title: Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery.
abstract: BACKGROUND
  Patient-controlled analgesia (PCA) with intravenous morphine and patient-controlled epidural analgesia (PCEA), using an opioid either alone or in combination with a local anesthetic, are two major advances in the management of pain after major surgery. However, these techniques have been evaluated poorly in elderly people. This prospective, randomized study compared the effectiveness on postoperative pain and safety of PCEA and PCA after major abdominal surgery in the elderly patient.
  
  
  METHODS
  Seventy patients older than 70 yr of age and undergoing major abdominal surgery were assigned randomly to receive either combined epidural analgesia and general anesthesia followed by postoperative PCEA, using a mixture of 0.125% bupivacaine and sufentanil (PCEA group), or general anesthesia followed by PCA with intravenous morphine (PCA group). Pain intensity was tested three times daily using a visual analog scale. Postoperative evaluation included mental status, cardiorespiratory and gastrointestinal functions, and patient satisfaction scores.
  
  
  RESULTS
  Pain relief was better at rest (P = 0.001) and after coughing (P = 0.002) in the PCEA group during the 5 postoperative days. Satisfaction scores were better in the PCEA group. Although incidence of delirium was comparable in the PCA and PCEA groups (24% vs. 26%, respectively), mental status was improved on the fourth and fifth postoperative days in the PCEA group. The PCEA group recovered bowel function more quickly than did the PCA group. Cardiopulmonary complications were similar in the two groups.
  
  
  CONCLUSIONS
  After major abdominal surgery in the elderly patient, patient-controlled analgesia, regardless of the route (epidural or parenteral), is effective. The epidural route using local anesthetics and an opioid provides better pain relief and improves mental status and bowel activity.
authors.affiliation: Department of Anesthesia, Centre Hospitalier Universitaire Montpellier, France. c-mann@chu-montpellier.fr
authors.forename: C
authors.initials: C
authors.lastname: Mann
authors.forename: Y
authors.initials: Y
authors.lastname: Pouzeratte
authors.forename: G
authors.initials: G
authors.lastname: Boccara
authors.forename: C
authors.initials: C
authors.lastname: Peccoux
authors.forename: C
authors.initials: C
authors.lastname: Vergne
authors.forename: G
authors.initials: G
authors.lastname: Brunat
authors.forename: J
authors.initials: J
authors.lastname: Domergue
authors.forename: B
authors.initials: B
authors.lastname: Millat
authors.forename: P
authors.initials: P
authors.lastname: Colson
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D003693:Delirium / Q000139:chemically induced / Q000523:psychology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D019148:Neuromuscular Blockade; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D015656:Respiratory Mechanics / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine