title: The effect of anesthesia choice on post-operative outcomes in women undergoing exploratory laparotomy for a suspected gynecologic malignancy.
abstract: OBJECTIVE
  To determine how anesthesia choice in women undergoing laparotomy for gynecologic malignancy affects pain control and narcotic use.
  
  
  METHODS
  This is a retrospective study of women who underwent laparotomy for suspected gynecologic malignancy from May 2012 to January 2013. Patients were categorized into one of three groups: 1) patient controlled analgesia (PCA); 2) PCA+transversus abdominis plane block (TAP); and 3) patient-controlled epidural analgesia (PCEA). Mean narcotic use and patient reported pain scores were compared.
  
  
  RESULTS
  The analysis includes 112 women (44 PCA, 30 TAP, 38 PCEA). Intraoperative factors were not different between groups with the exception of a significant difference in the rate of intra-operative complications (p=0.020), with lower rates in the PCEA group. The groups differed in intravenous narcotic use in each of the first three postoperative days (day 0: p=0.014; day 1: p<0.0001; day 2: p=0.048), with patients in the TAP group using the least on day 0 and those in the PCEA group using less on postoperative days 1 and 2. In addition, the PCEA group reported lower pain scores on postoperative days 1 and 2 (day 1: p=0.046; day 2: p=0.008).
  
  
  CONCLUSIONS
  The use of patient controlled epidural anesthesia after laparotomy for gynecologic malignancy is associated with decreased IV and PO narcotic use and improved pain control without increasing complications or length of hospital stay. Further investigation with prospective randomized trials is warranted to elucidate the optimal post-operative pain management technique.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, USA. Electronic address: clrivard@umn.edu.
authors.forename: Colleen
authors.initials: C
authors.lastname: Rivard
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Dickson
authors.affiliation: Masonic Cancer Center, Biostatistics and Bioinformatics, University of Minnesota, USA.
authors.forename: Rachel Isaksson
authors.initials: RI
authors.lastname: Vogel
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Argenta
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Teoh
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000765:Anesthesia, Conduction / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local
keywords: Laparotomy; Pain control; Regional anesthesia; TAP blocks