Patient-controlled analgesia epidural

Cooper DW, Saleh U, Taylor M, Whyte S, Ryall D, Kokri MS, Desira WR, Day H, McArthur E. Patient-controlled analgesia epidural fentanyl and i.v. morphine compared after caesarean section. Br J Anaesth 1999 82(3) 366-70. 

Dosages and routes of administration Morphine is available in different salt forms but the hydrochloride and sulfate (Vermeire and Remon, 1999) are used preferentially. The compound can be administered by the oral, parenteral or intraspinal route. Oral application is preferred for chronic pain treatment and various slow release forms have been developed to reduce the administration frequency to 2-3 times per day (Bourke et al., 2000). Parenteral morphine is used in intravenous or intramuscular doses of 10 mg, mostly for postoperative pain and self-administration devices are available for patient-controlled analgesia (PCA). Morphine is additionally used for intraspinal (epidural or intrathecal) administration. Morphine is absorbed reasonably well in the lower gastrointestinal tract and can be given as suppositories. 

Medico-technical instruments such as infusion pumps can be used in PCA (patient-controlled analgesia, Fig. 1) to provide patient-orientated and therapy as required, e.g. with morphine injection solutions. Depending on the patients perception of pain, they may add small doses of analgesics to the basic infusion by means of an electrically controlled infusion pump. The physician specifies the basic dose, which is infused independent of patient demands, the boluses that can be demanded, an hourly maximum dose and a refractory time that cannot be reduced between two doses. The infusion may be given intravenously, subcutaneously, epidurally or intraspinally. 

Alon E, Jaquenod M, Schaeppi B. Post-operative epidural versus intravenous patient-controlled analgesia. Minerva Anestesiol. 2003 69 443—4-46. 

Aygun S, Kocoglu H, Goksu S, et al. Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine + fentanyl combination. EurJ Gynaecol Oncol. 2004 25 498-501. 

Lebovits AH, Zenetos P, O Neill DK, et al. Satisfaction with epidural and intravenous patient-controlled analgesia. Pain Med. 2001 2 280-286. 

Senagore AJ, Delaney CP, Mekhail N, et al. Randomized clinical trial comparing epidural anaesthesia and patient-controlled analgesia after laparoscopic segmental colectomy. BrJ Surg. 2003 90 1195-1199. 

Yavuz L, Eroglu F, Ozsoy M. The efficacy of intravenous versus epidural tramadol with patient-controlled analgesia (PCA) in gynecologic cancer pain. EurJ Gynaecol Oncol. 2004 25 215-218. 

In a randomized, placebo-controlled, double-blind study of the relative efficacies of patient-controlled analgesia (PCA) regimens (63), 60 patients undergoing elective total hip or knee replacement were randomly allocated to receive epidural diamorphine 2.5 mg followed by a PCA bolus 1 mg with a 20-minute lockout (group 1), subcutaneous diamorphine 2.5 mg followed by a PCA bolus 1 mg with a 10-minute lockout (group 2), or epidural diamorphine 2.5 mg in 4 ml of 0.125% bupivacaine followed by a PCA bolus of 1 mg diamorphine in 4 ml... 

Tsueda K, Mosca PJ, Heine MF, Loyd GE, Durkis DA, Malkani AL, Hurst HE. Mood during epidural patient-controlled analgesia with morphine or fentanyl. Anesthesiology 1998 88(4) 885-91. 

SUvasti M, Pitkanen M. Continnous epidural analgesia with bupivacaine-fentanyl versus patient-controlled analgesia with i.v. morphine for postoperative pain relief after knee ligament surgery. Acta Anaesthesiol Scand 2000 44(1) 37 2. 

Bozkurt P. The analgesic efficacy and neuroendocrine response in paediatric patients treated with two analgesic techniques using morphine-epidural and patient-controlled analgesia. Paediatr Anaesth 2002 12(3) 248-54. 

Patient-controlled analgesia with epidural pethidine or a single bolus of epidural morphine 4 mg during the 24 hours after cesarean section has been studied in 78 women (91). There were no differences in the degree of analgesia or opioid adverse effects profiles. 

Kampe S, Randebrock G, Kiencke P, Hunseler U, Cranfield K, Konig DP, Diefenbach C. Comparison of continuous epidural infusion of ropivacaine and sufentanil -with intravenous patient-controlled analgesia after total hip replacement. Anaesthesia 2001 56(12) 1189-93. 

Satoh M, Hirabayashi Y, Seo N. [Intravenous patient controlled analgesia combined with continuous thoracic epidural analgesia for post-thoracotomy pain]. Masui 2000 49(11) 1222-1225. 

Patient-controlled analgesia as primary therapy or as supplementation for epidural or regional techniques Continue neuraxial opioids intrathecal or epidural analgesia Continue continuous neural blockade... 

Epidural anesthesia has been demonstrated to be an effective and acceptable alternative to opioid patient-controlled analgesia in many patients. However, the increased risks of hematoma in patients receiving anticoagulants have limited its use beyond the recovery period in these patients. 

Epidural morphine 4 mg has been compared with epidural morphine 5 mg as patient-controlled analgesia for postoperative analgesia in women after cesarean section the latter had more nausea and vomiting (16% versus 72%) and more pruritus (29% versus 82%) [103 ]. 

Werawatganon T, Charuluxanun S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev. 2005 CD004088. 

Antok E, Bordet F, Duflo F, et al. Patient-controlled epidural analgesia versus continuous epidural infusion with ropivacaine for postoperative analgesia in children. Anesth Analg. 2003 97 1608-1611. 

Aribogan A, Doruk N, Aridogan A, et al. Patient-controlled epidural analgesia after major urologic surgeries. A comparison of tramadol with or without bupivacaine. Urol bit. 2003 71 168-175. 

Evron S, Glezerman M, Sadan O, et al. Patient-controlled epidural analgesia for labor pain effect on labor, delivery and neonatal outcome of 0.125% bupivacaine vs 0.2% ropivacaine. IntJ Obstet Anesth. 2004 13 5-10. 

Gogarten W, Van de Velde M, Soetens E, et al. A multicentre trial comparing different concentrations of ropivacaine plus sufentanil with bupivacaine plus sufentanil for patient-controlled epidural analgesia in labour. Eur J Anaesthesiol. 2004 21 38M5. 

Halpern SH, Muir H, Breen TW, et al. A multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor. Anesth Analg. 2004 99 1532-1538. 

Paech Ml, Pavy TJ, Orlikowski CE, Evans SF. Patient-controlled epidural analgesia in labor the addition of cloni-dine to bupivacaine-fentanyl. Reg Anesth Pain Med 2000 25(l) 34-40. 

Liu SS, Moore JM, Luo AM, Trautman WJ, Carpenter RL. Comparison of three solutions of ropivacaine/fentanyl for postoperative patient-controlled epidural analgesia. Anesthesiology 1999 90(3) 727-33. 

Liu SS, Allen HW, Olsson GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards prospective experience with 1030 surgical patients. Anesthesiology 1998 88(3) 688-95. 

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