Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.
BACKGROUND
Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.


METHODS
Sixty patients undergoing thoracic or thoraco-abdominal surgery were studied prospectively. Patients were randomly assigned to receive either thoracic epidural analgesia or patient-controlled i.v. opiate analgesia (PCA) after operation. Visual analogue pain and sedation scores were recorded for the period of the study. QOL health surveys at 24 h (SF-8 acute form) and at 1 week (SF-36) were recorded. Results were examined by uni- and multivariate analyses corrected for the effect of multiple comparisons.


RESULTS
Mean pain scores were significantly lower in the epidural group at most time points. Physical and mental scores in the epidural group were significantly better than the PCA group for both SF-8 and SF-36 QOL health surveys (P<0.001).


CONCLUSIONS
Epidural analgesia with local anaesthetic and opioid improves QOL and delivers better analgesia compared with PCA in patients undergoing major thoraco-abdominal surgery.
Ali
M
M
Department of Surgery, Beaumont Hospital, Institute for Clinical Outcomes and Education (iCORE), St Vincent's University Hospital, Elm Park, Dublin 9, Ireland.
Winter
D C
DC
Hanly
A M
AM
O'Hagan
C
C
Keaveny
J
J
Broe
P
P
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D016629:Esophagectomy / Q000534:rehabilitation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control* / Q000523:psychology / Q000534:rehabilitation; D017060:Patient Satisfaction; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D013908:Thoracotomy / Q000534:rehabilitation; D055815:Young Adult
D000701:Analgesics, Opioid