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Improved Postoperative Pain Control for Cytoreductive Surgery in Women With Ovarian Cancer Using Patient-Controlled Epidural Analgesia
  1. Tak Kyu Oh, MD*,
  2. Myong Cheol Lim, MD, PhD,,
  3. Yumi Lee, PhD§,
  4. Jung Yeon Yun, MD, PhD*,
  5. Seungmin Yeon, MS and
  6. Sang-Yoon Park, MD, PhD,
  1. *Department of Anesthesiology and Pain Medicine,
  2. Center for Uterine Cancer, and
  3. Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Gyeonggi-do;
  4. §Department of Nursing, Sorabol College, Gyeongju-Si, Gyeongsangbuk-do; and
  5. Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Gyeonggi-do, Republic of Korea.
  1. Address correspondence and reprint requests to Sang-Yoon Park, MD, PhD, Center for Uterine Cancer and Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea. E-mail: sypark.ncc@hotmail.com.

Abstract

Objective Many studies have compared different methods of postoperative pain management in abdominal laparotomy patients; however, the conclusions have been inconsistent and controversial. This study aimed to compare the pain scores and complications of patients who underwent cytoreductive surgery for ovarian cancer and used either patient-controlled epidural analgesia (PCEA) or patient-controlled intravenous analgesia (PCA) for postoperative pain management. We hypothesized that PCEA would be superior to PCA for postoperative pain management in ovarian cancer surgery.

Materials and Methods The medical records of women who underwent ovarian cancer surgery in 2014 were reviewed retrospectively. Pain scores for postoperative days (PODs) 0 to 5 days and the incidence of complications were examined and compared in patients who received PCEA and PCA. Means were compared using an independent sample t test or Wilcoxon rank sum test, and proportions were compared using Fisher exact test or a χ2 test at each time point. A mixed-effects model was applied to determine correlations among repeated measurements. A P value less than 0.05 was considered significant.

Results Of the 105 study patients, 38 received PCEA and 67 received PCA. Pain scores were significantly lower in the PCEA group than the PCA group at POD 0 (2.47 ± 1.75 vs 4.39 ± 1.17; P < 0.001), 1 (2.65 ± 1.02 vs 3.32 ± 1.09; P < 0.001), and 3 (2.17 ± 1.13 vs 2.79 ± 1.08; P = 0.011), and tended to be lower in the PCEA group at PODs 2, 4, and 5. Patient-controlled epidural analgesia provided significantly better pain relief as analyzed by a mixed-effect model. Complications were not significantly different between both groups. There was no significant difference in pain relief between both groups at PODs 4 and 5.

Conclusions Patient-controlled epidural analgesia was more effective for postoperative pain management compared with PCA from POD 0 to POD 3 in patients with ovarian cancer who underwent cytoreductive surgery, without increasing the morbidity.

  • Ovarian cancer
  • Epidural analgesia
  • Patient-controlled analgesia
  • Postoperative pain

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Footnotes

  • The authors declare no conflicts of interest.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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