Subarachnoid and intravenous PCA versus bolus administration for postoperative pain relief in orthopaedic patients
| Autor: | Eberhard Kochs, I. Rundshagen, Th. Standl, Kai U. Schnabel, J. Schulte am Esch |
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| Rok vydání: | 1998 |
| Předmět: |
Male
Pirinitramide medicine.medical_specialty Visual analogue scale medicine.drug_class medicine.medical_treatment Anesthesia Spinal Piritramide Bone and Bones Subarachnoid Space Route of administration Bolus (medicine) medicine Humans General anaesthesia Prospective Studies Anesthetics Local Wakefulness Injections Spinal Aged Pain Measurement Bupivacaine Pain Postoperative Patient-controlled analgesia Local anesthetic business.industry Analgesia Patient-Controlled Nausea General Medicine Middle Aged Surgery Analgesics Opioid Anesthesiology and Pain Medicine Anesthesia Injections Intravenous Multivariate Analysis Female Analgesia Anesthesia Inhalation business medicine.drug |
| Zdroj: | Acta Anaesthesiologica Scandinavica. 42:1215-1221 |
| ISSN: | 1399-6576 0001-5172 |
| DOI: | 10.1111/j.1399-6576.1998.tb05280.x |
| Popis: | BACKGROUND: Patient-controlled analgesia (PCA) with intravenous piritramide and subarachnoid bupivacaine was studied during postoperative pain management in comparison with nurse-administered bolus injections. METHODS: Following general anaesthesia (n = 60) patients randomly received either 3.75-7.5 mg i.v. piritramide on demand (group P-Bolus) or via PCA (group P-PCA; initial bolus: 3.75 mg i.v. piritramide, baseline rate: 1 mg/h, demand-dose 1.5 mg, lockout time: 20 min). Following continuous spinal anaesthesia (n = 60; CSA; 28-G spinal catheter) patients randomly received a subarachnoid injection of 1.5 ml bupivacaine 0.25% every 2-4 h (group B-Bolus) or a baseline infusion of 0.5 ml/h bupivacaine 0.125% plus 0.5 ml bupivacaine 0.125% on demand via PCA (group B-PCA; lockout time: 30 min). Pain ratings were assessed hourly by patients using a visual analogue scale (0 = no pain, 100 mm = unbearable pain). STATISTICS: multivariate analysis of variance. RESULTS: While pain scores did not differ between group P-Bolus and P-PCA, group B-PCA showed the lowest pain ratings (18 +/- 22 mm) differing significantly from group B-Bolus (41 +/- 32 mm; P < 0.001). Group P-PCA required more piritramide than group P-Bolus (46 +/- 15 mg vs. 31 +/- 13 mg, P = 0.001). In contrast group B-PCA required less bupivacaine than group B-Bolus (18 +/- 4 vs. 23 +/- 7 mg, P = 0.002). CONCLUSION: PCA with CSA was more effective than nurse-administered bolus-administration of bupivacaine, while the present study failed to show superiority of i.v. PCA over i.v. bolus-administration of piritramide. PCA using the subarachnoid route is a promising concept for treatment of postoperative pain in orthopaedic patients, while the PCA piritramide regime of this study warrants improvement. |
| Databáze: | OpenAIRE |
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