Combination of thoracic epidural analgesia with patient-controlled intravenous analgesia versus traditional thoracic epidural analgesia for postoperative analgesia and early recovery of laparotomy: a prospective single-centre, randomized controlled trial

Background : Thoracic epidural analgesia (TEA) always been the first choice for postoperative pain treatment, but associated complications and contraindications may limit its use. Our study put forward a new analgesic strategy that combines thoracic epidural analgesia (TEA) with patient controlled intravenous analgesia (PCIA) to optimized TEA. Methods: Patients undergoing laparotomy were enrolled in this prospective randomized study. Patients were randomized to one of two groups: TEA/PCIA group and TEA group. Patients in TEA/PCIA group received TEA in the day of surgery and the first postoperative day and PCIA continued to use until the postoperative three days. Patients in TEA group received TEA during postoperative three days. A visual analogue scale (VSA) pain scores at rest and on movement at 6, 24,48,72h after surgery were recorded. In addition, we also compared the incidence of inadequate analgesia, adverse events, time to first mobilization, time to pass first flatus, time of oral intake recovery, time of urinary catheter removal, postoperative length of hospital stays, cumulative opioid consumption, and the overall cost in the two groups. We examined VAS pain scores using repeated measures analysis of variance; p < 0.05 was considered as statistically significant. Results: Eighty-six patients were analysed (TEA/PCIA=44, TEA=42). The mean VAS pain scores at rest and on movement in TEA/PCIA group were lower than TEA group, with a significant difference on movement ( P <0.05). TEA/PCIA group had lower pain scores on postoperative 3 days as compared with TEA group, with a significant difference at 48 h postoperatively ( P <0.05). The time to first mobilization and pass first flatus were shorter in TEA/PCIA group ( P <0.05). No significant difference between the two groups in terms of postoperative length of hospital stay, time of oral intake recovery, time of urinary catheter removal, cumulative opioid consumption, incidence of adverse events, incidence of inadequate analgesia, and overall cost. Conclusions: The combination of TEA with PCIA for patients undergoing laparotomy, can enhance postoperative pain control and facilitate early recovery without increasing the incidence of adverse effects and overall cost of hospitalization. Trial registration: ChiCTR1800020308 (China), 2018/12/23; registered at www.chictr.org.cn