Sex-related differences of patient-controlled epidural analgesia for postoperative pain

PainSchnabel A et al. | December 01, 2011

Reduced total patient–controlled epidural analgesia (PCEA) consumption in women might be a consequence of an increased incidence of motor blockade and vomiting; the latter point towards an opioid–free PCEA solution in female patients at high risk for vomiting.


  • Data from 14,988 adult patients (6506 women; 8482 men) receiving a PCEA between January 1998 and December 2009 were examined.
  • Demographic data and postoperative measurements assessed by the Acute Pain Service, including total PCEA consumption, pain scores, and complications, were analyzed by using PASW Statistics (18.0; SPSS Inc, Chicago, IL, USA).
  • Beyond standard descriptive analyses, gender–related differences were investigated using a stepwise multivariate analysis of variances.


  • Postoperative pain scores during rest and movement were almost equal between men and women.
  • However, women showed lower total PCEA consumption consistently throughout the 5–day observation period (relative reduction by 1.7%–10.2% compared to men; P=0.00).
  • Total PCEA consumption did not interact with surgical site (abdomen, thorax, extremity) (P=0.379) or age (<50, 50–75, >75years; P=0.330), but was influenced by body mass index (P=0.017) and vomiting (P=0.011).
  • Furthermore, motor blockade was greater in females compared to males (P=0.000).
  • In patients treated with PCEA, gender differences in numeric rating scale scores exist but are not clinically relevant.

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