Continuous intraoperative epidural infusions affect recovery room length of stay and analgesic requirements: a single-center observational study

Shah, Aalap; Nair, Bala G.; Spiekerman, Charles

doi:10.1007/s00540-017-2316-4

Cited by 6 publications

(5 citation statements)

References 25 publications

(25 reference statements)

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“…The multivariate analysis found that iTEA at PACU arrival was a significantly associated factor of severe pain at discharge from PACU and admission to the ward (adjusted OR of 4.77) compared to patients with effective TEA at PACU arrival. This result is similar to that a study by Shah et al 6 ., which demonstrated that intra-operative epidural management predicted pain level, PACU length of stay, and PACU opioid use.…”

Section: Ineffective Thoracic Epidural Analgesiasupporting

confidence: 93%

“…Thoracic epidural analgesia (TEA) is widely used to manage post-operative pain after major abdominal and thoracic surgery [1][2][3][4] and is considered superior to other methods in managing and reducing post-surgical pain [1][2][3][4][5] . In addition, it facilitates the recovery of bowel function [3][4][5] and reduces the length of hospital stay in open abdominal surgery 3,6 . It has been well-documented to improve the patient's quality of life after surgery 7 .…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Intraoperative Thoracic Epidural Analgesia in Major Abdominal and Thoracic Surgery and Its Prediction of Severe Pain at Discharge from the Post-Anesthetic Care Unit: A Prospective Cohort Study

Jamisho,

Pakpirom,

Srisintorn

et al. 2023

J Health Sci Med Res

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Objective: To assess the factors associated with ineffective thoracic epidural analgesia (iTEA) in the post-anesthesia care unit (PACU) among patients requiring TEA. Material and Methods: This prospective cohort was conducted on 146 patients requiring post-operative TEA. The verbal numeric rating scale (VNRS) was employed to assess TEA effectiveness on PACU arrival at 10, 20, and 30 minutes after surgery; iTEA was determined if the VNRS score was more than 3 and 4 at rest and during activity, respectively. The patient characteristics, and intra- and post-operative epidural management were collected. The risk factors of iTEA were evaluated using mixed-effects models. Moreover, factors associated with severe pain at PACU discharge were evaluated using logistic regression analyses. Results: The incidence of iTEA on PACU arrival, and at 10, 20, and 30 minutes after PACU arrival were 53.4%, 51.4%, 50.7%, and 36.3%, respectively. Intra-operative intravenous morphine supplementation and the cumulative fentanyl equivalent dose (every 10 mcg) were significantly associated with preventing the risk of iTEA on PACU arrival (OR 0.27; 95% CI=0.07-0.92) and during PACU stay (OR 0.87; 95% CI=0.77-0.97) compared to those who did not receive opioids. Moreover, iTEA on PACU arrival was a significant risk for severe pain at 30 minutes (adjusted OR 4.77; 95% CI=1.57-18.10). Conclusion: This study demonstrates a high incidence of iTEA immediately after surgery, and that intravenous opioid supplementation during and after surgery reduces the risk of iTEA. Lastly, iTEA on PACU arrival is a strong predictor of severe pain at discharge from PACU.

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Section: Ineffective Thoracic Epidural Analgesiasupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Intraoperative Thoracic Epidural Analgesia in Major Abdominal and Thoracic Surgery and Its Prediction of Severe Pain at Discharge from the Post-Anesthetic Care Unit: A Prospective Cohort Study

Jamisho,

Pakpirom,

Srisintorn

et al. 2023

J Health Sci Med Res

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“…Majority of studies, some of them with large sample sizes, have demonstrated significant benefits of EDA for patients' comfort and outcomes (17,44,49,50), with the study of Monaco and co-workers (48) being an example. They investigated 459 consecutive patients with open thoraco-abdominal aortic aneurysm repair, with 409 (89%) patients receiving thoracic EDA (TEA).…”

Section: Efficacymentioning

confidence: 99%

“…Complications after epidural puncture are rare but may have dramatic effects including paraplegia (68). However, the currently available literature suggests that the benefits of EDA outweigh its risks and side effects (44,46,49,50,69,70). Thoracic epidurals are inserted in close vicinity to the spinal cord; the procedure has to be performed by experienced professionals (71).…”

Section: Complicationsmentioning

confidence: 99%

Regional Catheters for Postoperative Pain Control: Review and Observational Data

Suksompong

Bormann

2020

Anesth Pain Med

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Context: Perioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against 'aggressive' measures. Evidence Acquisition: This is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences. Results: As evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other. Conclusions: Effective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from 'moderate, severe or worst' pain.

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“…Traditionally, quality improvement efforts have focused on methods to streamline the TEA placement process, limit delays related to TEA placement on the overall operating room work ow and improve compliance with intraoperative epidural infusion. (10)(11)(12)(13)(14) While most of these improvement measures address local departmental issues, there are limited data on TEA surveillance at a system-level. We therefore conducted a retrospective observational study to explore the prevalence of intravenous opioid rescue analgesia in the post-anesthesia care unit (PACU-OpResc) in patients with TEA and evaluated the feasibility of this measure as a marker of TEA failure.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Early Postoperative Intravenous Opioid Rescue as a Novel Quality Measure in Patients who Receive Thoracic Epidural Analgesia: A Retrospective Cohort Analysis and Prospective Performance Improvement Intervention

Levy

Santer

Zucco

et al. 2020

Preprint

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Background: In this study, we explored the prevalence of intravenous opioid rescue analgesia in the post-anesthesia care unit (PACU-OpResc) as a single marker of thoracic epidural analgesia (TEA) failure and evaluated the resource implications and quality improvement applications of this measure. Methods: We performed a retrospective analysis of all TEA placements during 2016-2018 at a single academic medical center in Boston, Massachusetts. The study exposure was the need for intravenous opioid rescue analgesia in the PACU (PACU-OpResc). Primary outcome was PACU length of stay (LOS). Secondary outcomes included delayed PACU discharge and intraoperative hypotension. The analyses were adjusted for confounding variables including patient comorbidities, surgical complexity, intraoperative intravenous opioids, chronic opioid use and local anesthetic bolus through TEA catheter. Post analysis chart review was conducted to determine the positive predictive value (PPV) of PACU-OpResc for inadequate TEA. As a first Plan-Do-Study-Act cycle, we then introduced a checkbox for documentation of a sensory level check (SLC) after TEA placement. Post implementation data was collected for 7 months. Results: PACU-OpResc was required by 211 (22.1%) patients who received preoperative TEA, was associated with longer PACU LOS (incidence rate ratio 1.20, 95% CI:1.07–1.34, p=0.001) and delayed discharge due to inadequate pain control (odds ratio 5.15, 95% CI 3.51–7.57, p<0.001). PACU-OpResc had a PPV of 76.3% and 60.4% for re-evaluation and manipulation of the TEA catheter in PACU, respectively. Following implementation of a checkbox, average monthly compliance with documented SLCs after TEA placement was noted to be 39.7%. During this time, a reduction of 8.2% in the rate of PACU-OpResc was observed.Conclusions: This study demonstrates that PACU-OpResc can be used as a quality assurance measure or surrogate for TEA efficiency, to track performance and monitor innovation efforts aimed at improving analgesia, such as our intervention to facilitate SLCs and reduced PACU-OpResc.

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Continuous intraoperative epidural infusions affect recovery room length of stay and analgesic requirements: a single-center observational study

Cited by 6 publications

References 25 publications

The Effectiveness of Intraoperative Thoracic Epidural Analgesia in Major Abdominal and Thoracic Surgery and Its Prediction of Severe Pain at Discharge from the Post-Anesthetic Care Unit: A Prospective Cohort Study

The Effectiveness of Intraoperative Thoracic Epidural Analgesia in Major Abdominal and Thoracic Surgery and Its Prediction of Severe Pain at Discharge from the Post-Anesthetic Care Unit: A Prospective Cohort Study

Regional Catheters for Postoperative Pain Control: Review and Observational Data

Evaluation of Early Postoperative Intravenous Opioid Rescue as a Novel Quality Measure in Patients who Receive Thoracic Epidural Analgesia: A Retrospective Cohort Analysis and Prospective Performance Improvement Intervention

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