Abstract
In a prospective, randomized, double-blinded study, 23 patients who had undergone Caesarean delivery under epidural anaesthesia were assessed to evaluate the effectiveness of patientcontrolled epidural analgesia (PCEA) with fentanyl compared with a single dose of epidural morphine for postoperative analgesia. Group A (n = 11) received epidural fentanyl 100 μg intraoperatively, then self-administered a maximum of two epidural fentanyl boluses 50 μg (10 μg · ml−1) with a lockout period of five minutes for a maximum of two doses per hour. Group B (n = 11) received a single bolus of epidural morphine 3 mg (0.5 mg · ml−1) intraoperatively and received the same instructions as Group A but had their PCA devices filled with 0.9% NaCl. Patients were assessed up to 24 hr for pain, satisfaction with pain relief, nausea and pruritus using visual analogue scales (VAS). The treatments for inadequate analgesia, nausea and pruritus as well as time to first independent ambulation were recorded. The ventilatory response to carbon dioxide challenge was measured at four and eight hours. Pain relief, satisfaction with pain relief, and the use of supplemental analgesics were similar in both groups. The mean 24 hr dose of epidural fentanyl used by group A patients was 680 μg. Pruritus was less common in Group A patients at the 8 and 24 hr observation periods (P < 0.0125). Both groups experienced the same degree of nausea and clinically unimportant respiratory depression. We conclude that PCEA with fentanyl provides analgesia equal to a single dose of epidural morphine and may be suitable for patients who have experienced considerable pruritus after epidural morphine adminstration.
Résumé
Cette étude randomisée et à double-aveugle vise à évaluer l’efficacité de l’épidurale auto-contrôlée au fentanyl comparée à une seule dose de morphine épidurale pour l’analgésie postopératoire. Vingt-trois opérées pour césarienne sont réparties en deux groupes: le group A (n = 11) a reçu une épidurale avec fentanyl 100 μg pendant l’intervention puis s’administre au pousse-seringue PCA deux bolus de fentanyl 50 μg (10 μg · ml−1) avec un intervalle de sécurité de cinq minutes pour un maximum de deux doses à l’heure. Le groupe B (n = 11) a reçu un seul bolus épidural de morphine 3 mg (0,5 mg · ml−1) pendant l’intervention, obtient les mêmes directives que le groupe A mais ne s’administre que du soluté physiologique par le pousse-seringue PCA. L’évaluation se continue jusqu’à 24 heures sur des échelles visuelks analogiques de la douleur, du degré de satisfaction, des nausées et vomissements, et du prurit. On enregistre le traitement de l’analgésie insuffisante, des nausées et du prurit, ainsi que le moment de l’autonomie ambulatoire. La réponse ventilatoire au dioxyde de carbone est mesurée à la quatrième et à la huitième heures. Le soulagement, la satisfaction et la supplémentation par des analgésiques sont les mêmes pour les deux groupes. La dose moyenne pour 24 heures de fentanyl épidural utilisée par le groupe A est de 680 μg. Le prurit est moins fréquent dans ce groupe aux périodes d’observation de huit et 24 heures (P < 0,0125). Les deux groupes ont souffert au même degré de nausées et de dépression respiratoire cliniquement sans importance. Nous concluons que l’anesthésie épidurale auto-contrôlée au fentanyl produit une analgésie égale à celle de la morphine épidurale; cette technique pourrait être utilisée avec avantages chez la patiente qui a déjà souffert d’un prurit important après l’administration de morphine épidurale.
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Yu, P.Y.H., Gambling, D.R. A comparative study of patient-controlled epidural fentanyl and single dose epidural morphine for post-caesarean analgesia. Can J Anaesth 40, 416–420 (1993). https://doi.org/10.1007/BF03009509
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DOI: https://doi.org/10.1007/BF03009509