Prospective observational study of postoperative epidural analgesia for major abdominal surgery

Duncan, F

Abstract

The number of surgical procedures is increasing worldwide. The Audit Commission set a target that only 5% of patients should experience severe post-operative pain.
Major abdominal surgery is a cause of severe post-operative pain. Epidural analgesia is regarded as the "gold standard" for treating this category of post-operative pain. A
randomised controlled trial conducted by the author suggested that it was possible to have 95% of patients pain controlled, but with a high incidence of hypotension.
Hypotension can restrict rather than enhance a patient's recovery after surgery. Building on this work, this thesis will explore whether it is possible to provide good
analgesia without serious side effects in the workplace.
Methods
This study reports the results of a prospective observational study (n = 480) designed to both describe the technique and examine the association of various factors with pain scores and the incidence of hypotension. Classical statistics and statistical process control methods, a unique feature of the study, were employed to analyse and learn from the data.
Results
Twenty-eight percent of patients reported severe pain. Lower pain scores were associated with female gender and elective surgery. An association exists between increasing age and decreasing pain scores on the first day. The incidence of hypotension was 56%. Low pain scores strongly correlated with hypotension. Many failures occurred due to technical problems.
Recommendations
It is important for nursing professionals to know the true risk/benefit profile of postoperative epidural analgesia as it is ward nursing staff who are primarily responsible
for monitoring the effectiveness of the technique, the patients' safety, and intervening to improve poor quality pain control. The results of this study suggest that epidural analgesia is far from the gold standard for postoperative analgesia. An urgent debate needs to take place to establish its true place in the management of postoperative pain.

Citation

Duncan, F. Prospective observational study of postoperative epidural analgesia for major abdominal surgery. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Oct 3, 2012
• Award Date: Jan 1, 2009