Background and Aims Advantages of PCEA over CEA have been demonstrated in obstetric patients. Whether similar benefit applies to surgical patients is unclear.

Aim: To assess possible advantages of patient controlled epidural analgesia (PCEA) over continuous epidural analgesia (CEA) in surgical patients

Methods Embase, PubMed and Cochrane library were searched, enabling systematic review of studies comparing PCEA and CEA in adult surgical patients (PROSPERO: CRD42018106644). Study quality was assessed using Cochrane Risk-of-Bias tool (RoB2). Primary outcome: pain score on postoperative day one (POD1). Secondary outcomes: 24 or 48 hour epidural or intravenous total analgesic dose, manual top-ups and patient satisfaction

Results Eleven trials (ten RCTs, one cohort-analysis, 1687 patients) with high heterogeneity of study characteristics were identified with a high to intermediate risk of bias. Three studies showed reduced pain scores on POD1 in PCEA compared to CEA patients (36–42%, P<0.05). Seven studies found comparable pain scores between groups, one study a higher pain score in PCEA patients. PCEA-use reduced epidural medication (28% to 76% reduction, P <0.01) in seven studies. Two studies found lower top-up frequency and higher analgesic satisfaction in PCEA; PCEA patients used less intravenous morphine (0.16 vs 3.45 mg per patient, P<0.05) in one study.

Conclusions Regarding pain scores, rescue systemic analgesics and patient satisfaction, PCEA in surgical patients had limited advantages over CEA. PCEA reduced the amount of epidural medication and top-up frequency. On the basis of current available evidence, we cannot conclude that PCEA offers major benefits over CEA in surgical patients.