A Prospective Survey of Patient-Controlled Epidural Analgesia with Bupivacaine and Clonidine After Total Hip Replacement
| Autor: | Yan Ma, James J. Bae, Mihai Bieltz, Spencer S. Liu, Barbara Wukovits |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Side effect Nausea Arthroplasty Replacement Hip Sedation Analgesic Clonidine medicine Humans Hydromorphone Prospective Studies Anesthetics Local Aged Pain Measurement Bupivacaine Pain Postoperative business.industry Analgesia Patient-Controlled Middle Aged Surgery Analgesia Epidural Analgesics Opioid Regimen Anesthesiology and Pain Medicine Anesthesia Drug Therapy Combination Female medicine.symptom business Adrenergic alpha-Agonists medicine.drug |
| Zdroj: | Anesthesia & Analgesia. 113:1213-1217 |
| ISSN: | 0003-2999 |
| DOI: | 10.1213/ane.0b013e318228fc8b |
| Popis: | BACKGROUND AND OBJECTIVES Patient-controlled epidural analgesia (PCEA) with bupivacaine and hydromorphone provides high quality analgesia after orthopedic surgery but is associated with a frequent incidence of opioid-related side effects (15%-30%). Epidural clonidine has a different side effect profile, but there are no large surveys documenting its use. We performed this prospective survey to evaluate analgesia and the side effect profile in total hip replacement patients before and after a systematic change from PCEA with bupivacaine/hydromorphone to bupivacaine/clonidine. METHODS Five hundred consecutive patients received PCEA with 0.06% bupivacaine and hydromorphone (10 mcg/mL) as a previously described prechange control group. The standard analgesic regimen was then systematically changed to 0.06% bupivacaine and clonidine (1 mcg/mL) without changing the PCEA settings or other aspects of perioperative care, and 500 consecutive patients were included as a postchange group. All data were prospectively entered and then abstracted from the electronic medical record. Data collection included daily verbal pain scores (VPS), pruritus, nausea, hypotension, need for IV fluid boluses, sedation, and respiratory depression. An online survey to measure staff satisfaction with the changeover was sent to all participating surgeons, anesthesiologists, physical therapists, and physician's assistants. RESULTS Patient characteristics were similar between groups. Most patients received central neuraxial anesthesia (99%). The clonidine group had lower VPS at rest (2.3 vs 3.7, P |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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