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Influence of Opioid Epidural Analgesia + PCEA Versus Intravenous Opioid Analgesia + PCA on Weaning Time and Postoperative Pulmonary Function



Influence of Opioid Epidural Analgesia + PCEA Versus Intravenous Opioid Analgesia + PCA on Weaning Time and Postoperative Pulmonary Function



Anesthesiology Abstracts of Scientific Papers Annual Meeting (2001): Abstract No. A-854



Introduction: Duration of postoperative (postop) mechanical ventilation (DMV) may be prolonged by i.v. opoid induced respiratory depression. Postop respiratory strength may be inhibited by epidural anesthesia (EA) using high dose local anesthetics. Regarding reinstitution of spontaneous ventilation with adequate respiratory strength the best analgesic technique remains to be defined. We compared the influence of intraoperative (intraop) lumbar opioid-EA + postop PCEA on gas exchange and static and dynamic lung function with intraop i.v. analgesia + postop opioid-PCA following major abdominal vascular surgery under standardized general anesthesia (GA). Methods: Following ethics committee approval and informed consent, 36 patients were randomly enrolled. All patients received GA with thiopental, sufentanil (Suf), cisatracurium, O2/N2O and isoflurane (et 0,5 %). In the EA+PCEA group (n = 15 ) 35 mug of Suf (adapted to body size) were injected preoperatively (epidural catheter L2/3) followed by an hourly postop infusion of 8 ml containing 1 mug/ml of Suf in ropivacaine 0,08%. After regaining consciousness, patients could request 4 ml bolus injections. In the PCA-group (n = 17) 2,3 mg/h of the mu1-opiate receptor agonist piritramid (adapted to body weight) were infused followed by injections of 2 mg upon request. The postop duration of sedation (DS) (defined as time to reach 37 degreeC core temperature) and the time of respiratory weaning (DW) until extubation were recorded. Tolerance of the tube was achieved by mild i.v. sedation using propofol. Minimal and maximal pain was measured after extubation and during the first two postoperative days using VAS. Before and for 2 days after surgery paO2, paCO2, VC, FEV1, (Custo Vit(R), Germany) peak flow (PF), (Vitalograph (R), Germany) and in- and exspiratory respiratory strength (TF in+ex) were measured using the incentive breath trainer triflow (R); (Kendall, Germany). Statistics: Chi-square, student t-test; *p<0,05. Results: Postoperative DS to reach 37 degreeC core temperature was similar in both groups (EA+PCEA: 4,5h; PCA: 4,4h). The quality of pain relief was good and not different between groups. The table shows mean hours of DMV and DW and mean percentages of the maximum decreases (-) or increases (+) of postoperative lung function parameters compared to preoperative values in both groups. Conclusion: Patients receiving opioid EA+PCEA could be weaned earlier and had a higher vital capacity following equivalent postoperative periods of sedation when compared to patients treated with intravenous opioids and postop opioid-PCA.

Accession: 035131195

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