Jin Hee Ahn1, Hyun Joo Ahn2. 1. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hyunjooahn@skku.edu.
Abstract
STUDY OBJECTIVE: We investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. DESIGN: Prospective observational study. SETTING: A tertiary care university hospital. PATIENTS: Fifty-six patients undergoing major upper abdominal surgery. INTERVENTIONS: TEA (n=28) was performed using a paramedian approach at T6-7 or T7-8. Hydromorphone (8 μg/mL) was added to 0.15% ropivacaine (bolus/lockout time/basal: 3 mL/15 minutes/5 mL). The iv-PCA regimen (n=28) included 20 μg/mL fentanyl (bolus/lockout time/basal: 0.5 mL/15 minutes/0.5 mL). The 2 analgesic methods were maintained for 3 days. MEASUREMENT: The primary end point was first gas-out time, and the secondary end points were hospital discharge, pain scores, and first voiding time. MAIN RESULTS: No differences in first gas-out time (TEA, 4.1±1.2 days; iv-PCA, 3.4±1.9 days; P=.15) or hospital stay (TEA, 9.8±2.2 days; iv-PCA, 11.4±5.2 days; P=.19) were observed between the 2 groups. A visual analog pain scale scores during rest and coughing were lower in the TEA than those for iv-PCA even with 40% to 46% less rescue analgesic. However, TEA delayed first voiding time (3.6±0.9 vs 2.8±1.6 days; P=.02) and required more frequent bladder catheterization (46% vs 11%; P=.008) than those of iv-PCA. CONCLUSION: TEA with a regimen of hydromorphone (8 μg/mL) added to 0.15% ropivacaine did not provide earlier gas-out compared to that of iv-PCA in patients who underwent major upper abdominal surgery.
STUDY OBJECTIVE: We investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. DESIGN: Prospective observational study. SETTING: A tertiary care university hospital. PATIENTS: Fifty-six patients undergoing major upper abdominal surgery. INTERVENTIONS:TEA (n=28) was performed using a paramedian approach at T6-7 or T7-8. Hydromorphone (8 μg/mL) was added to 0.15% ropivacaine (bolus/lockout time/basal: 3 mL/15 minutes/5 mL). The iv-PCA regimen (n=28) included 20 μg/mL fentanyl (bolus/lockout time/basal: 0.5 mL/15 minutes/0.5 mL). The 2 analgesic methods were maintained for 3 days. MEASUREMENT: The primary end point was first gas-out time, and the secondary end points were hospital discharge, pain scores, and first voiding time. MAIN RESULTS: No differences in first gas-out time (TEA, 4.1±1.2 days; iv-PCA, 3.4±1.9 days; P=.15) or hospital stay (TEA, 9.8±2.2 days; iv-PCA, 11.4±5.2 days; P=.19) were observed between the 2 groups. A visual analog pain scale scores during rest and coughing were lower in the TEA than those for iv-PCA even with 40% to 46% less rescue analgesic. However, TEA delayed first voiding time (3.6±0.9 vs 2.8±1.6 days; P=.02) and required more frequent bladder catheterization (46% vs 11%; P=.008) than those of iv-PCA. CONCLUSION:TEA with a regimen of hydromorphone (8 μg/mL) added to 0.15% ropivacaine did not provide earlier gas-out compared to that of iv-PCA in patients who underwent major upper abdominal surgery.
Authors: Thomas A Aloia; Bradford J Kim; Yun Shin Segraves-Chun; Juan P Cata; Mark J Truty; Qiuling Shi; Alexander Holmes; Jose M Soliz; Keyuri U Popat; Thomas F Rahlfs; Jeffrey E Lee; Xin Shelley Wang; Jeffrey S Morris; Vijaya N R Gottumukkala; Jean-Nicolas Vauthey Journal: Ann Surg Date: 2017-09 Impact factor: 12.969