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 Journal Article
| Authors: | Ferguson, S. E.; Malhotra, T.; Seshan, V. E.; Levine, D. A.; Sonoda, Y.; Chi, D. S.; Barakat, R. R.; Abu-Rustum, N. R. |
| Article Title: | 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 |
| 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. © 2009 Elsevier Inc. All rights reserved. |
| Keywords: | adult; controlled study; major clinical study; clinical trial; postoperative period; drug efficacy; drug withdrawal; postoperative care; laparotomy; ovarian neoplasms; bolus injection; controlled clinical trial; nausea; randomized controlled trial; pruritus; lung embolism; genital neoplasms, female; hypotension; length of stay; drug response; surgical infection; urinary tract infection; intermethod comparison; major surgery; antiemetic agent; perioperative period; morphine; analgesics, opioid; pain measurement; drug substitution; uterine cervical neoplasms; epidural analgesia; intravenous anagesia; major open gynecologic surgery; pain control; pcea; postoperative; bupivacaine; hydromorphone; ketorolac; analgesia; anesthetic recovery; epidural anesthesia; gynecologic cancer; gynecologic surgery; hallucination; ileus; intravenous anesthesia; pain assessment; patient controlled analgesia; postoperative pain; urine retention; visual analog scale; analgesia, epidural; analgesia, patient-controlled; infusions, intravenous; pain, postoperative; uterine neoplasms |
| Journal Title: | Gynecologic Oncology |
| Volume: | 114 |
| Issue: | 1 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2009-07-01 |
| Start Page: | 111 |
| End Page: | 116 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2009.03.014 |
| PUBMED: | 19395071 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 30 November 2010" - "CODEN: GYNOA" - "Source: Scopus" |
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