Solyarik S. Epidural patient controlled analgesia in patients after abdominal and orthopedic surgery.

On basis of research and analysis of postoperative analgesia in patients after abdominal and orthopedic surgery, we have improved the technique of patient-controlled epidural analgesia with an introduction of a syringe pump with an additional system of patient-controlled drug delivery. On all stages of the research, the patients from trial groups have had a better analgesia profile than the patients from the control group. Patients from all subgroups of the trial group had a better safety profile of analgesia, concerning such endpoints as frequency of significant hypotension, bradycardia, postoperative nausea and vomiting and sedation depth with a statistically significant difference between the trial and control groups of patients. We have conducted a research of systemic inflammatory response syndrome in patients undergoing epidural patient-controlled analgesia using bupivacaine, fentanyl and clonidine. Based on new scientific data obtained, we have developed a new concept of prolonged, highly efficient postoperative analgesia after abdominal and orthopedic (lower extremities) surgery in patients with severe respiratory and cardiovascular co-morbidity due to a better safety profile and lower frequency of complications. After analyzing the three options of drug combinations tested for patient controlled epidural analgesia after orthopedic and abdominal surgery, in terms of efficiency of pain control, hemodynamic stability and frequency of analgesia-related side-effects, we have obtained enough data to affirm that the best option is patient-controlled epidural analgesia using an infusion of 0.125% bupivacaine solution combined with 0.005% fentanyl and 0.01% clonidine solutions.