Is intravenous patient controlled analgesia enough for pain control in patients who underwent thoracoscopy?

Abstract

This prospective randomized study was conducted to evaluate the efficacy of two common analgesic techniques, thoracic epidural patient-controlled analgesia (Epidural PCA), and intravenous patient-controlled analgesia (IV PCA), in patients undergoing lobectomy by the video-assisted thoracic surgical (VATS) approach. Fifty-two patients scheduled for VATS lobectomy were randomly allocated into two groups: an Epidural PCA group receiving an epidural infusion of ropivacaine 0.2%+fentanyl 5 microg/mL combination at a rate of 4 mL/hr, and an IV PCA group receiving an intravenous infusion of ketorolac 0.2 mg/kg+fentanyl 15 microg/mL combination at a rate of 1 mL/hr. Pain scores were then recorded using the visual analogue scale at rest and during motion (VAS-R and VAS-M, 0-10) for five days following surgery. In addition, we measured the daily morphine consumption, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), satisfaction score, and the incidence of side effects. Thirty-seven patients out of 52 completed the study (18 in the Epidural PCA group, 19 in the IV PCA group). There were no differences in the pain scores, analgesic requirements, pulmonary function, satisfaction score, and the incidence of side effects between groups. This indicates that IV PCA and Epidural PCA are equally effective to control the postoperative pain after VATS lobectomy, which suggests that IV PCA may be used instead of Epidural PCA.

Keywords: Analgesia, Patient-Controlled; Pain Measurement; Thoracic Surgery, Video-Assisted.

Fig. 1

Mean visual analogue scores (VAS) at rest and during movement. Error bars indicate standard error mean. There are no significant differences between two groups. IV, intravenous; PCA, patient-controlled analgesia.

Fig. 2

Mean daily doses of intravenous morphine given as a rescue medication. Error bars indicate standard error mean. There are no significant differences between two groups. IV, intravenous; PCA, patient-controlled analgesia.

Fig. 3

Mean percentage changes in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁). Error bars indicate standard error mean. There are no significant differences between two groups. IV, intravenous; PCA, patient-controlled analgesia; POD, post-operative day.