Table 11: Postoperative (+/- pre-operative) epidural LA versus PCA IV analgesia:

Table 11: Postoperative (+/- pre-operative) epidural LA versus PCA IV analgesia: study details and qualitative outcomes



n treatment/





VAS scores and type of pain, where specified

Time to first analgesic request

Use of supplemental analgesic

Other important outcomes

Adams 2002

(LoE 2)


0.25% epidural bupivacaine (3 ml) preop + 0.375% bupivacaine (volume according to height, max 15 ml) postop (EpBup) vs. IV pirinitramide (up to 0.2 mg/kg) until clear decrease in pain, then 100 mg rectal diclofenac + PCA IV piritramide (0.025 mg/kg bolus, 10-min lockout) (Cont)

Postop: bupivacaine or piritramide, depending on study group

NS at all time points recorded (i.e. 0–180 min)


Not reported




Holmstrom 2005

(LoE 1)



Epidural bupivacaine (2.5–5 mg) for 48 h (EpBup) vs. control (Cont)

Postop: paracetamol (500 mg), dextropropoxy-fene (50/100 mg), supplemental morphine (5 mg oral/5 mg/ml IV), as required

At rest and on motion: NS in 1st 7 days postop or at 6 weeks follow-up


Mean morphine consumption over 1st 24 h: EpBup superior (p=0.001); over 2nd 24 h: NS; total over 3 days: EpBup superior (p<0.005)

Functional outcomes

Passive and active range of motion: NS


Blood loss, swelling: NS

Pettine 1989

(LoE 2)


Continuous epidural 0.125% bupivacaine infusion at 10 ml/h for 2–4 days postop (EpBup) vs. epidural catheter, removed in recovery room, IM narcotics (pethidine; hydroxyzine HCI) postop (Cont)

Postop: IM pethidine (1 mg/kg) + hydroxyzine HCl (25 mg) every 3–4 h or acetaminophen + codeine (30 mg), as required

EpBup superior on days 1–3 (p<0.002, in all cases), but NS on day 4


Mean daily amount of postop narcotics: EpBup superior on day 1 (p<0.0001) and day 2 (p<0.003), but NS on days 3 and 4

Functional outcomes

Range of flexion and extension at discharge: NS


Urinary retention: occurred in both groups–NS