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Korean J Anesthesiol > Volume 56(6); 2009 > Article
Korean Journal of Anesthesiology 2009;56(6):669-674.
DOI: https://doi.org/10.4097/kjae.2009.56.6.669   
A comparison of cervical epidural analgesia and intravenous patient-controlled analgesia after mastectomy with immediate latissimus dorsi flap breast reconstruction.
Kyu Sik Kang, Chang Won Kim, Ki Ryang Ahn, Chun Sook Kim, Siehyeon Yoo, Jin Hun Chung, Ji Won Chung, Sang Ho Kim
1Department of Anesthesiology and Pain Medicine, College of Medicine, University of Soonchunhyang Hospital, Cheonan, Korea. ksjsk@schch.co.kr
2National Medical Center, Korea.
3Department of Anesthesiology and Pain Medicine, College of Medicine, University of Soonchunhyang Hospital, Seoul, Korea.
Abstract
BACKGROUND
Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction.
METHODS
Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n = 30), 0.15% ropivacaine + fentanyl 4 microg/ml] or IV-PCA [Group IV-PCA (n = 30) fentanyl 20 microg/kg + ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C)7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation.
RESULTS
The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV- PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups.
CONCLUSIONS
We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction.
Key Words: Analgesia; Cervical epidural; Intravenous patient-controlled analgesia; Latissimus dorsi flap; Mastectomy


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