Ann Surg Treat Res.  2015 Feb;88(2):86-91. 10.4174/astr.2015.88.2.86.

Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer?

• Choi YY
• Park JS
• Park SY
• Kim HJ
• Yeo J
• Kim JC
• Park S
• Choi GS

• KMID: 1804125
• DOI: http://doi.org/10.4174/astr.2015.88.2.86

Abstract

PURPOSE
Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach.
METHODS
Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured.
RESULTS
Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03).
CONCLUSION
Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.

Keyword

Patient-controlled analgesia; Laparoscopy; Colorectal neoplasms

MeSH Terms

Analgesia
Analgesia, Patient-Controlled*
Colorectal Neoplasms*
Humans
Incidence
Laparoscopy*
Length of Stay
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Postoperative Nausea and Vomiting
Retrospective Studies

Figure

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  Fig. 1 Patient allocation into intravenous patient-controlled analgesia (IV-PCA) group and non-PCA group. DB, data base; EPIC, early postoperative intraperitoneal chemotherapy; Maj. combined Rx., major combined resection.

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  Fig. 2 Visual analogue scale (VAS) assessing pain and postoperative nausea and vomiting (PONV) in the two groups. PCA, patient-controlled analgesia; POD, postoperative day.

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  Fig. 3 Volume of rescue analgesia (intravenous tramadol) administered to patients in the two groups. PCA, patient-controlled analgesia; POD, postoperative day. *P < 0.05, significant difference.

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