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

• Published in: Acta anaesthesiologica Scandinavica Vol. 47; no. 4; pp. 457 - 465
• Main Authors: Flisberg, P., Rudin, Å., Linnér, R., Lundberg, C. J. F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01.04.2003; Blackwell
• Subjects: adverse effects; Analgesia, Epidural - adverse effects; Analgesia, Patient-Controlled; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anestesi och intensivvård; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology and Intensive Care; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Clinical Medicine; epidural analgesia; Female; Humans; Infusions, Intravenous; intravenous morphine; Klinisk medicin; Local anesthesia. Pain (treatment); Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Morphine - administration & dosage; Morphine - adverse effects; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; patient safety; postoperative analgesia; Prospective Studies; respiratory depression; respiratory depression; Intravenous administration; Toxicity; Morphine; Opiates; Narcotic analgesic; Bupivacaine; Pain; Surgery; Anilide; Human; Postoperative; patient safety; postoperative analgesia; epidural analgesia; Local anesthetic; Analgesia; Chemotherapy; Treatment; Perfusion; Extradural administration; intravenous morphine; adverse effects; Organic amide; Comparative study
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2003.00104.x

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 (0–10) 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.