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:: Volume 23, Issue 6 (Bimonthly 2019) ::
Feyz 2019, 23(6): 647-656 Back to browse issues page
Comparison of thoracic epidural analgesia method and intravenous PCA (Patient Controlled Analgesia) in terms of analgesia and surgical complications in patients with upper abdominal surgery
Vahideh ShahNazari , Afshin Farhanchi , Hamidreza Khorshid * , Sajjad Daneshyar
Department of Surgery, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, I.R. Iran. , hkhorshidi57@yahoo.com
Abstract:   (1747 Views)
Background: Prevention and treatment of acute postoperative pain have an important role in improvement of patients’ conditions. This study aimed to compare between two methods (IV- patient controlled analgesia and Thoracic Epidural Analgesia) in terms of analgesia and surgical complications in patients with upper abdominal surgery.
Materials and Methods: In this clinical trial study, the subjects were chosen from the patients referred to Besat hospital in Hamadan for upper abdominal surgery. Sample size in each group was 72 patients. Data was collected by a questionnaire that included assessment of pulmonary function, pain levels (in both quantitative and qualitative scales), postoperative complications, analgesic usage, and patient satisfaction. After all data was analyzed by SPSS V: 21.
Results: Postoperative pain during the first 24 hours after surgery was higher in epidural group by using quantitative and qualitative methods but in second 24 hours, pain in this group only by qualitative method was more (Which was statistically meaningful). Complications of analgesic techniques were similar in both groups, but nausea in the PCA group and paresthesia in the epidural group was higher. The respiratory parameters measured didn't show significant differences between two methods. Patient satisfaction was greater in the PCA group but there are no differences between groups in satisfaction of nurses.
Conclusion: The PCA method is effective as the thoracic epidural analgesia method in reducing post-operative pain, and since this method is simpler and less expensive, it can be used safely for post-operative analgesia. Also it's better not to use a thoracic epidural method in patients with spinal, neuromuscular and sensory disorders.
Keywords: Patient Controlled Analgesia, Thoracic epidural, Surgery
Full-Text [PDF 316 kb]   (656 Downloads)    
Type of Study: Research | Subject: medicine, paraclinic
Received: 2019/03/7 | Accepted: 2019/12/21 | Published: 2020/02/12
1. Ramsay MA. Acute postoperative pain management. Proc (Bayl Univ Med Cent) 2000; 13(3): 244–7.
2. [2] Peeters-Asdourian C, Gupta S. Choices in pain management following thoracotomy. Chest 1999; 115: 122S-4S.
3. Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg 2013; 26(3): 191–196.
4. Langlade A, Briard C, Bouguet D, Blanchard F, Conan F. Patient-controlled analgesia and postoperative pain. Cah Anesthesiol 1994; 42(2): 183-9.
5. Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intraabdominal surgery. Cochrane Database Syst Rev 2005; 100: 1536.
6. Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006; 15(1): 17–24.
7. Tavakoli A, Nourouzi M, Haji ZE. Patient's satisfaction from pain soothing after the surgery in Kerman hospitals (2005). J Kermanshah 2007: 206-14. [in Persian]
8. Ghergiani V, Nicolae G, Cindea I, Popescu R, Grasa C. Patient-controlled analgesia after major abdominal surgery in the elderly patient. Epid Analg 2012: 16-27.
9. Ohnhaus EE, Adler R. Methodological problems in the measurement of pain: A comparison between the verbal rating scale and the visual analogue scale. Pain 1975; 1(4): 379–84.
10. Loos MJ, Houterman S, Scheltinga MR, Roumen RM, Evaluating postherniorrhaphy groin pain: visual analogue or verbal rating scale?. Hernia 2008; 12(2): 147-51.
11. Holdgate A, Asha S, Craig J, Thompson J. Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emerg Med (Fremantle) 2003; 15(5-6): 441-6.
12. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005; 14(7): 798-804.
13. Lund I, Lundeberg T, Sandberg L, Budh CN, Kowalski J, Svensson E. Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups. BMC Med Res Methodol 2005; 5(1): 31.
14. George KA, Wright PM, Chisakuta AM, Rao NV. Thoracic epidural analgesia compared with patient controlled intravenous morphine after upper abdominal surgery. Acta Anaesthesiol Scand 2008; 38: 808-12.
15. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan Jr JA, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. Jama 2003; 290(18): 2455-63.
16. Soliman IE, Apuva JS, Fertal KM, Simpson PM, Tobian JD. Intravenous versus epidural analgesia after surgical repair of pectus excavatum. Am J Ther 2009; 16(5): 398-403.
17. Butkovic D, Kralik S, Matolic M, Kralik M, Toljan S, Radesic L. Postoperative analgesia with intravenous fentanyl PCA vs epidural block after thoracoscopic pectus excavatum repair in children. Br J Anesth 2007; 98(5): 677-81.
18. Clarke H, Chandy T, Srinivas C, Ladak S, Okubo N, Mitsakakis N, et al. Epidural analgesia provides better pain management after live liver donation: a retrospective study. Liver Transpl 2011; 17(3): 315-23.
19. Viscusi ER. Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg 2005; 101: 523-29.
20. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990; 13(4): 227-36.
21. Yosunkaya A, Tavlan A, Tuncer S, Reıslı R, Topal A, Ökeslı S. Comparison of the effects of intravenous and thoracic epidural patient-controlled analgesia with morphine after upper abdominal surgery. Pain Clin 2003; 15(3): 271-79.
22. Tripathi M, Pandey M. Epidural catheter fixation: subcutaneous tunneling with a loop to prevent displacement. Anaesth 2000; 55(11): 1113-6.
23. Motamed C, Farhat F, Rémérand F, Stéphanazzi J, Laplanche A. An analysis of postoperative epidural analgesia failure by computed tomography epidurography. Anesth Analg 2006; 103(4): 1026-32.
24. Arendt K, Segal S. Why epidurals do not always work. Rev Obstet Gynecol 2008; 1(2): 49–55.
25. Baggerly J. Epidural catheters for pain management: the nurse's role. J Neurosci Nurs 1986; 18(5): 290-5.
26. Manion SC, Brennan TJ. Thoracic epidural analgesia and acute pain management. Anesthesiology. ASA 2011; 115(1): 181-8.
27. Dennis J, Mills P. Thoracic epidural versus morphine patient controlled analgesia after laparoscopic colectomy. World J Laparosc Surg 2008; 1(3): 49-52.
28. Hansdottir V, Philip J, Olsen MF, Eduard C, Houltz E, Ricksten SE. Thoracic epidural versus intravenous patient-controlled analgesia after cardiac surgery: a randomized controlled trial on length of hospital stay and patient-perceived quality of recovery. Anesthesiology 2006; 104(1): 142-51.
29. Paulsen EK, Porter MG, Helmer SD, Linhardt PW, Kliewer ML. Thoracic epidural versus patient-controlled analgesia in elective bowel resections. Am J Surg 2001; 182(6): 570-7.
30. Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth 2001; 87(1): 36-46.
31. Moslemi F, Rasooli S, Baybordi A, Golzari SE. A comparison of patient controlled epidural analgesia with intravenous patient controlled analgesia for postoperative pain management after major gynecologic oncologic surgeries: a randomized controlled clinical trial. Anesthesiol Pain Med 2015; 5(5).
32. Wongyingsinn M, Baldini G, Charlebois P, Liberman S, Stein B, Carli F. Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program. Anesthesiol Pain Med 2011; 36: 241-8.
33. Radovanović D, Radovanović Z, Škorić-Jokić S, Tatić M, Mandić A, Ivković-Kapicl T. Thoracic epidural versus intravenous patient-controlled analgesia after open colorectal cancer surgery. Acta Clin Croat 2017; 56(2): 244-54.
34. Ali M, Winter DC, Hanly AM, O'hagan C, Keaveny J, Broe P. Prospective randomized controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth 2010; 104(3): 292–7.
35. Paulsen EK, Porter MG, Helmer SD, Linhardt PW, Kliewer ML. Thoracic epidural versus patient-controlled analgesia in elective bowel resections. Am J Surg 2009; 182(6): 570-77.
36. Wu CL, Jani ND, Perkins FM, Barquist E. Thoracic epidural analgesia versus intravenous patient-controlled analgesia for the treatment of rib fracture pain after motor vehicle crash. J Trauma 1999; 47(3): 564-7.
37. Pöpping DM, Elia N, Marret E, Remy C, Tramer MR. Protective effects of epidural analgesia on pulmonary complications. Arch Surg 2008; 143(10): 990-9.
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ShahNazari V, Farhanchi A, Khorshid H, Daneshyar S. Comparison of thoracic epidural analgesia method and intravenous PCA (Patient Controlled Analgesia) in terms of analgesia and surgical complications in patients with upper abdominal surgery. Feyz 2019; 23 (6) :647-656
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Volume 23, Issue 6 (Bimonthly 2019) Back to browse issues page
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