Analgesia following major gynecological laparoscopic surgery--PCA versus intermittent intramuscular injection.
OBJECTIVE
To compare the use of patient-controlled analgesia to intermittent intramuscular injections of morphine following major gynecological laparoscopic procedures in order to assess differences in level of pain, sedation, episodes of nausea and/or vomiting, hospitalization time and patient satisfaction with their postoperative analgesia.


METHODS
Seventy-two patients undergoing major gynecological laparoscopic surgery were randomized to receive either postoperative analgesia via intermittent intramuscular injection of morphine (Group 1) or patient controlled analgesia (PCA-Group 2). All patients received anesthesia via a standardized protocol. Postoperative pain levels were recorded via a 10 cm visual analogue scale, and sedation scores were recorded on a standard PCA form. Episodes of nausea and vomiting were also recorded on the same form.


RESULTS
There were no statistically significant differences between intramuscular analgesia and PCA for any of the factors studied. Most significantly it was found that most patients ceased to require either form of parenteral analgesia within 24 hours of their procedure, regardless of the operating time.


CONCLUSIONS
It is important for the surgeon to be aware of the effects of postoperative analgesia on his or her patients' level of satisfaction. We do not recommend the use of PCA analgesia following major laparoscopic gynecological surgery.
Rosen
D M
DM
Sydney Women's Endosurgery Centre, St. George Private Hospital, NSW, Australia. swec@tpgi.com.au
Lam
A M
AM
Carlton
M A
MA
Cario
G M
GM
McBride
L
L
D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D004305:Dose-Response Relationship, Drug; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007273:Injections, Intramuscular; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011446:Prospective Studies
D000701:Analgesics, Opioid; D009020:Morphine