A Comparison of Multimodal Perioperative Analgesia to Epidural Pain Management After Gastric Bypass Surgery

Schumann, Roman; Shikora, Scott A.; Weiss, Jocelyn M.; Wurm, Heinrich; Strassels, Scott A.; Carr, Daniel B.

doi:10.1213/00000539-200302000-00032

Cited by 45 publications

(17 citation statements)

References 16 publications

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“…In fact, some authors contend that continuous epidural infusions have no positive impact in upper abdominal operations. 10,14,[33][34] Others have raised concern about the safety of this analgesic modality, particularly when employed for liver resections, which harbor an inherent risk of coagulopathy and hepatotoxicity. [35][36][37] These uncertainties are further compounded by a paucity of randomized trials examining the efficacy of epidural analgesia in upper abdominal operations specifically, particularly in terms of pancreatic operations.…”

Section: Discussionmentioning

confidence: 99%

Epidural Analgesia for Pancreatoduodenectomy: A Critical Appraisal

Pratt

Steinbrook

Maithel

et al. 2008

Journal of Gastrointestinal Surgery

124

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Section: Discussionmentioning

confidence: 99%

Epidural Analgesia for Pancreatoduodenectomy: A Critical Appraisal

Pratt

Steinbrook

Maithel

et al. 2008

Journal of Gastrointestinal Surgery

124

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“…Contrarily, improved perioperative pain management may not only improve patient satisfaction with the perioperative experience (Thomas et al, 1998) but also reduce length of stay in the hospital and decrease the risk of pulmonary and cardiovascular complications (Tsui et al, 1997;Kehlet and Holte, 2001;Gloth, 2001;Walder et al, 2001;Schumann et al, 2003). Pain control has been implicated in the reduction of postoperative mortality (Bonnet and Marret, 2005;Walder et al, 2001;Wu et al, 2004) although this is controversial (Liu and Wu, 2007).…”

Section: Introductionmentioning

confidence: 99%

Independent risk factors for postoperative pain in need of intervention early after awakening from general anaesthesia

Mei

Seeling

Franck

et al. 2010

European Journal of Pain

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Despite advances in postoperative pain management, the proportion of patients with moderate to severe postoperative pain is still ranging 20-80%. In this retrospective study, we investigated 1736 patients to determine the incidence of postoperative pain in need of intervention (PPINI)defined as numeric rating scale >4 at rest in the post anaesthesia care unit early after awakening from general anaesthesia, and to identify possible risk factors. The proportion of patients with PPINI was 28.5%. On multivariate analysis, younger age (OR=1.300 [1.007-1.678], p=0.044), female gender (OR=1.494 [1.138-1.962], p=0.004), obesity (OR=1.683 [1.226-2.310], p=0.001), use of nitrous oxide (OR=1.621 [1.110-2.366], p=0.012), longer duration of surgery (OR=1.165 [1.050-1.292], p=0.004), location of surgery (musculoskeletal OR=2.026 [1.326-3.095], p=0.001; intraabdominal OR=1.869 [1.148-3.043], p=0.012), and ASA-PS I-II (OR=1.519 [1.131-2.039], P=0.005) were identified as independent risk factors for PPINI. Patients with PPINI experienced significantly more PONV (10.3% vs. 6.2%, p=0.003), more psychomotor agitation (5.5% vs. 2.7%, p=0.004), needed more application of opioid in PACU (62.8% vs. 24.2%, p<0.001), stayed significantly longer in PACU (89.6min [70-120] vs. 80min [60-100], p<0.001), had a longer median length of hospital stay (6.6 days [4.0-8.8] vs. 6.0 days [3.2-7.8]], p<0.001), and longer postoperative stay (5.0 days [3.0-6.5] vs. 4.1 days [2.5-5.8], p<0.001]). Patients with PPINI required more piritramid (8.0mg [5.0-12.0] vs. 5.0mg [3.0-7.8], p<0.001) in PACU than patients without. The identification of patients at high risk for immediate postoperative pain in need of intervention would enable the formation of effective postoperative pain management programs.

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“…Blended anesthesia was also the standard anesthetic technique used by Schumann et al [24]. However, as reported by Schumann et al [24] and confirmed by the published data [25,26], failure to place the epidural catheter or inadequate epidural catheter function are more frequent in this population. The population we studied underwent a laparotomic (open) surgical approach; however, at our institution, the current trend is toward a laparoscopic approach.…”

Section: Discussionmentioning

confidence: 81%