Intravenous anesthesia


Anesthesia and Pain Medicine. 2002 Mar. 6(1): 24-31
ⓒ Korean Society for Intravenous Anesthesia
The Effect of Intravenous Patient-Controlled Analgesia on Patients with Thoracotomy
Hee Pyoung Park, Yong Seok Oh
Department of Anesthesiology, College of Medicine, Seoul National University, Seoul, Korea

BACKGROUND: Pain is the most important factor responsible for ineffective ventilation and cough in patients undergoing thoracotomy. Intravenous patient-controlled analgesia (PCA) is widely used for postoperative pain control. Opoid contained PCA is likely to increase the incidence of postoperative nausea and vomiting (PONV). We studied the effect of PCA on patients with thoracotomy.
METHOD: After consciousness was recovered from anesthetic emergence, PCA was connected to 85 patients in postanesthetic recovery room or intensive care unit. The PCA regimen was composed of ketorolac, fentanyl and morphine, and the doses of drugs was adjusted according to patient\'s age and sex. The PCA was set at basal rate 0.5 ml/hr, bolus dose 1 ml, lockout time 10 min. The incidence and severity of nausea, vomiting, sedation, pain and other side effects were assessed at 1, 4, 8, 12, 18, 24, 36, 48, 60 and 72 hr postoperatively.
RESULT: The highest VAS score was 5.7 on 1hr postoperatively. As time went by, VAS score decreased to 3.1. PONV occurred in 31 patients. The incidence of PONV is higher in female than in male (P < 0.01). Sedation occurred in 40 patients, and drowsy state is most common. Both pruritus and urinary retention occurred in 12 patients respectively. Respiratory depression below 8 breaths/min was not observed in all subjects.
CONCLUSION: The use of PCA on patients undergoing thoracotomy represented satisfactory pain relief except immediate postoperative period. Side effects, such as PONV and sedation, were successfully treated by supportive care and temporary hold of infusion of PCA.
Key words : Analgesia, patient-controlled, Surgery, thoracotomy, Complications, postoperative, nausea and vomiting
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