Effects Of PCIA Vs PCEA On Platelet Activation In Patients Undergoing Radical Colon Carcinoma Operation

Objective To compare the effects of patient-controlled intravenous analgesia（PCIA） and patient-controlled epidural analgesia （PCEA） on platelet activationin patients undergoing radical colon carcinoma operationMethods Sixty-four ASA I or II patients, age43-65yr, weighing45-68kg,undergoing radical colon carcinoma operation, were randomly divided into2groups(n=32each): PCIA group and PCEA group. PCA pumps were connected at the end ofoperation.The PCIA solution contained sufentanil3μg/kg, tropisetron5mg,Vitamin B6100mg in130ml of normal saline. The PCIA pump was set up todeliver a1.8ml bolus dose with a15-min lockout interval and background infusion at2ml/h. The PCIA solution contained sufentanil0.5μg/kg and0.125%ropivacaine in300ml of normal saline.The PCEA pump was set up to deliver a2.5ml bolus dosewith a20-min lockout interval and background infusion at5ml/h after a loading doseof5ml. Visual Analogue Scale （VAS） was maintained3after operation.Venous blood samples were taken before anesthesia, at60min after beginning ofoperation, and at the end of operation and4,12,24and48h after operation todetermine the concentrations of plasma insulin and cortisol and blood glucose. Venousblood samples were taken at30min before operation,1h after beginning ofoperation,and at30min and4,12,24and48h after operation (T0～6) to measure theconcentrations of serum platelet-granzyme membrane protein-140(GMP-140).Theside effects were recorded after operation.Results30and29patients completed the study in groups PECA and PCIArespectively. There was no significant difference in the concentrations of plasmainsulin and cortisol and blood glucose at each time point between the two groups (P>0.05). The concentrations of serum GMP-140was significantly higher at T1～6thanthe baseline value at T0(P <0.05). The concentrations of serum GMP-140and incidence of nausea and vomiting were significantly lower at T3~6in group PCEA thanin group PCIA (P <0.05). One case happened pruritus in group PCIA, and respiratorydepression and local anesthetic intoxication were not observed in the two groups.Conclusion PCEA has better inhibitory effect on the overactivation of plateletthan PCIA, which may be helpful for preventing metastases of carcinoma cells orpostoperative thrombosis, and it is more suitable for postoperative analgesia inpatients undergoing radical colon carcinoma operation.