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Table of Contents
LETTER TO EDITOR
Year : 2013  |  Volume : 29  |  Issue : 1  |  Page : 123

Efficacy and safety of thoracic epidural analgesia after major abdominal surgery for acute post-operative pain


Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India

Date of Web Publication10-Jan-2013

Correspondence Address:
Anirban Hom Choudhuri
12/203, East End Apartments, Mayur Vihar I,Delhi - 110 096
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.105821

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How to cite this article:
Choudhuri AH, Dhingra A, Uppal R. Efficacy and safety of thoracic epidural analgesia after major abdominal surgery for acute post-operative pain. J Anaesthesiol Clin Pharmacol 2013;29:123

How to cite this URL:
Choudhuri AH, Dhingra A, Uppal R. Efficacy and safety of thoracic epidural analgesia after major abdominal surgery for acute post-operative pain. J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2019 Nov 13];29:123. Available from: http://www.joacp.org/text.asp?2013/29/1/123/105821

Sir,

The benefits of thoracic epidural analgesia after abdominal surgeries are well established [1] but the safety and efficacy during the postoperative period is highly variable and depends on the nature of the drug, mode of administration, type of surgery, presence of co-morbidities, etc.

We undertook a retrospective study over 22-month period in patients, who underwent major abdominal surgery and received thoracic epidural analgesia, to assess the safety and efficacy of thoracic epidural analgesia used for relief of acute post-operative pain and compare outcomes of continuous epidural infusion and intermittent epidural administration. All the patients who underwent major abdominal surgery with placement of thoracic epidural catheter between February 2009 and December 2010 were retrospectively analyzed. The epidural charts were screened to include only the patients who received uneventful thoracic epidural analgesia in the operating room and were likely to remain on epidural analgesia for a minimum of 3 days postoperatively and the catheter was unlikely to be removed before at least 2 days of analysis. A total of 101 patients were taken for analysis.

The patients received 0.125% Bupivacaine in normal saline with fentanyl 2 mcg/ml either 8 hourly intermittent bolus or as continuous infusion during the postoperative period. The rate of infusion and the volume of epidural bolus during intermittent boluses were based upon the discretion of anesthetist depending on the hemodynamic status, severity of pain etc. The pain scores were recorded every 4 hourly on day 1 and 8 hourly on day 2 and day 3. Intravenous paracetamol or intramuscular diclofenac was used in the appropriate dosage as rescue analgesic whenever VAS > 3.

The hemodynamic parameters were continuously monitored and recorded hourly on day 1 and 2 hourly on day 2 and 3. Results were expressed as mean ± SD or percentage as appropriate. Ordinal data were compared using the Chi-square test. The difference in the pain scores according to the continuous or intermittent epidural administration was detected by one-way ANOVA (analysis of variance).

There was satisfactory analgesia after major abdominal surgery using thoracic epidural technique alone in 56% of the patients on day 1, 67% of patients on day 2 and 62% of patients on day 3 after surgery. More patients in the intermittent bolus required rescue analgesics (70.45% vs. 29.54%; P < 0.05) than the continuous infusion group. Hypotension was more common in the intermittent bolus than continuous infusion group only on day 1 but was not severe to discontinue epidural analgesia. The same effect has also been observed in a few studies [2],[3] in different settings where the requirements of rescue analgesics for inadequate pain relief were more common with intermittent epidural analgesia.

 
  References Top

1.Ali M, Winter DC, Hanly AM, O'Hagan C, Keaveny J, Broe P. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth 2010;104:292-7.  Back to cited text no. 1
[PUBMED]    
2.Boutros A, Blary S, Bronchard R, Bonnet F. Comparison of intermittent epidural bolus, continuous epidural infusion and patient-controlled epidural analgesia during labor. Int J Obstet Anesth 1999;8:236-41.  Back to cited text no. 2
[PUBMED]    
3.Vallejo MC, Ramesh V, Phelps AL, Sah N. Epidural labor analgesia: Continuous infusion versus patient-controlled epidural analgesia with background infusion versus without background infusion. J Pain 2007;8:970-5.  Back to cited text no. 3
[PUBMED]    




 

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