A comparison of nurse-administered and patient-controlled analgesia

S146

Poster 243 BLUE Mon-Tues Exhibit Hall

EPIDURAL PFXHIDINR FOR POSTOPRRATIVR ANALGRSIA AFTER LUMMR SPINE SURGERY.

Abs No

W.Wew*, T.Harh&, A.Weyland’, H.Kolemla’, U.Braun’ Depts. of Ana&hesiolog$ and Neurosurge$, University of Goettingen, D-2400 Goettingen, FRG.

286

m OF INVRSTIGATIONr Conventional postoperative analgesia tkquently provides inadequate pain relief and prevents early mob&ration after lumbar spine surgery. Intraoperative accesaii of the epidural space facilitates insertion of a catheter for opioid injection without additional risks related to percutaneous puncture. This study was undertaken to evaluate systemic absorption and amdgeaic e&aey of pet&line injected into the traumatized epidural space. m 20 ASA I-II patients scheduled for lumbar disc surgery were randomly assigned for intraoperative placement of an epidural catheter and postoperative on-demand injection of pethidine 50 mg (n= 10,EG) or tramado mg SC(n= 10, CG). The study was carried out during the fkst postoperative 24 h in a single blind mode. Postoperative pain was quantilIed by visual anslog scale (VAS). Heart rate (HR) and respiratory rate (RR) were recorded continuously. Immediately before and 30 min after injection pethid& serum levels were determined. Preoperatively and 2 h after the first pethidine injection a segmental pain threshold testing was performed by thermal contact stimulus in the C4, Tb4, ThlO, Ll,and Sl segments. R]BsuLTs: The cumuIative frequency of required analgesia was 34 in the EG and 18 in the CG. Mean pre/post-injection VAS-scores were 56/9 in the EG and 6O/l9 in the CG respectkly. Duration of near maximum VAS-reduction was 2 h. Maximum serum pethidine concentmtions of 400 ng/ml appeared after four injections. An early drop of RR below lO/miu was detected after 6 epidural injections. There were only 2 increases in HR >lS% of pre-injection levels after pethidine applicationThe pre/postinjection pain threshold testing could not show any spechlc segmental am&&a in the EG. Sedation after injection of the opioide occurred in both groups, 2 (1) patients of the EC (CC) complained of nausea. One case of wound infection occurred in the CG. The median urine norepinepbrine excretion in the EG (27 ug/d) was 13 ug less than in the CG. CONCLIJSJQ& Epidural petbidine provided a fast onset, high quality analgesia without increased side effects after lumbar disc surgery. The injection close to the operation site did not seem to enhance systemic absorption. Serum concentrations did rarely reach reported amdgesic levels even after repeated injections. Systemic cumulation did occur but levels never approached those reported for respiratory depression. The documented reduction of RR seemed to be related to maximum serum levels within 30 min alter injection. The spinal analgesic component of a lipophil opioid like pethidine seems to be clinically unaltered after injection close to the traumatized epidural space.

Poster 244 BLUE Mon-Tues Exhibit Hall

A COMPARISON OF NURSEADMINISTERED AND PATIENT-CONTROLLED ANALGESIA I-I. Gwen, J.L. Plummer, L. Ho kins* and J. Cushnie, Department of Anaesthesia and Intensive Care, Flinders rKedical Centre, Bedford Park, 5042, South Australia.

Abs No

287

I

to one of 3 treatment

oup i. Judged by patients reports *ofpain PCA provided better pain relief than IMI, due, at Fas;i art, to that group recewmgmore morphme. Although hourly measurement of stoperatrve pam &I led to mtrsmg staff admrmstermg more morphme to those patients the core p” lary m that group was niit less pain

worse than than in d