Anesth Pain Med.  2017 Oct;12(4):363-370. 10.17085/apm.2017.12.4.363.

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

• Kim YK
• Lee JH
• Kang SH
• Choi Y
• Lee JY
• Lee SY
• Lee SN
• Lee EJ
• Lee C

• KMID: 2405856
• DOI: http://doi.org/10.17085/apm.2017.12.4.363

Abstract

BACKGROUND
Efforts for improving surgical outcomes in elderly patients should include the prevention of perioperative complications and proper postoperative pain management. Epidural analgesia is effective in decreasing perioperative stress and postoperative complications, and in improving recovery. Recently, it has been suggested that epidural analgesia may attenuate immune suppression during the perioperative period and lead to reductions in cancer recurrence and improvements in overall survival. Assuming that these effects of epidural analgesia are present in vulnerable elderly patients, we compared the efficacy of epidural patient-controlled analgesia and intravenous patientcontrolled analgesia on postoperative outcomes in elderly patients who had undergone gastrectomy.
METHODS
We evaluated 214 elderly patients who had undergone elective open gastrectomy for gastric cancer from 2011 to 2014. The demographic characteristics, analgesic efficacy, complications within the first 30 postoperative days, hospital stay, 24-month postoperative morbidity, cancer recurrence, and mortality were studied retrospectively.
RESULTS
Two-hundred and five patients were analyzed. Eighty-five patients received epidural patient-controlled analgesia (EPCA group) and 120 patients received intravenous patient- controlled analgesia (IVPCA group). The maximum pain scores were decreased to a greater extent in the EPCA group on the day of the operation (P < 0.001) and on the first postoperative day (P = 0.001) when compared to the IVPCA group. The patients in the EPCA group also required less analgesics on the day of the operation (P = 0.033) than those in the IVPCA group. The effect of EPCA on complications within the first 30 postoperative days, 24-month postoperative morbidity, cancer recurrence, and mortality were negligible in our study.
CONCLUSIONS
EPCA provided more effective pain control than IVPCA in elderly patients who had undergone elective gastric cancer surgery, but did not affect postoperative outcomes.

Keyword

Elderly; Epidural analgesia; Injections; Intravenous; Neoplasm recurrence; Outcomes

MeSH Terms

Aged*
Analgesia
Analgesia, Epidural
Analgesia, Patient-Controlled*
Analgesics
Gastrectomy*
Humans
Length of Stay
Mortality
Pain, Postoperative
Perioperative Period
Postoperative Complications
Recurrence
Retrospective Studies*
Stomach Neoplasms
Analgesics

Figure

• 

  Fig. 1 Recurrence-free survival of 85 patients provided with epidural patient-controlled analgesia and 120 patients provided with intravenous patient-controlled analgesia. Kaplan-Meier estimate with 95% confidence interval. Slash marks represent censored values (P = 0.743).

• 

  Fig. 2 Overall survival of 85 patients provided with epidural patient-controlled analgesia and 120 patients provided with intravenous patient-controlled analgesia. Kaplan-Meier estimate with 95% confidence interval. Slash marks represent censored values (P = 0.872).

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