Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 2,435 patients

Abstract

In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA) for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA)-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20–39 years) and elderly (age ≥70 years) patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6–48 hours postsurgery. While younger patients exhibited greater incidence of numbness, motor weakness, and discontinuation of PCA postsurgery, elderly patients exhibited greater incidence of hypotension, nausea/vomiting, rescue analgesia, and antiemetic administration. Upon multivariate analysis, low fentanyl dosage and history of smoking were found to be associated with an increased need for rescue analgesia among younger patients, while physical status classification III/IV and thoracic surgery were associated with a decreased need for rescue analgesia among the elderly. Discontinuation of PCA was more frequent among younger patients than the elderly (18.5% vs 13.5%, P=0.001). Reasons for discontinuation of PCA among young and elderly patients, respectively, were nausea and vomiting (6.8% vs 26.6%), numbness or motor weakness (67.8% vs 11.5%), urinary retention (7.4% vs 8.7%), dizziness (2.2% vs 5.2%), and hypotension (3.1% vs 20.3%). In conclusion, PCEA was more frequently associated with numbness, motor weakness, and discontinuation of PCA in younger patients and with hypotension, nausea/vomiting, and a greater need for rescue analgesics/antiemetics among elderly patients. Therefore, in order to minimize the adverse effects of PCEA and enhance pain relief, different PCEA regimens and administration/prevention strategies should be considered for young and elderly patients.

Postoperative Pain Management in Total Knee Arthroplasty

“…Compared with parenteral opioids, epidural analgesia provides better postoperative analgesia with less nausea, vomiting, and pruritus. However, some studies show that epidural anesthesia is associated with many adverse effects, such as urinary retention, hypotension, pruritus, and motor block. Among these, the main drawback of epidural anesthesia is inadvertent motor nerve block, which delays physical therapy and rehabilitation.…”

“…However, some studies show that epidural anesthesia is associated with many adverse effects, such as urinary retention, hypotension, pruritus, and motor block. Among these, the main drawback of epidural anesthesia is inadvertent motor nerve block, which delays physical therapy and rehabilitation. In addition, epidural anesthesia limits the options for postoperative prophylaxis against deep venous thrombosis.…”

Analgesia Epidural Postoperatoria: ¿cuál es su papel en la práctica anestésica actual?

“…(19), por lo que en la actualidad no se recomienda la analgesia epidural lumbar, excepto en obstetricia. Otro factor que puede contribuir a la elevada incidencia de bloqueo motor es el uso de una perfusión continua en lugar de la modalidad controlada por el paciente (PCA), que permite individualizar el tratamiento, adaptándose a las necesidades analgésicas de cada paciente, disminuyendo dosis y efectos secundarios (20).…”

Does exhalation while rising from the bed relieve motion-induced pain after abdominal surgery?

“…Koh et al investigated the incidence of adverse effects of epidural anesthesia in 2,435 postoperative patients in Korea, and found a high incidence of numbness and motor paralysis in young people (67.8%), while these were found in 11.5% of the elderly. Likewise, it was reported that low blood pressure is experienced by 3.1% of young people and 20.3% of the elderly after surgery, and that the incidence of hypotension and vomiting is higher in the elderly than in younger patients [8]. Therefore, a nonpharmacological method for relieving pain is desired.…”