Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life

Ali, M.; Winter, Desmond C.; Hanly, Ann; O'Hagan, C.; Keaveny, J.; Broe, Patrick J.

doi:10.1093/bja/aeq006

Cited by 96 publications

(56 citation statements)

References 30 publications

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“…Epidural analgesia is usually associated with cardiovascular complications such as hypotension but we did not identify this complication in the PCEA group [20,35]. We found a greater incidence of fistula in patients who received epidural analgesia but the difference was not statistically significant due to the very low incidence.…”

Section: Discussionmentioning

confidence: 57%

“…We estimated this for a comparison made with a t-test for independent samples, with 95% power, a level of significance of 0.05, a bidirectional p value, and equal sample sizes in the compared groups. We identified a standard deviation of 1.36 in a previous study as a base of variability in our calculations [20]. A sample size of 45 subjects per group was found, and we increased it to 50 to allow for loss to follow up.…”

Section: Statistical Analysesmentioning

confidence: 99%

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mprovement of recovery parameters using patient-controlled epidural analgesia after oncological surgery. A prospective, randomized single center study

Zgaia

Lisencu

Rogobete

et al. 2017

Rom J Anaesth Int Care

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Purpose: The aim of this study was to compare patient-controlled epidural analgesia (PCEA) versus conventional opioid intravenous (IV) infusion after gastrointestinal cancer surgery regarding several postsurgery parameters of recovery.Methods: One hundred and one patients were prospectively randomized to receive either thoracic/ lumbar PCEA (PCEA group) or the standard analgesia technique used in our hospital, conventional IV infusion of morphine (IVMO group) after gastrointestinal cancer surgery. Pain intensity, time of mobilization and bowel function recovery were analyzed post-surgery. We also evaluated postoperative complications and length of Postoperative-Intermediate Intensive Care Unit (PI-ICU) stay and hospital stay.Results: Pain intensity was significantly less in the PCEA group in comparison with the IVMO Group at awakening 2, 8, 24, 30 and 48 hours after surgery (p <0.001, p <0.001, p <0.001, p = 0.043, p = 0.036, and p = 0.029, respectively). The latency to bedside mobilization, walking, first postoperative flatus and apparition of first stool were significantly faster (1.74 versus 2.26 days, 3.06 versus 3.78 days, 2.1 versus 3.14 days and 3.73 versus 5.28 days, respectively) in the PCEA group than in the IVMO group (p <0.001, p <0.001, p <0.001, and p <0.001, respectively). The incidence of nausea/vomiting was significantly lower in the PCEA group in comparison with the IVMO group (p = 0.001). Surgical-associated complications were significantly lower in the IVMO Group than in the PCEA group (p = 0.023). Length of PI-ICU stay was similar in the two groups but length of hospital stay was significantly shorter in PCEA group (4 versus 5 days p = 0.2849, 9 versus 12 days; p <0.001).Conclusions: PCEA provides better postoperative pain control, improves postoperative recovery after gastrointestinal cancer surgery compared with conventional intravenous morphine infusion. Therefore, it is more acceptable than conventional pain management.

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Section: Discussionmentioning

confidence: 57%

Section: Statistical Analysesmentioning

confidence: 99%

mprovement of recovery parameters using patient-controlled epidural analgesia after oncological surgery. A prospective, randomized single center study

Zgaia

Lisencu

Rogobete

et al. 2017

Rom J Anaesth Int Care

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“…To better control intraoperative and postoperative pain, epidural analgesia was administrated by thoracic catheter. [9][10][11][12][13][14][15] In Table 1 we summarized advantages of thoracic epidural anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Cytoreductive surgery and hyperthermic intraoperative chemotherapy is better with open or closed abdomen? Analysis of clinical outcomes

et al. 2017

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The No statistical significant difference was found in the modification of cardiac frequency (P=0.136), of the median arterial pressure (P=0.128), in central venous pressure (P=0.384), cardiac output (P=0.092), and in Stroke Volume Variation (P=0.815) between the 2 groups. Recovery time in the Intensive Care Unit was 5±3 days for group 1 and 5±2 days for group 2.Recovery time was 17±6 days for group 1 and 20±11 days for group 2.There are no data confirming better outcomes of HIPEC with open or closed technique. An experienced operating team is required to decrease morbidity and mortality rate.

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“…Most reports in literature have a protocol of thoracic epidural analgesia for perioperative pain management [2,3,6,8,10]. Prospective randomised control trials have found epidural analgesia superior to intravenous patient controlled analgesia (IV-PCA) in appropriate indications [11][12][13][14]. These patients may also require local anaesthetics with opioids via epidural for longer time than the conventional 48-72 h, with Schmidt et al [2] reporting median usage of 7 days continuous infusion.…”

Section: Pain Managementmentioning

confidence: 99%

Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Sheshadri

Chakravarthy

2016

Indian J Surg Oncol

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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has emerged as one of the primary modalities of treatment of diffuse peritoneal malignancies. It is a complex surgical procedure with the patients facing major and potentially life threatening alterations of haemodynamic, respiratory, metabolic and thermal balance with significant fluid losses and the perioperative management is challenging for anaesthesiologists and intensive care physicians. Though the alterations are short lived, these patients require advanced organ function monitoring and support perioperatively. The anaesthesiologist is involved in the management of haemodynamics, respiratory function, coagulation, haematologic parameters, fluid balance, thermal variations, and metabolic and nutritional support perioperatively. The chemotherapy instillate used are known to cause nephrotoxicity, cardiotoxicity, dyselectrolytemia and lactic acidosis. The preoperative polypharmacy for pain control, previous surgery and/or chemotherapy, malnourished status secondary to feeding problems and tumour wasting syndrome make the task all the more challenging. The anaesthesiologist also needs to consider the perioperative care from a quality of life perspective and proper preoperative counselling is important. The present overview summarizes the challenges faced by the anaesthesiologist regarding the pathophysiological alterations during the Cytoreductive surgery and Hyperthermic intraperitoneal chemotherapy in the preoperative, intraoperative and postoperative periods.

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Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life

Cited by 96 publications

References 30 publications

mprovement of recovery parameters using patient-controlled epidural analgesia after oncological surgery. A prospective, randomized single center study

mprovement of recovery parameters using patient-controlled epidural analgesia after oncological surgery. A prospective, randomized single center study

Cytoreductive surgery and hyperthermic intraoperative chemotherapy is better with open or closed abdomen? Analysis of clinical outcomes

Anaesthetic Considerations in the Perioperative Management of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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