PATIENT SATISFACTION WITH INTRAVENOUS PCA OR EPIDURAL MORPHINE

In many institutions postoperative patients may receive morphine for analgesia administered into the epidural space, epidural opioid analgesia (EOA), or through intravenous self-administered patient-controlled analgesia pumps (PCA). Although a number of studies have compared the two approaches with regard to efficacy and side effects, there is less known with regard to patient satisfaction and its sources. In this study 711 patients using PCA morphine and 205 patients receiving epidural morphine following a variety of gynaecological, urological, orthopaedic, and general surgical procedures rated their satisfaction with the method they used on a 0-10 verbal analogue satisfaction scale (0 = very dissatisfied; 10 = very satisfied). A consecutive subset of 100 patients (50 from EOA group and 50 from the PCA group) underwent further evaluation to identify advantages and disadvantages of the technique used which contributed to their satisfaction and/or dissatisfaction. Overall satisfaction (mean +/- SD) in the two large groups was 8.6 +/- 1.8 for PCA and 9.0 +/- 1.5 for EOA (P < 0.01). In the subset of 100 patients, there were differences between the EOA and PCA groups with regard to the advantages and disadvantages selected. Patients in the PCA group identified ''personal control'' and ''method worked quickly'' as advantages whereas patients receiving EOA selected ''clear mind,'' ''effective relief resting, '' and ''effective relief while moving or coughing''. The single disadvantage identified more frequently by PCA patients was ''pain immediately after surgery before method became effective. '' Disadvantages identified more frequently by EOA patients were ''side effects'' and ''poor pain relief'' We conclude that overall patient satisfaction was high whether patients received PCA or EOA. The reasons for satisfaction or dissatisfaction differ depending on the method used