Journal of Anesthesia

, Volume 21, Issue 1, pp 1–6 | Cite as

A comparison of intravenous-based and epidural-based techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy

  • Kohki Nishikawa
  • Saori Kimura
  • Yuki Shimodate
  • Motohiko Igarashi
  • Akiyoshi Namiki
Original articles



We wished to compare the effectiveness of intravenous-based (IV) and epidural-based (EPI) techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. Effectiveness was compared in terms of reduction of postoperative pain and adverse events, and achieving a high level of patient satisfaction.


Thirty American Society of Anesthesiologists (ASA) physical status I-II patients aged more than 65 years, scheduled for laparoscopic cholecystectomy, were enrolled in this study. The patients in the IV group (n = 15) received modified neurolept anesthesia with droperidol 0.2 mg·kg−1 and pentazocine 0.15–0.3 mg·kg−1 (maximum dose of 1.0 mg·kg−1) and 60% nitrous oxide in oxygen, followed by postoperative intravenous infusion of 20 µg·ml−1 buprenorphine, provided with a patient-controlled analgesia pump programmed to deliver a bolus of 0.5 ml with a lockout interval of 15 min and a background infusion of 0.5 ml·h−1. The patients in the EPI group (n = 15) had combined epidural analgesia and general anesthesia with sevoflurane and 60% nitrous oxide in oxygen, followed by the epidural infusion of a 0.125% bupivacaine and 5 µg · ml−1 buprenorphine mixture by means of an on-demand analgesic system (bolus of 2 ml, lockout interval of 60 min, and background infusion of 2 ml·h−1).


The quality of postoperative analgesia was similar in the two groups. The incidences of intraoperative hypotension and bradycardia and postoperative hypotension were significantly lower in the IV group than in the EPI group (P < 0.05). A significantly higher level of patient satisfaction was found in the IV group compared with that in the EPI group (P < 0.05). The major contributor to dissatisfaction in the EPI group was anxiety or discomfort associated with the epidural procedures.


Modified neurolept anesthesia with pentazocine and postoperative i.v. analgesia with buprenorphine were superior to epidural-based techniques, in terms of hemodynamic stability and patient satisfaction, in elderly patients undergoing laparoscopic cholecystectomy.

Key words

Modified neurolept anesthesia Intravenous Epidural Pentazocine Buprenorphine Laparoscopic cholecystectomy Age factors 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Edwards, ND, Barclay, K, Catling, SJ, Martin, DG, Morgan, RH 1991Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenacAnaesthesia4610771080PubMedGoogle Scholar
  2. 2.
    Jitapunkul, S, Pillay, I, Ebrahim, S 1991The abbreviated mental test: its use and validityAge Ageing20332336PubMedCrossRefGoogle Scholar
  3. 3.
    Jensen, MP, Chen, C, Brugger, AM 2002Postsurgical pain outcome assessmentPain99101109PubMedCrossRefGoogle Scholar
  4. 4.
    Trzepacz, PT, Baker, RW, Greenhouse, J 1988A symptom rating scale for deliriumPsychiatry Res238997PubMedCrossRefGoogle Scholar
  5. 5.
    Nishikawa, K, Nakayama, M, Omote, K, Namiki, A 2004Recovery characteristics and post-operative delirium after long-duration laparoscope-assisted surgery in elderly patients: propofol-based vs sevoflurane-based anesthesiaActa Anaesthesiol Scand48162168PubMedCrossRefGoogle Scholar
  6. 6.
    Mann, C, Pouzeratte, Y, Boccara, G, Peccoux, C, Vergne, C, Brunat, G, Domergue, J, Millat, B, Colson, P 2000Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgeryAnesthesiology92433441PubMedCrossRefGoogle Scholar
  7. 7.
    Peyton, PJ, Myles, PS, Silbert, BS, Rigg, JA, Jamrozik, K, Parsons, R 2003Perioperative epidural analgesia and outcome after major abdominal surgery in high-risk patientsAnesth Analg96548554PubMedCrossRefGoogle Scholar
  8. 8.
    Norris, EJ, Beattie, C, Perler, BA, Martinez, EA, Meinert, CL, Anderson, GF, Grass, JA, Sakima, NT, Gorman, R, Achuff, SC, Martin, BK, Minken, SL, Williams, GM, Traystman, RJ 2001Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgeryAnesthesiology9510541067PubMedCrossRefGoogle Scholar
  9. 9.
    Collins, KM, Docherty, PW, Plantevin, OM 1984Postoperative morbidity following gynaecological outpatient laparoscopy. A reappraisal of the serviceAnaesthesia39819822PubMedGoogle Scholar
  10. 10.
    Narchi, P, Benhamou, D, Fernandez, H 1991Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopyLancet33815691570PubMedCrossRefGoogle Scholar
  11. 11.
    Levine, JD, Gordon, NC 1988Synergism between analgesic actions of morphine and pentazocinePain33369372PubMedCrossRefGoogle Scholar
  12. 12.
    Lehmann, KA, Grond, S, Freier, J, Zech, D 1991Postoperative pain management and respiratory depression after thoracotomy: a comparison of intramuscular piritramide and intravenous patient-controlled analgesia using fentanyl or buprenorphineJ Clin Anesth3194201PubMedCrossRefGoogle Scholar
  13. 13.
    Lehmann, KA, Reichling, U, Wirtz, R 1988Influence of naloxone on the postoperative analgesic and respiratory effects of buprenorphineEur J Clin Pharmacol34343352PubMedCrossRefGoogle Scholar
  14. 14.
    Goldman, L, Caldera, DL 1979Risks of general anesthesia and elective operation in the hypertensive patientsAnesthesiology50285292PubMedCrossRefGoogle Scholar
  15. 15.
    Li, S, Coloma, M, White, PF, Watcha, MF, Chiu, JW, Li, H, Huber, PJ,Jr 2000Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgeryAnesthesiology9312251230PubMedCrossRefGoogle Scholar
  16. 16.
    Song, D, Greilich, NB, White, PF, Watcha, MF, Tongier, WK 2000Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphyAnesth Analg91876881PubMedCrossRefGoogle Scholar

Copyright information

© JSA 2007

Authors and Affiliations

  • Kohki Nishikawa
    • 1
  • Saori Kimura
    • 1
  • Yuki Shimodate
    • 1
  • Motohiko Igarashi
    • 1
  • Akiyoshi Namiki
    • 2
  1. 1.Department of AnesthesiaMuroran City General HospitalMuroranJapan
  2. 2.Department of AnesthesiologySapporo Medical University School of MedicineSapporoJapan

Personalised recommendations