title: Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion.
abstract: METHODS
  A prospective, randomized, double-blind clinical trial was conducted.
  
  
  OBJECTIVE
  To compare the efficacy of patient-controlled analgesia (PCA) with that of patient-controlled epidural analgesia (PCEA) in terms of overall patient satisfaction with postoperative pain management after lumbar spine fusion.
  
  
  BACKGROUND
  In numerous surgical disciplines, PCEA and PCA have proved to be effective methods of postoperative pain control. The literature states that with PCEA, less opioid use is required during the immediate postoperative period to maintain equivalent pain control compared to PCA. Continuous epidural infusion has been assessed in spine fusion patients, but PCEA has not been evaluated. Furthermore, this is the first prospective randomized clinical trial to assess overall patient satisfaction while stratifying patients for both anxiety level and preoperative opioid use.
  
  
  METHODS
  For this study, 74 patients were assigned randomly to one of two treatment groups, with PCA and PCEA administered in a double-blind manner for a 3-day postoperative course. All the patients received both PCA and PCEA delivery systems. Assessment was by a blinded, independent observer. Overall patient satisfaction with pain management was assessed by a visual analog scale at the end of postoperative day 3. Secondary measures included: three scales from the Functional Independence Measure instrument; opioid quantity; side effects; and length of hospital stay.
  
  
  RESULTS
  Thirty-eight patients were randomized to PCA, and 36 were randomized to PCEA. No baseline variable differences between the groups were observed. The results showed no difference between the groups on the following measures: overall patient satisfaction with pain management, ambulation, and length of stay. The PCA patients used significantly more opioid than the PCEA patients.
  
  
  CONCLUSIONS
  Both postoperative analgesic regimens provided good overall patient satisfaction. The only clinical advantage of PCEA over PCA for spine fusion patients was the lower amount of opioid consumed, although the PCEA group experienced significantly more side effects than the PCA group. There were no other significant differences. Therefore, patient or physician preference could select either postoperative pain management delivery system.
authors.affiliation: Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver Hospital and Health Sciences Centre. cfisher@vanhosp.bc.ca
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.forename: Lise
authors.initials: L
authors.lastname: Belanger
authors.forename: Edward G
authors.initials: EG
authors.lastname: Gofton
authors.forename: Hamed S
authors.initials: HS
authors.lastname: Umedaly
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Noonan
authors.forename: Caroline
authors.initials: C
authors.lastname: Abramson
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wing
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brown
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D007902:Length of Stay; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D009294:Narcotics