The effect of patient controlled analgesia and continuous epidural infusion on length of hospital stay after total knee or total hip replacement.

The purpose of this study was to determine the correlation between patient controlled analgesia and continuous epidural analgesia after total knee or total hip replacement on the length of hospital stay. Stress responses to postoperative pain, including decreased mobility, compromised respiratory function, increased catecholamine release, and hypercoagulation, may adversely affect patient recovery, thus lengthening hospital stay. A retrospective chart review of 127 adult, American Society of Anesthesiology (ASA) I, II, or III, patients who had undergone total knee arthroplasty (TKA) or total hip replacement (THR) was obtained. One patient group received epidural anesthesia and postoperative analgesia (EAA) through continuous catheter infusion of bupivacaine or preservative free morphine. The second group underwent general anesthesia and postoperative patient controlled anesthesia (G-PCA) of meperidine hydrochloride or morphine. Length of stay (LOS) was defined as the time period beginning with admission to the post-anesthesia care unit (PACU) until 10 AM the day of discharge. The mean LOS, in hours, for EAA-morphine was 121; compared with EAA-bupivacaine, 142; G-PCA-meperidine, 134; and G-PCA-morphine, 142. These findings were not statistically significant at P = 0.054. LOS did not correlate with age, weight, height, type or surgery, or the ASA classification. Further research into the effectiveness of continuous infusion of epidural bupivacaine and epidural morphine and their impact on LOS may be warranted.