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Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

[L’analgésie péridurale auto-contrôlée, comparée à une perfusion péridurale continue, réduit les besoins analgésiques après une intervention chirurgicale majeure]

From the Department of Anesthesiology; University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Address correspondence to: Dr. Thomas Standl, Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Martini Strasse 52, 20246 Hamburg, Germany. Phone: +49 40 42803-4614; Fax: +49 40 42803-5024; Email: standl{at}uke.uni-hamburg.de

Purpose: To compare the quality of pain relief and incidence of side effects between 24-hr postoperative continuous epidural infusion (CEI) and subsequent patient-controlled epidural analgesia (PCEA) with different analgesics after major abdominal surgery.

Methods: Twenty-eight women undergoing extended gynecological tumour surgery received postoperative CEI with 0.15 mL•kg^-1•hr^-1 0.2% ropivacaine (R: n = 14) or 0.125% bupivacaine plus 0.5 µg•mL^-1 sufentanil (BS: n = 14) during 24 postoperative hours. Twenty-four hours later, postoperative pain management was switched to PCEA without background infusion and 5 mL single bolus application of R or BS every 20 min at most. Visual analogue scales (VAS; 1–100 mm) were assessed by patients at rest and on coughing after 24 hr of CEI and PCEA. Side effects, doses of local anesthetics and opioids were recorded and plasma concentrations of total and unbound ropivacaine and bupivacaine were measured.

Results: Patients required lower doses of each respective analgesic medication with PCEA (R: 108 ± 30 mL; BS: 110 ± 28 mL) than with CEI (R: 234 ± 40; BS: 260 ± 45; P < 0.01). Ropivacaine plasma concentrations were lower 24 hr after PCEA when compared with CEI (P < 0.01). No patient after PCEA but two after CEI (n = 4; NS) presented motor block. PCEA with R provided better postoperative pain relief than CEI (37 ± 32 vs 59±27, P < 0.05). No difference in parenteral opioid rescue medication between CEI and PCEA was seen.

Conclusion: PCEA in comparison to preceding CEI provides equivalent analgesia with lower local anesthetic doses and plasma levels, and without motor blocking side effects, irrespective of the applied drug regimen.

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