A Randomized Controlled Trial of Early Oral Analgesia in Gynecologic Oncology Patients Undergoing Intra-Abdominal Surgery

Recently there has been renewed interest in the use of oral analgesia for pain control in the postoperative period. This randomized, controlled trial was conducted to investigate the use of early oral analgesia after intra-abdominal surgery in gynecologic oncology patients. Two hundred twenty women, recruited between July 1997 and January 2000, served as study subjects. In the immediate postsurgical period, all patients were placed on a patient-controlled analgesia (PCA) pump with a basal dose of 0.5 mg/h morphine with a patient-controlled bolus of up to 1 mg every 10 minutes. On the first postoperative day, all patients were placed on a clear liquid diet as tolerated and were randomly assigned to two pain control groups. One group continued postoperative analgesia by PCA (N = 107), and the second was placed on a schedule of 20 mg of morphine elixir every 4 hours with an additional dose of 10 mg every 2 hours as needed. On the second postoperative day, the basal parental and scheduled oral doses ceased, but patient-initiated doses were continued until 24 hours before discharge, when all patients were switched to oxycodone 5 mg/acetaminophen 325 mg. There were no clinical or demographic differences in the two groups of patients. There were no significant differences between the two groups in morphine usage (adjusting for the differences between oral and parental administration) or overall pain and sedation scores, as measured by patient ratings on a 10-point linear scale. No patient reported intolerable pain or side effects. The incidence of nausea, vomiting, and abdominal distension was similar for both groups, and no patient required treatment for intractable nausea or vomiting. Both groups were similar in time to flatus, time to regular diet, and length of hospital stay. There was no difference in the complication rate for either group.