Effects of Intravenous and Epidural Patient-Controlled Analgesia on Postoperative Pain and Knee Rehabilitation after a Unilateral Total Knee Replacement.
10.4097/kjae.2001.40.1.47
- Author:
Jeong Seon HAN
1
;
Soo Kyung PARK
;
Myung Sin SUH
;
Eun Sook YOO
;
Sook Young LEE
;
Byung Hyun MIN
;
Bong Ki MOON
Author Information
1. Departments of Anesthesiology, Ajou University School of Medicine, Suwon, Korea.
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Analgesia: pain;
patient-controlled;
postoperative;
Analgesics: epidural;
intravenous;
ketorolac;
morphine;
Anesthetics, local: bupivacaine;
Surgery: total knee replacement;
rehabilitation
- MeSH:
Analgesia, Epidural;
Analgesia, Patient-Controlled*;
Arthroplasty, Replacement, Knee*;
Bupivacaine;
Humans;
Ketorolac;
Knee*;
Morphine;
Pain, Postoperative*;
Rehabilitation*
- From:Korean Journal of Anesthesiology
2001;40(1):47-53
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Postoperative pain is a major concern after a total knee replacement (TKR). It hinders early intense physical therapy, the most influential factor for good postoperative knee rehabilitation. The purpose of this study was to compare intravenous patient-controlled analgesia (IV-PCA) using morphine and continuous ketorolac IV infusion with patient-controlled epidural analgesia (PCEA) using morphine and continuous bupivacaine infusion in terms of analgesic efficacy and postoperative knee rehabilitation after a unilateral TKR. METHODS: Eighteen patients undergoing a unilateral total knee replacement were randomly allocated to one of the two groups. In group IV-PCA (n = 9), 30 min before the end of surgery, patients received ketorolac 30 mg IV bolus followed by continuous infusion with ketorolac (5 mg/h) and IV-PCA with morphine (20microgram/kg, lockout 10 min). In group PCEA (n = 9), 30 min before the end of surgery, patients received 2 mg morphine bolus followed by continuous infusion with 0.1% bupivacaine (2 ml/h) and PCEA with morphine (1 mg, lockout 15 min). RESULTS: There were significant differences in visual analogue scale scores at the first 2-hours after the unilateral TKR, cumulative morphine consumption and number of postoperative days required to obtain 90o knee flexion. CONCLUSIONS: PCEA using a morphine-bupivacaine combination provided better pain relief and faci litated the continuous passive motion more than IV-PCA using a morphine-ketorolac combination. This results in possible faster postoperative knee rehabilitation.
