Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients

Abstract

Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients. Link to publication Citation for published version (APA): Flisberg, P., Rudin, Å., Linnér, R., & Lundberg, C. J. F. (2003). Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiologica Scandinavica, 47(4), 457-465. DOI: 10.1034457-465. DOI: 10. /j.1399457-465. DOI: 10. -6576.2003 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background: Adverse effects may still limit the use of continuous epidural and intravenous analgesia in surgical wards. This study postulated that postoperative epidural analgesia was more efficient, and had fewer side-effects than intravenous morphine. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large patient population. Methods: During a five-year period 2696 patients undergoing major surgery, received either epidural or intravenous analgesia for postoperative pain relief. The patients were prospectively monitored in surgical wards. Pain was evaluated with a numeric rating scale (0Ð10) at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/ nightmares/confusion, nausea/vomiting, pruritus, orthostatism/ leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest. Results: Epidural analgesia was used in 1670 patients, and intravenous morphine in 1026 patients. Patients with epidural analgesia experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism/leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the intravenous group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements. Conclusion:In a large patient population the use of epidural and intravenous postoperative analgesia was considered safe in surgical wards, and the incidence of adverse effects was low.Patients with epidural analgesia experienced overall less pain, while opioid related side-effects were more common with intravenous morphine analgesia.

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

“…Mann et al 19 conclude that epidural local anesthetics with opioid improve mental status compared with IV-PCA. Th e study performed by Flisberg et al 33 showed that patients with EA were less confused compared with patients with iv morphine analgesia. Th e lower incidence of postoperative delirium in TEA group could be attributed to superior pain therapy and reduced opioid consumption, earlier recovery of postoperative ileus, and initiation of oral feeding, lower levels of sedation and more effi cient mobilization 35 .…”

“…A large patient sample in the study performed by Flisberg et al 33 showed that patients with EA had better analgesia after major surgery with a reduced incidence of respiratory depression and sedation compared with patients with iv morphine analgesia.…”

Thoracic epidural anesthesia and epidural hematoma

“…I T has been shown that postoperative epidural analgesia provides better dynamic pain control and reduces overall mortality compared with traditional postoperative treatment modalities (1)(2)(3). However, serious complications such as spinal hematoma with neurological deficits following epidural and spinal anesthesia may lead to a devastating situation for the individual patient.…”

Retrospective Analysis of Single-Dose Extended-Release Epidural Morphine Usage

“…The drug of choice using epidural analgesia is local anesthetics but in the interest of improving efficacy of pain control, opioids are usually added. However epidural opioids may cause pruritis and urinary retention [10,12,14] and the risks associated with placing epidural catheters are low but may include epidural hematomas, infections and catheter migration into the thecal sac area [12].…”

“…Advantages of epidural anesthesia are early ambulation and related decrease in pulmonary complications [6,7], nausea and sedation compared to systemic opiate pain control [8][9][10]. Pain control is often better achieved using epidural anesthesia than with IV narcotics [12][13][14][15]. Patients show less of a stress response determined by lower circulating levels of epinephrine, norepinephrine, cortisol and serum glucose [11].…”