A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery

• Published in: Gynecologic oncology Vol. 114; no. 1; pp. 111 - 116
• Main Authors: Ferguson, Sarah E, Malhotra, Tim, Seshan, Venkatraman E, Levine, Douglas A, Sonoda, Yukio, Chi, Dennis S, Barakat, Richard R, Abu-Rustum, Nadeem R
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2009
• Subjects: Analgesia, Epidural - methods; Analgesia, Patient-Controlled - methods; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Epidural analgesia; Female; Genital Neoplasms, Female - surgery; Hematology, Oncology and Palliative Medicine; Humans; Infusions, Intravenous; Intravenous anagesia; Major open gynecologic surgery; Morphine - administration & dosage; Morphine - therapeutic use; Obstetrics and Gynecology; Ovarian Neoplasms - surgery; Pain control; Pain Measurement; Pain, Postoperative - drug therapy; PCEA; Postoperative; Uterine Cervical Neoplasms - surgery; Uterine Neoplasms - surgery; Postoperative; Major open gynecologic surgery; PCEA; Intravenous anagesia; Pain control; Epidural analgesia
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2009.03.014

Abstract Objective To determine the effect of perioperative patient-controlled epidural analgesia (PCEA) compared to postoperative intravenous (IV) patient-controlled analgesia (PCA) on postoperative recovery parameters after major open gynecologic surgery. Methods A randomized controlled clinical trial included women undergoing laparotomy for a gynecologic disorder. Patients were randomized to postoperative IV morphine PCA (control arm) or to postoperative morphine–bupivacaine PCEA (treatment arm). Postoperative outcomes such as pain, and length of hospital stay were compared with an intention-to-treat analysis. The primary endpoint was postoperative pain at rest and when coughing — assessed by a 10-point visual analog scale (VAS). Results Between 9/04 and 6/07, 153 patients were randomized and 135 were evaluable (PCEA = 67; PCA = 68). Over 75% of the women in this study had gynecologic cancer. Patients in the PCEA arm had significantly less postoperative pain at rest on Day 1 and during the first 3 postoperative days when coughing compared to the PCA arm ( P < 0.05). The mean pain score at rest on Day 1 was 3.3 for the PCEA group compared to 4.3 for the PCA group ( P = 0.01). Overall, postoperative pain at rest and while coughing in the first 6 days was less in women treated with PCEA compared to PCA ( P < 0.003). Conclusions PCEA offers superior postoperative pain control after laparotomy for gynecologic surgery compared to traditional IV PCA. Women requiring major open surgery for gynecologic cancer should be offered PCEA for postoperative pain management if there are no contraindications.