Abstract
Patient Controlled Analgesia is system used in postoperative pain relief which enables patients to self titrate analgesia to their desired pain relief .This study has been a prospective study where patients were randomly allocated into two groups (30 patients each).Group A- Patients given general anaesthesia and post operative intravenous fentanyl (IV group).Group B- Patients given general anaesthesia and epidural catheter placed where post operative pain was managed with patient controlled epidural analgesia using fentanyl and bupivacaine (PCEA group).All patients received verbal and written instructions on the use of PCEA after taking informed consent . In IV Group:-The first dose of fentanyl (50 mcg ) was given on first analgesic request and then iv fentanyl 50 mcg repeated every 4 hrs post operatively. PCEA Group: Epidural analgesia provided by post operative administration of 0.125% bupivacaine and 5 mcg/ml fentanyl mixture using a PCEA pump programmed to deliver 1 ml bolus with a lock out interval of 20 minute and a background infusion of 2 ml per hour. The cumulative fentanyl dose recorded during the 24 hrs of the study. Postoperatively, the vital parameters, pain score and the side-effects of fentanyl were recorded at regular intervals for 24 hours. The overall pain scores were significantly lower in the PCEA group when compared to the IV group. The current study showed that postoperative PCA techniques by the epidural is more effective when compared with the parenteral route.
Keywords:- Pain,Patient Controlled Analgesia,Patient Controlled Epidural Analgesia, Fentanyl, Bupivacaine, lock out interval.
References
- Mersy H. Pain terms ; A list with definition and notes on usage. Recommended by the IASP subcommittee on Taxonomy. Pain. 1979; 6; 249-252.
- Jorgen BD, Kehlet H; Post operative pain and its management. Wall and Melzacks Textbook of pain. 5th ed. Elsevier Churchill Livingstone; Philadephia; 2006. p635.
- Wightmanja K.; A prospective survey of the incidence of postoperative pulmonary complications. British Journal of Surgery 1968; 5 5 85-91.
- Pfluge E, Bonicaj J.; Physiopathology and control of postoperative pain. Archives of Surgery 1977; 112: 773-81.
- Spence AA.; Relieving acute pain. British Journal of Anaesthesia 1980; 52 2454.
- Cohen FL. ;Post surgical pain relief: patients’ status and nurses’ medication choices. Pain 1980; 9: 265-74.
- Marks RM, Sachar EJ. ;Undertreatment of medical inpatients with narcotic analgesics. Annals of Internal Medicine
- Webs Of, Sriwatanakku, All Lozaj L, Weintraugm, Lasagnal ;Attitudes of patients, house staff and nurses towards postoperative analgesic care. Anaesthesia and Analgesia 1983; 62 7W.
- Pearce, Jeremy ; “Philip H. Sehazer, 90, Expert of pain and how to ease it”. New York Times, Retrieved 2010-11-22.
- Wangj, K, Naussl A, Thomajes; Pain relief by intrathecally applied morphine in man. Anesthesiology 1979; 5 0 149-51.
- Beharh, Olshwang, M Agorfa, Davidsojtn; Epidural morphine in treatment of pain. Lancet 1979; 1: 527-8.
- Tamsena, Hartvicb, Dahlstrobm, Lindstromb, Holmdahmlm;Patient controlled analgesic therapy in the early postoperative period. Acta Anaesthesiology Scandinavica 1979; 23: 462-70.
- Karanikolas M, Aretha D, Kiekkas P, Monantera G, Tsolakis I, Filos KS (October 2010). "Case report. Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathic/ischaemic pain in haemodialysis patients: a case series". J Clin Pharm Ther. 35(5): 603–8. doi:10.1111/j.1365-2710.2009.01114.x. PMID20831684.
- Cathy S. Jewell; Chambers, James Q.; Chearney, Lee Ann; Romaine, Deborah S.; Candace B. Levy (2007). The Facts on File encyclopedia of health and medicine. New York: Facts on File. ISBN0-8160-6063-0.
- EA Welchew and D.P. Breen; Patient Controlled on demand epidural fentanyl Anaesthesia; 1991, vol 46, 438-441.
- Cooper DW, Turner G; Patient-controlled extradural analgesia to compare bupivacaine, fentanyl and bupivacaine with fentanyl in the treatment of postoperative pain. Br J 1993; 70: 503-7.
- Behare BK, Puri GD, Ghai B.; Patient controlled epidural analgesia with fentanyl and bupivacaine provides better analgesia than Intravenous morphine patient controlled analgesia for early thoracotomy pain.J Postgrad Med. 2008,54:86-90.
- Badner NH, Komar WE. Bupivacaine 0.1% does not improve post operative epidural fentanyl analgesia after abdominal or thoracic surgery. Can J Anaesth. 1992; 39 : 330-6.
- Claude Mann et al; comparison of intravenous of epidural patient controlled analgesia in the elderly after major Abdominal Surgery; 2000, 92-433-41 Lippincott Williams & Wilkins.
- Saito, Y., Uchida, H., Kaneko, M., Nakatani, T. and Kosaka,Y.; Comparison of continuous epidural infusion of morphine/ bupivacaine with fentanyl/ bupivacaine for postoperative pain relief. Acta Anaesthesiol Scand, 1994; 3398-401.
- Walder et al; efficacy and safety of patient controlled opiod analgesia for acute post operative pain Acta Anaestheisa and Scand, 2001, 45; 795-804.Ready B, Oden R Chadwick H, et al. Development of ananesthesiology-based postoperative pain management service.Anesthesiology 1988; 68: 100-6.
Corresponding Author
Rita Upadhyay
A-87, Samdariya Residency, Shatabdipuram, Vijay Nagar,
Jabalpur, India 482003 Mobile No. 9179137714
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.130
