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Epidural Analgesia Compared With Intravenous Morphine Patient-Controlled Analgesia: Postoperative Outcome Measures After Mastectomy With Immediate TRAM Flap Breast Reconstruction
  1. Darin J. Correll, M.D.,
  2. Eugene R. Viscusi, M.D.,
  3. Zvi Grunwald, M.D. and
  4. John H. Moore, M.D.
  1. From the Departments of Anesthesiology (D.J.C., E.R.V., Z.G.) and Surgery (J.H.M.), Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. (D.J.C. is now with the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.)
  1. Reprint requests: Eugene R. Viscusi, M.D., Director, Acute Pain Management Service, Thomas Jefferson University, 111 S 11th St, Suite G8490, Philadelphia, PA 19107-5092. E-mail: eugene.viscusi{at}


Background and Objectives Epidural analgesia has been shown to provide superior pain control compared with intravenous (IV) opioids after major surgical procedures. In this study, we compared the effect of epidural analgesia and IV morphine patient-controlled analgesia (PCA) on pain relief, duration of hospitalization, oral nutrition, ambulation, and side effects in patients undergoing a major surgical procedure (i.e., unilateral mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction).

Methods Eighteen patients were prospectively randomized to receive either epidural analgesia or PCA during the postoperative period. The intensity of pain was assessed daily by a 100-mm visual analog scale. The total length of hospital stay, time to ambulation, and time to oral nutrition were recorded.

Results The epidural group had significantly lower pain scores at 3 evaluation times through postoperative day number 4 (P < .05). The total length of hospitalization for the epidural group (median, 101 hours) was significantly less than the PCA group (median, 126 hours; P = .0498). The time to first ambulation, time to first bowel sounds, time to tolerating oral nutrition, incidence of nausea/vomiting or pruritus, and time to first flatus were not statistically different between the groups.

Conclusions These results show that epidural analgesia compared with PCA offered improved pain control after breast reconstruction with immediate transverse rectus abdominis musculocutaneous flap reconstruction. It also resulted in a 25-hour reduction in time of hospitalization.

  • Breast surgery
  • Epidural local anesthetics
  • PCA opioids
  • Postoperative pain

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  • Parts of this work were presented as abstracts at ASRA, May 5-9, 1999, Philadelphia, PA, and the International Anesthesia Research Society, March 10-14, 2000, Honolulu, HI.

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