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Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer?

Choi YY, Park JS, Park SY, Kim HJ, Yeo J, Kim JC, Park S, Choi GS - Ann Surg Treat Res (2015)

Bottom Line: The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured.The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001).The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03).

View Article: PubMed Central - PubMed

Affiliation: Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Purpose: Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach.

Methods: Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured.

Results: Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03).

Conclusion: Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.

No MeSH data available.


Related in: MedlinePlus

Patient allocation into intravenous patient-controlled analgesia (IV-PCA) group and non-PCA group. DB, data base; EPIC, early postoperative intraperitoneal chemotherapy; Maj. combined Rx., major combined resection.
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Figure 1: Patient allocation into intravenous patient-controlled analgesia (IV-PCA) group and non-PCA group. DB, data base; EPIC, early postoperative intraperitoneal chemotherapy; Maj. combined Rx., major combined resection.

Mentions: A total of 297 consecutive colorectal cancer patients were evaluated, of which 261 met the study criteria. The remaining 36 patients were excluded for the following reasons: distant metastasis, open surgery, presence of diverting stoma, early postoperative intraperitoneal chemotherapy, and undergoing combined resections. Postoperative pain was controlled by either a conventional PCA protocol (n = 155) or a non-PCA protocol (n = 106) according to the joint decision between the patient and physician (Fig. 1).


Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer?

Choi YY, Park JS, Park SY, Kim HJ, Yeo J, Kim JC, Park S, Choi GS - Ann Surg Treat Res (2015)

Patient allocation into intravenous patient-controlled analgesia (IV-PCA) group and non-PCA group. DB, data base; EPIC, early postoperative intraperitoneal chemotherapy; Maj. combined Rx., major combined resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325645&req=5

Figure 1: Patient allocation into intravenous patient-controlled analgesia (IV-PCA) group and non-PCA group. DB, data base; EPIC, early postoperative intraperitoneal chemotherapy; Maj. combined Rx., major combined resection.
Mentions: A total of 297 consecutive colorectal cancer patients were evaluated, of which 261 met the study criteria. The remaining 36 patients were excluded for the following reasons: distant metastasis, open surgery, presence of diverting stoma, early postoperative intraperitoneal chemotherapy, and undergoing combined resections. Postoperative pain was controlled by either a conventional PCA protocol (n = 155) or a non-PCA protocol (n = 106) according to the joint decision between the patient and physician (Fig. 1).

Bottom Line: The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured.The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001).The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03).

View Article: PubMed Central - PubMed

Affiliation: Colorectal Cancer Center, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Purpose: Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach.

Methods: Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured.

Results: Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03).

Conclusion: Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.

No MeSH data available.


Related in: MedlinePlus