| The Evaluation of Intravenous Patient Controlled Analgesia and Continuous Epidural Analgesia for Pain Relief after Cesarean Delivery. |
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Youn Soo Kim, Young Kil Choi, Nam Sik Woo |
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Department of Anesthesiology, College of Medicine, Konkuk University, Seoul, Korea. |
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| Abstract |
BACKGROUND
Routine management of postoperative pain have been changed as a result of technological advances in drug delivery systems. The purpose of this study was to compare the effect of continuous epidural analgesia(CEA) system and intravenous patient controlled analgesia (IV-PCA) system for pain relief after cesarean delivery.
METHODS
Sixty adult women were randomly assigned to receive analgesics either IV-PCA or CEA after cesarean delivery with general anesthesia for operation. IV-PCA group was received 30 mg intramuscular injection of ketorolac after awakening, followed by IV-PCA. PCA unit was filled with 60 ml; mixed with morphine 10 mg, fentanyl 1000 microgram, ketorolac 180 mg, and normal saline. It had a flow rate of 0.5 ml/hr and lockout interval was 15minutes. CEA group was received a bolus of epidural morphine 3mg and 8ml of 0.25% bupivacaine before the end of operation, followed by CEA. CEA unit was filled with 100 ml; mixed with morphine 4 mg, fentanyl 500 microgram, 0.5% bupivacaine 20 ml, and normal saline. It had a flow rate of 2ml/hr. The degree of analgesia was subjectively evaluated by a visual analogue scale(VAS).
Patients were evaluated 0, 1, 2, 6, 12, 24, and 48hours after operation for pain relief, sedation, nausea, vomiting, pruritus, and respiratory rate.
RESULTS
VAS pain score were significantly lower in CEA group than IV-PCA group at 0(8.0+/-1.4 vs 3.9+/-0.7), 1(4.4+/-1.3 vs 3.3+/-0.9) and 2hours(3.9+/-1.2 vs 3.3+/-0.8)(p<0.05). There were no apparent cases of respiratory depression and motor weakness of lower extrimity. Nausea or vomiting occurred in 7 patients(23%) of IV-PCA group, and occurred in 3 patients(10%) of CEA group.
Pruritus occurred in 6 patients(20%) of IV-PCA group, and occurred in 11 patients (37%) of CEA group. Sedation occurred in 9 patients(30%) of IV-PCA group.
Conculsions: We conclude that the CEA with small dose of morphine, fentanyl and bupivacaine is an easy and effective method for pain control after cesarean delivery. |
| Key Words:
Analgesia: patient controlled, epidural, intravenous; postoperative; Analgesics: fentanyl; ketorolac; morphine; Anesthetics, local: bupivacaine; Surgery: obstetrics |
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