl- bupivacaine analgesia (p < 0.05). There were no differences in other adverse events such as urinary retention, sedation, and motor block among the three groups. No respiratory depression was found in any patient. CONCLUSIONS: Patients receiving epidural fentanyl- bupivacaine PCA experienced better overall pain relief, while morphine PCA, either epidurally or intravenously, caused more side effects. It is considered safe to use continuous epidural PCA with fentanyl- bupivacaine in patients receiving major elective surgery.
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Authors | Yun-Hui Teng, Jenkin S Hu, Shen-Kou Tsai, Chinsan Liew, Ping-Wing Lui |
Journal | Chang Gung medical journal
(Chang Gung Med J)
Vol. 27
Issue 12
Pg. 877-86
(Dec 2004)
ISSN: 2072-0939 [Print] China (Republic : 1949- ) |
PMID | 15754777
(Publication Type: Clinical Trial, Comparative Study, Journal Article)
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Chemical References |
- Analgesics, Opioid
- Anesthetics, Intravenous
- Mesylates
- bupirimate
- Morphine
- Fentanyl
- Bupivacaine
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Topics |
- Aged
- Analgesia, Epidural
(adverse effects)
- Analgesia, Patient-Controlled
(methods)
- Analgesics, Opioid
(therapeutic use)
- Anesthetics, Intravenous
(therapeutic use)
- Bupivacaine
(therapeutic use)
- Female
- Fentanyl
(therapeutic use)
- Humans
- Infusions, Intravenous
- Male
- Mesylates
(therapeutic use)
- Middle Aged
- Morphine
(therapeutic use)
- Nausea
(chemically induced)
- Pain, Postoperative
(therapy)
- Postoperative Care
- Pruritus
(chemically induced)
- Retrospective Studies
- Treatment Outcome
- Urinary Retention
(chemically induced)
- Vomiting
(chemically induced)
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