抄録
We conducted a retrospective study to evaluate postoperative pain intensity and side effects caused by fentanyl administered during patient–controlled epidural analgesia (PCEA) with a mixture of ropivacaine (1.5 mg/ml) and fentanyl (1 µg/ml or 2 µg/ml) in elderly patients who underwent laparoscopic–assisted colon surgery (LAC) for colon cancer.
A total of 68 elderly patients aged >70 years were divided into 4 groups by gender and fentanyl dose administered during PCEA with 1.5 mg/ml of ropivacane: an LM group, which included 6 males who received fentanyl at a dose of 1 µg/ml during PCEA; an LF group, which included 18 females who received fentanyl at a concentration of 1 µg/ml during PCEA; an HM group, which included 27 males who received fentanyl at a concentration of 2 µg/ml during PCEA; and an HF group, which included 17 females who received fentanyl at a concentration of 2 µg/ml during PCEA. PCEA was administered at the rate of 3 ml/h using the CADD–Legacy® PCA machine type. The bolus dose was 2 ml, the lock–out period was 15 min, and the maximum effective number of bolus was 2 times/h. Pain intensity at rest and during movement was measured twice daily for 4 days following surgery using a 100–mm nongraduated visual analog scale (VAS). One–way analysis of variance, the Kruskal–Wallis test, and the chi–square test were used for statistical analyses depending on the type of data. A p–value of <0.05 was considered statistically significant. If a significant difference was observed, a multiple comparison test of Bonferroni or Dunn’s post–test was used.
Pain intensity at rest and during movement was not significantly different among the 4 groups. The number of PCEA bolus injections administered and the number of requests for PCEA were comparable among the 4 groups. The incidence of postoperative itching was 88.2％ in the HF group; this was significantly higher than that in the HM (51.9％) and LF groups (33.3％). The incidence of postoperative nausea and vomiting were 47.1％ in the HF group; this was significantly higher than that in the HM group (11.1％). There was no case of lower limb paralysis after 1 postoperative day in all groups.
In conclusion, the findings of this study suggest that the degree and frequency of postoperative itching caused by fentanyl administered during PCEA can be potentially decreased, without altering postoperative pain intensity, by lowering the concentration of fentanyl combined with a low dose of ropivacane following LAC in elderly female patients.
