Efficacy, side effects and costs of postoperative pain therapy: Intravenous and epidural patient-controlled analgesia (PCA).

Improvement of the quality of analgesia, reduction of side effects and costs by application of epidural (PCEA) in comparison to intravenous patient-controlled analgesia (PCA) in postoperative pain treatment. Methods: 62 patients with upper abdominal surgery took part in this randomised prospective study which was approved by the local ethics committee. Epidural catheters were inserted at T 8/9 (group PCEA). General anaesthesia was performed with propofol, sufentanil 2 mu g/kg, pancuronium, enfiurane and O-2:N2O = 1:2. Postoperative analgesia consisted of epidural bupivacaine 0.25% + sufentanil 2 mu g/ml (BS) (bolus 0.05 ml/kg, lockout 10 min) in group PCEA, or of intravenous morphine (bolus 2 mg, lockout 10 min) in group PCA. The following parameters were recorded until the evening of postoperative day 4: pain intensity at test (VASH, 1-10) and on coughing (VASH, 1-10), blood pressure, heart rate, blood gas analysis, ability to ambulate, pruritus, nausealvomiting (PONV), patient satisfaction (0-4), time and expenses for postoperative pain treatment. Results: Median VASR (1 vs 2) and VASH (3 vs 4.5) were lower, cough intensity (2 vs 1) and patient satisfaction score (4 vs 3) were higher in PCEA compared to PCA. Ability to ambulate, pruritus, PONV, haemodynamics, p(a)O(2) and p(a)CO(2) were comparable. Postoperative pain treatment with PCEA was more timeconsuming (407 vs 299 min) and expensive (71 vs 40$/day) than PCA. Conclusion: PCEA in comparison to PCA after major abdominal surgery provides superior analgesia with comparable side effects at approximately 80% higher costs.