Weinbroum, A.A. (2005). Superiority of postoperative epidural over intravenous patient-controlled analgesia in orthopedic oncologic patients. Surgery, 138, 869–876.

To compare patient-controlled analgesia (PCA) post-operative pain control by IV morphine versus epidural ropivacaine plus fentanyl analgesia in patients undergoing lower-body oncologic orthopedic procedures attributed to bone malignancy

Patients were assigned randomly. There was no control group.

• N = 70
• KEY DISEASE CHARACTERISTICS: Patients with mild systemic disease and those with non-incapacitating severe disease
• OTHER KEY SAMPLE CHARACTERISTICS: Preoperative pain controlled by non-steroidal anti-inflammatory drugs

• LOCATION: Post-anesthesia care unit and ward in Israel

• Randomized controlled trial

• Numeric rating scale (NRS) (0–10) pain at rest
• Subjective sedation (1 = fully awake to 10 = heavily sedated)
• Subjective feeling of well-being on a numeric scale (1 = feeling bad to 10 = feeling content)

• Subjectively rated pain less in patient-controlled epidural analgesia (PCEA) than IV PCA (p = 0.001)
• Feelings of sedation and well-being evened out over time (post-op day 5).
• Incidence of side effects (e.g., nausea, vomiting, pruritus) higher in IV PCA group

Postoperative ropivacaine plus fentanyl via PCEA reduces pain better and affords better subjective feelings than morphine IV PCA after resection of bone malignancy carried out under combined general and epidural anesthesia.

• Only pain intensity at rest reported (patient remained immobile 48–72 hours)
• The effect of improved pain, sedation, and well-being on long-term rehabilitation was not studied.
• Cost was not assessed.
• In the United States, prophylactic venous thrombotic event (VTE) treatment would be avoided with a PCEA.
• Small sample size