BJA Advance Access published online on February 5, 2007
British Journal of Anaesthesia, doi:10.1093/bja/ael367
Randomized, double-blind comparison of patient-controlled epidural infusion vs nurse-administered epidural infusion for postoperative analgesia in patients undergoing colonic resection
1 Department of Anaesthesia
2 Academic Research and Development Unit, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK
3 University of Portsmouth Institute of Medicine, Health and Social Care, St. George's Building, 141 High Street, Portsmouth PO1 2HY, UK
* Corresponding author: Department of Anesthesia, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK. E-mail: jeremy.nightingale{at}porthosp.nhs.uk
BACKGROUND: There is little published evidence of the analgesic efficacy of patient-controlled epidural analgesia (PCEA) for postoperative pain relief. The aim of this study was to compare the analgesic efficacy of epidural infusion of bupivacaine 0.125% and fentanyl 4 µg ml–1 administered by either PCEA with a background infusion or nurse-administered continuous epidural infusion (CEI) after major intra-abdominal surgery.
METHODS: In a double-blind, randomized clinical trial, 205 adult patients undergoing colonic resection by laparotomy received either PCEA or CEI. Pain scores were recorded via a four-point verbal rating scale at 1, 2, 3, 4, 8, 12, 24, 48, and 72 h after surgery. The administration of epidural top-ups and systemic analgesia over the same period was also recorded, and patient satisfaction questionnaires completed.
RESULTS: The median area under the curve of pain against time was significantly lower in the PCEA group (2 vs 24, P<0.001) as were median summary pain scores on movement (0.67 vs 1.33, P<0.001). Significantly fewer patients in the PCEA group received one or more epidural top-ups (13 vs 36%, P = 0.0002) or any systemic analgesics (41 vs 63%, P = 0.0021). Patients in the PCEA group were significantly more likely to be very satisfied than in the CEI group (76 vs 43%, P<0.0001).
CONCLUSIONS: PCEA provides greater analgesic efficacy than CEI for postoperative analgesia after major intra-abdominal surgery, and a decreased requirement for physician or nurse intervention.
Keywords: anaesthetics local, bupivacaine; analgesia, postoperative; analgesia, patient-controlled; analgesic techniques, epidural; analgesics opioid, fentanyl
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