title: Improved Postoperative Pain Control for Cytoreductive Surgery in Women With Ovarian Cancer Using Patient-Controlled Epidural Analgesia.
abstract: OBJECTIVE
  Many studies have compared different methods of postoperative pain management in abdominal laparotomy patients; however, the conclusions have been inconsistent and controversial. This study aimed to compare the pain scores and complications of patients who underwent cytoreductive surgery for ovarian cancer and used either patient-controlled epidural analgesia (PCEA) or patient-controlled intravenous analgesia (PCA) for postoperative pain management. We hypothesized that PCEA would be superior to PCA for postoperative pain management in ovarian cancer surgery.
  
  
  METHODS
  The medical records of women who underwent ovarian cancer surgery in 2014 were reviewed retrospectively. Pain scores for postoperative days (PODs) 0 to 5 days and the incidence of complications were examined and compared in patients who received PCEA and PCA. Means were compared using an independent sample t test or Wilcoxon rank sum test, and proportions were compared using Fisher exact test or a χ(2) test at each time point. A mixed-effects model was applied to determine correlations among repeated measurements. A P value less than 0.05 was considered significant.
  
  
  RESULTS
  Of the 105 study patients, 38 received PCEA and 67 received PCA. Pain scores were significantly lower in the PCEA group than the PCA group at POD 0 (2.47 ± 1.75 vs 4.39 ± 1.17; P < 0.001), 1 (2.65 ± 1.02 vs 3.32 ± 1.09; P < 0.001), and 3 (2.17 ± 1.13 vs 2.79 ± 1.08; P = 0.011), and tended to be lower in the PCEA group at PODs 2, 4, and 5. Patient-controlled epidural analgesia provided significantly better pain relief as analyzed by a mixed-effect model. Complications were not significantly different between both groups. There was no significant difference in pain relief between both groups at PODs 4 and 5.
  
  
  CONCLUSIONS
  Patient-controlled epidural analgesia was more effective for postoperative pain management compared with PCA from POD 0 to POD 3 in patients with ovarian cancer who underwent cytoreductive surgery, without increasing the morbidity.
authors.affiliation: *Department of Anesthesiology and Pain Medicine, †Center for Uterine Cancer, and ‡Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Gyeonggi-do; §Department of Nursing, Sorabol College, Gyeongju-Si, Gyeongsangbuk-do; and ∥Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Gyeonggi-do, Republic of Korea.
authors.forename: Tak Kyu
authors.initials: TK
authors.lastname: Oh
authors.forename: Myong Cheol
authors.initials: MC
authors.lastname: Lim
authors.forename: Yumi
authors.initials: Y
authors.lastname: Lee
authors.forename: Jung Yeon
authors.initials: JY
authors.lastname: Yun
authors.forename: Seungmin
authors.initials: S
authors.lastname: Yeon
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000700:Analgesics
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