title: Comparison of epidural and intravenous patient controlled analgesia in patients undergoing radical cystectomy.
abstract: OBJECTIVE
  Postoperative analgesia is an important factor influencing surgical outcomes. We aimed to evaluate the role of patient controlled epidural analgesia (PCEA) versus intravenous (IV) patient controlled analgesia (PCA) in patients undergoing radical cystectomy.
  
  
  METHODS
  We reviewed data from consecutive patients who had a radical cystectomy at our institution between 2003 and 2007 to evaluate the effect of either PCEA or IV PCA on the patients' postoperative pain--the primary outcome--as well as secondary outcomes including time to begin eating solid food, time to ambulation, and length of hospital stay. The patients received either hydromorphone or morphine via IV PCA, or bupivacaine and hydromorphone or ropivacaine via PCEA. Pooled t tests and Wilcoxon rank sum tests were used to compare outcomes. A mixed model regression analysis was used to compare pain scores.
  
  
  RESULTS
  Data was analyzed from 131 patients to compare 73 patients (56%) who received PCEA versus 58 patients (44%) who received IV PCA. No significant differences in patient mobilization, progress to eating solid food, or length of hospital stay were detected, although there was a trend for earlier progress to eating solid food for patients in the PCEA group (p = 0.09). Using a mixed model analysis, we found no significant difference in pain scores at rest (p = 0.11). However, pain scores during activity were significantly lower for patients in the PCEA group, (p = 0.02), with a significant interaction effect (p = 0.03), indicating that the benefit with PCEA occurred in the early postoperative period.
  
  
  CONCLUSIONS
  Our findings suggest that compared with IV PCA, PCEA for radical cystectomy patients can result in lower immediate postoperative pain during activity, with a trend to earlier progress to eating solid foods, but no shortening of hospital stay.
authors: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors: Paul
authors: P
authors: Toren
authors: Salima
authors: S
authors: Ladak
authors: Clement
authors: C
authors: Ma
authors: Stuart
authors: S
authors: McCluskey
authors: Neil
authors: N
authors: Fleshner
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D015653:Cystectomy / Q000379:methods; D006801:Humans; D007275:Injections, Intravenous; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D000700:Analgesics