Efficacy of Programmed Intermittent Bolus Epidural Analgesia in Thoracic Surgery

A Randomized Controlled Trial

M. Higashi; K. Shigematsu; E. Nakamori; S. Sakurai; K. Yamaura

Disclosures

BMC Anesthesiol. 2019;19(107) 

In This Article

Results

Fifty patients who underwent open lung lobectomy or partial lobectomy were randomly divided into the CEI group (n = 25) and PIB group (n = 25). In the CEI group, 2 patients were excluded because of ineffectiveness of epidural analgesia and instability in the patient's state due to the original disease. In the remaining 23 patients of the CEI group, additional 2 patients were excluded from the analysis because of machine trouble; finally, 21 patients were included in the analysis. In PIB group, 4 patients were excluded (2 patients owing to ineffectiveness of epidural analgesia and 2 patients owing to change in surgical procedure), and 21 patients were finally included in the analysis (Figure 1). Patient characteristics are shown in Table 1.

The mean number of PCA administrations and total amount of local anesthetic were not significantly different between the two study groups up to 24 h after surgery. However, the mean number of PCA administrations was significantly lower in the PIB group than in the CEI group at 24–36 h after surgery (median [lower–upper quartiles]: 0 [0–2.5] vs. 2 [0.5–5], P = 0.018) and total amount of local anesthetic was also significantly lower in the PIB group than in the CEI group at 24–36 h after surgery (median [lower–upper quartiles]: 41 [41–48.5] vs. 47 [43–56] mL, P = 0.035) (Figure 3). The use of rescue analgesics was not significantly different between the two study groups (Table 2). The VAS scores during resting, deep breathing, coughing, and moving after the surgery were also not significantly different between the two study groups (Figure 4).

Figure 3.

PCA data after surgery. Data are presented as median [lower–upper quartiles]. The Mann–Whitney U test was used for comparison of categorical variables. *P < 0.05. PCA: patient-controlled analgesia, PIB: programmed intermittent bolus, CEI: continuous epidural infusion

Figure 4.

VAS scores at POD 1. Data are presented as median [lower–upper quartiles]. The Mann–Whitney U test was used for comparison of categorical variables. VAS: visual analog scale, PIB: programmed intermittent bolus, CEI: continuous epidural infusion, POD: postoperative day

The frequencies of adverse events, such as nausea, vomiting, and dizziness on standing up, were not significantly different between the two study groups (Table 3). The frequency of hypotension was greater in the PIB group than in the CEI group at 0–12 h and 12–24 h postoperatively (3.3% vs. 0.5%, P = 0.018 and 7.9% vs. 0%, P = 0.017, respectively) (Table 4).

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