胸腔鏡下肺癌手術に対する術後鎮痛法の検討

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  • Postoperative analgesia for patients undergoing video-assisted thoracic surgery for lung cancer
  • キョウコウキョウ カ ハイガン シュジュツ ニ タイスル ジュツゴ チンツウホウ ノ ケントウ

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We conducted a retrospective study to evaluate the postoperative analgesic efficacy and side effects of two common analgesic techniques in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer. A total of 98 adult patients under categories 1-3 of the American Society of Anesthesiologists` physical status classification system were divided into two groups-a patient-controlled epidural analgesia (PCEA) group, which included 82 patients who had received a mixture of 2 μg/ml fentanyl and 1.5 mg/ml ropivacaine, and the intravenous patient-controlled analgesia (IVPCA) group, which included 16 patients who had received 1 mg/ml morphine. Pain intensity in both groups, measured by a 100-mm non-graduated visual analog scale (VAS), was < 30 mm at rest in most cases in both groups. However, the VAS score during movement was 48.5 mm in group PCEA and 60.3 mm in group IVPCA on the day of surgery. Nausea and vomiting were observed in 18% of patients in group PCEA and 25% in group IVPCA. The IVPCA patients were significantly more sedated than the PCEA patients. We conclude that patients undergoing VATS may not have been provided sufficient analgesia during movement in postoperative pain management.

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