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| |  Similar Pain Management, Various Recovery Outcomes for Epidural Versus Intravenous Patient-Controlled Analgesia After Gynaecologic Oncology Surgery: Presented at SGO By Gabe Waggoner SAN ANTONIO, Tex -- February 9, 2009 -- In the setting of open gynaecologic oncology surgery, patients choosing patient-controlled epidural analgesia (PCEA) were no better off in terms of pain management than those opting for patient-controlled intravenous analgesia (PCA), researchers reported here at the Society for Gynecologic Oncology (SGO) 40th Annual Meeting on Women's Cancer. A team of researchers prospectively enrolled 240 nonrandomised patients in a study of the 2 analgesic approaches, led by Lee-May Chen, MD, University of California-San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California. Patients selected their mode of pain management after consultation with anaesthesia and surgical teams. The authors described the results from both methods in terms of pain management, ambulation, tolerance of a regular diet, and discharge readiness, at a focused plenary session here on February 7. The study was designed to determine pain-control equivalence, as defined by a difference of less than 10% in patients with a Visual Analogue Scale pain score of less than 2 on a scale of 0 to 10. Two hundred and five of the enrolled patients had evaluable outcomes (98 for PCA and 107 for PCEA). The surgical breakdown was as follows: staging/debulking surgery for ovarian, tubal, or peritoneal cancer, 86; surgery for endometrial cancer, 49; surgery for cervical cancer, 18; surgery for nongynaecologic cancers, 5; and surgery for benign conditions, 47. Cancer patients were statistically significantly more likely to receive an epidural, Dr. Chen noted. Patients opting for PCEA, she said, tended to have longer preoperative anaesthesia time, and were more likely to have pressor use during surgery. The team found no difference in surgical time for patients diagnosed with cancer, however, and patients using PCEA were transferred to the intensive-care unit slightly more often. Although patients in both groups had comparable levels of pain control on the first day after surgery, PCEA patients needed more supplemental pain medication. PCEA patients also had a longer time to first ambulation, but the researchers found no difference in time to regular diet tolerance or in discharge readiness between the 2 groups. "Pain control was comparable between the 2 groups, but the pain control was not as ideal as we were hoping," Dr. Chen said. "We found no difference in pain management between PCEA and PCA, and we found no difference in return of bowel function and discharge." She pointed out, however, that "epidural complications may influence the effectiveness of pain management."
[Presentation title: Perioperative Outcomes Comparing Patient-Controlled Epidural With Patient-Controlled Intravenous Analgesia in Gynecologic Oncology Surgery. Abstract 53]
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