Comparison of computer-integrated patient-controlled epidural analgesia with no initial basal infusion versus moderate basal infusion for labor and delivery : A randomized controlled trial

Sng, Ban Leong; Woo, David; Leong, Wan Ling; Wang, Hao; Assam, Pryseley Nkouibert; Sia, Alex

doi:10.4103/0970-9185.142842

Cited by 13 publications

(16 citation statements)

References 14 publications

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“…Many previous studies of PCA using the VFIM were conducted in patients using “computer-integrated” patient-controlled epidural analgesia (PCEA) during labor and delivery [ 14 , 15 , 16 , 17 ]. Their results suggested that patient satisfaction was greater in those using the computer-integrated PCEA than in those using traditional PCEA, but that the incidence of breakthrough pain and the cumulative local anesthetic consumption did not differ significantly between groups [ 15 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

Jung

Kim

et al. 2021

Medicina

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Background and objectives: The fixed-rate continuous background infusion mode with bolus dosing is a common modality for intravenous patient-controlled analgesia (PCA). However, some patients suffer from inadequate analgesia or opioid-related adverse effects due to the biphasic pattern of postoperative pain. Therefore, we investigated the postoperative analgesic efficacy of PCA using an optimizing background infusion mode (OBIM) where the background injection rate varies depending on the patient’s bolus demand. Materials and Methods: We prospectively enrolled 204 patients who underwent laparoscopic cholecystectomy in a randomized, controlled, double-blind study. Patients were allocated to either the optimizing (group OBIM) or the traditional background infusion group (group TBIM). The numeric rating scale (NRS) score for pain was evaluated at admission to and discharge from the recovery room, as well as at the 6th, 24th, and 48th postoperative hours. Data on bolus demand count, total infused volume, and background infusion rate were downloaded from the PCA device at 30-min intervals until the 48th postoperative hour. Results: The NRS score was not significantly different between groups throughout the postoperative period (p = 0.621), decreasing with time in both groups (p < 0.001). The bolus demand count was not significantly different between groups throughout (p = 0.756). The mean total cumulative infused PCA volume was lower in group OBIM (84.0 (95% confidence interval: 78.9−89.1) mL) than in group TBIM (102 (97.8−106.0) mL; p < 0.001). The total cumulative opioid dose in fentanyl equivalents, after converting sufentanil to fentanyl using an equipotential dose ratio, was lower in group OBIM (714.1 (647.4−780.9) μg) than in group TBIM (963.7 (870.5−1056.9) μg); p < 0.001). The background infusion rate was significantly different between groups throughout the study period (p < 0.001); it was higher in group OBIM than in group TBIM before the 12th postoperative hour and lower from the 18th to the 48th postoperative hour. Conclusions: The OBIM combined with bolus dosing reduces the cumulative PCA volume and opioid consumption compared to the TBIM combined with bolus dosing, while yielding comparable postoperative analgesia and bolus demand in patients undergoing laparoscopic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

Jung

Kim

et al. 2021

Medicina

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“…Epidural anesthesia and analgesia are commonly used for obstetric anesthesia. Epidural anesthesia is safe for use in cesarean sections, even in patients with cardiac diseases and severe pulmonary hypertension [4,7,[10][11][12][13][14][15][16]. Several methods, including wound infiltration with a local anesthetic and magnesium sulphate, wound infiltration with tramadol and levobupivacaine, a magnesium sulphate infusion for preemptive analgesia, a transverse abdominal plane block (TAPB) performed by adding dexamethasone to levobupivacaine, infiltration by placing a continuous catheter for a TAPB or the wound area, the administration of intrathecal and intravenous betamethasone, and the addition of dexmedetomidine to increase the efficacy of epidural anesthesia and analgesia have all been used to treat pain after a cesarean section [17][18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…In some previous studies, higher volumes of epidural analgesia provided better pain scores when compared to lower volumes [8,9]. Conversely, some studies showed that the delivery of small volumes (5 mL) via the epidural route was also sufficient [7].…”

Section: Introductionmentioning

confidence: 94%

“…With epidural analgesia, fewer systemic effects are observed, while longer and more reliable analgesia is provided at lower drug dosages [5]. Epidural analgesia can be initiated at a range of volumes, but there is inadequate data about the exact volumes and PCA protocols after a cesarean section [6,7]. In some previous studies, higher volumes of epidural analgesia provided better pain scores when compared to lower volumes [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

et al. 2020

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This study was conducted after obtaining Ethics Committee approval from the İnönü University Medical Faculty (2015/171) and informed consent from all of the Background/aim: The aim of this study was to compare the effects of different epidural initiation volumes on postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient-controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections.Materials and methods: Eighty-one pregnant women, aged 18-45 years, were included in this randomized, double-blind study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into 3 groups and different volumes (20 mL, 10 mL, and 5 mL) of the study drug (0.0625% bupivacaine plus 2 μg/mL of fentanyl) were administered 90 min after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed, and side effects were recorded postoperatively.Results: There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 h was lower in Group 20 than in the other groups. Conclusions: The PCEA initiations with different volumes provided similar pain scores. However, the 20 mL volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.

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“…Many previous studies of PCA using the VFIM were conducted in patients using "computer-integrated" patient-controlled epidural analgesia (PCEA) during labor and delivery [13][14][15][16]. Their results suggested that patient satisfaction was greater in those using the computer-integrated PCEA than in those using traditional PCEA, but that the incidence of breakthrough pain and the cumulative local anesthetic consumption did not differ statistically significantly between groups [14,16].…”

Section: Discussionmentioning

confidence: 99%

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

Jung¹,

So²,

Kim³

et al. 2020

Preprint

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Background and objectives: Traditional intravenous, patient-controlled analgesia (PCA) uses a fixed-rate continuous background infusion mode. However, some patients suffer from inadequate analgesia or opioid-related adverse effects due to the biphasic pattern of postoperative pain. Therefore, we investigated the postoperative analgesic efficacy of PCA using an optimizing background infusion mode (OBIM), where the background injection rate varies depending on the patient's bolus demand. Materials and Methods: We prospectively enrolled 204 patients who underwent laparoscopic cholecystectomy in a randomized, controlled, double-blind study. Patients were allocated into either the optimizing (group OBIM) or the traditional background infusion group (group TBIM). The numeric rating scale (NRS) score for pain was evaluated at admission to and discharge from the recovery room, as well as at the 6th, 24th, and 48th postoperative hours. Data of bolus demand count, total infused volume, and background infusion rate was downloaded from the PCA device at 30-min intervals until the 48th postoperative hour. Results: The NRS score was not significantly different between groups throughout the postoperative period (P = 0.621), decreasing with time in both groups (P < 0.001). The bolus demand count was not significantly different between groups throughout (P = 0.756). The mean cumulative infused PCA volume was lower in group OBIM [84.0 (95% confidence interval: 78.9−89.1) mL) than in group TBIM [102 (97.8−106.0) mL] (P < 0.001). The background infusion rate was significantly different between groups throughout (P < 0.001); it was higher in group OBIM than in group TBIM before the 12th postoperative hour, and lower from the 18th to the 48th postoperative hours. Conclusions: The OBIM combined with bolus dosing is useful in that it reduces the cumulative PCA volume compared to the TBIM combined with bolus dosing, while yielding comparable postoperative analgesia and bolus demand in patients undergoing laparoscopic cholecystectomy.

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Comparison of computer-integrated patient-controlled epidural analgesia with no initial basal infusion versus moderate basal infusion for labor and delivery : A randomized controlled trial

Cited by 13 publications

References 14 publications

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume and Opioid Consumption Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

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