Randomized Study of Patient Controlled Epidural Analgesia (PCEA) Using Fentanyl and Bupivacaine versus Patient Controlled Analgesia (PCA) With Intravenous (IV) Morphine for Abdominal Surgery

Abstract

Randomized Study of Patient Controlled Epidural Analgesia (PCEA) Using Fentanyl and Bupivacaine versus Patient Controlled Analgesia (PCA) With Intravenous (IV) Morphine for Abdominal Surgery.

Background: Effective pain relief helps in early mobilization leading to quick recovery and shorter hospital stay.

Materials and Methods: Our aim was to compare, IV PCA and PCEA in terms of analgesic efficacy and side effects after major abdominal surgery. After ethics committee approval, written valid informed consent and sample size calculation, patients were randomly assigned into one of 2 groups of 40 each. Postoperatively, patients in Group A received IV morphine 1mg/ml and patients in Group B received epidural fentanyl 5mcg/ml and bupivacaine 0.125%. PCA pump was programmed to deliver 2ml bolus with a lockout interval of 10 minutes. No background infusion was used. Patients were assessed for pain, sedation, pulse rate, respiratory rate, blood pressure, oxygen saturation and side effects were looked for at 0, 2, 8, 12 and 24 hours. Rescue analgesia was given with IV Tramadol 2mg/kg when VAS > 4 at rest despite three consecutive PCA boluses. All calculations were done at 90% power and 5% significance using two sided tests.

Results: No statistical difference was found in analgesia though quality of analgesia was better with PCEA. Requirement of rescue analgesia and incidence of nausea and vomiting was more with IV PCA though statistically insignificant.

Conclusion: IVPCA using morphine and PCEA using bupivacaine and fentanyl are similar in efficacy. However, PCEA produced better quality of analgesia. Advantages of PCA over conventional pain management include individualization as patients are the best to assess their pain and can get medication as needed by pressing a button.