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Chang CY, Tu YK, Kao MC, Shih PC, Su IM, Lin HY, Chien YJ, Wu MY, Chen CH, Chen CT. Effects of opioids administered via intravenous or epidural patient-controlled analgesia after caesarean section: A network meta-analysis of randomised controlled trials. EClinicalMedicine 2023; 56:101787. [PMID: 36590790 PMCID: PMC9800204 DOI: 10.1016/j.eclinm.2022.101787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Post-caesarean section analgesia is important physiologically and psychologically for both mothers and infants. Patient-controlled analgesia is a well-established method of administering opioids for postoperative pain. However, to date, no study has systematically investigated the effects of opioids administered through intravenous patient-controlled analgesia (IVPCA) or patient-controlled epidural analgesia (PCEA) in parturients who have undergone caesarean section. METHODS This systematic review and network meta-analysis aimed to evaluate the analgesic and adverse effects of opioids administered via IVPCA or PCEA in parturients who have undergone a caesarean section. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched from inception through 02 10, 2022 for relevant records. Randomised controlled trials (RCTs) that compared opioids administered via IVPCA or PCEA and reported outcomes of interest were included. Studies were excluded if the solution for patient-controlled analgesia contained antiemetics and/or other analgesics in addition to opioids. The methodological quality of RCTs was assessed using the revised Cochrane Risk of Bias Tool. Summary data were extracted from each eligible study. The primary outcome was pain intensity, and the secondary outcomes were opioid-related adverse effects. Frequentist network meta-analyses were performed using a contrast-based random-effects model. This study is registered with PROSPERO, CRD42021254040. FINDINGS Twenty-three studies with 2589 parturients were included. Compared with IVPCA morphine as a reference treatment, PCEA fentanyl had better analgesic effects at 4 h (mean difference [MD] in the visual analogue scale score, -0.75; 95% confidence interval [CI] [-1.16, -0.34]) and 8 h (MD, -0.93; 95% CI [-1.57, -0.28]) and yielded lower odds of developing nausea/vomiting (odds ratio [OR], 0.27; 95% CI [0.09, 0.80]) and sedation/drowsiness (OR, 0.22; 95% CI [0.11, 0.45]). However, PCEA fentanyl may be more likely to cause pruritus than IVPCA treatments. INTERPRETATION Considering the analgesic efficacy; opioid-induced nausea, vomiting, and sedation; and the well-being of breastfed infants, PCEA fentanyl may be the treatment of choice for post-caesarean section analgesia. FUNDING The Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (TCRD-TPE-111-27).
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Affiliation(s)
- Chun-Yu Chang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chang Kao
- Department of Anesthesiology, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
| | - Ping-Cheng Shih
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Min Su
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Han-Yu Lin
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Hao Chen
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chu-Ting Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Corresponding author. Department of Anesthesiology, Taipei Tzu Chi Hospital, 289, Jianguo Rd., Sindian District, New Taipei City, 23142, Taiwan.
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Yousef AAAM, Atef AM, Awais WM. Comparison of fentanyl versus meperidine as supplements to epidural clonidine-bupivacaine in patients with lower limb orthopedic surgery under combined spinal epidural anesthesia. BMC Anesthesiol 2015; 15:146. [PMID: 26468074 PMCID: PMC4606990 DOI: 10.1186/s12871-015-0126-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The analgesic and sedative effect of clonidine explain its common use as adjuvant in regional anesthesia, however the hemodynamic instability associated with its neuroaxial administration is the major drawback. Our study hypothesis is to compare the hemodynamic and analgesic effect of epidural fentanyl in comparison to meperidine when added to clonidine in patients undergoing lower limbs orthopedic surgery using combined spinal-epidural anesthesia. METHODS One hundred thirty five ASA physical status I or II patients were recruited for lower limb orthopedic surgery. All received 2 mL intrathecal 0.5 % hyperbaric bupivacaine, 10 mL epidural 0.25 % plain bupivacaine, and 1 mL epidural clonidine 2 μg/kg (Clonidine group) and then either 1 ml fentanyl 25 μg (Fentanyl Group) or 1 ml meperidine 25 mg (Meperidine Group). The quality of surgical anesthesia, incidence of hypotension and bradycardia, intra-operative pain assessment, and onset of postoperative pain, sedation scores and side effects in the postoperative period were recorded. RESULTS The 1(st) analgesic requirement in the postoperative period was significantly prolonged in the meperidine group (p = 0.001). Significant decrease in the mean arterial blood pressure in fentanyl group was at 15, 30, 45, 60 and 90 min (p = 0.035, 0.019, 0.027, 0.032 and 0.039) respectively, significant decrease in meperdine group was at 15 and 30 min (p = 0.038 and 0.043), while in clonidine group a significant decrease was at 15, 30, 45, and 60 min (p = 0.025, 0.028, 0.036 and 0.042) respectively. Among group changes, the mean arterial blood pressure was significantly higher in meperdine group at 30, 45, 60 and 90 min (p = 0.007, 0.015, 0.029 and 0.033) respectively. A significant decrease in the heart rate in fentanyl group at 15, 30 and 45 min (p = 0.035, 0.018 and 0.029), in meperdine group a significant decrease in the heart rate was at 15 min (p = 0.038), while in clonidine group a significant decrease was at 15, and 30 min (p = 0.016 and 0.003) . Among group changes, the heart rate was significantly higher in meperdine group at 30, 45 and 60 min (p = 0.021, 0.017 and 0.011). VAS were significantly lower in meperdine group in comparison to fentanyl and clonidine groups at 2 h, 3 h and 4 h post-operative period (p = 0.024, 0.001 and 0.039). CONCLUSION The combined administration of epidural clonidine and meperidine provided better intraoperative hemodynamics and prolonged postoperative analgesia than epidural clonidine fentanyl combination in patients undergoing lower limb orthopedic surgery. TRIAL REGISTRATION Clinical Trail Registry (Clinicaltrail.gov) NCT 02128451 .
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Affiliation(s)
| | - Ashraf Mohamed Atef
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Waleed Mohamed Awais
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
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McDonnell NJ, Keating ML, Muchatuta NA, Pavy TJG, Paech MJ. Analgesia after caesarean delivery. Anaesth Intensive Care 2009; 37:539-51. [PMID: 19681409 DOI: 10.1177/0310057x0903700418] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As the number of women giving birth by caesarean increases throughout most of the developed world, so too is research into postoperative pain relief for these women. Like most other post-surgical populations, the new mother needs effective pain relief so that she can mobilise early but she also has the added responsibility of needing to care for her newborn baby. There is no 'gold standard' for post-caesarean pain management; the number of options is large and the choice of method is at least partly determined by drug availability, regional and individual preferences, resource limitations and financial considerations. Most methods rely on opioids, supplemented with anti-inflammatory analgesics, nerve blocks or other adjunctive techniques. The aim of this review is to detail commonly used opioid-based methods and to review the evidence supporting non-opioid methods, when incorporated into a multimodal approach to post-caesarean pain management. Areas of promising research are also discussed.
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Affiliation(s)
- N J McDonnell
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
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Tay TG, Brake TJ, Kwan AS. Patient-controlled epidural analgesia: a prospective audit of epidural pethidine 4 mg/ml and ropivacaine 0.2% with fentanyl 2 micrograms/ml. Anaesth Intensive Care 2003; 31:412-7. [PMID: 12973966 DOI: 10.1177/0310057x0303100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A prospective audit of one hundred and forty-seven (147) Acute Pain Service (APS) patients, who received postoperative patient-controlled epidural analgesia (PCEA) using pethidine 4 mg/ml or ropivacaine 0.2% with fentanyl 2 micrograms/ml in general surgical or orthopaedic wards over a twelve-month period, is presented. Data were collected from APS observation charts over a 48-hour period postoperatively. We found no significant difference in postoperative analgesia or side-effects between pethidine and ropivacaine with fentanyl in orthopaedic or general surgical patients.
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Affiliation(s)
- T G Tay
- Pain Management Unit, Department of Anaesthesia, United Christian Hospital, Kwun Tong, Hong Kong
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5
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Bird A, Wallis M. Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion. J Adv Nurs 2002; 40:522-31. [PMID: 12437601 DOI: 10.1046/j.1365-2648.2002.02409.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In Australian hospitals, epidural infusions are commonly used for the management of post-operative pain in maternity and surgical patients, with little research evidence to indicate the efficacy of the educational preparation of nurses undertaking pain management. AIMS To describe nurses' assessment skills and knowledge related to the management of a patient with an epidural infusion and to explore relationships between these variables and the levels of education/clinical experience of the nurses. METHODS This descriptive correlational study used a convenience sample of surgical and obstetric unit registered nurses to explore relationships between the knowledge and skill in epidural management and the educational preparation of the nurse. Data were collected via survey and observation, using instruments developed by the research team. RESULTS The nurses had a good knowledge base for the performance of sensory blockade assessment but scored less well in motor blockade assessment and clinical decision-making. Nurses who had clinical experience, had completed a self- directed learning package and who worked in surgical areas scored higher on the survey than other nurses. Observation scores revealed a range of performance outcomes. There was only a weak correlation between knowledge and skill performance. There were no differences in scores for the observation exercise for different groups of nurses. CONCLUSION The results of this study indicated that the nurses' theoretical knowledge outweighed their clinical skill performance and clinical decision-making. Education for nurses regarding the management of epidural infusions needs to be comprehensive, context specific and have the capacity to develop the nurse's autonomous critical thinking and clinical decision-making skills. Strategies for this include self-directed learning packages best supplemented by a demonstration of clinical skills and supervised practice.
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MESH Headings
- Analgesia
- Analgesia, Epidural/nursing
- Attitude of Health Personnel
- Clinical Competence/standards
- Drug Monitoring/nursing
- Education, Nursing, Continuing/standards
- Educational Status
- Health Knowledge, Attitudes, Practice
- Hospitals, District
- Hospitals, General
- Humans
- Nursing Assessment/standards
- Nursing Education Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/psychology
- Pain, Postoperative/drug therapy
- Pain, Postoperative/nursing
- Perioperative Nursing/education
- Postoperative Care/education
- Postoperative Care/nursing
- Queensland
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Affiliation(s)
- Annette Bird
- Acute Pain Service, Gold Coast Hospital, Queensland, Australia.
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6
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Banks S, Pavy T. A portable, disposable device for patient-controlled epidural analgesia following Caesarean section: evaluation by patients and nurses. Aust N Z J Obstet Gynaecol 2001; 41:372-5. [PMID: 11787908 DOI: 10.1111/j.1479-828x.2001.tb01312.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Twenty patients undergoing elective Caesarean section were provided with a pethidine-primed disposable Go Medical epidural infuser for postoperative pain control. Patients and nurses evaluated the device by completing a questionnaire. The infuser delivered adequate analgesia, was easy to understand and use, provided the patients with control over their pain relief and allowed good mobility The nursing staff found the device easy to prime and understand, the only drawback being the occasional incidence of equipment failure. The patients expressed a high level of satisfaction with the device and all would use it again if offered the chance. We conclude that the Go Medical epidural infuser is a safe and effective device as used in the postnatal ward setting.
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Affiliation(s)
- S Banks
- Department of Anaesthesia, King Edward Memorial Hospitalfor Women, Subiaco, Western Australia, Australia
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Pavy TJ, Paech MJ, Evans SF. The effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery. Anesth Analg 2001; 92:1010-4. [PMID: 11273941 DOI: 10.1097/00000539-200104000-00038] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nonsteroidal antiinflammatory drugs, including ketorolac, are widely used for postoperative analgesia. This randomized, double-blinded trial compared IV ketorolac or saline combined with meperidine patient-controlled epidural analgesia (PCEA) after cesarean delivery. Fifty healthy parturients scheduled for elective cesarean delivery under combined spinal-epidural anesthesia received PCEA plus either IV ketorolac (Group K) or saline (Group C) for 24 h. The ketorolac dose was modified, after six patients had been studied, based on new product information recommending a maximum of 120 mg ketorolac over 24 h. Group K (n = 24) and Group C (n = 20) were demographically similar. During the first 24 h, Group K used significantly less meperidine (P < 0.05). Postoperative pain at rest and with movement, and patient satisfaction, did not differ significantly between groups, except that worst pain at 12 h was less in Group K (P < 0.005). The two groups were similar with respect to patient recovery and side effects. IV ketorolac, as an adjunct to PCEA after cesarean delivery, produced a meperidine dose-sparing effect of approximately 30%, but did not significantly improve pain relief, reduce opioid-related side effects, or change patient outcome.
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Affiliation(s)
- T J Pavy
- Department of Anaesthesia and Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Subiaco 6008, Western Australia, Australia
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8
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Paech MJ, Pavy TJ, Orlikowski CE, Kuh J, Yeo ST, Lim K, Evans SF. Postoperative intraspinal opioid analgesia after caesarean section; a randomised comparison of subarachnoid morphine and epidural pethidine. Int J Obstet Anesth 2000; 9:238-45. [PMID: 15321077 DOI: 10.1054/ijoa.2000.0758] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A randomised, blinded clinical trial was performed to evaluate intraspinal opioid analgesic techniques after caesarean section. Healthy term parturients having elective caesarean section under combined spinal-epidural anaesthesia were allocated to one of three groups. Postoperative analgesia, including non-steroidal anti-inflammatory drugs, was provided using either pethidine patient-controlled epidural analgesia (group PCEA) or subarachnoid morphine 200 microg, the latter supplemented as required with patient-controlled intravenous pethidine (group SMPCIA) or oral paracetamol and codeine (group SMO). Maternal analgesia, side effects, recovery and satisfaction were assessed for 48 h. Of 144 parturients enrolled, 137 completed the study (PCEA n = 44, SMPCIA n = 45, SMO n = 48). The groups were demographically similar. All participants experienced good pain relief, including median visual analogue pain scores (0-100) with movement <40 between 0-24 h. However, pain scores were significantly lower at 8 and 12 h in those receiving subarachnoid morphine (P< 0.05). Women in groups receiving subarachnoid morphine experienced more severe pruritus (P<0.001), nausea (P< 0.001) and drowsiness (P< 0.05). Postoperative recovery of bowel function and ambulation occurred earlier in those using PCEA, although this did not appear to be of clinical significance. Patient satisfaction was similar, although women in group SMO were least likely to choose this approach again (P<0.05). We concluded that all three techniques provided effective analgesia for a prolonged period postoperatively. Better pain relief, but more opioid-related side effects, resulted from subarachnoid morphine 200 microg, and re-evaluation of reduced doses of subarachnoid morphine may be warranted.
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Affiliation(s)
- M J Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.
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9
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Khaw KS, Ngan Kee WD, Critchley LA. Epidural meperidine does not cause hemodynamic changes in the term parturient. Can J Anaesth 2000; 47:155-9. [PMID: 10674510 DOI: 10.1007/bf03018852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Meperidine has local anesthetic properties and, therefore, when given epidurally it has the potential to cause hemodynamic changes. Our objective was to study the hemodynamic effects of an analgesic dose of epidural meperidine (50 mg) in 34 ASA 1-2 term parturients scheduled for elective Cesarean section under epidural anesthesia. METHODS A lumbar epidural catheter was inserted and patients lay in the supine left wedge position. Intravenous fluid preload was withheld, and hemodynamic measurements comprising of mean arterial pressure, cardiac output and heart rate were made using automatic oscillotonometry (Dinamap 1486SX) and transthoracic electrical bioimpedance (Bomed NCCOM3). Following baseline measurements, the hemodynamic effects of sequential epidural injection of first, 10 ml saline, and 20 min thereafter, 50 mg meperidine diluted to 10 ml with saline, were recorded. Sensory blockade was assessed following each injection using loss of temperature discrimination to ice. Paired Student t tests were used to compare changes in hemodynamic variables. RESULTS Epidural meperidine produced a small increase from the saline values in the mean (SD) cardiac output of 5.81 +/-1.44 to 6.04+/-1.54 L x min(-1) (P<0.05), and mean arterial pressure of 77.1+/-8.8 to 79.3+/-9.9 mm Hg (P<0.05). Sensory changes, the upper level of which ranged from L1 to T1, were detected in 94% of patients given epidural meperidine. Epidural saline injection had no such hemodynamic effects, but produced a detectable sensory level in two patients. CONCLUSION Epidural meperidine, 50 mg, caused minimal hemodynamic changes in term parturients.
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Affiliation(s)
- K S Khaw
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Peoples Republic of China.
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10
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Rundshagen I, Kochs E, Standl T, Schnabel K, Schulte am Esch J. Subarachnoid and intravenous PCA versus bolus administration for postoperative pain relief in orthopaedic patients. Acta Anaesthesiol Scand 1998; 42:1215-21. [PMID: 9834808 DOI: 10.1111/j.1399-6576.1998.tb05280.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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MESH Headings
- Aged
- Analgesia/nursing
- Analgesia, Patient-Controlled/methods
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/therapeutic use
- Anesthesia, Inhalation
- Anesthesia, Spinal
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Anesthetics, Local/therapeutic use
- Bone and Bones/surgery
- Bupivacaine/administration & dosage
- Bupivacaine/adverse effects
- Bupivacaine/therapeutic use
- Female
- Humans
- Injections, Intravenous
- Injections, Spinal
- Male
- Middle Aged
- Multivariate Analysis
- Nausea/chemically induced
- Pain Measurement
- Pain, Postoperative/drug therapy
- Pirinitramide/administration & dosage
- Pirinitramide/adverse effects
- Pirinitramide/therapeutic use
- Prospective Studies
- Subarachnoid Space
- Wakefulness/drug effects
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Affiliation(s)
- I Rundshagen
- Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany
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Ngan Kee WD, Khaw KS, Ma ML. The effect of the addition of adrenaline to pethidine for patient-controlled epidural analgesia after caesarean section. Anaesthesia 1998; 53:1012-6. [PMID: 9893547 DOI: 10.1046/j.1365-2044.1998.00521.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have investigated the addition of adrenaline to pethidine for patient-controlled epidural analgesia after elective Caesarean section. In a randomised, double-blind study, patients received patient-controlled epidural analgesia for 24 h using pethidine 5 mg.ml-1 with adrenaline 5 micrograms.ml-1 (adrenaline group, n = 40) or pethidine 5 mg.ml-1 without adrenaline (plain group, n = 38). Visual analogue scale pain scores at rest and on coughing measured 2 h, 6 h and 24 h after surgery were similar between the two groups. There was a trend towards lower mean total consumption of pethidine in the adrenaline group (231.5 mg; SD 140.5 mg) compared with the plain group (289.5 mg; SD 139.5 mg; p = 0.071). Patients in the adrenaline group had higher visual analogue scale scores for nausea at 2 h and 24 h and higher scores for pruritus at 2 h compared with the plain group. Addition of adrenaline to pethidine for patient-controlled epidural analgesia does not appear to have significant clinical advantages.
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Affiliation(s)
- W D Ngan Kee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, People's Republic of China
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12
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Abstract
Pethidine is an effective epidural opioid for the treatment of acute pain. Its use has been well described in Australian and New Zealand practice, particularly in the field of obstetric anaesthesia. Reported methods of delivery have included bolus injection, continuous infusion and patient-controlled epidural analgesia. Areas of application have included treatment of postoperative pain, labour pain and intraoperative pain. Because of its intermediate lipid solubility, pethidine may have advantages over many other epidural opioids. However, potential for accumulation of norpethidine limits its use to relatively short durations of treatment.
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Affiliation(s)
- W D Ngan Kee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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13
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Patient-Controlled Epidural Analgesia After Caesarean Section Using a Disposable Deviee. Aust N Z J Obstet Gynaecol 1997. [DOI: 10.1111/j.1479-828x.1997.tb02415.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ngan Kee WD, Khaw KS, Ma ML. Patient-controlled epidural analgesia after caesarean section using meperidine. Can J Anaesth 1997; 44:702-6. [PMID: 9232297 DOI: 10.1007/bf03013381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To determine the effects of the addition of a background infusion to patient-controlled epidural analgesia (PCEA) using meperidine for analgesia after Caesarean section. METHODS In a randomized, double-blind study, we assigned 40 patients having elective Caesarean section to receive postoperative analgesia by patient-controlled epidural analgesia (PCEA) using meperidine 5 mg.ml-1 with (group Pi) or without (group Po) a background infusion of 10 mg.hr-l. The PCEA settings (20 mg bolus, 10 min lockout interval, four-hour maximum dose 150 mg) were otherwise identical. We compared pain at rest, pain on coughing, side effects, number of PCEA demands, drug consumption and patient satisfaction between groups in the first 24 hr after surgery. RESULTS Total consumption of meperidine was greater in group Pi (median 390 mg) than in group Po (median 240 mg; P = 0.017) and the number of PCEA demands was greater in group Po (median 12) than in group Pi (median 7.5; P = 0.012). Analgesia, side effects and patient satisfaction was similar between groups. CONCLUSION Addition of a background infusion to PCEA using meperidine after Caesarean section has no clinical benefit.
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Affiliation(s)
- W D Ngan Kee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Kee WDN. Postoperative Epidural Opioid Analgesia. Anesth Analg 1997. [DOI: 10.1213/00000539-199706000-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ngan Kee WD, Lam KK, Chen PP, Gin T. Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia using pethidine or fentanyl. Anaesth Intensive Care 1997; 25:126-32. [PMID: 9127653 DOI: 10.1177/0310057x9702500203] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We compared patient-controlled epidural analgesia (PCEA) with patient-controlled intravenous analgesia (PCIA) using pethidine or fentanyl in a randomized, double-blind crossover study of 80 patients after caesarean section. Patients received pethidine by PCEA or PCIA, or fentanyl by PCEA or PCIA, with a crossover of the route of administration at 12h. For pethidine, pain scores were lower with PCEA vs PCIA from 4 to 16h (P < 0.05). Pethidine consumption was lower with PCEA vs PCIA from 12 to 24h (P = 0.0005). Patients preferred PCEA to PCIA (P = 0.015). For fentanyl, pain scores were lower with PCEA vs PCIA at 12h (P = 0.045). Fentanyl consumption was lower with PCEA vs PCIA from 0 to 12h (P = 0.0007). Patients had similar preference for PCEA and PCIA. Pain scores and side-effects were similar between drugs. Plasma pethidine was similar between groups. Plasma fentanyl was higher with PCIA vs PCEA at 12h (P = 0.002). PCEA has advantages over PCIA and pethidine may be the preferred drug.
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Affiliation(s)
- W D Ngan Kee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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