J Korean Med Sci.  2009 Oct;24(5):930-935. 10.3346/jkms.2009.24.5.930.

Is Intravenous Patient Controlled Analgesia Enough for Pain Control in Patients Who Underwent Thoracoscopy?

• Kim JA
• Kim TH
• Yang M
• Gwak MS
• Kim GS
• Kim MJ
• Cho HS
• Sim WS

• KMID: 1782017
• DOI: http://doi.org/10.3346/jkms.2009.24.5.930

Abstract

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.

Keyword

Analgesia, Patient-Controlled; Pain Measurement; Thoracic Surgery, Video-Assisted

MeSH Terms

Adult
Aged
Amides/therapeutic use
Analgesia, Epidural/methods
Analgesia, Patient-Controlled/*methods
Analgesics, Opioid/therapeutic use
Anesthesia, Intravenous/methods
Anesthetics, Local/therapeutic use
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Female
Fentanyl/therapeutic use
Humans
Ketorolac/therapeutic use
Male
Middle Aged
Pain Measurement
Pain, Postoperative/*drug therapy/prevention & control
Prospective Studies
Thoracoscopy

Figure

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  Fig. 1 Mean visual analogue scores (VAS) at rest and during movement. Error bars indicate standard error mean. There are no significant differences between two groups. IV, intravenous; PCA, patient-controlled analgesia.

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  Fig. 2 Mean daily doses of intravenous morphine given as a rescue medication. Error bars indicate standard error mean. There are no significant differences between two groups. IV, intravenous; PCA, patient-controlled analgesia.

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  Fig. 3 Mean percentage changes in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Error bars indicate standard error mean. There are no significant differences between two groups. IV, intravenous; PCA, patient-controlled analgesia; POD, post-operative day.

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