Comparison of PCEA with and without night-time infusion in colorectal surgery

Simona Mărgărit¹, I.Acalovschi², Liana Vele³, Codruţa Călăian³
1) Catedra ATI. Universitatea de Medicină şi Farmacie „Iuliu Haţieganu”. 2) Clinica ATI, Spitalul Clinic de Adulţi, Cluj-Napoca. 3) Medici rezidenţi ATI

Abstract

Patient-controlled epidural analgesia (PCEA) provides effective and safe postoperative analgesia after major thoraco-abdominal surgery. PCEA with background infusion could improve analgesia, reduce analgesic requirement but could increase the incidence of side effects. This study was designed to assess the analgesic efficacy, quality of sleep and side effects of a supplemental night-time infusion in patient-controlled epidural analgesia after colorectal surgery.

Methods. After institutional approval and informed consent, 45 patients ASA I/II were included in a double-blind, randomized study. Patients were scheduled for colonic surgery. An epidural catheter was inserted through the T10-T11 or T11-T12 interspinous space into the epidural space. Intraoperative and postoperative analgesia were performed by epidural route. A PCA pump containing 0.125% bupivacaine and 5 g/ml fentanyl was connected to the epidural catheter and started on initiation of wound closure. Patients were divided into two groups: PCEA alone and PCEA plus infusion. The PCEA alone group received boluses on demand and the PCEA plus infusion group received an infusion during the night in addition to the intermittent boluses. The outcome measurements included: pain scores at rest, on movement and on coughing, the average hourly demands, the average hourly consumption and the incidence of side effects. The hourly consumption included patient demands and infusion during the night. Evaluation was performed at 8:00 a.m. on the day of surgery, at 8:00, 2:00 a.m., and 8:00 p.m. on postoperative day 1 and at 8:00 on postoperative day 2.

Results. Pain scores at rest, on movement and on coughing were significantly lower in the PCEA plus infusion than in the PCEA alone group only at 8:00 a.m. on postoperative day 2. The average hourly demands were not diminished by night-time infusion during the study period. The incidence of pruritus was significantly greater in the PCEA plus infusion group than in the PCEA alone group.

Conclusions. The use of night-time infusion in the PCEA regimen decreased the incidence of postoperative pain but did not provide additional advantages.

Key words: patient-controlled epidural analgesia, bolus, night-time infusion

Perfuzia bazală nocturnă asociată analgeziei controlate de pacient pe cale peridurală (PCEA) în chirurgia abdominală

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.1, 32-38