Zhu, Z., Wang, C., Xu, C., & Cai, Q. (2013). Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: A prospective randomized trial. Gastric Cancer, 16, 193–200.

To compare effects of patient-controlled epidural analgesia (PCEA) and patient-controlled IV analgesia (PCIA) after surgery for gastric cancer

Patients undergoing radical gastrectomy were randomized to receive either PCEA or PCIA. Patients receiving PCEA had a catheter inserted at T8–9 before anesthesia induction and postoperatively received an infusion of .05% bupivacaine and 100 mcg/ml morphine at a basal rate of 4 ml per hour for 48 hours, supplemented with rescue boluses of 4 ml with a 30-minute block-out period. The PCIA group received morphine at a basal rate of 1 mg per hour with rescue boluses of 1 mg every 10 minutes as needed. The primary outcome was postoperative pain at rest on day 1 after surgery.

• N = 60
• MEAN AGE = 60.35 years
• MALES: 53.3%, FEMALES: 46.7%
• KEY DISEASE CHARACTERISTICS: 11.7% had total gastrectomy. Others had distal gastrectomy with Billroth I or II. 66.7% had stage 3 disease.

• SITE: Single site 
• SETTING TYPE: Inpatient 
• LOCATION: China

• PHASE OF CARE: Active antitumor treatment

• Randomized parallel group

• Visual analog scale for pain

The mean pain scores in the PCEA group on days 1 and 2 were 2.9 (p < .01) and 2.3 (p < .05), respectively, compared to scores of 3.8 and 3.3, respectively, in the PCIA group. Pain on coughing was also significantly lower in the PCEA group (p < .05). Time to passage of flatus was lower in the PCEA group (p < .05), with 0.8 days' difference on average. Patients receiving PCEA had an average 10.7-day hospital stay, compared to 11.9 days in the PCIA group (p < .05). No differences were seen in post-operative complications between groups.

Findings show that post-operative analgesia with PCEA resulted in better pain control and lower hospital stay compared to analgesia with PCIA.

• Small sample of less than 100
• Risk of bias (no blinding)

Epidural analgesia may provide better post-operative pain management than IV analgesia. Nurses need to know how to care for and monitor potential complications with the use of epidural catheters.