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document
Epidural analgesia compared with intravenous morphine patient-controlled analgesia : postoperative outcome measures after mastectomy with immediate TRAM flap breast reconstruction . 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 .
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Intervention_Pharmacological
Epidural analgesia
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Intervention_Pharmacological
intravenous morphine
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Intervention_Pharmacological
patient-controlled analgesia ( PCA )
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Intervention_Pharmacological
epidural analgesia or PCA
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Outcome_Pain
intensity of pain
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Outcome_Other
total length of hospital stay
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Outcome_Other
time to ambulation
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Outcome_Other
time to oral nutrition
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Outcome_Pain
pain scores
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Outcome_Other
total length of hospitalization
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Outcome_Other
time to first ambulation
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Outcome_Other
time to first bowel sounds
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Outcome_Other
time to tolerating oral nutrition
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Outcome_Physical
incidence of nausea/vomiting or pruritus
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Outcome_Other
time to first flatus
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Participant_Condition
mastectomy with immediate TRAM flap breast reconstruction
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Participant_Condition
major surgical procedure ( i.e.
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Participant_Condition
unilateral mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction ) .
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Participant_Sample-size
Eighteen