Comparison of patient controlled epidural analgesia with continuous epidural analgesia for postoperative pain control after surgeries for gynaecological cancers- a randomized controlled study

Abstract

Author(s): Jashma Chandveettil*, Gnanam Sathyamurthy and Rajani Sundar

Introduction: Pain free recuperation is the basic right of every surgical patient. Postoperative pain has a deleterious effect on the short-term and long-term outcome of patients. In this study, we compared Patient Controlled Epidural Analgesia (PCEA) with background infusion with Continuous Epidural Analgesia (CEA) for quality of pain relief in postoperative patients with gynaecological cancers. Materials and methods: This was a randomized controlled trial conducted in a tertiary hospital in India. The patients with gynaecological cancers who underwent surgery with midline laparotomy were randomized into two groups. One group received CEA (Group-CEA) with ropivacaine and fentanyl at 6-10 ml/hour titrated for pain and the other group received CEA at a basal dose of 6ml/hour and bolus PCEA (Group-PCEA) for residual pain. The patients were studied for 36 hours after extubation. Primary outcome measured was the pain score using the Numerical Rating Scale (NRS) and secondary outcomes were morphine consumption, hemodynamic parameters, motor and sensory block and adverse effects. Results: The mean NRS pain scores up to 6 hours, 24 hours and 36 hours for Group-CEA and Group-PCEA were 0.23±0.39, 0.13±0.13 and 3.6±6.1 and 0.36±0.60, 0.19±0.26 and 5.7±6.1 respectively. The Differences in pain score and morphine consumption between CEA and PCEA groups at different time points namely up to 6th, 24th and 36th hours were calculated. The pain scores and morphine consumption in the CEA and PCEA groups was not statistically significant at any time points. Two patients in the Group-PCEA and none in the Group-CEA had motor block. The level of sensory block, effect on the hemodynamic parameters and adverse effects were comparable. Conclusion: In gynaecological cancer surgeries performed through midline laparotomy, both CEA and PCEA with background infusion provide effective analgesia with no significant difference in pain scores.

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