Amit Patel1, Maria Stasiowska, Umeer Waheed, Stephen J Brett, Parind B Patel. 1. From the *Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, Hammersmith Hospital; and †MRC Clinical Sciences Centre and ‡Centre for Haematology, Hammersmith Hospital, Imperial College London, London, UK.
Abstract
OBJECTIVES: The objective of this study was to investigate the analgesic efficacy of functional and prematurely aborted epidurals after pancreaticoduodenectomy in critical care, as this is unknown. METHODS: Data from elective pancreaticoduodenectomy recipients admitted to the critical care unit over 44 months were prospectively collected. Epidural (0.1% bupivacaine and 2 µg/mL fentanyl) analgesic efficacy was assessed with a ranked categorical verbal pain score (primary end point). If no epidural was placed, intravenous (IV) fentanyl patient-controlled analgesia (PCA) was used. RESULTS: Eighty-six pancreaticoduodenectomy patients had a mean age of 66.5 years; 61.6% were men; and 73 received an epidural, whereas 13 received an IV PCA. Epidural abortion rate was 42.5%, associated with a higher 24-hour (P = 0.02) but not 48-hour pain score. Overall, fewer patients reported any pain (P = 0.010; number needed to harm, 3.2; 95% confidence interval, 1.7-3.2) or severe pain (P = 0.006; number needed to harm, 2.9; 95% confidence interval, 2.1-4.7) with functional epidurals. Pain (sensitivity, 93.8%) and severe pain (specificity, 87.8%) were predictive of epidural abortion. Most postepidural analgesia was IV PCA (P = 0.097) after both functional and aborted epidurals. CONCLUSIONS: Premature epidural abortion rate was high and associated with analgesic morbidity. Pain score was predictive of epidural abortion. Thus, preference toward epidural analgesia cannot be supported.
OBJECTIVES: The objective of this study was to investigate the analgesic efficacy of functional and prematurely aborted epidurals after pancreaticoduodenectomy in critical care, as this is unknown. METHODS: Data from elective pancreaticoduodenectomy recipients admitted to the critical care unit over 44 months were prospectively collected. Epidural (0.1% bupivacaine and 2 µg/mL fentanyl) analgesic efficacy was assessed with a ranked categorical verbal pain score (primary end point). If no epidural was placed, intravenous (IV) fentanylpatient-controlled analgesia (PCA) was used. RESULTS: Eighty-six pancreaticoduodenectomy patients had a mean age of 66.5 years; 61.6% were men; and 73 received an epidural, whereas 13 received an IV PCA. Epidural abortion rate was 42.5%, associated with a higher 24-hour (P = 0.02) but not 48-hour pain score. Overall, fewer patients reported any pain (P = 0.010; number needed to harm, 3.2; 95% confidence interval, 1.7-3.2) or severe pain (P = 0.006; number needed to harm, 2.9; 95% confidence interval, 2.1-4.7) with functional epidurals. Pain (sensitivity, 93.8%) and severe pain (specificity, 87.8%) were predictive of epidural abortion. Most postepidural analgesia was IV PCA (P = 0.097) after both functional and aborted epidurals. CONCLUSIONS: Premature epidural abortion rate was high and associated with analgesic morbidity. Pain score was predictive of epidural abortion. Thus, preference toward epidural analgesia cannot be supported.
Authors: J V Groen; A A J Khawar; P A Bauer; B A Bonsing; C H Martini; T H Mungroop; A L Vahrmeijer; J Vuijk; A Dahan; J S D Mieog Journal: BJS Open Date: 2019-04-29
Authors: Jesse V Groen; David E F Slotboom; Jaap Vuyk; Chris H Martini; Albert Dahan; Alexander L Vahrmeijer; Bert A Bonsing; J Sven D Mieog Journal: J Gastrointest Surg Date: 2019-02-26 Impact factor: 3.452