Is patient controlled epidural analgesia the best option for postoperative analgesia in cancer surgery? - A Romanian experience

Background and Goal of Study: Despite the advantages of loco-regional analgesia for postoperative pain, patient controlled epidural analgesia (PCEA) is rarely used and is not included in local protocols and guidelines for postoperative pain management in Romania. The aim of our study was to investigate the efficiency of PCEA in postoperative period in cancer surgery, regarding pain control, postoperative complications and other advantages as early mobilization, return of bowel movements. 
Materials and Methods: We performed a prospective, randomized, controlled study, which included 100 patients scheduled for gastrointestinal cancer surgery. Patients were randomly allocated into two parallel groups: Group M - patients receiving intravenous opioids and Group P -patients receiving PCEA. Acute postsurgical pain, postoperative mobilization, bowel movements and complications were assessed at certain intervals of time, for a period of 48 hours post-operative or until discharge. 
Results and Discussion: Patients in the Group P had significantly lower intensity of postoperative pain than patients in the Group M (p-value < 0.001).
Also, these patients had early mobilization (p-value < 0.001) and bowel movements (p-value < 0.001) and less nausea and vomiting in the postoperative period (p-value < 0.001) but more surgery associated postoperative complications.
Conclusions
The severity of acute post-surgical pain was significantly reduced for the first 48 hours after surgery in patients who benefited from PCEA.

PCEA was associated with fewer nausea and vomiting, earlier gastrointestinal function recovery and postoperative mobilization. 
Surgery-associated complications were more frequent after PCEA.

Does patient controlled epidural analgesia is the best option for postoperative analgesia in cancer surgery? – A Romanian experience