• Paul Toren, Salima Ladak, Clement Ma, Stuart McCluskey, and Neil Fleshner.
• Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
• Can J Urol. 2009 Aug 1;16(4):4716-20.

ObjectivePostoperative analgesia is an important factor influencing surgical outcomes. We aimed to evaluate the role of patient controlled epidural analgesia (PCEA) versus intravenous (IV) patient controlled analgesia (PCA) in patients undergoing radical cystectomy.MethodsWe reviewed data from consecutive patients who had a radical cystectomy at our institution between 2003 and 2007 to evaluate the effect of either PCEA or IV PCA on the patients' postoperative pain--the primary outcome--as well as secondary outcomes including time to begin eating solid food, time to ambulation, and length of hospital stay. The patients received either hydromorphone or morphine via IV PCA, or bupivacaine and hydromorphone or ropivacaine via PCEA. Pooled t tests and Wilcoxon rank sum tests were used to compare outcomes. A mixed model regression analysis was used to compare pain scores.ResultsData was analyzed from 131 patients to compare 73 patients (56%) who received PCEA versus 58 patients (44%) who received IV PCA. No significant differences in patient mobilization, progress to eating solid food, or length of hospital stay were detected, although there was a trend for earlier progress to eating solid food for patients in the PCEA group (p = 0.09). Using a mixed model analysis, we found no significant difference in pain scores at rest (p = 0.11). However, pain scores during activity were significantly lower for patients in the PCEA group, (p = 0.02), with a significant interaction effect (p = 0.03), indicating that the benefit with PCEA occurred in the early postoperative period.ConclusionOur findings suggest that compared with IV PCA, PCEA for radical cystectomy patients can result in lower immediate postoperative pain during activity, with a trend to earlier progress to eating solid foods, but no shortening of hospital stay.

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