title: Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer Treated by Open versus Laparoscopic Surgery: Results from the Randomised LACE Trial.
abstract: Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n = 353) or TLH (n = 407) (2005-2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery. Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%, P < 0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0-2 days (99.7% versus 98.5%, P = 0.09), a significantly higher proportion of TAH patients required opioids 3-5 days (70% versus 22%, P < 0.0001), 6-14 days (35% versus 15%, P < 0.0001), and 15-60 days (15% versus 9%, P = 0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62, P < 0.0001) and four weeks (0.89 versus 0.63, P = 0.01) following surgery. Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.
authors: Queensland University of Technology, School of Public Health, Institute of Health and Biomedical Innovation, Brisbane, QLD 4059, Australia.
authors: Jannah
authors: J
authors: Baker
authors: Monika
authors: M
authors: Janda
authors: David
authors: D
authors: Belavy
authors: Andreas
authors: A
authors: Obermair
references: Int J Gynecol Cancer. 2011 Oct;21(7):1306-11
references: 21841489
references: Cancer. 1987 Oct 15;60(8 Suppl):2035-41
references: 3652025
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD003677
references: 19588344
references: Am J Obstet Gynecol. 2011 Jan;204(1):65.e1-6
references: 20869036
references: BJOG. 2010 May;117(6):746-51
references: 20236108
references: Aust N Z J Obstet Gynaecol. 2010 Apr;50(2):159-63
references: 20522073
references: Int J Gynecol Cancer. 2011 May;21(4):722-9
references: 21546874
references: Gynecol Oncol. 2011 Dec;123(3):528-31
references: 21968341
references: Lancet Oncol. 2010 Aug;11(8):763-71
references: 20638901
references: Int J Gynecol Cancer. 2011 Feb;21(2):251-6
references: 21270608
references: Semin Surg Oncol. 1990;6(3):194-8
references: 2189200
references: J Minim Invasive Gynecol. 2008 Jul-Aug;15(4):395-401
references: 18602044
references: Lancet Oncol. 2010 Aug;11(8):772-80
references: 20638899
references: J Clin Oncol. 2009 Nov 10;27(32):5331-6
references: 19805679
references: Aust N Z J Obstet Gynaecol. 2005 Apr;45(2):140-3
references: 15760316
references: Maturitas. 2010 Apr;65(4):320-4
references: 20079589
references: BMC Cancer. 2009 Jan 15;9:23
references: 19146684
references: Int J Gynecol Cancer. 2010 May;20(4):570-5
references: 20686375
references: Reg Anesth Pain Med. 2012 May-Jun;37(3):310-7
references: 22531384
references: Br J Anaesth. 2012 Jun;108(6):998-1005
references: 22466819
references: Int J Gynecol Cancer. 2008 May-Jun;18(3):387-99
references: 17692084
references: Eur J Cancer. 2012 May;48(8):1147-53
references: 22548907