Background and aims: To compare effectiveness and safety of epidural patient-controlled analgesia (PCEA) using 0.125% levobupivacaine and intravenous patient-controlled analgesia (PCIA) with morphine in elderly patients after femoral fractures surgery.                                                                                    Methods: Randomized, prospective, controlled study in an academic hospital. Patients were ≥ 65 years old, scheduled for the femoral fracture fixation from July 2016 to September 2017. Analgesia was assessed by Numerical Rating Scale (NRS) every 3 hours after surgery for 72 hours.  Anxiety and depression were assessed before and after surgery by Hospital Anxiety and Depression Scale (HADS). Postoperative evaluation included mental status, cardio-respiratory, gastrointestinal and motor functions.                                                                                                                         Results: Study population included 70 patients, 35 in each group. The NRS pain scores were significantly lower in the PCEA group at all postoperative time points. Anxiety scores were significantly higher in the PCIA group at certain postoperative time points. Mental functions were better preserved in the PCEA group. In the both groups respiratory and hemodynamic values remained within the normal range throughout the study period. There was no significant difference in the presence of side effects and depression scores between the groups.
Conclusions: PCEA with 0.125% levobupivacaine provides better pain relief, reduces anxiety and improves mental status compared to PCIA with morphine in studied population.

COMPARISON OF INTRAVENOUS AND EPIDURAL PATIENT-CONTROLLED ANALGESIA IN ELDERLY AFTER FEMORAL FRACTURES SURGERY: RANDOMIZED CONTROLLED TRIAL