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A Randomized Controlled Trial of Early Oral Analgesia in Gynecologic Oncology Patients Undergoing Intra-Abdominal Surgery

From the Departments of Obstetrics, Gynecology and Reproductive Medicine, and Surgery, Division of Gynecologic Oncology, State University of New York at Stony Brook, Stony Brook, New York.

Address reprint requests to: Michael L. Pearl, MD, Long Island Gynecologic Oncologists, P.C., 994 Jericho Turnpike, Smithtown, NY 11787; E-mail: mlpearl{at}notes.cc.sunysb.edu.

OBJECTIVE: To evaluate the safety and efficacy of early oral analgesia after intra-abdominal surgery in gynecologic oncology patients.

METHODS: Over a 2.5-year period, 227 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early oral versus traditional parenteral analgesia. All patients initially received parenteral morphine via a patient-controlled analgesia (PCA) pump with a basal dose of 0.5 mg/h and a PCA dose of 1 mg with a 10-minute lockout. On the first postoperative day, all patients began a clear liquid diet, which was advanced as tolerated. Patients allocated to early oral analgesia were switched from parenteral to oral morphine. They received a scheduled dose of 20 mg every 4 hours with an additional dose of 10 mg every 2 hours as needed for breakthrough pain. Patients allocated to traditional parenteral analgesia continued to receive parenteral morphine via a PCA pump with basal and PCA doses. On the second postoperative day, the scheduled oral and basal parenteral doses were discontinued. The oral and parenteral PCA doses were continued until 24 hours before discharge, at which time the patient was switched to oxycodone 5 mg/ acetaminophen 325 mg.

RESULTS: There were no significant differences among the groups in any demographic or clinical indices, including age, case distribution, surgery length, blood loss, time to return of bowel function, length of hospital stay, pain, sedation, and satisfaction scores, and incidence of nausea, vomiting, or major postoperative complications.

CONCLUSIONS: Early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery is safe and efficacious.

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