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

A previous prospective comparative study reported no difference in resting or dynamic pain scores among women with gynecologic cancer undergoing laparotomy and radical hysterectomy who were treated with either local anesthetic/opioid patient-controlled epidural analgesia (PCEA) or conventional intravenous (IV) opioid patient-controlled analgesia (PCA). However, there was a shorter hospital stay, earlier return of bowel function, and use of less morphine in the PCEA group. No prospective randomized trials have compared IV PCA to PCEA for postoperative control of pain in women treated for benign or malignant gynecologic diseases. This prospective randomized study compared the effect of PCEA and IV morphine PCA on pain scores and other postoperative recovery parameters in women undergoing major open abdominal surgery. Between 2004 and 2007, 67 patients were randomized to PCEA (treatment group) and 68 to the IV PCA (control group). The majority of study women (75%) had gynecologic cancer. Pain and other postoperative outcomes were compared with an intention-to-treat analysis. A 10-point visual analog scale (VAS) was used to measure postoperative pain, at rest and when coughing. There was significantly less pain at rest among patients in the PCEA group postoperatively on day 1 compared to the PCA group (mean VAS: 3.3 vs. 4.3, P = 0.01). Superior pain control during coughing was found in the PCEA group for first 3 postoperative days; the mean VAS scores on days 1, 2, and 3 were 5.5, 5.0, and 4.7 in the PCEA group, and 6.7, 6.5, and 5.7 in the PEA group (P < 0.05). During the first 6 days, overall postoperative pain in the PCEA group was significantly lower during both rest and coughing compared to the PCA group (P < 0.003). No significant major adverse events were associated with placement or use of the thoracic epidural, and an extremely low rate of epidural malfunctioning was noted. These data show superior pain control by PCEA in comparison to conventional IV PEA among women undergoing major open abdominal surgery, and are consistent with the findings of other randomized controlled trials in different patient populations.

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