Local and Regional Anesthesia Dovepress Factors Influencing the Quality of Postoperative Epidural Analgesia: an Observational Multicenter Study

Background Epidural analgesia (EDA) is used widely for postoperative pain treatment. However, studies have reported a failure rate of EDA of up to 30%. We aimed to evaluate the quality of postoperative EDA in patients undergoing a laparotomy in five Norwegian hospitals. Methods This was a multicenter observational study in patients undergoing a laparotomy with epidural-based postoperative analgesia. Data were registered at three time points. Technical aspects, infusion rates, pain intensity, assessment procedures, side effects, and satisfaction of patients and health personnel were recorded. The use of other pain medications and coanalgesics was registered. Results Three hundred and seventeen patients were included. Pain control at rest was satisfactory in 89% of patients at 24 hours and in 91% at 48 hours. Pain control when coughing was satisfactory in 62% at 24 hours and in 59% at 48 hours. The spread of hypoesthesia was consistent for each individual patient but varied between patients. The hypoesthetic area was not associated with pain intensity, and the precision of the EDA insertion point was not associated with the pain score. Few side effects were reported. EDA was regarded as effective and functioning well by 64% of health personnel. Conclusion EDA was an effective method for postoperative pain relief at rest but did not give sufficient pain relief during mobilization. The use of cold stimulation to assess the spread of EDA had limited value as a clinical indicator of the efficacy of postoperative pain control. Validated tools for the control of EDA quality are needed.

[1]  N. Tzanakis,et al.  Predictors of laterality of motor block during epidural analgesia in a mixed surgical population , 2013, Acta anaesthesiologica Scandinavica.

[2]  J. Hermanides,et al.  Failed epidural: causes and management. , 2012, British journal of anaesthesia.

[3]  P. Parker.  Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: A fundamental distinction requiring standardized measurement , 2012, PAIN.

[4]  C. Kalkman,et al.  Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. , 2011, British journal of anaesthesia.

[5]  E. Bäckryd,et al.  Movement‐evoked breakthrough cancer pain despite intrathecal analgesia: a prospective series , 2011, Acta anaesthesiologica Scandinavica.

[6]  U. Chohan,et al.  Appropriate length of epidural catheter in the epidural space for postoperative analgesia: evaluation by epidurography , 2011, Anaesthesia.

[7]  O. Fredheim,et al.  [Post-operative pain management in hospitals]. , 2011, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[8]  I. Gilron,et al.  Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: A fundamental distinction requiring standardized measurement , 2011, PAIN®.

[9]  H. Kehlet,et al.  Subacute pain and function after fast‐track hip and knee arthroplasty , 2009, Anaesthesia.

[10]  R. Vonthein,et al.  Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery , 2009, Anaesthesia.

[11]  A. Stubhaug,et al.  Management of acute postoperative pain: Still a long way to go! , 2008, PAIN®.

[12]  J. Lau,et al.  Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. , 2006, The Cochrane database of systematic reviews.

[13]  C. Motamed,et al.  An Analysis of Postoperative Epidural Analgesia Failure by Computed Tomography Epidurography , 2006, Anesthesia and analgesia.

[14]  Hui Zheng,et al.  Epidural Pain Relief Versus Systemic Opioid-Based Pain Relief for Abdominal Aortic Surgery , 2006, The Cochrane database of systematic reviews.

[15]  G. Mistraletti,et al.  Epidural analgesia in the Post-Anaesthesia Care Unit. , 2005, Current drug targets.

[16]  T. Werawatganon,et al.  Patient controlled intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. , 2005, The Cochrane database of systematic reviews.

[17]  C. Mann,et al.  Comparison of Intravenous or Epidural Patient-controlled Analgesia in the Elderly after Major Abdominal Surgery , 2000, Anesthesiology.

[18]  L. Ready,et al.  Acute Pain: Lessons Learned From 25,000 Patients , 1999, Regional Anesthesia & Pain Medicine.

[19]  L. Arendt-Nielsen,et al.  Block of pinprick and cold sensation poorly correlate with relief of postoperative pain during epidural analgesia. , 1999, The Clinical journal of pain.

[20]  E. Riley,et al.  Changes in the Position of Epidural Catheters Associated with Patient Movement , 1997, Anesthesiology.

[21]  E. Riley,et al.  Changes in the position of epidural catheters associated with patient movement. , 1997 .

[22]  G H Smith,et al.  Assessment of Pain , 2011 .