Ss. Liu et al., PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH BUPIVACAINE AND FENTANYL ON HOSPITAL WARDS - PROSPECTIVE EXPERIENCE WITH 1,030 SURGICAL PATIENTS, Anesthesiology, 88(3), 1998, pp. 688-695
Background: The efficacy and safety of patient-controlled epidural ana
lgesia (PCEA) for postoperative analgesia on hospital wards was studie
d. Methods: Postoperative analgesia was provided for 1,030 patients wi
th PCEA using 0.05% bupivacaine and fentanyl, 4 mu g/ml, in a standard
ized manner, Patients were seen at least twice a day by the staff of t
he anesthesia pain management service, Prospectively gathered data inc
luded verbal pain scores at rest and activity (0-10); consumption of b
upivacaine and fentanyl; and incidences of pruritus, nausea, sedation,
hypotension, motor block, and respiratory depression, Descriptive sta
tistics were used. Risk factors for side effects were determined using
logistic regression, Results: The study included 552 women and 477 me
n who underwent a median (mode) of 3 (2) days of PCEA. Their mean age
was 59 +/- 16 yr and their mean weight was 76 +/- 19 kg, There were 45
4 abdominal, 165 gynecologic, 126 urologic, 108 vascular, 90 thoracic,
83 orthopedic, and 4 plastic surgical procedures, Median (mode) pain
scores were 1 (0) at rest and 4 (5) with activity on postoperative day
1, Incidences of side effects were 16.7% (pruritus), 14.8% (nausea),
13.2% (sedation), 6.8% (hypotension), 2% (motor block), and 0.3% (resp
iratory depression), Reasons for termination of PCEA were elective (82
%), displaced epidural catheter (12%), anticoagulation (3%), infection
(1%), side effects (1%), inadequate analgesia (1%), and other (<1%).
Risk factors for side effects were female sex, patient weight <73 kg,
patient age <58 yr, bupivacaine and fentanyl consumption >9 ml/h, use
of analgesic adjuncts, and lumbar placement of epidural catheters. Con
clusion: Patient-controlled epidural analgesia provides effective and
safe postoperative analgesia on hospital wards.