Effect of Intravenous Patient-controlled Analgesia or Patient-controlled Epidural Analgesia after Laparoscopic Myomectomy on Postoperative Nausea and Vomiting and Postoperative Pain: A Retrospective Study

Abstract

Postoperative pain and postoperative nausea and vomiting (PONV) are distressing for patients, and can inhibit postoperative recovery. This study examined the differences in postoperative pain intensity and PONV intensity between patients who received intravenous (IV) patient-controlled analgesia (PCA) or patient-controlled epidural analgesia (PCEA) for the control of pain after laparoscopic myomectomy. A retrospective chart review was performed of 62 consecutive patients who underwent laparoscopic myomectomy at Kitasato Institute Hospital, Tokyo, Japan. Patients who received IV-PCA (n = 30) as their primary postoperative analgesic modality were compared with patients who received PCEA (n = 32). Demographic profiles for the two groups were similar regarding characteristics at the time of surgery. Dose per hour of fentanyl in IV-PCA was significantly less than that in PCEA (P < 0.001). For the first postoperative days, pain intensity was significantly lower in patients who received PCEA than in those who received IV-PCA (P < 0.001). There were no significant between-group differences in the incidence of PONV and adverse events of PCA. However, clinically significant severe PONV (PONV grade = 3) was more frequent in IV-PCA than in PCEA.

Our study shows that use of PCEA significantly reduces postoperative pain in the early postoperative period in patients who undergo laparoscopic myomectomy compared with the use of IV-PCA. PONV is more severe in IV-PCA than in PCEA.