Patient controlled epidural vs intravenous analgesia in gynecologic oncology: A systematic review

Background: Gynecologic oncology surgery includes a large variety of procedures which are mainly characterized as major abdominal operations. To date, the effectiveness of patient-controlled epidural analgesia (PCEA) has not been comparedto patient-controlled intravenous analgesia(PCA) for postoperative pain management in patients undergoing these procedures. Objective: The purpose of the present systematic review is to evaluate the effectiveness of PCEA compared to traditional PCA analgesia. Methods: We conducted a systematic review searching the Medline (1966-2016), Scopus (2004-2016), Clinical Trials.gov (2008-2016), Cochrane Central Register of Controlled Trials CENTRAL (1999-2016) and Google Scholar (2004-2016) databases together with reference lists from included studies. All prospective and retrospective observational cohort studies were included. Results: Four studies were finally included in our review which involved 512 women. Two studies reported that PCEA is superior to PCA in terms of postoperative VAS pain scores ( p<.05 ). The remaining two did not support these findings. The two methods seem to be comparable in terms of side effects, including nausea and postoperative ileus. Discussion: According to our systematic review there seem to be evidence which support the use of PCEA in gynecologic oncology patients. However, given the small number of published studies and the increased costs of the later method for postoperative pain management further research is needed to corroborate our findings.