Continuous epidural analgesia is superior to intravenous opioid patient-controlled analgesia in relieving postoperative pain for up to 72 hours after abdominal surgery

Werawatganon T, Charuluxananan S

Published Online:

October 8, 2008

Continuous epidural analgesia (CEA) is more effective than intravenous opioid patient-controlled analgesia (PCA) in relieving postoperative pain for up to 72 hours after abdominal surgery. CEA is associated with a higher incidence of generalized itching than PCA. There is insufficient evidence to draw comparisons about the other advantages and disadvantages of these two methods of pain relief.

Abstract (click to read)

Background:

There are two common techniques for postoperative pain control after intra-abdominal surgery: patient-controlled analgesia (PCA) with intravenous opioids and continuous epidural analgesia (CEA). It is uncertain which method has better pain control and fewer adverse effects.

Objectives:

The objective of this review was to compare PCA opioid therapy with CEA for pain control after intra-abdominal surgery in terms of analgesic efficacy, side effects, patient satisfaction and surgical outcome by meta-analysis of the relevant trials.

Search strategy:

We searched CENTRAL (The Cochrane Library Issue 4, 2002), MEDLINE (January 1966 to October 2002), EMBASE (January 1988 to October 2002), and reference lists of articles. We also contacted researchers in the field.

Selection criteria:

Randomized controlled trials of adult patients after intra-abdominal surgery comparing the effect of two pain control regimens in terms of analgesic efficacy and side effects. In the patient-controlled analgesia (PCA) group the patient should be able to operate the device himself. In the continuous epidural analgesia group there was no PCA device.

Data collection and analysis:

Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials.

Main results:

Nine studies involving 711 participants were included. The PCA group had a higher pain visual analogue scale than the CEA group during 6, 24 and 72 hour periods. The weighted mean difference and 95% confidence interval of resting pain was 1.74 (95% CI 1.30 to 2.19), 0.99 (95% CI 0.65 to 1.33), and 0.63 (95% CI 0.24 to 1.01), respectively. The length of hospital stay and other adverse effects were not statistically different except that the incidence of pruritus was lower in the PCA group, odds ratio of 0.27 (95% CI 0.11 to 0.64).

Authors' conclusions:

CEA is superior to opioid PCA in relieving postoperative pain for up to 72 hours in patients undergoing intra-abdominal surgery, but it is associated with a higher incidence of pruritus. There is insufficient evidence to draw comparisons about the other advantages and disadvantages of these two methods of pain relief.

This record should be cited as:

Werawatganon T, Charuluxananan S. Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004088. DOI: 10.1002/14651858.CD004088.pub2

Assessed as up to date:

October 14, 2004

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Primary Review Group:

Anaesthesia Group

Health topics:

Anaesthesia & pain control > Peri-anaesthetic/peri-operative care > Post-operative pain

Gastroenterology > Abdominal surgery > Post-operative pain

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Continuous epidural analgesia is superior to intravenous opioid patient-controlled analgesia in relieving postoperative pain for up to 72 hours after abdominal surgery

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