Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry

Abstract

(1) Background: In many surgical procedures, regional analgesia (RA) techniques are associated with improved postoperative analgesia compared to systemic pain treatment. As continuous RA requires time and experienced staff, it would be helpful to identify settings in which continuous RA has the largest benefit. (2) Methods: On the basis of 23,911 data sets from 179 German and Austrian hospitals, we analyzed the association of perioperative RA with patient-reported pain intensity, functional impairment of movement, nausea and opioid use for different surgeries. Regression analyses adjusted for age, sex and preoperative pain were performed for each surgery and the following groups: patients receiving continuous RA (surgery and ward; RA++), RA for surgery only (RA+−) and patients receiving no RA (RA−−). (3) Results: Lower pain scores in the RA++ compared to the RA−− group were observed in 13 out of 22 surgeries. There was no surgery where pain scores for RA++ were higher than for RA−−. If maximal pain, function and side effects were combined, the largest benefit of continuous RA (RA++) was observed in laparoscopic colon and sigmoid surgery, ankle joint arthrodesis, revision (but not primary) surgery of hip replacement, open nephrectomy and shoulder surgery. The benefit of RA+− was lower than that of RA++. (4) Discussion: The additional benefit of RA for the mentioned surgeries is larger than in many other surgeries in clinical routine. The decision to use RA in a given surgery should be based on the expected pain intensity without RA and its additional benefits.

Pain management in cancer surgery: Global inequities and strategies to address them

“…4 The specific regional approach and benefit varies by surgery. 5 In general, patients undergoing more painful cancer procedures like major abdominal surgeries, thoracotomies, and amputations benefit from continuous epidural and perineural anesthetic infusions although singleshot fascial plane blocks and local wound infiltration are appropriate for less invasive procedures. Procedure-specific perioperative pain management guidelines like those released by the multidisciplinary PROSPECT group under the academic umbrella of the European Society for Regional Anaesthesia and Pain Medicine can be helpful in formulating institutional practices.…”

Training programmes for healthcare professionals in managing postoperative epidural analgesia: A scoping review protocol

“…Epidural analgesia is an effective technique advocated worldwide for postoperative analgesia after a wide range of surgical procedures, as it reduces the administration of systemic opioids and subsequently improves postoperative outcomes 1,2 . Epidural analgesia has shown substantial benefits for pain management, physical function, reduction of nausea and sedation and overall recovery in several surgical populations 3 . Although epidural analgesia is widely used on surgical wards, systematic education of surgical ward nurses in managing epidural analgesia appears to be lacking 3,4 …”

“…Epidural analgesia is a complex pain treatment modality with potential side effects. It requires education of healthcare staff in specific patient monitoring, care and operation of medical devices 3,4 . Surgical ward nurses play a key role in the frontline monitoring and treatment of postoperative pain 5 .…”

“…Peri‐ and postoperative pain control through epidural analgesia is essential for many patients undergoing surgery to prevent respiratory deterioration and facilitate mobilisation—all important factors in patients' postoperative recovery. Inadequate staff knowledge and skills may therefore compromise the quality and safety of postoperative epidural pain management 3,8 …”

“…1,2 Epidural analgesia has shown substantial benefits for pain management, physical function, reduction of nausea and sedation and overall recovery in several surgical populations. 3 Although epidural analgesia is widely used on surgical wards, systematic education of surgical ward nurses in managing epidural analgesia appears to be lacking. 3,4 Epidural analgesia is a complex pain treatment modality with potential side effects.…”