Evaluation of postoperative pain control for women undergoing surgery for gynaecologic malignancies

(1) To compare the benefits of epidural analgesia and patient-controlled analgesia (PCA) in the management of postoperative pain in women with gynaecologic malignancies,and (2) to understand issues related to the delivery of pain control strategies.

A retrospective cohort study, based on chart review, was conducted of all women with gynaecologic malignancies who received either PCA or epidural analgesia at the Henderson Division of Hamilton Health Sciences, Hamilton, Ontario, from May 20, 1999, to July 17, 2001. Both objective (i.e., daily pain scores) and subjective (i.e., nursing progress notes) concerns were captured in the data collection instrument.

Ninety-seven women had PCA and 122 had epidural analgesia as their primary form of postoperative analgesia. Pain scores were excellent (<2, range 0-10) in both groups. The nausea score was superior for the epidural group. Twenty percent of women experienced motor blocks and 17% had sensory blocks, which impeded their ability to walk for the first 3 days after surgery. Pruritus, rash, and Benadryl use were seen in more than 20% of the epidural group. Prolonged catheterization and a 3-fold increased risk of urinary tract infections were seen in the epidural group. Epidural catheter leaks occurred in 12.3% of the women on epidural analgesia.

Postoperative pain management was excellent both in women who received PCA and in those who received epidural analgesia. Problems related to the delivery of pain control were more common in the epidural group.