Effects Of Intravenous And Epidural Analgesia On Postoperative Lung Function And Pulmonary Infection Of The Elders Following Laparoscopic Radical Prostatectomy

Objective To compare the effects of patient-controlled intravenous analgesia?PCIA?and patient-controlled epidural analgesia?PCEA?on postoperative lung function and pulmonary infection for the elderly patients with prostatic cancer after laparoscopic radical prostatectomy?LRP?.Methods Sixty elderly patients?age ? 65 years?with prostatic cancer were randomized into two groups?n=30?:i.e.PCIA group,and PCEA group.Visual analogue scale?VAS?were recorded when the patient was resting and coughing at the following time points: 1h,4h,12 h,24h,36 h,48h after operation.The centre of ventilation?Co V?,dependent silent spaces?DSS?,nondependent silent spaces?NSS?were assessed at the sixth intercostals space 1d before and 1d,2d after operation.Pulmonary function was continuously monitored in the following periods:1d before operation and 1d,2d after operation.The modified Clinical Pulmonary Infection Score?m CPIS?was assessed on 1d before and 1d,3d,5d after operation.Results Group PCIA patients showed significantly increased postoperative pain at rest at postoperative hour 1 and 12 and on activity at postoperative hour 1 and 48?P<0.05?compared with gourp PCEA patients.In PCIA group,the DDS and NSS were significantly higher than those in PCEA group?p<0.05?at 1d and 2d after operation.DDS and NSS increased significantly at postoperative hour 24 compared with that at preoperative hour 24 and decreased significantly at postoperative hour 48 compared with that at postoperative hour 24?p<0.05?.FVC,FEV₁,PEF decreased significantly 1d and 2d after operation compared with those 1d before operation and increased significantly 2d after operation compared with 1d after operation?P<0.05?.While the changes in FVC,FEV₁,and PEF seemed less significant between two groups?P >0.05?.Compared with group PCIA,the m CPIS in group PCEA decreased significantly at 1d,3d,and 5d after operation.Conclusion Epidural anesthesia produced increased recovery of ventilation distribution and significantly lower m CPIS and relatively better pain control in elderly patients undergoing laparoscopic radical prostatectomy.