Postoperative pain management in gynecologic oncology patients utilizing epidural opiate analgesia and patient‐controlled analgesia

Perioperative Pain Management in Gynecologic Oncology Surgery

“…De León-Casasola, et al demonstrated that in those patients undergoing cancer-related hysterectomy, intestinal function recovery was faster in those receiving patient-controlled epidural analgesia (PCEA) than in those who received PCA 28 . In the study by Rivard, et al in all patients who underwent laparotomy with vertical abdominal incision with suspected gynecologic malignancy, PCEA was shown to be associated with a decrease in pain scale levels and postoperative opioid total use, with postoperative ileum occurring in 13.4% of patients 24,29 . According to meta-analyses results, epidural analgesia provides superior postoperative pain control in comparison with systemic opioid administration, in addition to an important decrease in adverse effects 30,31 .…”

“…The anesthetic technique has been shown to impact on postoperative pain evolution and control 22 . The use of anesthesia and subsequent epidural analgesia has shown pain improvement in comparison with other techniques such as patient controlled analgesia (PCA), and has therefore been accepted by numerous gynecologic oncology groups 23 . There are meta-analyses supporting the use of epidural anesthesia, since it shows superiority especially in those patients who underwent laparotomy or torachotomy 24 .…”

“…Intraoperative management is usually addressed by anesthesiologists, whereas postoperative pain is traditionally managed by surgeons, although this tendency is changing into a common perioperative management by the anesthetic-surgical team 33 . Since the PCA system introduction in the 1980s, postoperative pain daily management has extensively been optimized 33 .…”

“…Since the PCA system introduction in the 1980s, postoperative pain daily management has extensively been optimized 33 . This PCA provides adequate pain control, great satisfaction, and less adverse effects compared with administration on an as-needed basis.…”

Evidence-Based Anesthesia for Major Gynecologic Surgery

“…Retrospective and nonrandomized prospective trials report conflicting evidence of beneficial [44][45][46][47] or detrimental effect 48,49 of epidural analgesia with regards to tumor spread and survival in gynecologic oncology surgeries. Most retrospective trials, [50][51][52] but not all, 53 report possible survival benefit in women receiving epidural analgesia for gynecologic malignancies.…”