Abstract
BackgroundEpidural analgesia is conventionally used as the mainstay of analgesia in open abdominal surgery but has a small life-changing risk of complications (epidural abscesses or haematomas). Local wound-infusion could be a viable alternative and are associated with fewer adverse effects.MethodsA retrospective observational analysis of individuals undergoing open hepato-pancreato-biliary surgery over 1 year was undertaken. Patients either received epidural analgesia (EP) or continuous wound infusion (WI) + IV patient controlled anaesthesisa (PCA) with an intraoperative spinal opiate. Outcomes analyzed included length of stay, commencement of oral diet and opioid use.ResultsBetween Jan 2016- Dec 2016, 110 patients were analyzed (WI n=35, EP n=75). The median length of stay (days) was 8 in both the WI and EP group (p=0.846), the median time to commencing oral diet (days) was 3 in WI group and 2 in EP group (p=0.455). There was no significant difference in the amount of oromorph, codeine or tramadol (mg) between WI and EP groups (p=0.829, p=0.531, p=0.073, respectively).ConclusionsContinuous wound infusion + IV PCA provided adequate analgesia to patients undergoing open hepato-pancreato-biliary surgery. It was non-inferior to epidural analgesia with respect to hospital stay, commencement of oral diet and opioid use.
Highlights
Open hepato-pancreato-biliary procedures are known to be associated with high-levels of post-operative pain [1]
All patients with wound infusion (WI) received post-operative patient-controlled analgesia (PCA) (n=35), with 24/35 patients receiving preoperative spinal analgesia. 18 (24%) of epidural analgesia (EP) patients concurrently received post-operative patient controlled anaesthesisa (PCA) within the first 48 hours, which was defined as epidural failure (Fig 1)
Our results highlight that there is no difference in the length of High dependency unit (HDU) stay between the WI-SP, with patients receiving only postoperative PCA (WI-PCA) or EP groups
Summary
Open hepato-pancreato-biliary procedures are known to be associated with high-levels of post-operative pain [1]. Epidural analgesia (EP) is currently the mainstay of pain control following open hepato-pancreato-biliary procedures in most centres [3] It is an effective modality which has superseded systemic intravenous opioids due to superior analgesic properties and fewer opioid-related side effects [4]. EP has a greater analgesic efficacy, it can cause life-threatening or life-changing (albeit rare) complications, such as epidural abscess or haematoma. Despite these complications being rare, EP-associated post-operative hypotension is a relatively common complication [4] and subsequent fluid-resuscitation has Jackson et al BMC Anesthesiology (2022) 22:26 been linked to acute kidney injury and fluid overload [1, 5]. Local wound-infusion could be a viable alternative and are associated with fewer adverse effects
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