title: Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis.
abstract: The authors performed a meta-analysis and found that epidural analgesia overall provided superior postoperative analgesia compared with intravenous patient-controlled analgesia. For all types of surgery and pain assessments, all forms of epidural analgesia (both continuous epidural infusion and patient-controlled epidural analgesia) provided significantly superior postoperative analgesia compared with intravenous patient-controlled analgesia, with the exception of hydrophilic opioid-only epidural regimens. Continuous epidural infusion provided statistically significantly superior analgesia versus patient-controlled epidural analgesia for overall pain, pain at rest, and pain with activity; however, patients receiving continuous epidural infusion had a significantly higher incidence of nausea-vomiting and motor block but lower incidence of pruritus. In summary, almost without exception, epidural analgesia, regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patient-controlled analgesia.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland 21287, USA. chwu@jhmi.edu
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
authors.forename: Seth R
authors.initials: SR
authors.lastname: Cohen
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Richman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rowlingson
authors.forename: Genevieve E
authors.initials: GE
authors.lastname: Courpas
authors.forename: Kristin
authors.initials: K
authors.lastname: Cheung
authors.forename: Elaina E
authors.initials: EE
authors.lastname: Lin
authors.forename: Spencer S
authors.initials: SS
authors.lastname: Liu
mesh_terms: D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid