Patient Controlled Intravenous Opioid Analgesia Versus Continuous Epidural Analgesia for Pain After Intra-Abdominal Surgery

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…A regional anaesthetic block used in addition to general anaesthesia during surgery can minimise the need for postoperative intravenous opiates, thereby allowing rapid awakening from anaesthesia which can facilitate early enteral intake and mobilisation on the day of surgery. In open surgery, the use of epidural analgesia has proven to be superior to opioid-based alternatives for several important outcomes [81], including pain [82], PONV [83] and complications [84]. In laparoscopic surgery, emerging data indicate that alternative methods such as spinal anaesthesia, intravenous lidocain and patient-controlled anaesthesia (PCA) may be equally effective [80].…”

“…It offers superior analgesia in the first 72 h after surgery [82] and earlier return of gut function provided the patient is not fluid-overloaded. A national audit by Cook et al on behalf of the UK Royal College of Anaesthetists has quantified the risks and highlighted its safety provided good practice is adhered to [65].…”

“…Using low-dose concentrations of local anaesthetic combined with a short-acting opiate appears to offer the best combination of analgesia while minimising the risk of motor block and hypotension due to sympathetic blockade. Several meta-analyses have shown improved outcomes with TEA compared with opioid-based analgesia, including pain, complications, PONV and insulin resistance [81][82][83][84][85]. Hypotension induced by sympathetic block should be treated with vasopressors provided the patient is not hypovolaemic.…”

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

“…There is no routine administration of maintenance intravenous fluids, and efforts are made to minimize intravenous systemic narcotics. 34 The patient is deemed suitable for discharge home when oral intake is adequate to maintain hydration, pain control is adequate with oral analgesics, and the patient can ambulate safely. Before discharge, the patient is counseled to provide appropriate postdischarge expectations and an understanding of issues that would require contacting the surgical team or presentation to the emergency department.…”

Locked out and still knocking: predictors of excessive demands for postoperative intravenous patient-controlled analgesia

“…3 In spite of these advantages of PCA, we know very little about the factors that govern its effective use. Recent reviews and studies have focused on the role of various PCA parameters; including drugs, [6][7][8] routes, 9,10 doses and lockout intervals, 6,11,12 and background infusion rates, 13 but surprisingly little research has been conducted to understand the psychological and emotional factors that predict effective use of PCA. A better understanding of how specific psychosocial factors relate to postoperative PCA use may contribute to improved pain control and reduced adverse effects.…”