硬脊膜外自控式術後止痛較靜脈式自控式術後止痛有較多之副作用

Epidural analgesia has more adverse events than intravenous analgesia

研究目的：為了要了解三種手術後自控式止痛的效果和副作用。方法：將本院在2007年當中，接受手術後自控式止痛的4939個患者分為三組。這三 組分別為（1）靜脈式嗎啡自控式術後止痛，（2）靜脈式吩坦尼自控式術後止痛，（3）硬脊膜外自控式術後止痛。所有的患者在手術後兩天，由疼痛部門評估疼痛分數和副作用的發生及嚴重度，並在結束使用手術後止痛裝置時詢問整體的滿意度。結果：有更脊膜外自控式術後止痛有最佳的滿意度分數（3.455±0.51），但是其副作用（噁心／嘔吐、搔癢、姿態性暈眩）的發生亦高於其他兩組。結論：三種手術後止痛皆是安全的且有效。硬脊膜外自控式術後止痛的止痛效果， 無論在休息或動作的狀態中，皆優於靜脈式嗎啡自控式術後止痛和靜脈式吩坦尼自控式術後止痛。在大部分的患者中，其三種手術後自控式止痛措施副作用的症狀皆是輕微 的。

Objectives: To understand the efficacy and side effects of the most used three modalities of patient-controlled analgesia devices. Methods: 4939 patients who received PCA after their operation in 2007 was divided into three groups according to the PCA devices. The three groups are (1) intravenous morphine (IPCAM) (2) intravenous fentanyl (IPCAF) and (3) epidural patient-controlled analgesia (PCEA) All patients were assessed by acute pain service for two consecutive days including the verbal rating scale (VRS), occurrence and severity of adverse events and satisfaction score at the end of PCA. All data were compared and analyzed. Results: The PCEA group had the highest satisfaction score (3.455±0.51), but the incidences of adverse events (nausea/vomiting, pruritus, orthostatism) were also higher than the other two groups. Conclusions: The three modalities of the PCA devices are safe and effective for postoperative pain management. The PCEA provided significantly superior analgesia effect compared with IPCAM or IPCAF groups at rest and mobilization. The symptom of side effects caused by different PCA modality and regimen was mild in most patients.