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Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion.
Spine (Phila Pa 1976). 2003 Apr 15; 28(8):739-43.S

Abstract

STUDY DESIGN

A prospective, randomized, double-blind clinical trial was conducted.

OBJECTIVE

To compare the efficacy of patient-controlled analgesia (PCA) with that of patient-controlled epidural analgesia (PCEA) in terms of overall patient satisfaction with postoperative pain management after lumbar spine fusion.

SUMMARY OF BACKGROUND DATA

In numerous surgical disciplines, PCEA and PCA have proved to be effective methods of postoperative pain control. The literature states that with PCEA, less opioid use is required during the immediate postoperative period to maintain equivalent pain control compared to PCA. Continuous epidural infusion has been assessed in spine fusion patients, but PCEA has not been evaluated. Furthermore, this is the first prospective randomized clinical trial to assess overall patient satisfaction while stratifying patients for both anxiety level and preoperative opioid use.

METHODS

For this study, 74 patients were assigned randomly to one of two treatment groups, with PCA and PCEA administered in a double-blind manner for a 3-day postoperative course. All the patients received both PCA and PCEA delivery systems. Assessment was by a blinded, independent observer. Overall patient satisfaction with pain management was assessed by a visual analog scale at the end of postoperative day 3. Secondary measures included: three scales from the Functional Independence Measure instrument; opioid quantity; side effects; and length of hospital stay.

RESULTS

Thirty-eight patients were randomized to PCA, and 36 were randomized to PCEA. No baseline variable differences between the groups were observed. The results showed no difference between the groups on the following measures: overall patient satisfaction with pain management, ambulation, and length of stay. The PCA patients used significantly more opioid than the PCEA patients.

CONCLUSIONS

Both postoperative analgesic regimens provided good overall patient satisfaction. The only clinical advantage of PCEA over PCA for spine fusion patients was the lower amount of opioid consumed, although the PCEA group experienced significantly more side effects than the PCA group. There were no other significant differences. Therefore, patient or physician preference could select either postoperative pain management delivery system.

Authors+Show Affiliations

Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver Hospital and Health Sciences Centre. cfisher@vanhosp.bc.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12698113

Citation

Fisher, Charles G., et al. "Prospective Randomized Clinical Trial Comparing Patient-controlled Intravenous Analgesia With Patient-controlled Epidural Analgesia After Lumbar Spinal Fusion." Spine, vol. 28, no. 8, 2003, pp. 739-43.
Fisher CG, Belanger L, Gofton EG, et al. Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion. Spine (Phila Pa 1976). 2003;28(8):739-43.
Fisher, C. G., Belanger, L., Gofton, E. G., Umedaly, H. S., Noonan, V. K., Abramson, C., Wing, P. C., Brown, J., & Dvorak, M. F. (2003). Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion. Spine, 28(8), 739-43.
Fisher CG, et al. Prospective Randomized Clinical Trial Comparing Patient-controlled Intravenous Analgesia With Patient-controlled Epidural Analgesia After Lumbar Spinal Fusion. Spine (Phila Pa 1976). 2003 Apr 15;28(8):739-43. PubMed PMID: 12698113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion. AU - Fisher,Charles G, AU - Belanger,Lise, AU - Gofton,Edward G, AU - Umedaly,Hamed S, AU - Noonan,Vanessa K, AU - Abramson,Caroline, AU - Wing,Peter C, AU - Brown,Jennifer, AU - Dvorak,Marcel F, PY - 2003/4/17/pubmed PY - 2004/2/11/medline PY - 2003/4/17/entrez SP - 739 EP - 43 JF - Spine JO - Spine (Phila Pa 1976) VL - 28 IS - 8 N2 - STUDY DESIGN: A prospective, randomized, double-blind clinical trial was conducted. OBJECTIVE: To compare the efficacy of patient-controlled analgesia (PCA) with that of patient-controlled epidural analgesia (PCEA) in terms of overall patient satisfaction with postoperative pain management after lumbar spine fusion. SUMMARY OF BACKGROUND DATA: In numerous surgical disciplines, PCEA and PCA have proved to be effective methods of postoperative pain control. The literature states that with PCEA, less opioid use is required during the immediate postoperative period to maintain equivalent pain control compared to PCA. Continuous epidural infusion has been assessed in spine fusion patients, but PCEA has not been evaluated. Furthermore, this is the first prospective randomized clinical trial to assess overall patient satisfaction while stratifying patients for both anxiety level and preoperative opioid use. METHODS: For this study, 74 patients were assigned randomly to one of two treatment groups, with PCA and PCEA administered in a double-blind manner for a 3-day postoperative course. All the patients received both PCA and PCEA delivery systems. Assessment was by a blinded, independent observer. Overall patient satisfaction with pain management was assessed by a visual analog scale at the end of postoperative day 3. Secondary measures included: three scales from the Functional Independence Measure instrument; opioid quantity; side effects; and length of hospital stay. RESULTS: Thirty-eight patients were randomized to PCA, and 36 were randomized to PCEA. No baseline variable differences between the groups were observed. The results showed no difference between the groups on the following measures: overall patient satisfaction with pain management, ambulation, and length of stay. The PCA patients used significantly more opioid than the PCEA patients. CONCLUSIONS: Both postoperative analgesic regimens provided good overall patient satisfaction. The only clinical advantage of PCEA over PCA for spine fusion patients was the lower amount of opioid consumed, although the PCEA group experienced significantly more side effects than the PCA group. There were no other significant differences. Therefore, patient or physician preference could select either postoperative pain management delivery system. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/12698113/Prospective_randomized_clinical_trial_comparing_patient_controlled_intravenous_analgesia_with_patient_controlled_epidural_analgesia_after_lumbar_spinal_fusion_ DB - PRIME DP - Unbound Medicine ER -