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Analgesia for 2nd trimester termination of pregnancy: a randomized controlled trial of intravenous versus epidural patient controlled analgesia
Abstract Number: T 6
Abstract Type: Original Research
Introduction: Termination of pregnancy (TOP) in the 2nd trimester is indicated for fetal genetic anomalies or fetal disease incompatible with life. Little is published regarding optimal analgesia for medical uterine evacuation initiated by synthetic prostaglandins. In some institutions there is increased utilization of epidural analgesia (1), whilst in others intravenous analgesia is most commonly used (2). To date, there are no randomized controlled trials comparing the efficacy of intravenous (IVPCA) versus epidural (PCEA) patient controlled analgesia. We set out to compare the efficacy of the two modalities, using a validated postoperative recovery assessment tool, the Quality of Recovery-40 (QoR-40) scale.
Methods: All women admitted to our institution for 2nd trimester TOP from June 2012 to January 2013 were invited to participate, and those recruited were randomized to receive either IVPCA with fentanyl or PCEA with bupivacaine, with the option to crossover between groups if dissatisfied. The QoR-40 questionnaire was administered pre-procedure; just prior to hospital discharge; and 24 hours post discharge (QoR scores 1, 2, and 3 respectively). Our primary outcome was the QoR-40 aggregate score, with a minimum score of 40 indicating poor recovery, and a maximum score of 200 indicating ideal recovery. Secondary outcomes included duration of procedure, patient’s overall satisfaction and pain scores (VAS 0-10), side effects and obstetrical complications.
Results: 72 women were approached, 35 declined and 4 were ineligible; 33 agreed to participate. There were no significant differences in patient demographics or duration of procedure between the groups. The QoR aggregate scores at different assessment times, patient satisfaction and maximum pain scores were similar in both groups (Table 1). Two patients (11.7%) of the IVPCA group crossed over to the PCEA group, whilst none from the PCEA group changed to IVPCA. A total of 11 (36.7%) women required surgical intervention for retained products of conception, with similar incidence in both groups.
Conclusion: IVPCA and PCEA provide similar quality of recovery and similar overall patient satisfaction for women undergoing 2nd trimester TOP. Both methods of pain relief appear to offer a satisfactory degree of analgesia for the procedure, despite a trend towards lower maximal pain scores in the epidural group.
References:1) Int J Obstet Anesth 2007; 16:383-4; 2) Can J Anesth 2003; 50: 1039–1046.