Efficacy of Postoperative Patient-controlled and Continuous Infusion Epidural Analgesia versus Intravenous Patient-controlled Analgesia with Opioids

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
Anesthesiology (Impact Factor: 5.88). 12/2005; 103(5):1079-88; quiz 1109-10. DOI: 10.1097/00000542-200511000-00023
Source: PubMed


The authors performed a meta-analysis and found that epidural analgesia overall provided superior postoperative analgesia compared with intravenous patient-controlled analgesia. For all types of surgery and pain assessments, all forms of epidural analgesia (both continuous epidural infusion and patient-controlled epidural analgesia) provided significantly superior postoperative analgesia compared with intravenous patient-controlled analgesia, with the exception of hydrophilic opioid-only epidural regimens. Continuous epidural infusion provided statistically significantly superior analgesia versus patient-controlled epidural analgesia for overall pain, pain at rest, and pain with activity; however, patients receiving continuous epidural infusion had a significantly higher incidence of nausea-vomiting and motor block but lower incidence of pruritus. In summary, almost without exception, epidural analgesia, regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patient-controlled analgesia.

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    • "Indeed, a meta-analysis found that both forms of epidural analgesia (continuous infusion and patient-controlled analgesia) provided significantly superior postoperative analgesia compared to IV-PCA for all types of surgery and pain assessments. Interestingly, the exceptions were epidural regimens based only on hydrophilic opioids [35]. Further, it was demonstrated that the combination of adrenaline (2 µg/ml) with a low dose of fentanyl (2 µg/ml) and bupivacaine (1 mg/ml) improves the overall synergic analgesic effect when administered at the thoracic epidural space (above the conus medullaris) coincident with the incision level. "
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    ABSTRACT: Korean J Pain 2014 July; Vol. 27, No. 3: 200-209 Bujedo BM – In this review, the authors purpose was to spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose–limiting side effects to improve postoperative analgesia. The results obtained from meta–analyses of RTCs is considered to be the ‘highest’ level and support their use. However, it´s a fact that meta–analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient’s outcome.
    The Korean journal of pain 07/2014; 27(3):200-209. DOI:10.3344/kjp.2014.27.3.200
    • "The role of epidural anesthesia or regional anesthesia in fast-track rehabilitation program should be stressed. Postoperative epidural analgesia can avoid stress-induced neurological, endocrinological and homeostatic changes or the blocking of sympathetic nerve-related surgical stress response, reduce complications such nausea, vomiting and enteroparalysis after operation, early ambulation, improve the intestinal function and shorten the hospital stay time of patients after resection of gastric cancer.[17181920212223] "
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    ABSTRACT: OBJECTIVE: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS) in patients undergoing laparoscopic assisted total gastrectomy. MATERIALS AND METHODS: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22) patients received enhanced recovery programme (ERAS) management and rest twenty-five (n = 25) conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. RESULTS: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h) when compared to conventional group (140 ± 28 h). ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h). There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43) g/L vs. (73.07 ± 19.32) g/L, d3 (126.10 ± 18.62) g/L vs. (160.72 ± 26.18) g/L)]. CONCLUSION: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.
    Journal of Minimal Access Surgery 07/2014; 10(3):132-8. DOI:10.4103/0972-9941.134876 · 0.81 Impact Factor
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    • "This finding was also supported by Nikolajsen and Haroutiunian (2011) who reported in their meta-analysis study that PCA has a similar effect on pain management as other methods. Whereas, Wu and colleagues (2005) reported that epidural regimen provided superior postoperative analgesia compared to intravenous PCA. The controversial reports related to the effectiveness of PCA and other pain management methods evoked questions related to factors that may contribute to pain management methods. "
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    ABSTRACT: Management of postoperative pain using patient controlled analgesia (PCA) has increased for its proven advantages over conventional methods of pain control. The purpose of this study was to investigate patients' satisfaction about using PCA post surgical intervention among patients at Saudi health care settings. A cross-sectional, descriptive correlational design was used to collect data from patients using PCA post surgical interventions. The analysis showed that patients had a moderate to high level of perception about efficacy of PCA, and had a moderate level of knowledge about PCA use and its function. The duration of using a PCA pump, patients' age, gender, marital status, educational level, type of surgery, and their work status were significant predictors (F 7, 76 = 5.13, p < .001; R(2)= 0.59). PCA offers patients with an individualized analgesic therapy that meets the patients' demand of pain control. The implications for nurses and medical staff are discussed.
    Clinical Nursing Research 05/2013; 23(4). DOI:10.1177/1054773813488418 · 1.28 Impact Factor
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