Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery

Background: Patient-controlled analgesia (PCA) with intravenous morphine an d patient-controlled epidural analgesia (PCEA), using an opioid either alon e or in combination with a local anesthetic, are two major advances in the management of pain after major surgery. However, these techniques have been evaluated poorly in. elderly people. This prospective, randomized study co mpared the effectiveness on postoperative pain and safety of PCEA and PCA a fter major abdominal surgery in the elderly patient. Methods: Seventy patients older than 70 yr of age and undergoing major abdo minal surgery were assigned randomly to receive either combined epidural an algesia and general anesthesia followed by postoperative PCEA, using a mixt ure of 0.125% bupivacaine and sufentanil (PCEA group), or general anesthesi a followed by PCA with intravenous morphine (PCA group). Pain intensity was tested three times daily using a visual analog scale. Postoperative evalua tion included mental status, cardiorespiratory and gastrointestinal functio ns, and patient satisfaction scores. Results: Pain relief was better at rest (P = 0.001) and after coughing (P = 0.002) in the PCEA group during the 5 postoperative days. Satisfaction sco res were better in the PCEA group, Although incidence of delirium was compa rable in the PCA and PCEA groups (24% vs. 26%, respectively), mental status was improved on the fourth and fifth postoperative days in the PCEA group. The PCEA group recovered bowel function more quickly than did the PCA grou p. Cardiopulmonary complications were similar In the two groups. Conclusion After major abdominal surgery in the elderly patient, patient-co ntrolled analgesia, regardless of the route (epidural or parenteral), is ef fective. The epidural route using local anesthetics and an opioid provides better pain relief and improves mental status and bowel activity.