Comparison of epidural and intravenous patient controlled analgesia in patients undergoing radical cystectomy.
Bibliographic record
Abstract
OBJECTIVE: Postoperative analgesia is an important factor influencing surgical outcomes. We aimed to evaluate the role of patient controlled epidural analgesia (PCEA) versus intravenous (IV) patient controlled analgesia (PCA) in patients undergoing radical cystectomy. METHODS: We reviewed data from consecutive patients who had a radical cystectomy at our institution between 2003 and 2007 to evaluate the effect of either PCEA or IV PCA on the patients' postoperative pain--the primary outcome--as well as secondary outcomes including time to begin eating solid food, time to ambulation, and length of hospital stay. The patients received either hydromorphone or morphine via IV PCA, or bupivacaine and hydromorphone or ropivacaine via PCEA. Pooled t tests and Wilcoxon rank sum tests were used to compare outcomes. A mixed model regression analysis was used to compare pain scores. RESULTS: Data was analyzed from 131 patients to compare 73 patients (56%) who received PCEA versus 58 patients (44%) who received IV PCA. No significant differences in patient mobilization, progress to eating solid food, or length of hospital stay were detected, although there was a trend for earlier progress to eating solid food for patients in the PCEA group (p = 0.09). Using a mixed model analysis, we found no significant difference in pain scores at rest (p = 0.11). However, pain scores during activity were significantly lower for patients in the PCEA group, (p = 0.02), with a significant interaction effect (p = 0.03), indicating that the benefit with PCEA occurred in the early postoperative period. CONCLUSION: Our findings suggest that compared with IV PCA, PCEA for radical cystectomy patients can result in lower immediate postoperative pain during activity, with a trend to earlier progress to eating solid foods, but no shortening of hospital stay.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".