Patient-controlled epidural analgesia versus conventional epidural analgesia after total hip replacement - a randomized trial

Abstract

Aims. Patient-controlled analgesia (PCA) is usually considered a better option for pain management compared to conventional analgesia. The beneficial effect of PCA has been assessed in a number of studies; however, the results are inconsistent. The goal of this study was to compare of patient-controlled epidural analgesia (PCEA) to conventional epidural analgesia after total hip replacement (THR). Methods. This prospective study was performed at the Department of Anesthesia and Intensive Care Medicine at a tertiary university hospital. After THR, patients were admitted to the intensive care unit (ICU) and randomized to one of two groups (PCEA and non-PCEA). Postoperative pain in the PCEA group was treated using a standardized protocol, while the analgesia in the non-PCEA group was based on physician prescription according to the patient's clinical condition. The total consumption of analgesics, patients' satisfaction, pain intensity, and analgesia-related complications were recorded for 24 h after surgery. Results. The final sample consisted of 111 patients (PCEA group, n=55 and non-PCEA group, n=56). The PCEA group had significantly lower total consumption of analgesic mixtures (0.9±0.3 and 1.3±0.4 mL/kg per day, P<0.001).There was greater patient satisfaction (P<0.001) in the PCEA group. The mean pain intensity over 24 hours postoperatively was similar for both groups (P=0.14). There was no significant difference in rate of analgesia-related complications between the groups (hypotension, P=0.14; bradypnea, P=0.11). Conclusion. Compared to conventional epidural analgesia based on physician prescription, PCEA led to less total analgesic consumption and greater patient satisfaction after THR.

Comparison of Patient-Controlled versus Continuous Epidural Analgesia in Adult Surgical Patients: A Systematic Review

“…After the removal of duplicates, 1774 studies were screened for titles and abstracts. Initially, we selected 11 studies, including 1687 patients [14][15][16][17][18][19][20][21][22][23][24]. To improve homogeneity for the final analysis, we decided to include only randomized controlled studies without serious flaws in methodology and studies using epidural analgesia containing local anesthetic in protocols of PCEA (including the boluses) and CEA.…”

“…Green signifies a low risk of bias, and yellow is an unclear risk of bias. Hering [21], Lubenow [17], Maca [20], Nightingale [24], Nolan [16], Silvasti [22].…”

The Beneficial Effect of Dexmedetomidine Combined With Epidural-Controlled Analgesia on the Reduction of Fever and Inflammation During Labour in Term-Pregnant Women

“…The higher the score on the modified Bromage scale, the more severe the lower extremity motor block. The evaluation criteria for maternal satisfaction were as follows: the maternal satisfaction score ranges from 0 to 100, and the higher the score, the higher the maternal satisfaction (4). When the score is lower than 60, it is considered that the puerperae are not satisfied with the treatment they are receiving.…”

“…The use of epidural analgesics can effectively reduce pain during labour, reduce the incidence of postpartum adverse reactions and help promote postpartum recovery of puerperae [3]. Commonly used epidural analgesics include fentanyl and ropivacaine [4,5]. However, fentanyl is prone to causing nausea and vomiting, respiratory depression, pruritus, drowsiness and other adverse reactions in patients [6].…”

Effects of Lumbar Plexus Block Combined with Infiltration Anesthesia on Anesthesia Comfort Scores and Stress Responses in Elderly Patients Undergoing Hip Replacement

“…Local infiltration anesthesia refers to the stratified injection of local anesthetics along the surgical incision line to block the nerve endings in tissues. This anesthesia, with higher security and effectiveness, can effectively relieve the patients' early postoperative pain, decrease their dosage of opioids, and reduce the occurrence rate of complications [ 9 ]. At present, there are studies reporting the effect of the combination of local infiltration anesthesia, general anesthesia, and patient-controlled analgesia pump, but there is still a gap in the study on the application of local infiltration anesthesia combined with lumbar plexus block or combined spinal-epidural anesthesia in hip replacement.…”