Ambulatory postoperative ward-based epidural analgesia: a retrospective review of 1,147 cases

Abstract

A retrospective review of 1,147 patients who received epidural analgesia (EA) in surgical wards from January 2008 to December 2009 to determine the prevalence of early ambulation and assess the efficacy and safety of EA for postoperative pain management. Outcome measures were the prevalence of ambulation, pain scores at rest/movement and adverse events. Patients (N = 1,147) who received postoperative EA between January 2008 and December 2009 were included. Motor function was assessed using the Bromage scale. Ambulation was defined as: Day 1: mobilisation from bed to chair, walking on the spot, taking a few steps, thereafter walks of increasing duration and distance at least twice daily. Pain scores were measured using the verbal numerical rating scale (0-10), ≤4 signifying successful analgesia. Daily assessments and data recordings were performed by clinical nurse specialists (CNSs) using standardised charts. Data collected included patient demographics, surgical procedure, ambulation achieved, pain scores at rest/movement and adverse events. The data was analysed using Microsoft Excel(®). The prevalence of ambulation was 88% and this was maintained for the duration of EA. Ninety-eight percent of patients reported pain scores of ≤4 at rest and 88% reported pain scores of ≤4 on movement. Adverse events included motor block 12%, nausea 9%, hypotension 8%, catheter dislodgement 3.8%, leakage from insertion site 1.6%, decubitus ulcers 0.58% and infection 0.001%. Mean duration of EA was 4 days. Ward-based EA facilitates early ambulation, provides excellent postoperative pain relief and is associated with low prevalence of adverse events.