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Background: In postoperative analgesia of total knee arthroplasty (TKA) in elderly patients, epidural analgesia has been proved to be a highly effective method. The goal of this study was to compare between patient-controlled epidural analgesia (PCEA) and continuous epidural analgesia (CEA) for their efficacy of analgesia, analgesic requirement and side effects after TKA in elderly patients. Methods: Eighty eight elderly patients over 60 years, undergoing TKA were randomly allocated to PCEA and CEA group. The PCEA group could demand a 2 ml bolus of 0.1% levobupivacaine and 0.0002% fentanyl solution with a lockout interval of 8 minutes, a total dose limit of 15 ml/h and a basal infusion rate of 3 ml/h. The CEA group received a continuous basal infusion of 5 ml/h of the same solution. The pain scores (verbal numerical rating scale, VNRS) at rest and coughing, analgesic consumption, patient satisfaction and side effects were recorded immediately before and at 1, 3, 6, 12, 24, 48 hour after the initiation of epidural analgesia. Results: VNRS revealed no intergroup differences at each time interval, and were not exceeding 3 in both groups. The PCEA group (n = 44) revealed significantly less analgesic consumption compared to the CEA group (n = 44, P < 0.05), but no significant intergroup differences were noticed in side effects. Conclusions: PCEA using 0.1% levobupivacaine and 0.0002% fentanyl solution for postoperative analgesia after TKA in elderly patients provide comparable analgesia and side effects with less requirement of analgesics in comparison to CEA. (Korean J Anesthesiol 2006; 50: 285~91)