• Sarah E Ferguson, Tim Malhotra, Venkatraman E Seshan, Douglas A Levine, Yukio Sonoda, Dennis S Chi, Richard R Barakat, and Nadeem R Abu-Rustum.
• Department of Surgical Oncology, Division Gynecologic Oncology Princess Margaret Hospital, University of Toronto, Toronto, Canada.
• Gynecol. Oncol. 2009 Jul 1;114(1):111-6.

ObjectiveTo determine the effect of perioperative patient-controlled epidural analgesia (PCEA) compared to postoperative intravenous (IV) patient-controlled analgesia (PCA) on postoperative recovery parameters after major open gynecologic surgery.MethodsA randomized controlled clinical trial included women undergoing laparotomy for a gynecologic disorder. Patients were randomized to postoperative IV morphine PCA (control arm) or to postoperative morphine-bupivacaine PCEA (treatment arm). Postoperative outcomes such as pain, and length of hospital stay were compared with an intention-to-treat analysis. The primary endpoint was postoperative pain at rest and when coughing--assessed by a 10-point visual analog scale (VAS).ResultsBetween 9/04 and 6/07, 153 patients were randomized and 135 were evaluable (PCEA=67; PCA=68). Over 75% of the women in this study had gynecologic cancer. Patients in the PCEA arm had significantly less postoperative pain at rest on Day 1 and during the first 3 postoperative days when coughing compared to the PCA arm (P<0.05). The mean pain score at rest on Day 1 was 3.3 for the PCEA group compared to 4.3 for the PCA group (P=0.01). Overall, postoperative pain at rest and while coughing in the first 6 days was less in women treated with PCEA compared to PCA (P<0.003).ConclusionsPCEA offers superior postoperative pain control after laparotomy for gynecologic surgery compared to traditional IV PCA. Women requiring major open surgery for gynecologic cancer should be offered PCEA for postoperative pain management if there are no contraindications.

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