Comparison of the Analgesic Efficacy and Adverse Effects of Patients Controlled Epidural vs. Intravenous Analgesia after Lung Cancer Radical Resection

Objective: To evaluate the analgesia efficacy and side effects of patient-controlled epidural analgesia and patient-controlled intravenous analgesia on patients with lung cancer after radical resection.Methods: 1214 ASA Ⅰ-Ⅱ patients with pulmonary lobectomy,were divided into patient-controlled epidural analgesia group(PCEA,n=1023) and patient-controlled intravenous analgesia group(PCIA,n=191).Epidural catheter was placed at T5~6 or T6~7 interspace.At the end of operation,PCEA started with a loading dose of ropivacaine(2.5 mg) and fentanyl(0.05 mg) 5 mL through the epidural catheter,followed by PCEA of ropivacaine(0.15 %~0.2 %) + fentanyl(1.8~3.6 g/mL) in 275 mL(background infusion 3~5 mL/h,bolus dose 3~5 mL,lock-out interval 15 min).In group PCIA,the patients were received a loading dose of sufentanil 5 g followed by PCIA of sufentanil(0.5 g/mL) in 275 mL(background infusion 3-5 mLl/h,bolus dose 3-5 mL,lock-out interval 15 min).The same general anesthesia was given to both groups.The analgesia and sedation were evaluated by visual analogue scale(VAS) and ramsay sedation score(RSS) respectively.Adverse reaction and clinical outcomes were analyzed for PCEA and PCIA groups.Results: One thousand and two patients received epidural analgesia,and one hundred and eighty-six patients received intravenous analgesia,with equivalent baseline patient demographics between two groups.VAS score in the PCEA group was lower than those in the PCIA group,at the postoperative 2 h static state and postoperative 6 h,and 24 h activity(P0.05).Ramsay score was lower in the PCEA group than those in the PCIA group at the postoperative 48 h(P0.05).The duration of hospitalization was significantly shorter in the PCEA group than those in the PCIA group(P0.05).The incidence rates of nausea and vomiting,pulmonary complications,incision infection and postoperative delirium of PCEA groups were all significantly lower in the PCEA group than those in the PCIA group(P0.05).Conclusion: PCEA and PCIA postoperative analgesia achieved satisfactory analgesic effects on patients undergoing lung cancer radical resection.PCEA had fewer adverse reactions and shorter duration of hospitalization with the advantages to perioperative analgesia and rehabilitation in patient undergoing lung cancer radical resection.