1. Postoperative analgesic efficacy of PIB with PCEA for VATE-E
Hironobu Ueshima, Haruko Shibata, Yukiko Tsushima, Hiroshi Otake
Department of Anesthesiology, Showa University Hospital, Tokyo, Japan
【Results】　　
〈Patient’s demographics〉 　 〈The number of pushed PCA 〉
〈The number of required PCA 〉　　　　　　　　　　　　　　
【Discussion】
We have shown that compared with continuous infusion, program intermittent bolus mode had more effective analgesic effects for VATE-E. This study shows that intermittent bolus must be effective for perioperative pain management in not only open surgery but also thoracoscopic surgery. A fewer number of pushed PCA may decrease complications such as a change of hemodynamics too. This result leads to earlier rising2. In addition, the decrease of additional analgesic relates to reduce medical expenses.
Limitation
・Suitable mode of CADD
・Adequate concentration of local anesthetic
【Conclucion】
　 PIB mode with PCEA showed more effectiveness for VATS-E than continuous infusion.
【Reference】
1. Intermittent epidural bolus compared with continuous epidural infuseons for labor analgesia: a systematic review and meta-analysis. Anesth Analg. 2013
2. Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study. Int J Obstet Anesth. 2016
3. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on
maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesth Analg. 2011
【Introduction】
Patient Controlled Epidural Analgesia (PCEA) is a proven effective postoperative analgesic therapy for various thoracic and abdominal surgeries. The share of video-assisted thoracoscopic and laparoscopic surgeries have dramatically increased and those procedures are proven to be less invasive than traditional open thoracotomy and laparotomy. Postoperative analgesia for those less invasive approaches could be different from that for open surgeries. CADD-Solis ambulatory infusion pump (Smith Medical Japan Ltd. Tokyo) provides new delivery mode of infusion drugs called Program Intermittent Bolus (PIB) mode. 
Although there are several studies showing that PIB mode with PCEA provided better analgesia than Continuous Infusion (CI) with PCEA in obstetric anesthesia, there are only a few studies about PIB mode for postoperative pain management for abdominal surgeries1-3. Currently, there is no study about PIB for thoracic surgery. 
We investigated the efficacy of the PIB for Video-Assisted Thoracoscopic Esophagectomy (VATE-E).
【Material and Method】
Study type: A prospective study, which divide into I group and C gourp
Condition: Video-assisted thoracoscopic surgery
Study period: From Junuary to October 2016
Excluded cases: the cases of changed from VATE-E to open thoracoscopic and the patients who cannot insert epidural catheter
CADD content
I group: The set flow rate was intermittent bolus of 6mL of levobupivacaine 0.1% every hour and 3mL levobupivacaine 0.1% lock out time: 20 minutes for 2 days
C group: The set flow rate was continuous 6mL of levobupivacaine 0.1% every hour and 3mL levobupivacaine 0.1% lock out time: 20 minutes for 2 days
Patients were requested to push PCEA button if patients felt the pain more than 4 out of 10 in numeric rating scale
Investigation items
Patient’s demographics, operation time, anesthesia time, surgery contents,
Primary outcome: the number of pushed PCEA between the operation end and at postoperative 24 hours and between postoperative 24 hours and at postoperative 48 hours
Secondary outcomes: the number of requested PCEA between the operation end and at postoperative 24 hours and between postoperative 24 hours and at postoperative 48 hours, and the number of patients used additional analgesic and withdrawal patient within postoperative 48 hours.
Statistical analysis: The JMPR Pro software version (SAS Institute, Cary, NC ) was used to test the normality of the data. The measured data were compared using Mann-Whitney’s U-test and χ2 test for 2 group difference. The numbers of pushed and demanded PCA were compared by using the Mann-Witney U-test for pairwise comparisons. The number of the patient used additional analgesic and withdrawal patient were compared by using the Fisher’s exact test.
Declaration of interest:The authors have no financial relationships to this study.
Declaration of interest
The authors have no financial relationships to this study.
Declaration of interest
The authors have no financial relationships to this study.
Declaration of interest
The authors have no financial relationships to this study.
Declaration of interest
The authors have no financial relationships to this study.
Declaration of interest
The authors have no financial relationships to this study.