Patient Controlled Epidural Analgesia (PCEA) with or without Background Infusion using Fentanyl and Bupivacaine for Major Upper Abdominal Surgery

Background Pain thresholds vary in individuals. Need for analgesia thereby differs in individuals. Methods The aim was to compare, patient controlled epidural analgesia (PCEA) with demand bolus (Group A) versus demand bolus and continuous infusion (Group B) in terms of analgesic efficacy and side effects after major abdominal surgery. The primary outcome of the study was VAS score at rest and on coughing, number of demand and successful delivery of analgesia. The secondary outcomes evaluated were total fentanyl and bupivacaine doses, frequency of rescue analgesia, sedation scores and side effects. No drug was given through epidural catheter passed preoperatively. Postoperatively, when VAS > 3, Patient Controlled Analgesia (PCA) pump was programmed to deliver on demand, 3.5 ml containing 10 mcg of Fentanyl and 2 mg of Bupivacaine in Group A with a lockout interval of 15 minutes. In Group B, continuous infusion of same solution at 3.5 ml/hr was also given. Patient was asked to rate the analgesia. Rescue analgesia was given with IV Tramadol 2mg/kg when VAS > 3 at rest despite three consecutive demands. Results 74 patients were studied. Number of demands, VAS scores was significantly less in group B. Requirement of rescue analgesia was more in group A. Amount of bupivacaine and fentanyl needed and incidence of nausea and vomiting were more in the group B. No incidence of over sedation, hypotension and respiratory depression was noted. Conclusion PCEA with continuous infusion plus demand bolus gave better quality of analgesia and had better acceptability, without any significant side effects.