title: Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study.
abstract: BACKGROUND
  Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA).
  
  
  METHODS
  Fifty patients, ASA I-II, participated in this prospective, double-blinded study. All patients had TEA. After operation, they were randomized into two groups of 25 patients: Group PCLA (patient-controlled local analgesia): self-administration of 10 ml of ropivacaine 2 mg ml⁻¹ via the intra-abdominal catheter for 48 h. Group TEA: infusion of 10 ml h⁻¹ of ropivacaine 1 mg ml⁻¹, fentanyl 2 μg ml⁻¹, and epinephrine 2 μg ml⁻¹ epidurally for 48 h. The primary endpoint was pain on coughing at 4 h after operation. Rescue medication was morphine i.v. as required.
  
  
  RESULTS
  Pain on coughing at 4, 24, and 48 h was significantly lower in Group TEA [0 (0-10)] compared with Group PCLA [4 (0-10)] (P<0.05). Significantly lower pain intensity was also found in Group TEA compared with Group PCLA at the incision site, deep pain, and pain on coughing at 4 and 24 h (P<0.05). Morphine consumption was significantly greater in Group PCLA [12 (0-46)] compared with Group TEA [0 (0-20)] at 0-48 h after operation [median (range)] (P=0.015). Maximum expiratory pressure was higher in Group TEA compared with Group PCLA at 24 h (P<0.01).
  
  
  CONCLUSIONS
  TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.
authors.affiliation: Division of Anesthesiology and Intensive Care, Department of Medicine, Clinical Epidemiology and Biostatistical Unit, Orebro University, Orebro, Sweden. federica.fant@orebroll.se
authors.forename: F
authors.initials: F
authors.lastname: Fant
authors.forename: K
authors.initials: K
authors.lastname: Axelsson
authors.forename: D
authors.initials: D
authors.lastname: Sandblom
authors.forename: A
authors.initials: A
authors.lastname: Magnuson
authors.forename: S-O
authors.initials: SO
authors.lastname: Andersson
authors.forename: A
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000368:Aged; D000577:Amides; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D004311:Double-Blind Method; D004837:Epinephrine / Q000627:therapeutic use; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D011468:Prostatectomy; D000077212:Ropivacaine; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D005283:Fentanyl; D004837:Epinephrine