Epidural analgesia superior to patient-controlled analgesia for postoperative pain relief in gynecologic oncology surgery

OBJECTIVE: To compare the efficacy of epidural versus patient-controlled analgesia (PCA) for postoperative pain management in patients undergoing laparotomies for gynecologic cancer. METHODS: A retrospective cohort of 172 patients (86 in each group) undergoing laparotomy from May 2004 to August 2005 was identified. Information from medical records was abstracted, including patient characteristics, cancer type, surgical procedure, postoperative complications, pain scores, day tolerating general diet, and discharge day. Groups were compared using the χ test for association and Wilcoxon rank sum test. Adjusted comparisons were made using analysis of variance models. RESULTS: Baseline differences between the groups included cancer type, with epidural patients more likely to have benign disease and PCA patients more likely to have ovarian cancer. Pain scores on postoperative days 0 and 1 were significantly lower for users of epidurals versus PCA (1.5 vs. 3.8, P < 0.001; and 2.0 vs. 3.2, P < 0.001, respectively). Pain scores on days 2 through 4 were not significantly different. Patients with benign disease had a shorter length of stay than those with cancer (3.2 vs. 5.3, P < 0.001) and tolerated a general diet sooner (2.5 vs. 3.9, P < 0.001), irrespective of pain management type. Patients with epidurals were more likely to experience hypotension (21% vs. 7%, P = 0.02). Patients with PCA were more likely to receive a blood transfusion (26% vs. 7%. P = 0.002). There were no other differences in postoperative adverse events. CONCLUSIONS: The results suggest that patients experience superior pain relief with epidurals compared with PCA, with minor differences in postoperative adverse events.