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KMID : 1155520150100010021
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Anesthesia and Pain Medicine
2015 Volume.10 No. 1 p.21 ~ p.26
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A prospective observational cohort study on postoperative intravenous patient-controlled analgesia in surgeries
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Lee Gwan-Woo
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Abstract
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Background: An electrical patient-controlled analgesia (PCA) pump enabled us to collect infusion history of opioid analgesic and other efficacy parameters of PCA, including delivery-to-attempt (D/A) ratio. This study evaluated the effectiveness of PCA in a large population of surgical patients using numerical rating scale (NRS) for pain and D/A ratio.
Methods: A total of 6,847 patients were enrolled in this study. All patients received intravenous bolus of fentanyl (0.2 μg /kg) one hour before the end of the surgery. Basal infusion rate, demand bolus, and lockout time of the PCA pump was set as 1 ml/h, 1 ml, and 15 minutes, respectively. The concentration of fentanyl in the analgesic solution was 15 μg/ml.
Results: NRS scores for pain and D/A ratios for the first 6 hours after operations were as follows (median, 25?75%): open colorectal surgery (NRS: 6.5, 5.0?8.0; D/A: 62.5, 46.2?77.8%), laparoscopic colorectal surgery (NRS: 6.0, 4.5?7.0; D/A: 69.2, 50.0?81.9%), open hepato-biliary-pancreas surgery (NRS: 6.0, 4.5?7.0; D/A: 59.2, 38.7?75.0%), open stomach surgery (NRS: 5.0, 4.0?6.7; D/A: 58.1, 41.2?75.0%), open abdominal vascular surgery (NRS: 5.0, 3.5?6.5; D/A: 58.3, 40.0?81.3%), laparoscopic stomach surgery (NRS: 5.0, 4.0?6.0; D/A: 63.6, 45.5?80.0%), laparoscopic hepato-biliary-pancreas surgery (NRS: 5.0, 4.0?6.0; D/A: 66.7, 50.0?80.8%), vascular bypass surgery (NRS: 4.0, 3.0?6.0; D/A: 64.5, 42.7?84.0%), anal surgery (NRS: 4.0, 3.0?5.8; D/A: 71.4, 60.0?100%), and breast surgery (NRS: 3.0, 3.0?4.0; D/A: 86.6, 67.2?100%).
Conclusions: Mean D/A ratios for the first 6 hours after all operations except anal and breast surgeries were below 70%, suggesting that a higher amount of fentanyl should be administered during this period.
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KEYWORD
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General surgery, Patient-controlled analgesia, Postoperative pain
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