Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2020, 164(1):108-114 | DOI: 10.5507/bp.2018.068

Patient-controlled epidural analgesia versus conventional epidural analgesia after total hip replacement - a randomized trial

Jan Macaa, Jan Neisera, Lenka Grasslovac, Michaela Trlicovad, Dana Streitovaa,b, Renata Zoubkovaa,b
a Department of Anesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czech Republic
b Department of Nursing, St. Elisabeth University of Health and Social Sciences, Bratislava, Slovak Republic
c Department of Rehabilitation and Physical Therapy, University Hospital of Ostrava, Czech Republic
d Faculty of Medicine, University of Ostrava, Czech Republic

Aims: Patient-controlled analgesia (PCA) is usually considered a better option for pain management compared to conventional analgesia. The beneficial effect of PCA has been assessed in a number of studies; however, the results are inconsistent. The goal of this study was to compare of patient-controlled epidural analgesia (PCEA) to conventional epidural analgesia after total hip replacement (THR).

Methods: This prospective study was performed at the Department of Anesthesia and Intensive Care Medicine at a tertiary university hospital. After THR, patients were admitted to the intensive care unit (ICU) and randomized to one of two groups (PCEA and non-PCEA). Postoperative pain in the PCEA group was treated using a standardized protocol, while the analgesia in the non-PCEA group was based on physician prescription according to the patient's clinical condition. The total consumption of analgesics, patients' satisfaction, pain intensity, and analgesia-related complications were recorded for 24 h after surgery.

Results: The final sample consisted of 111 patients (PCEA group, n=55 and non-PCEA group, n=56). The PCEA group had significantly lower total consumption of analgesic mixtures (0.9±0.3 and 1.3±0.4 mL/kg per day, P<0.001).There was greater patient satisfaction (P<0.001) in the PCEA group. The mean pain intensity over 24 hours postoperatively was similar for both groups (P=0.14). There was no significant difference in rate of analgesia-related complications between the groups (hypotension, P=0.14; bradypnea, P=0.11).

Conclusion: Compared to conventional epidural analgesia based on physician prescription, PCEA led to less total analgesic consumption and greater patient satisfaction after THR.

Keywords: patient-controlled analgesia, epidural analgesia, analgesics, drug consumption, total hip replacement, pain relief

Received: August 7, 2018; Accepted: October 19, 2018; Prepublished online: November 6, 2018; Published: March 26, 2020  Show citation

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Maca, J., Neiser, J., Grasslova, L., Trlicova, M., Streitova, D., & Zoubkova, R. (2020). Patient-controlled epidural analgesia versus conventional epidural analgesia after total hip replacement - a randomized trial. Biomedical papers, 164(1), 108-114. doi: 10.5507/bp.2018.068
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