Efficacy of Postoperative Epidural Analgesia

Block, Brian M.; Liu, Spencer S.; Rowlingson, Andrew J.; Cowan, A; Cowan, John A.; Wu, Christopher L.

doi:10.1001/jama.290.18.2455

Cited by 923 publications

(506 citation statements)

References 51 publications

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“…However, recent ✠ ❀ declarative [8,15,53,61] or patient-based [42] surveys have described much higher frequencies of epidural analgesia use (> 60%). This limited use of epidural analgesia may have contributed to the high maximal pain score obtained in our survey and does not facilitate the development of rehabilitation programs [9,58]. The reasons for this limited use may include higher risks [12], medical and legal concerns, insufficient reimbursement, insufficient training of anesthesiologists [10] and organizational difficulties.…”

Section: Discussion (1382 Words)mentioning

confidence: 90%

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

Fletcher

Fermanian

Mardaye

et al. 2008

Pain

250

133

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(249 words)We carried out a national survey on postoperative pain (POP) management in a representative sample (public/private, teaching/non teaching, size) of 76 surgical centers in France. Based on medical records and questionnaires, we evaluated adult patients 24 hours after surgery, concerning information, pre and postoperative pain, evaluation, treatment and side effects. A local consultant provided information about POP management. Data were recorded for 1900 adult patients, 69.3% of whom remembered information on POP.Information was mainly delivered orally (90.3%) and rarely noted on the patient's chart (18.2%). Written evaluations of POP were frequent on the ward (93.7%) with appropriate intervals (4.1 (4.0) hours), but not frequently prescribed (32.7%). Pain evaluations were based on visual analog scale (21.1%), numerical scale (41.2%), verbal scale (13.8%) or non numerical tool (24%). Pain was rarely a criterion for recovery room discharge (19.8%).Reported POP was mild at rest (2.7 (1.3), moderate during movement (4.9 (1.9) and intense at its maximal level (6.4 (2.0). Incidence of side effects was similar according to patient (26.4%) or medical chart (25.1%) including mostly nausea and vomiting (83.3%). Analgesia was frequently initiated during anesthesia (63.6%). Patient-controlled analgesia (21.4%) was used less frequently than subcutaneous morphine (35.1%) whose prescription frequently did not follow guidelines. Non-opioid analgesics used included paracetamol (90.3%), ketoprofen (48.5%) and nefopam (21.4%). Epidural (1.5%) and peripheral (4.7%) nerve blocks were underused. Evaluation (63.4%) or treatment (74.1%) protocols were not available for all patients.This national, prospective, patient-based, survey reveals both progress and persistent challenges in POP management.

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Section: Discussion (1382 Words)mentioning

confidence: 90%

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

Fletcher

Fermanian

Mardaye

et al. 2008

Pain

250

133

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“…A regional anaesthetic block used in addition to general anaesthesia during surgery can minimise the need for postoperative intravenous opiates, thereby allowing rapid awakening from anaesthesia which can facilitate early enteral intake and mobilisation on the day of surgery. In open surgery, the use of epidural analgesia has proven to be superior to opioid-based alternatives for several important outcomes [81], including pain [82], PONV [83] and complications [84]. In laparoscopic surgery, emerging data indicate that alternative methods such as spinal anaesthesia, intravenous lidocain and patient-controlled anaesthesia (PCA) may be equally effective [80].…”

Section: Standard Anaesthetic Protocolmentioning

confidence: 99%

“…Using low-dose concentrations of local anaesthetic combined with a short-acting opiate appears to offer the best combination of analgesia while minimising the risk of motor block and hypotension due to sympathetic blockade. Several meta-analyses have shown improved outcomes with TEA compared with opioid-based analgesia, including pain, complications, PONV and insulin resistance [81][82][83][84][85]. Hypotension induced by sympathetic block should be treated with vasopressors provided the patient is not hypovolaemic.…”

Section: Postoperative Analgesia In Open Surgerymentioning

confidence: 99%

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

et al. 2012

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Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidencedbased enhanced perioperative protocol. Methods Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of goodquality trials (quality of evidence and recommendations according to the GRADE system). Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced

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“…Analgesia is administered through a multimodal approach, including an epidural catheter or regional block for all patients. 32 Postoperatively, the patient is immediately allowed a diet, and efforts are made to mobilize the patient on postoperative day zero. 33 The Foley catheter is routinely removed by postoperative day 2 or earlier, even if an epidural catheter remains in place.…”

Section: Quality Improvement Programsmentioning

confidence: 99%

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

Keenan

Speicher

Nussbaum

et al. 2015

Journal of the American College of Surgeons

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Efficacy of Postoperative Epidural Analgesia

Cited by 923 publications

References 51 publications

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

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Efficacy of Postoperative Epidural Analgesia

Cited by 923 publications

References 51 publications

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

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Product

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Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations