A Comparison of Patient-Controlled Epidural Analgesia and Continuous Epidural Analgesia after Total Knee Arthroplasty in Elderly Patients over 60 Years of Age.

Lee,  Sang Hyun; Kim,  Yun Jin; Baik,  Hee Jung; Kim,  Jong Hak

doi:2006.50.3.285

Randomized Controlled Trial

Korean Journal of Anesthesiology 2006;50(3):285-291.
DOI: https://doi.org/10.4097/kjae.2006.50.3.285

A Comparison of Patient-Controlled Epidural Analgesia and Continuous Epidural Analgesia after Total Knee Arthroplasty in Elderly Patients over 60 Years of Age.

Sang Hyun Lee, Yun Jin Kim, Hee Jung Baik, Jong Hak Kim

Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Korea. ankyj@ewha.ac.kr

Abstract

BACKGROUND
In postoperative analgesia of total knee arthroplasty (TKA) in elderly patients, epidural analgesia has been proved to be a highly effective method. The goal of this study was to compare between patient-controlled epidural analgesia (PCEA) and continuous epidural analgesia (CEA) for their efficacy of analgesia, analgesic requirement and side effects after TKA in elderly patients.
METHODS
Eighty eight elderly patients over 60 years, undergoing TKA were randomly allocated to PCEA and CEA group. The PCEA group could demand a 2 ml bolus of 0.1% levobupivacaine and 0.0002% fentanyl solution with a lockout interval of 8 minutes, a total dose limit of 15 ml/h and a basal infusion rate of 3 ml/h. The CEA group received a continuous basal infusion of 5 ml/h of the same solution. The pain scores (verbal numerical rating scale, VNRS) at rest and coughing, analgesic consumption, patient satisfaction and side effects were recorded immediately before and at 1, 3, 6, 12, 24, 48 hour after the initiation of epidural analgesia.
RESULTS
VNRS revealed no intergroup differences at each time interval, and were not exceeding 3 in both groups. The PCEA group (n = 44) revealed significantly less analgesic consumption compared to the CEA group (n = 44, P < 0.05), but no significant intergroup differences were noticed in side effects.
CONCLUSIONS
PCEA using 0.1% levobupivacaine and 0.0002% fentanyl solution for postoperative analgesia after TKA in elderly patients provide comparable analgesia and side effects with less requirement of analgesics in comparison to CEA.

Key Words: analgesia; continuous epidural analgesia; fentanyl; levobupivacaine; patient-controlled epidural analgesia; total knee arthroplasty