The Evaluation of Intravenous Patient Controlled Analgesia and Continuous Epidural Analgesia for Pain Relief after Cesarean Delivery.
10.4097/kjae.1998.35.1.125
- Author:
Youn Soo KIM
1
;
Young Kil CHOI
;
Nam Sik WOO
Author Information
1. Department of Anesthesiology, College of Medicine, Konkuk University, Seoul, Korea.
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Analgesia: patient controlled, epidural, intravenous;
postoperative;
Analgesics: fentanyl;
ketorolac;
morphine;
Anesthetics, local: bupivacaine;
Surgery: obstetrics
- MeSH:
Adult;
Analgesia;
Analgesia, Epidural*;
Analgesia, Patient-Controlled*;
Analgesics;
Anesthesia, General;
Bupivacaine;
Drug Delivery Systems;
Female;
Fentanyl;
Humans;
Injections, Intramuscular;
Ketorolac;
Morphine;
Nausea;
Pain, Postoperative;
Passive Cutaneous Anaphylaxis;
Pruritus;
Respiratory Insufficiency;
Respiratory Rate;
Vomiting
- From:Korean Journal of Anesthesiology
1998;35(1):125-131
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Routine management of postoperative pain have been changed as a result of technological advances in drug delivery systems. The purpose of this study was to compare the effect of continuous epidural analgesia(CEA) system and intravenous patient controlled analgesia (IV-PCA) system for pain relief after cesarean delivery. METHODS: Sixty adult women were randomly assigned to receive analgesics either IV-PCA or CEA after cesarean delivery with general anesthesia for operation. IV-PCA group was received 30 mg intramuscular injection of ketorolac after awakening, followed by IV-PCA. PCA unit was filled with 60 ml; mixed with morphine 10 mg, fentanyl 1000 microgram, ketorolac 180 mg, and normal saline. It had a flow rate of 0.5 ml/hr and lockout interval was 15minutes. CEA group was received a bolus of epidural morphine 3mg and 8ml of 0.25% bupivacaine before the end of operation, followed by CEA. CEA unit was filled with 100 ml; mixed with morphine 4 mg, fentanyl 500 microgram, 0.5% bupivacaine 20 ml, and normal saline. It had a flow rate of 2ml/hr. The degree of analgesia was subjectively evaluated by a visual analogue scale(VAS). Patients were evaluated 0, 1, 2, 6, 12, 24, and 48hours after operation for pain relief, sedation, nausea, vomiting, pruritus, and respiratory rate. RESULTS: VAS pain score were significantly lower in CEA group than IV-PCA group at 0(8.0+/-1.4 vs 3.9+/-0.7), 1(4.4+/-1.3 vs 3.3+/-0.9) and 2hours(3.9+/-1.2 vs 3.3+/-0.8)(p<0.05). There were no apparent cases of respiratory depression and motor weakness of lower extrimity. Nausea or vomiting occurred in 7 patients(23%) of IV-PCA group, and occurred in 3 patients(10%) of CEA group. Pruritus occurred in 6 patients(20%) of IV-PCA group, and occurred in 11 patients (37%) of CEA group. Sedation occurred in 9 patients(30%) of IV-PCA group. Conculsions: We conclude that the CEA with small dose of morphine, fentanyl and bupivacaine is an easy and effective method for pain control after cesarean delivery.
