scholarly journals Effect of dexmedetomidine infusion for intravenous patient-controlled analgesia on the quality of recovery after laparotomy surgery

Oncotarget ◽  
2017 ◽  
Vol 8 (59) ◽  
pp. 100371-100383 ◽  
Author(s):  
Juan Xin ◽  
Yabing Zhang ◽  
Leng Zhou ◽  
Fei Liu ◽  
Xiaoshuang Zhou ◽  
...  
Keyword(s):  
Patient Controlled Analgesia ◽  
Quality Of Recovery ◽  
Dexmedetomidine Infusion

Thoracic Epidural versus  Intravenous Patient-controlled Analgesia after Cardiac Surgery

2006 ◽  
Vol 104 (1) ◽  
pp. 142-151 ◽  
Author(s):  
Vigdis Hansdottir ◽  
Julia Philip ◽  
Monika Fagevik Olsen ◽  
Christina Eduard ◽  
Erik Houltz ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Thoracic Epidural Analgesia ◽  
Patient Controlled Analgesia ◽  
Thoracic Epidural ◽  
Quality Of Recovery ◽  
Intravenous Morphine

Background Perioperative thoracic epidural analgesia reduces stress response and pain scores and may improve outcome after cardiac surgery. This prospective, randomized trial was designed to compare the effectiveness of patient-controlled thoracic epidural analgesia with patient-controlled analgesia with intravenous morphine on postoperative hospital length of stay and patients' perception of their quality of recovery after cardiac surgery. Methods One hundred thirteen patients undergoing elective cardiac surgery were randomly assigned to receive either combined thoracic epidural analgesia and general anesthesia followed by patient-controlled thoracic epidural analgesia or general anesthesia followed by to patient-controlled analgesia with intravenous morphine. Postoperative length of stay, time to eligibility for hospital discharge, pain and sedation scores, degree of ambulation, lung volumes, and organ morbidities were evaluated. A validated quality of recovery score was used to measure postoperative health status. Results Length of stay and time to eligibility for hospital discharge were similar between the groups. Study groups differed neither in postoperative global quality of recovery score nor in five dimensions of quality of recovery score. Time to extubation was shorter (P < 0.001) and consumption of anesthetics was lower in the patient-controlled thoracic epidural analgesia group. Pain relief, degree of sedation, ambulation, and lung volumes were similar between the study groups. There was a trend for lower incidences of pneumonia (P = 0.085) and confusion (P = 0.10) in the patient-controlled thoracic epidural analgesia group, whereas cardiac, renal, and neurologic outcomes were similar between the groups. Conclusions In elective cardiac surgery, thoracic epidural analgesia combined with general anesthesia followed by patient-controlled thoracic epidural analgesia offers no major advantage with respect to hospital length of stay, quality of recovery, or morbidity when compared with general anesthesia alone followed by to patient-controlled analgesia with intravenous morphine.

scholarly journals Enhanced Recovery after Lumbar Spine Fusion

2020 ◽  
Vol 133 (2) ◽  
pp. 350-363 ◽  
Author(s):  
Ellen M. Soffin ◽  
James D. Beckman ◽  
Audrey Tseng ◽  
Haoyan Zhong ◽  
Russel C. Huang ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Oral Intake ◽  
Patient Controlled Analgesia ◽  
C Reactive Protein ◽  
Quality Of Recovery ◽  
Reactive Protein ◽  
Pain Scores ◽  
Clinically Important Difference ◽  
Recovery Group

Background Prospective trials of enhanced recovery after spine surgery are lacking. We tested the hypothesis that an enhanced recovery pathway improves quality of recovery after one- to two-level lumbar fusion. Methods A patient- and assessor-blinded trial of 56 patients randomized to enhanced recovery (17 evidence-based pre-, intra-, and postoperative care elements) or usual care was performed. The primary outcome was Quality of Recovery-40 score (40 to 200 points) at postoperative day 3. Twelve points defined the clinically important difference. Secondary outcomes included Quality of Recovery-40 at days 0 to 2, 14, and 56; time to oral intake and discharge from physical therapy; length of stay; numeric pain scores (0 to 10); opioid consumption (morphine equivalents); duration of intravenous patient-controlled analgesia use; complications; and markers of surgical stress (interleukin 6, cortisol, and C-reactive protein). Results The analysis included 25 enhanced recovery patients and 26 usual care patients. Significantly higher Quality of Recovery-40 scores were found in the enhanced recovery group at postoperative day 3 (179 ± 14 vs. 170 ± 16; P = 0.041) without reaching the clinically important difference. There were no significant differences in recovery scores at days 0 (175 ± 16 vs. 162 ± 22; P = 0.059), 1 (174 ± 18 vs. 164 ± 15; P = 0.050), 2 (174 ± 18 vs. 167 ± 17; P = 0.289), 14 (184 ± 13 vs. 180 ± 12; P = 0.500), and 56 (187 ± 14 vs. 190 ± 8; P = 0.801). In the enhanced recovery group, subscores on the Quality of Recovery-40 comfort dimension were higher (longitudinal mean score difference, 4; 95% CI, 1, 7; P = 0.008); time to oral intake (−3 h; 95% CI, −6, −0.5; P = 0.010); and duration of intravenous patient-controlled analgesia (−11 h; 95% CI, −19, −6; P < 0.001) were shorter; opioid consumption was lower at day 1 (−57 mg; 95% CI, −130, −5; P = 0.030) without adversely affecting pain scores (−2; 95% CI, −3, 0; P = 0.005); and C-reactive protein was lower at day 3 (6.1; 95% CI, 3.8, 15.7 vs. 15.9; 95% CI, 6.6, 19.7; P = 0.037). Conclusions Statistically significant gains in early recovery were achieved by an enhanced recovery pathway. However, significant clinical impact was not demonstrated. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals The effect of newly designed dual-channel elastomeric pump for intravenous patient-controlled analgesia after total laparoscopic hysterectomy: a randomised, double-blind, prospective study

2020 ◽  
Author(s):  
Seok Kyeong Oh ◽  
Heezoo Kim ◽  
Young Sung Kim ◽  
Chung Hun Lee ◽  
Jung Suk Oh ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Flow Rate ◽  
Normal Saline ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Patient Controlled Analgesia ◽  
Quality Of Recovery ◽  
Dual Channel ◽  
Group 16

Abstract Background: A newly designed intravenous patient-controlled analgesia (PCA) device with dual-channel elastomeric infusion pump has been recently introduced. One channel is a continuous line with a constant flow rate basal infusion, while the other channel has an adjustable flow rate and bolus function, and is labeled as a selector-bolus channel. This study compared dual and single channel intravenous PCA in terms of clinical effect and quality of recovery.Methods: Eighty-four patients undergoing total laparoscopic hysterectomy were randomly allocated to a 1-channel group (n = 41) or a 2-channel group (n = 43). Only the selector-bolus channel was utilised, but the continuous channel was not utilised in the 1-channel group, but both channels were utilised in the 2-channel group. In the 1-channel group, 16 µg/kg fentanyl, 2 mg/kg ketorolac, and 12 mg ondansetron with normal saline was administered to the selector-bolus channel, and normal saline only in the continuous channel for blinding. In the 2-channel group, 16 µg/kg fentanyl was administered to the selector-bolus channel, and ketorolac (2 mg/kg) and ondansetron (12 mg) were administered via the continuous channel. The quality of recovery was evaluated preoperatively and 24 h postoperatively using the Quality of Recovery-40 (QoR-40). Cumulative PCA consumption, postoperative pain rated using the numeric rating scale (NRS; during rest/cough), and postoperative nausea were evaluated 6, 12, 24, 36, and 48 hours after surgery. Incidence of vomiting and use of antiemetics and rescue analgesics were measured.Results: The 24-h postoperative QoR-40 score was higher in the 2-channel group than in the 1-channel group (P=0.031). The incidence of nausea at 12 h and 36 h was significantly higher in the 1-channel group (P=0.043 and 0.040, respectively), and antiemetic use was more frequent in the 1-channel group (P=0.049). Patient satisfaction was higher in the 2-channel group (P=0.036). No significant differences were observed in pain scores during resting/cough or cumulative PCA consumption.Conclusions: The 2-channel PCA showed a lower incidence of nausea and antiemetics administration, and consequently higher overall patient satisfaction and quality of recovery with comparable analgesic efficacy to that of the 1-channel PCA after total laparoscopic hysterectomy.Trial registration: Registered at ClinicalTrials.gov, NCT04082039 on 9 September 2019.

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