Is postoperative epidural analgesia better than patient-controlled analgesia for radical cystectomy?

Abstract

Background: The purpose of this study was to evaluate postoperative epidural analgesia (EPA) and intravenous patientcontrolled analgesia (PCA) in terms of morbidity and mortality in patients undergoing radical cystectomy for bladder cancer. Methods: A retrospective study on patients undergoing radical cystectomy for clinical Tis-4N0M0 urothelial carcinoma of the bladder was performed. Patients were separated into two groups: primary EPA or PCA for postoperative analgesia. The surgical complication severity was determined according to the Clavien system. Mann-Whitney U tests, χ 2 with Yates' correction, or Fisher's exact test were used. Predictive risk factors were explored using univariable and multivariable Cox regression models. Results: Of the 274 patients studied, 209 (76%) received EPA and 65 (24%) had PCA. Baseline balance was observed. Similar complication rates were observed between the EPA (36%) and PCA (34%) (p=0.382). Patients greater than 70 years of age had more complications (35% vs 21%, p=0.002). PCA patients had higher rates of high-grade complications compared with EPA patients [40% vs 20% (p=0.0007)]. Only age at time of surgery (p=0.032) was associated with complications. Patients with pulmonary disease had a higher risk of complications (p=0.001). EPA or PCA were not predictors for overall survival. Conclusions: There does not appear to be a significant difference in terms of morbidity or mortality between EPA and PCA following radical cystectomy (RC). Rare, catastrophic complications specific to EPA may occur. Standardized reporting of surgical complications is essential to compare studies and appropriately counsel patients.

Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

“…In their single-centre, retrospective analysis of 131 RC patients, Toren et al 30 noted no difference in early outcomes, including pain scores and LOS, between those who received IV PCA and PCEA. Gomez et al 31 similarly showed no differences in complications or survival between RC patients receiving IV PCA and TEA in their retrospective cohort of 274 patients. In a more recent series of 302 patients undergoing RC, aside from modest decreased amounts of total opioid requirement, Winer et al 32 observed no difference in early outcomes-including LOS, return of bowel function, and early complications -between those who received epidural analgesia and those who received other perioperative pain management strategies.…”