Subcutaneous-PCA: an alternative to IV-PCA for postoperative pain management

Patients (n = 120) undergoing major orthopedic (e.g., total hip replacement), urologic (e.g., radical prostatectomy), or gynecologic (e.g., total abdominal hysterectomy) procedures were randomly assigned to receive either morphine or oxymorphone postoperatively using a patient-controlled analgesic (PCA) delivery system. The opioid analgesic was administered either intravenously (IV-PCA) or subcutaneously (SQ-PCA) during the 72-h study period. Oxymorphone, 0.65 +/- 0.42 mg/h (0-24 h), 0.53 +/- 0.35 mg/h (24-48 h), and 0.42 +/- 0.31 mg/h (48-72 h), was as effective as morphine, 2.2 +/- 1.6 mg/h (0-24 h), 1.6 +/- 1.2 mg/h (24-48 h), and 1.2 +/- 1.1 mg/h (48-72 h), in providing postoperative pain relief (mean values +/- SD). Although the average opioid dosage requirements were 10 to 28% higher with SQ-PCA, it is an acceptable alternative to conventional IV-PCA for pain control after major surgical procedures. Postoperative analgesia scores and patient satisfaction were similar in all four PCA treatment groups. Thus, SQ-PCA with either oxymorphone or morphine represents a clinically acceptable alternative to IV-PCA in the treatment of postoperative pain.