Comparison of Analgesic Requirements for Postoperative Pain Control in Patients Undergoing Major Orthopedic Surgery

Hwang, Hyun Sook; Kim, Hyun Hae; Shin, Jin Woo; Leem, Chung Gill; Lee, Cheong; Yang, Hong Seuk; Lee, Dong Myung

Abstract

BACKGROUND
In postoperative pain management, using a patient-controlled analgesia (PCA) device, the number of requests and total infusing dose of analgesics can be measured. Therefore, it is more objective to compare the pain intensity among different types of operation when a PCA device is used. Using PCA fentanyl consumption as a parameter, an attempt was made to elucidate the differences in the intensity of pain associated with total hip and total knee replacements by comparing the fentanyl requirements. METHODS: Sixty female patients, with ages greater than 50 yrs, undergoing an elective total hip replacement (THR, n = 20), total knee replacement (TKR, n = 20) or posterolateral lumbar spinal fusion (PLF, n = 20), were enrolled to the present study. Fentanyl was administered in a calculated loading dose before the end of surgery, in order to achieve acceptable analgesia (VNRS = 5), which was followed by fentanyl-ketorolac PCA. Patients were followed up for 2 days postoperatively. The verbal numeric rating scale (VNRS), total dose, rescue dose and side effects of PCA were all checked. RESULTS: The fentanyl consumption was greater in the TKR than in either the THR or PLF groups at each assessment (P< 0.05). The VNRS was higher in the TKR than in either the THR or PLF groups during the postoperative days (P< 0.05). The rescue analgesic count was greater in the TKR than in either the THR or PLF groups (P< 0.01). No statistical differences in side effects were found between the 3 groups. CONCLUSIONS: Using the PCA fentanyl consumption as parameter, the magnitude of pain intensity could be distinguished between the 3 major orthopedic surgeries under examination. The pain intensity was greater in the TKR than in either the THR or PLF groups.