Patient-controlled post-operative analgesia : a comparison between the epidural site and the intravenous site.

Abstract

IV-PCA (intravenous patient controlled analgesia) has become an accustomed and accepted technique of postoperative pain relief in the local scene. CEI (continuous epidural infusion) is usually offered as pain relief during labour. However, PCEA (patient controlled epidural analgesia) is a pain relief technique that has just been introduced and as is the case locally with most novel techniques, it is being received with scepticism. The area of uncertainty when PCEA is administered on patients brings along the PICO question of this project: In patients undergoing gynaecologic/abdominal surgery (Population) is PCEA (Intervention): more effective than (Comparison) IV-PCA in (Outcome) reducing pain postoperatively? The key words used to retrieve the literature were amalgamations of "INTRAVENOUS PATIENT CONTROLLED ANALGESIA" or "IV-PCA", "COMPARE", "PATIENT CONTROLLED EPIDURAL ANALGESIA" or "PCEA", "POSTOPERATIVE", "POSTOPERATIVE PAIN", "GYNAECOLOGIC SURGERY" and "ABDOMINAL SURGERY". The criteria included studies that focused on IV-PCA versus PCEA, studies written in English and those studies that focused on adults that underwent, abdominal and/or gynaecology surgery. The exclusion criteria incorporated studies using only PCEA or only IV -PCA, solely thoracic and/or orthopaedic surgery, guidelines, editorials and testimonials. This search led to the retrieval of 3 randomised control studies and 1 cohort study that were appraised using the check lists using the Critical Appraisal Skill Programme (CASP) tools from the Public Health Resources Unit. These checklists have been adapted to assist people to decipher evidence from health research. Two of the studies concluded that PCEA provides better pain control, whereas one study concluded that both techniques offered good pain relief, however the cohort study revealed that PCEA did not provide better pain management than IV-PCA. Nevertheless, it can be concluded that PCEA may be considered the better technique to use especially when the benefits outweigh the risks, and furthermore when the staff are knowledgeable and confident enough with both the PCEA and to educating the patients who will be self-benefitting from this technique. The findings of this project highlightened the importance of addressing the following areas, postoperative pain management, staff training, pre-assessment clinics that involve the pain management team and patient education.