Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients

Deni, Francesco; Finco, Gabriele; Corno, Laura; Landoni, Giovanni; Túri, Sándor; Colnaghi, Eleonora; Comotti, Laura; Musu, Mario; Meani, Renato; Mello, Ana Paula de Queiroz; Perotti, Valeria; Pasculli, Nicola; Beretta, Luigi; Zangrillo, Alberto

doi:10.22514/sv121.102016.14

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…The large number of treated patients confirms the safety in the use of both epidural analgesia and IV PCA with morphine. The present follow-up to our previous report 12 nearly doubles the sample size, while not increasing the complication rate and confirming the promising findings that we previously reported. Interestingly, no major complications or permanent deficits have been reported in this series, which to our knowledge represents the third largest ever published on the topic.…”

Section: Discussionsupporting

confidence: 93%

“…As previously described, 12 an anesthesia fellow dedicated to the management of postoperative pain and to the prevention and treatment of possible complications is on-call 24 hours per day, 7 days per week. A senior anesthesiologist can be contacted at any moment to discuss any issue related to pain management.…”

Section: Methodsmentioning

confidence: 99%

“…We updated our previously published experience describing the performance of the APS of a large surgical center, focusing on major and minor complications of epidural analgesia and IV opioids together with a comparison of the postoperative pain management between these 2 strategies.…”

Section: Introductionmentioning

confidence: 99%

“…In order to ensure an appropriate management of acute postoperative pain, the APS has an important role in training patients and the medical and nursing staff involved in perioperative care, and in performing audits and clinical research on the efficacy of existing and new methods of treatment. 10, 11 We updated our previously published experience describing the performance of the APS of a large surgical center, 12 focusing on major and minor complications of epidural analgesia and IV opioids together with a comparison of the postoperative pain management between these 2 strategies.…”

Section: Introductionmentioning

confidence: 99%

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Acute Pain Service: A 10‐Year Experience

et al. 2019

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Background Pain management after surgery is crucial to decrease perioperative morbidity and mortality. Acute pain services (APS) are multidisciplinary teams that represent a modern strategy to address pain inside hospitals. The APS defines and applies pain treatment protocols specific for each surgery. To evaluate the performance of the APS at our institute, we performed a large retrospective cohort study focusing on complications of epidural analgesia and IV opiates. Methods Data from the 10 years of activity of the APS were collected. Pain was assessed using the VAS at rest (VASr) and during movement (VASm) at each daily visit; the presence of side effects and complications was also assessed. Results A total of 17,913 adult patients were followed by APS during the study period. Epidural analgesia was used in 7,776 cases (43%), while 9,239 (52%) patients used IV patient‐controlled analgesia (PCA). A combination of the 2 was used in 87 patients (0.5%). A total of 456 perineural catheters (2.6%) were placed, while 442 patients(2.5%) used other analgesic techniques. We recorded 163 dural punctures during catheter placement, with no epidural hematoma, epidural abscess, or meningitis, and no permanent modification in sensitive or motor functions. Conclusions In our large case series, APS was confirmed safe and effective in treating postoperative pain, using both epidural analgesia and IV PCA with morphine.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Pain Service: A 10‐Year Experience

et al. 2019

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Morphine

2018

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Epidural Analgesia in Open Thoraco-abdominal Aortic Aneurysm Repair

Monaco

Pieri

Barucco

et al. 2019

European Journal of Vascular and Endovascular Surgery

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Thoracic epidural analgesia is effective in reducing post-operative pain with no effect on major post-operative complications. The use of thoracic epidural analgesia, if not contraindicated, might be considered in clinical practice in open thoraco-abdominal aortic aneurysm repair, as it could improve peri-operative management and promote recovery. Objective: Epidural analgesia improves pain control and outcomes of abdominal aortic aneurysm procedures, while the effect of thoracic epidural analgesia on thoraco-abdominal aortic aneurysm (TAAA) repair is unknown. The aim of the study was to evaluate thoracic epidural analgesia effects in patients undergoing open TAAA repair in terms of pain control and clinically relevant outcomes. Methods: This was a retrospective study of a prospectively collected database. Patients undergoing open TAAA repair between January 2009 and December 2016. Results: Four hundred and fifty-nine consecutive patients were included. Thoracic epidural analgesia was used in 409 (89%) of cases. On multivariable analysis, patients who received thoracic epidural analgesia experienced reduced post-operative pain (odds ratio [OR] 0.003, 95% confidence interval [CI] 0.0007e0.009; p < .001), a lower rate of acute kidney injury (AKI; OR 0.39, 95% CI 0.21e0.71 [p ¼ .002]), atrial fibrillation (OR 0.47, 95% CI 0.23e0.95; p ¼ .04), acute myocardial infarction (AMI; OR 0.189, 95% CI 0.05e0.64; p ¼ .008), and paraplegia (OR 0.31, 95% CI 0.157e0.615; p ¼ .001) compared with the conventional analgesia (CA) group. After propensity score matching, 43 patients in the CA group were compared with 43 in thoracic epidural analgesia group. On case match analysis thoracic epidural analgesia showed a significant reduction in postoperative pain (p < .001) and no differences in the incidence of AKI, atrial fibrillation, AMI, and paraplegia. In the thoracic epidural analgesia group there were no epidural haematomas. Conclusion: Thoracic epidural analgesia was effective in reducing post-operative pain with no effect on major post-operative complications. The use of thoracic epidural analgesia, if not contraindicated, might be considered in clinical practice, even in patients undergoing open TAAA repair. Whether a better postoperative management enhances patient's recovery in this setting remains to be tested.

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Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients

Cited by 4 publications

References 8 publications

Acute Pain Service: A 10‐Year Experience

Acute Pain Service: A 10‐Year Experience

Morphine

Epidural Analgesia in Open Thoraco-abdominal Aortic Aneurysm Repair

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