Bone Cancer Research Today is a free monthly online journal that collates and summarizes the latest research about Bone Cancer, including details on symptoms, types, treatment.

Superiority of postoperative epidural over intravenous patient-controlled analgesia in orthopedic oncologic patients.

Weinbroum AA

Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. draviw@tasmc.health.gov.il

BACKGROUND: Surgery for bone malignancy is associated with intense postoperative pain. Patient-controlled epidural analgesia (PCEA) and intravenous patient-controlled analgesia (IV-PCA) are used currently for postoperative pain control. METHODS: The degree of pain control after resection of bone malignancy under combined general and epidural anesthesia followed postoperatively by prospectively randomized PCEA (ropivacaine 3.2 mg + fentanyl 8 microg/dose) or IV-PCA (morphine 2 mg/dose) (n = 35/group) was assessed. Postoperative analgesia delivery continued for up to 96 h; intramuscular rescue with diclofenac 75 mg was also available. RESULTS: The mean hourly pain score among the PCEA patients was 3.0 +/- 0.9, compared with 4. 7 +/- 0.6 (P < .01) among the IV-PCA patients. All mean hourly pain scores in the PCEA patients, except for the first 2 hours of treatment, were less than 4/10, but they were higher in the IV-PCA patients. The demand for diclofenac was 2 times (n = 10) lower for the PCEA patients, compared with their IV counterparts (n = 20, P < .01); the same difference applied to the overall side effects (n = 15 vs n = 30, P < .01). Self-rated wakefulness and feelings of well-being were better in the PCEA patients. CONCLUSIONS: Postoperative ropivacaine + fentanyl via PCEA reduces pain better and affords better subjective feelings than IV morphine via PCA after resection of bone malignancy carried out under combined general and epidural anesthesia.

Published 18 November 2005 in Surgery, 138(5): 869-76.
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