PATIENT CONTROLLED EPIDURAL ANALGESIA VERSUS CONVENTIONAL EPIDURAL ANALGESIA AFTER TOTAL HIP REPLACEMENT: A RANDOMIZED TRIAL IN PAKISTAN

Abstract

Objective: To compare the efficacy and safety of patient‑controlled epidural analgesia (PCEA) with a conventional fixed‑rate epidural regimen during the first 24 hours after primary unilateral THR in a Pakistani tertiary hospital Methods: Sixty adults undergoing primary THR at a Pakistani tertiary hospital were randomised to either conventional epidural infusion (Group A) or PCEA (Group B). Primary outcome was mean visual analogue scale (VAS) score over 24 h. Secondary outcomes comprised motor block, sedation, haemodynamic events, bupivacaine consumption and satisfaction. Analyses used t‑test or χ²; p < 0.05. Results: Baseline demographics were comparable. PCEA yielded lower VAS at 2 h (3.15 ± 1.09 vs 5.02 ± 1.30), 12 h (2.31 ± 0.70 vs 3.80 ± 1.20) and 24 h (1.97 ± 0.60 vs 2.80 ± 1.10; p < 0.001). Motor block ≥ grade 2 was absent in Group B but affected 50 % of controls at 12 h. Sedation and rescue tramadol were reduced, while satisfaction improved. Total bupivacaine volume was 10 mL higher with PCEA, but analgesic efficiency doubled. No serious adverse events occurred. Conclusion: PCEA provided superior analgesia, less motor impairment and greater patient satisfaction than conventional epidural infusion after THR, supporting its routine use in enhanced‑recovery pathways.