Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids - A meta-analysis

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
Anesthesiology (Impact Factor: 6.17). 12/2005; 103(5):1079-88; quiz 1109-10. DOI: 10.1097/00000542-200511000-00023
Source: PubMed

ABSTRACT 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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    • "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 · 0.87 Impact Factor
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    • "Epidural analgesia is commonly used for the treatment of postoperative pain after major abdominal surgery despite the well-known risks and the long list of contraindications [1] [2]. "
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    ABSTRACT: Purpose. Transversus abdominis plane (TAP) blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0-10) at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23-48) mg (median, IQR) within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.
    Anesthesiology Research and Practice 05/2012; 2012:596536. DOI:10.1155/2012/596536
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    • "This specialist technique enables analgesics to infuse close to the spinal nerves where they exert a powerful analgesic effect. Evidence suggests epidurals provide a superior form of pain relief when compared to intravenous opioids (Werawatganon and Charuluxanun 2005, Wu et al. 2005). Contraindications include systemic sepsis, coagulation disorder, local anaesthetic allergy and raised intracranial pressure. "
    Perioperative Care of the Child: A Nursing Manual, 11/2009: pages 39 - 65; , ISBN: 9781444314625
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