Comparison of patient controlled epidural infusion versus physician controlled epidural infusion for postoperative analgesia in patients undergoing major abdominal surgeries

Background and Aims: For effective patient-controlled epidural analgesia (PCEA) without many systemic effects after major intra-abdominal surgeries, optimal analgesic solution, background infusion rates, and settings need to be determined. The primary aim was to compare the efficacy of PCEA versus physician-controlled epidural analgesia (PhCEA) in terms of pain relief after major intra-abdominal surgeries. The secondary aim was, to establish an acceptable PCEA regime, to compare the vitals, amount of drug used, acute pain service (APS) interventions, rescue analgesics, and side effects. Material and Methods: This prospective randomized study was conducted on consenting 102 adult patients undergoing major intra-abdominal surgeries. The study drug was levobupivacaine 0.125% with fentanyl 2 ug mL(-1). Trained nursing staff assessed patients and data were collected at fixed intervals (0, 1, 2, 4, 8, 12, and 24 h) till 24 hours post-surgery. Chi-square test, independent 't' test, and Mann-Whitney U test were used and P value < 0.05 was considered as significant. Results: Pain scores were comparable in between the groups. Patients in the PCEA group had significantly (P = 0.000) fewer APS interventions (2.2 vs. 1.4 times) and need for rescue analgesics (1.8 vs. 0.8 times). There was no incidence of deep sedation, pruritus, hypotension, numbness, or complete motor block in either group. Conclusion: PCEA with background infusion is better than PhCEA after major intra-abdominal surgeries as it requires lesser pain team interventions and rescue analgesics. Epidural administration of lower concentration of opioid and local anesthetic gives adequate pain relief without any untoward side effects.