Prospective Randomized Trial

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

http://snipurl.com/jf4ae  [www_sciencedirect_com]

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.