کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5884521 | 1567656 | 2016 | 6 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Original ContributionEffect of thoracic epidural analgesia on recovery of bowel function after major upper abdominal surgery Original ContributionEffect of thoracic epidural analgesia on recovery of bowel function after major upper abdominal surgery](/preview/png/5884521.png)
- Thoracic epidural analgesia (TEA) did not shorten the first gas-out time.
- TEA delayed the first voiding time.
- TEA did not promote earlier discharge compared to iv-PCA.
- Pain score was lower in TEA with 40% to 46% less rescue analgesics.
Study ObjectiveWe 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.DesignProspective observational study.SettingA tertiary care university hospital.PatientsFifty-six patients undergoing major upper abdominal surgery.InterventionsTEA (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.MeasurementThe primary end point was first gas-out time, and the secondary end points were hospital discharge, pain scores, and first voiding time.Main ResultsNo 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.ConclusionTEA 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.
Journal: Journal of Clinical Anesthesia - Volume 34, November 2016, Pages 247-252