Comparison Between Two Methods of Patient-Controlled Analgesia Through Intravenous and Thoracic Epidural to Control Pain and Complications After Surgery in Esophageal Cancer Patients: A Randomized Controlled Trial
-
Maziar Maghsoudloo
,
Sina Abbassi
,
Shahram Samadi
,
Mohammad Taghi Beigmohammadi
,
Asghar Hajipour
,
Mahboubeh Atashgahi
,
Siavash Abbassi
,
Fariba Badrzadeh
,
Omid Nabavian
Abstract
The aim of this study was to compare the post-operation analgesic effects of patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients who were undergoing esophageal cancer surgery. This was a randomized clinical trial. 80 patients undergone esophagostomy were randomly divided into two groups: 40 patients in the epidural PCA and 40 patients in the intravenous PCA group were evaluated. Post-operation pain score was assessed using the universal pain assessment tool (UPAT) in both groups at 24 and 48 hours after surgery. Secondary outcomes included AKI, MI, CVA, pulmonary complications, ICU stay and three months survival. Mean pain scores were similar in the two groups (P>0.05). There was no significant difference between the two groups for rescue treatment, three months’ survival, CVA, MI and AKI. However, ICU stay (P=0.008) and pulmonary complications (P=0.05) were greater in PCIA group. The results indicate that none of the PCEA and PCIA methods have any superiority in terms of pain control and the incidence of analgesic-related side effect complications after surgery in patients undergoing esophagostomy and confirm sufficient analgesia by both.
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12. Ashok A, Niyogi D, Ranganathan P, Tandon S, Bhaskar M, Karimundackal G, et al. The enhanced recovery after surgery (ERAS) protocol promotes recovery following esophageal cancer resection. Surg Today 2020;50:323-34.
13. Salicath JH, Yeoh EC, Bennett MH. Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults. Cochrane Database Syst Rev 2018;8:Cd010434.
14. Li Y, Dong H, Tan S, Qian Y, Jin W. Effects of thoracic epidural anesthesia/analgesia on the stress response, pain relief, hospital stay, and treatment costs of patients with esophageal carcinoma undergoing thoracic surgery: A single center, randomized controlled trial. Medicine (Baltimore) 2019;98:e14362.
15. Zhu Z, Wang C, Xu C, Cai Q. Influence of patient- controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial. Gastric Cancer 2013;16:193-200.
2. Zhu G, Zhang L, Dan J, Zhu Q. Differential effects and mechanisms of local anesthetics on esophageal carcinoma cell migration, growth, survival and chemosensitivity. BMC Anesthesiol 2020;20:126.
3. Kumar S, Brown G, Sutherland F, Morgan J, Andrews D, Ling LH, et al. The Transesophageal Echo Probe May Contribute to Esophageal Injury After Catheter Ablation for Paroxysmal Atrial Fibrillation Under General Anesthesia: A Preliminary Observation. J Cardiovasc Electrophysiol 2015;26:119-26.
4. Li Z, Abreu Z, Penner T, He L, Liu X, Bargman JM. Analysis of Hospitalization after Peritoneal Dialysis Catheter Implantation. Perit Dial Int 2016;36:540-6.
5. Corsini EM, Zhou N, Antonoff MB, Mehran RJ, Rice DC, Roth JA, et al. Postoperative Bleeding and Acute Kidney Injury in Esophageal Cancer Patients Receiving Ketorolac. Ann Thorac Surg 2021;111:1111-7.
6. Singh A, Jindal P, Khurana G, Kumar R. Post-operative effectiveness of continuous wound infiltration, continuous epidural infusion and intravenous patient-controlled analgesia on post-operative pain management in patients undergoing spinal surgery. Indian J Anaesth 2017;61:562-9.
7. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-12.
8. Wu CL, Cohen SR, Richman JM, Rowlingson AJ, Courpas GE, Cheung K, et al. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology 2005;103:1079-88.
9. Zutshi M, Delaney CP, Senagore AJ, Mekhail N, Lewis B, Connor JT, et al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 2005;189:268-72.
10. Tseng WC, Lin WL, Lai HC, Huang TW, Chen PH, Wu ZF. Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy pain following video-assisted thoracic surgery: A randomized controlled study. Medicine (Baltimore) 2019;98:e16403.
11. Ham SY, Kim EJ, Kim TH, Koo BN. Comparison of Perioperative Renal Function Between Epidural and Intravenous Patient-Controlled Analgesia After Living-Donor Hepatectomy: A Retrospective Study. Transplant Proc 2018;50:1365-71.
12. Ashok A, Niyogi D, Ranganathan P, Tandon S, Bhaskar M, Karimundackal G, et al. The enhanced recovery after surgery (ERAS) protocol promotes recovery following esophageal cancer resection. Surg Today 2020;50:323-34.
13. Salicath JH, Yeoh EC, Bennett MH. Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults. Cochrane Database Syst Rev 2018;8:Cd010434.
14. Li Y, Dong H, Tan S, Qian Y, Jin W. Effects of thoracic epidural anesthesia/analgesia on the stress response, pain relief, hospital stay, and treatment costs of patients with esophageal carcinoma undergoing thoracic surgery: A single center, randomized controlled trial. Medicine (Baltimore) 2019;98:e14362.
15. Zhu Z, Wang C, Xu C, Cai Q. Influence of patient- controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial. Gastric Cancer 2013;16:193-200.
| Files | ||
| Issue | Vol 61 No 6 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v61i6.13833 | |
| Keywords | ||
| Esophageal carcinoma Patient-controlled epidural analgesia Patient-controlled intravenous analgesia | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Maghsoudloo M, Abbassi S, Samadi S, Beigmohammadi MT, Hajipour A, Atashgahi M, Abbassi S, Badrzadeh F, Nabavian O. Comparison Between Two Methods of Patient-Controlled Analgesia Through Intravenous and Thoracic Epidural to Control Pain and Complications After Surgery in Esophageal Cancer Patients: A Randomized Controlled Trial. Acta Med Iran. 2023;61(6):334-340.
