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

A. Matsumoto, S. Satomi, S. Narasaki, S. Kamiya, H. Miyoshi, Y.M. Tsutsumi

Department of Anesthesiology and Critical Care, Hiroshima University, Kasumi, Hiroshima, Japan. yasuo223@hiroshima-u.ac.jp

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• Anesthesiology

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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