Post-operative pain management : epidural analgesia versus patient-controlled analgesia

Abstract

Background: The World Health Organization and the International Association for the Study of Pain (2004) have declared pain management to be a fundamental human right. Despite this, acute post-operative pain remains common, and most patients still experience moderate to severe pain in the post-operative period. Patient-controlled analgesia (PCA) and epidural analgesia (EDA) are both commonly used to manage pain post-major surgeries. Research Question: Does patient-controlled analgesia (PCA) compared to the use of epidural analgesia reduce post-operative pain following major surgery? PICO Elements: The population (P) were patients’ post-major surgery. The intervention (I) patient-controlled analgesia was compared (C) to epidural analgesia. The outcome (O) was the management of pain after a major surgery. Method: Alternative keywords were developed using the PICO components. These alternative terms, together with Boolean operators and truncation symbols, were used in a systematic search of trustworthy databases which includes PubMed, Scopus, and EBSCO. The inclusion criteria used were peer-reviewed articles, published in English language from 2013 to 2021. The studies selected were limited to systematic reviews (SRs), meta-analysis (MA) and randomised control trials (RCTs). The PRISMA flow diagram was used to screen the most significant articles. The Critical Appraisal Skills Programme (CASP) tools were utilised to enhance the critical appraisal of seven significant studies, which comprised five randomised controlled trials and two systematic reviews and meta-analyses. Outcomes and Conclusion: At face value, epidural analgesia was shown to be preferred to patient-controlled analgesia for pain management after major surgeries. However, it is noted that evidence in this regard is inconclusive, and more research is needed in regard to the efficacy, safety, and effectiveness of the two interventions. Implications & Recommendations: Further research with larger sample sizes and the inclusion of epidural analgesia in the local settings are all possible recommendations which can be implemented.