Evaluation of Postoperative Pain Control for Women Undergoing Surgery for Gynaecologic Malignancies

Elit, Laurie; Thomas, Heidi; Trim, K; Mazurka, John; Moens, Francois

doi:10.1016/s1701-2163(16)30431-5

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Another retrospective study in 97 patients with gynecologic malignancy compared patient-controlled analgesia to postoperative epidural and found less nausea with epidural, but noted a three-fold increase in urinary tract infections and prolonged urinary catheterization. 7 While small in size and mostly retrospective, these studies raise a question over the complications associated with epidural use.…”

Section: Discussionmentioning

confidence: 99%

Postoperative complications of epidural analgesia at hysterectomy for gynecologic malignancies: an analysis of the National Surgical Quality Improvement Program

Ackroyd

Hernández

Roberts

et al. 2020

Int J Gynecol Cancer

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ObjectiveThe aim of this study was to identify the rate of 30-day postoperative complications after the use of epidural in women undergoing hysterectomy for gynecologic malignancy. Secondary outcome was the impact of epidural on hospital length of stay.MethodsA retrospective cohort study was conducted using the American College of Surgeons’ National Surgical Quality Improvement Program database. This large dataset includes perioperative risk factors and 30-day post-operative outcomes from more than 680 hospitals. Women who underwent abdominal hysterectomy for a gynecologic malignancy from January 2014 to December 2017 were included. Adult patients (18 years or older) who underwent abdominal hysterectomy were identified using common procedure terminology and international classification of diseases codes. Only laparotomy cases were included, and minimally invasive cases (laparoscopy, transvaginal) were excluded due to the small prevalence of epidural cases in this cohort. All patients received general anesthesia. If patients were noted to have “epidural anesthesia” they were included in the epidural cohort and those receiving other adjuvant techniques (regional blocks or spinal anesthesia) were excluded. The primary outcome of interest was the 30-day occurrence of a pulmonary embolism, deep-vein thrombosis, pneumonia, and urinary tract infection. Those who received epidural analgesia were matched in a 1:1 ratio with a similar group of patients who did not receive epidural analgesia using a calculated propensity score to control for confounding factors.ResultsA total of 2035 (13.8%) patients undergoing abdominal hysterectomy for a gynecologic malignancy received epidural analgesia. 1:1 propensity-matched samples included 2035 patients in both epidural and no-epidural groups. Patient characteristics between groups were similar. Overall 30-day complication rates were higher in the epidural group (75.9% vs 62.0%, P<0.01). Specific complications that were higher in the epidural group included: blood transfusion (28.9% vs 22.8%); wound disruption (2.0% vs 1.1%); surgical site infection (10.1% vs 7.2%); and delay in return of bowel function (12.3% vs 9.3%) (all P<0.05). Hospital length of stay was significantly longer in the epidural group as compared with the no-epidural group (5.69 days vs 4.79 days, P<0.01) and readmissions were higher in the epidural group (10.5% vs 9.7%, P<0.01), but there was no difference in 30-day mortality between the groups (P=0.62).DiscussionThe rate of 30-day complications and length of stay among women undergoing an abdominal hysterectomy for gynecologic malignancy was higher for those who received epidural analgesia, but there was no difference in 30-day mortality. Although epidural analgesia can provide a number of benefits when used for postoperative pain control, the possible association with increased 30-day morbidity and length of stay needs to be considered.

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Section: Discussionmentioning

confidence: 99%

Postoperative complications of epidural analgesia at hysterectomy for gynecologic malignancies: an analysis of the National Surgical Quality Improvement Program

Ackroyd

Hernández

Roberts

et al. 2020

Int J Gynecol Cancer

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“…Reduced mobility is associated with an increased risk of venous thromboembolism (VTE) and may result in protracted urinary catheterization, with a subsequent increase in urinary tract infections (UTI) [2,4,12,13]. Prolonged catheterization, in particular, has become a quality metric and many hospitals emphasize early removal to reduce infection risk.…”

Section: Introductionmentioning

confidence: 99%

Epidural Analgesia after Gynecologic Oncology Surgery in the Era of Enhanced Recovery

Barroilhet¹

2018

OAJS

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To date, studies evaluating epidural analgesia for postoperative pain in gynecologic surgery have shown inconsistent results. There are studies demonstrating the efficacy of epidural use during abdominal and pelvic surgery [4,[9][10][11]. While one publication demonstrated that the analgesic Abstract Objective: To compare pain scores, opioid use, and frequency of complications in gynecologic oncology patients who received epidural analgesia versus those who did not.Methods: Two hundred fifty-four patients who underwent laparotomy between 2011 and 2013 were included in this retrospective study. We compared demographics, details of surgery, length of hospitalization, complications, pain scores, and total systemic opioids used between the epidural and no epidural groups. Opioid use was reported in intravenous (IV) morphine equivalents.Results: Demographic data were similar between the two groups. One hundred seventy-eight patients (70%) received an epidural. Reported mean pain scores were slightly lower during the first 24 hours for those with an epidural compared to those without (2.6+1.7 vs. 3.1+2.1, P=.0558). Patients with an epidural used significantly less systemic opioids in the first 24 hours after surgery (47.1+ 22.8 mg vs. 87.1+ 65.6 mg; P<.001). There were no differences in thirty-day complications (epidural group 39.9%, no-epidural group 35.5%; p=0.513), venous thrombo embolism (VTE) (3.0% vs 1.0%; P=.53) or length of hospital stay (5.7+ 4.4 vs. 6.3+ 5.9 days; P=.42). Conclusion:Patients undergoing laparotomy in gynecologic oncology who received an epidural used half the amount of systemic opioids in the first 24 hours. There was no difference in post-operative complications, thrombo embolic events or hospital stay between the two groups. Pain scores were similar. Decreased systemic opioid use in the first 24 hours after surgery without an increase in complications may be an important step to facilitate goal attainment in enhanced surgical recovery pathways.

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Anaesthesia for gynaecological oncology surgery

Moore

McLeod

2009

Current Anaesthesia & Critical Care

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Evaluation of Postoperative Pain Control for Women Undergoing Surgery for Gynaecologic Malignancies

Cited by 3 publications

References 10 publications

Postoperative complications of epidural analgesia at hysterectomy for gynecologic malignancies: an analysis of the National Surgical Quality Improvement Program

Postoperative complications of epidural analgesia at hysterectomy for gynecologic malignancies: an analysis of the National Surgical Quality Improvement Program

Epidural Analgesia after Gynecologic Oncology Surgery in the Era of Enhanced Recovery

Anaesthesia for gynaecological oncology surgery

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