title: Superiority of postoperative epidural over intravenous patient-controlled analgesia in orthopedic oncologic patients.
abstract: BACKGROUND
  Surgery for bone malignancy is associated with intense postoperative pain. Patient-controlled epidural analgesia (PCEA) and intravenous patient-controlled analgesia (IV-PCA) are used currently for postoperative pain control.
  
  
  METHODS
  The degree of pain control after resection of bone malignancy under combined general and epidural anesthesia followed postoperatively by prospectively randomized PCEA (ropivacaine 3.2 mg + fentanyl 8 microg/dose) or IV-PCA (morphine 2 mg/dose) (n = 35/group) was assessed. Postoperative analgesia delivery continued for up to 96 h; intramuscular rescue with diclofenac 75 mg was also available.
  
  
  RESULTS
  The mean hourly pain score among the PCEA patients was 3.0 +/- 0.9, compared with 4. 7 +/- 0.6 (P < .01) among the IV-PCA patients. All mean hourly pain scores in the PCEA patients, except for the first 2 hours of treatment, were less than 4/10, but they were higher in the IV-PCA patients. The demand for diclofenac was 2 times (n = 10) lower for the PCEA patients, compared with their IV counterparts (n = 20, P < .01); the same difference applied to the overall side effects (n = 15 vs n = 30, P < .01). Self-rated wakefulness and feelings of well-being were better in the PCEA patients.
  
  
  CONCLUSIONS
  Postoperative ropivacaine + fentanyl via PCEA reduces pain better and affords better subjective feelings than IV morphine via PCA after resection of bone malignancy carried out under combined general and epidural anesthesia.
authors.affiliation: Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. draviw@tasmc.health.gov.il
authors.forename: Avi A
authors.initials: AA
authors.lastname: Weinbroum
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D001859:Bone Neoplasms / Q000601:surgery*; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D009020:Morphine; D000077212:Ropivacaine; D005283:Fentanyl