Our Experience in Epidural Analgesia Following Large Abdominal Surgeries.
Full Text PDF

Keywords

epidural analgesia
open abdominal surgery
acute pain
prevention

How to Cite

Bafti, N., & Baftiu, R. (2019). Our Experience in Epidural Analgesia Following Large Abdominal Surgeries. Albanian Journal of Trauma and Emergency Surgery, 3(2). https://doi.org/10.32391/ajtes.v3i2.65

Abstract

Background: Epidural analgesia is a gold standard in post-operative pain control in patients undergoing large abdominal interventions. Different studies report a failure ratio of epidural analgesia of 20-32%.

The aim of this study is to analyze the success rate of epidural analgesia and its consequences in patients that have been subject to large abdominal surgeries.

Materials and methods: We have prospectively collected the data of 50 patients that were subject to open abdominal surgeries during a 2 year timeframe (September 2015 – September 2017) at University Clinical Center of Kosovo. Experienced anesthesiologists inserted the epidural catheters. A dedicated team used the Verbal Scale to collect the data regarding post-operative pain during coughing or moving. The success rate of eidural catheter was measured in terms of: the scale of pain, pulmonary post-operative infection and length of hospital stay.

Results: The study group included 33 males and 17 females, most of whom were subject to liver surgery. The secondary liver formations (70%), primary tumours (20%) as well as beningn liver disorders(10%) were an indication for liver resection. Large resections (≥3 segments) were completed in 44% of patients, small liver resections were (≤2 segments) completed in 48% of patients, while 8% of patients were considered inoperative. Epidural analgesia was successful in 46 patients (92%). Bacterial colonisation of the catheter was observed in only one case. There were no neurological complications. 5 (10%) patients showed radiologicalsigns of a pulmonary infection. Three patients (6%) had surgical wound infection. One patient died of hepatic insufficiency after massive right liver resection and cholecystectomy due to gallbladder carcinoma. The average length of hospital stay was 6 days.

Conclusions: Our experience concludes that epidural analgesia is a safe and effective way of pain relief after abdominal surgeries.

https://doi.org/10.32391/ajtes.v3i2.65
Full Text PDF

References

Nishimori M, Ballantyne JC, Low JH. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 2006; 3: CD005059.[PubMed]

Kehlet H. Modification of responses to surgery by neural blockade: clinical implications. In: Cousins M, Bridenbaugh P, editors. (eds) Neural blockade in clinical anesthesia and management of pain, 2nd edn. Philadelphia, PA: J. B. Lippincott & Co, 1988, pp. 145–188.

McLeod G, Davies H, Munnoch N, et al. Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures. Anaesthesia 2001; 56(1): 75–81.[PubMed]

Hughes KS, Rosenstein RB, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors. Dis Colon Rectum1988; 31(1): 1–4. [PMC free article] [PubMed]

Kanas GP, Taylor A, Primrose JN, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol 2012; 4: 283–301. [PMC free article] [PubMed]

Scheele J, Stangl R, Altendorf-Hofmann A, et al. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991; 110(1): 13–29. [PubMed]

Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002; 235(6): 759–766.[PMC free article] [PubMed]

Jamison RL, Donohue JH, Nagorney DM, et al. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch Surg 1997; 132(5): 505–510, discussion 511. [PubMed]

Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005; 241(5): 715–722, discussion 722–724. [PMC free article] [PubMed]

Mayo SC, Pulitano C, Marques H, et al. Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J Am Coll Surg2013; 216(4): 707–716, discussion 716–718. [PMC free article] [PubMed]

Bromage PR, Camporesi E, Chestnut D. Epidural narcotics for postoperative analgesia.Anesth Analg 1980; 59(7): 473–480. [PubMed]

Van der Auwera D, Verborgh C, Camu F. Analgesic and cardiorespiratory effects of epidural sufentanil and morphine in humans. Anesth Analg 1987; 66(10): 999–1003. [PubMed]

Melendez JA, Arslan V, Fischer ME, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 1998; 187(6): 620–625. [PubMed]

D’Angelica M, Maddineni S, Fong Y, et al. Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions. World J Surg 2006; 30(3): 410–418. [PubMed]

Armstrong PJ, Burgess RW. Choice of incision and pain following gallbladder surgery. Br J Surg 1990; 77(7): 746–748. [PubMed]

Halasz NA. Vertical vs horizontal laparotomies I. Early postoperative comparisons. Arch Surg 1964; 88: 911–914. [PubMed]

Proske JM, Zieren J, Muller JM. Transverse versus midline incision for upper abdominal surgery. Surg Today 2005; 35(2): 117–121. [PubMed]

Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth2009; 102(2): 179–190. [PubMed]

Tsui SL, Yong BH, Ng KF, et al. Delayed epidural catheter removal: the impact of postoperative coagulopathy. Anaesth Intensive Care 2004; 32(5): 630–636. [PubMed]

Dureuil B, Cantineau JP, Desmonts JM. Effects of upper or lower abdominal surgery on diaphragmatic function. Br J Anaesth 1987; 59(10): 1230–1235. [PubMed]

De Pietri L, Siniscalchi A, Reggiani A, et al. The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia. Anesth Analg 2006; 102(4): 1157–1163. [PubMed]

Warner DO, Warner MA, Ritman EL. Human chest wall function during epidural anesthesia. Anesthesiology 1996; 85(4): 761–773. [PubMed]

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.