Ferguson, S.E., Malhotra, T., Seshan, V.E., Levine, D.A., Sonoda, Y., Chi, D.S., . . . Abu-Rustum, N.R. (2009). A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery. Gynecologic Oncology, 114(1), 111–116.doi:10.1016/j.ygyno.2009.03.014
To evaluate the effect of bupivacaine-morphine patient-controlled epidural analgesia (PCEA) versus IV morphine patient-controlled analgesia (PCA) on pain at rest and during coughing and on time to potential discharge, length of hospital stay, nausea, vomiting, pruritus, and overall patient satisfaction
Control group received IV morphine PCA 1 mg/hour basal rate with rescue dose of 1 mg every 10 minutes as needed by PCA. The women in the treatment arm had thoracic epidural morphine-bupivacaine PCEA 100 mcg/ml with 0.05% bupivacaine basal rate 4 mg/hour with rescue boluses of 4 ml every 30 minutes. In both treatment arms, therapy was titrated to ensure adequate pain control with treatment of any side effects.
Prospective randomized trial
Visual analog scale (VAS), a 10-point pain scale regarding side effects
For the first six postoperative days, women treated with PCEA morphine-bupivacaine had less pain at rest and during coughing than did women treated with conventional IV PCA. The incidence and severity of adverse effects were not significantly different between groups.
Nurses must be knowledgeable about postoperative care, the complications associated with abdominal surgery, and optimization of perioperative PCEA.