Efficiency of tapering programmed intermittent epidural analgesia in video-assisted thoracic surgery: a double-blind, prospective, randomized study.

UNLABELLED:

OBJECTIVE

Programmed intermittent epidural bolus (PIEB) is an effective analgesic method owing to the redistribution of the drug solution, which leads to a gradual improvement in postoperative pain over time. This study aimed to compare the postoperative analgesic effects of patient-controlled epidural analgesia (PCEA) with those of tapering PIEB (t-PIEB), in which the drug dosage is decreased over time, and continuous epidural infusion (CEI). MATERIALS AND

METHODS

Patients undergoing video-assisted thoracoscopic surgery (VATS) with general and epidural anesthesia were randomized in a 1:1 ratio into the t-PIEB and CEI groups. Patients in the t-PIEB group received 3 mL of 0.2% ropivacaine from the pump every hour, whereas those patients in the CEI group received the same drug solution continuously at a rate of 3 mL/h. In both groups, a 2-mL bolus of 0.2% ropivacaine was administered postoperatively, with additional PCEA as needed. In the t-PIEB group, the dosage was gradually decreased to 2 mL/dose after 25 h and to 1 mL/dose after 49 h. The primary endpoint was the number of times the patient pressed the PCA button at 24, 48, and 72 h.

RESULTS

No significant difference was observed in the frequency of PCA button pressing between the two groups during the observation period. The t-PIEB group had a significantly lower usage of ropivacaine.

CONCLUSIONS

Nt-PIEB could have analgesic effects comparable to those of CEI for postoperative pain following VATS with less medication use.

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