Randomized trial comparing 3 methods of postoperative analgesia in gynecology patients: patient-controlled intravenous, scheduled intravenous, and scheduled subcutaneous

• Published in: American journal of obstetrics and gynecology Vol. 197; no. 5; pp. 472.e1 - 472.e7
• Main Authors: Bell, Jeffrey G., MD, Shaffer, Lynn E.T., MS, Schrickel-Feller, Trista, MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.11.2007; Elsevier
• Subjects: Adult; Analgesia, Patient-Controlled; Analgesics, Opioid - administration & dosage; Biological and medical sciences; Female; Genital Diseases, Female - surgery; Genital Neoplasms, Female - surgery; Gynecology. Andrology. Obstetrics; Humans; hydromorphone; Hydromorphone - administration & dosage; Infusions, Intravenous; Injections, Subcutaneous; Leiomyoma - surgery; Male; Medical sciences; Middle Aged; Obstetrics and Gynecology; Pain Measurement; Pain, Postoperative - prevention & control; Patient Satisfaction; patient-controlled analgesia; postoperative analgesia; route of administration; postoperative analgesia; hydromorphone; patient-controlled analgesia; route of administration; Human; Postoperative; Intravenous administration; Subcutaneous; Gynecology; Method; Obstetrics; Analgesia; Randomization; Treatment; Surgery; Clinical trial; Comparative study
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2007.03.039

Objective The objective of the study was to determine whether any of 3 routes of opioid administration (patient-controlled analgesia [PCA], scheduled intermittent intravenous [IV], or scheduled intermittent subcutaneous [SQ]) provides superior pain relief and satisfaction among patients undergoing abdominal gynecologic surgery. Study Design Patients were randomized to intravenous hydromorphone by PCA, IV hydromorphone via scheduled nurse-administered doses, or SQ hydromorphone via scheduled nurse-administered doses. Self-reported pain and satisfaction were recorded over 48 hours following arrival at the nursing unit. Linear mixed effects modeling was used to compare outcomes among the groups. Results Neither pain scores nor satisfaction differed by group. PCA patients had higher total opioid use ( P < .0001) and a higher rate of pruritus ( P = .04). Conclusion Given these findings as well as those in previous literature, no specific method of postoperative analgesia appears to be superior.