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Randomized trial comparing 3 methods of postoperative analgesia in gynecology patients: patient-controlled intravenous, scheduled intravenous, and scheduled subcutaneous.

Bell JG, Shaffer LE, Schrickel-Feller T

Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, OH, USA.

OBJECTIVE: The objective of the study was to determine whether any of 3 routes of opioid administration (patient-controlled analgesia [PCA], scheduled intermittent intravenous [i.v.], or scheduled intermittent subcutaneous [s.q.]) provides superior pain relief and satisfaction among patients undergoing abdominal gynecologic surgery. STUDY DESIGN: Patients were randomized to intravenous hydromorphone by PCA, i.v. hydromorphone via scheduled nurse-administered doses, or s.q. hydromorphone via scheduled nurse-administered doses. Self-reported pain and satisfaction were recorded over 48 hours following arrival at the nursing unit. Linear mixed effects modeling was used to compare outcomes among the groups. RESULTS: Neither pain scores nor satisfaction differed by group. PCA patients had higher total opioid use (P < .0001) and a higher rate of pruritus (P = .04). CONCLUSION: Given these findings as well as those in previous literature, no specific method of postoperative analgesia appears to be superior.

Published 5 November 2007 in Am J Obstet Gynecol, 197(5): 472.e1-7.
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