Comparison of Intravenous or Epidural Patient-controlled Analgesia in the Elderly after Major Abdominal Surgery

Mann, C.; Pouzeratte, Y.; Boccara, Gilles; Peccoux, Christophe; Vergne, Christine; Brunat, Georges; Domergue, J; Millat, Bertrand; Colson, P

doi:10.1097/00000542-200002000-00025

Cited by 317 publications

(185 citation statements)

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“…Only a few conditions may limit the use of PCA -whether epidural or iv -such as postoperative mechanical ventilation in highly sedated patients. Extremes of age should not be an exclusion criteria for PCEA, since the successful use of PCEA has been documented in elderly patients 27 as well as in children. 28 Further studies will be required to demonstrate whether the pain scores obtained with PCEA during stress and mobilization in our study can be improved by using low-dose background infusions 13,29 or a low dose/high volume concept.…”

Section: Sample Size Calculation and Statistical Analysismentioning

confidence: 99%

Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

Standl

Burmeister

Ohnesorge

et al. 2003

Can J Anesth/J Can Anesth

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Section: Sample Size Calculation and Statistical Analysismentioning

confidence: 99%

Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

Standl

Burmeister

Ohnesorge

et al. 2003

Can J Anesth/J Can Anesth

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“…The epidural route utilising a combination of local anesthetic and opioid provides better pain relief, improved mental status and bowel activity after major abdominal surgery. 5 The addition of a single dose of diclofenac suppository post-operatively may enhance the quality of post-operative pain relief and may reduce the epidural local anesthetic/opioid requirements.…”

mentioning

confidence: 99%

Single dose diclofenac suppository reduces post-Cesarean PCEA requirements

Lim

Chong

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: To assess the analgesic efficacy of administering, immediately after surgery, a single dose of diclofenac (100 mg suppository) to women who had undergone lower segment Cesarean section (LSCS) under combined spinal-epidural anesthesia, and received post-operative patient-controlled epidural analgesia (PCEA) with ropivacaine 0.2% and fentanyl 2 µg·ml -1 .Methods: Forty-eight ASA physical status I or II term parturients scheduled for elective LSCS under regional anesthesia were enrolled into this randomised double-blind study. The patient-controlled epidural analgesia device was programmed to deliver a bolus of 4 ml of local anesthetic mixture with a lockout period of ten minutes and an hourly limit of 12 ml. There was no baseline infusion. The study commenced upon the patient's first demand for analgesia post-operatively and the patients were assessed at one, six, 12 and 24 hr post-operatively for pain scores on movement, dermatomal level of sensory blockade, degree of motor blockade and volume of local anesthetic used. At conclusion of the study, patients' satisfaction scores were recorded.Results: The two groups of patients were similar demographically. Patients who received a diclofenac suppository used 52.8 ± 17.8 ml of local anesthetic mixture while those who did not, used 74 ± 25 ml (P <0.005). Pain scores and satisfaction scores did not differ significantly between the groups.Conclusion: A single administration of 100 mg diclofenac suppository is effective in reducing post-Cesarean epidural local anesthetic/opioid requirements by 33% for the first 24 hr post-operatively.

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“…In one multicentre study, the incidence of POCD after minor surgery was 6.8% a week after the operation (Canet et al, 2003), whereas the frequency of POCD after major surgery reached above 25% (Moller et al, 1998). At three months, however, difference was much smaller (6.6% vs. 9.9% in these studies) .The different rates of early POCD after these operations may be due to differences in the surgical process, type of anaesthesia and anaesthetic agents used (intravenous versus inhalational) as well as differences in the treatment of post-operative pain (Mann et al, 2000). Furthermore, several minor surgical operations are done in outpatients and not in an inpatient environment (Canet et al, 2003).…”

Section: Association With Surgical Operationsmentioning

confidence: 70%

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

Pappa¹,

Theodosiadis²,

Tsounis³

et al. 2016

GJHS

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Background: Many studies have shown that a large number of patients undergoing surgery show a measurable cognitive deterioration after surgery, while many of them still show cognitive deficits even three months later an operation. These specific cognitive deficits in which there is a temporal association between surgery and mental disorders are defined as postoperative impairment of cognitive function. Among cognitive disorders occurring during the postoperative period, the post-operative cognitive dysfunction (POCD) is less studied.Aim: Risk factors concerning POCD will be overviewed in order to be considered as a measure of prevention of POCD.Method: A literature search using combined keywords was undertaken on bibliographic databases including PubMed, Google Scholar and Scopus and through systematic selection 72 scientific articles were identified. Concerning the selection criteria, the material of this study consists of sources published mainly over the last fifteen years, while some articles that published before 2000 were selected because they were considered to be important.Results: These disorders frequently occur in patients of advanced age. It is obvious that as the population of humanity ages, many older people are likely to develop health problems that require surgery and therefore a large number of people are likely to develop post-operative cognitive disorders. For the appearance of POCD, as for other mental disorders (e.g. delirium), several factors are implicated. According to the findings, except the advanced age, genetic polymorphism, idiosyncratic condition, the presence of metabolic syndrome and neurological diseases, the type of anaesthesia and surgical operation and sleep disturbance are among the most important risk factors.

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Comparison of Intravenous or Epidural Patient-controlled Analgesia in the Elderly after Major Abdominal Surgery

Abstract: After major abdominal surgery in the elderly patient, patient-controlled analgesia, regardless of the route (epidural or parenteral), is effective. The epidural route using local anesthetics and an opioid provides better pain relief and improves mental status and bowel activity.

Cited by 317 publications

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Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

Single dose diclofenac suppository reduces post-Cesarean PCEA requirements

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

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