INCIDENCE OF RESPIRATORY DEPRESSION WITH IV-PCA AND EPIDURAL ANALGESIA MANAGED BY AN ACUTE PAIN SERVICE

1998 ◽  
Vol 23 (Sup 1) ◽  
pp. 41 ◽  
Author(s):  
M. Group ◽  
J. A. Grass ◽  
P. Shrewsbery ◽  
N. Mekhail
Keyword(s):  
Epidural Analgesia ◽  
Respiratory Depression ◽  
Acute Pain ◽  
Acute Pain Service

scholarly journals Epidural Analgesia: Prospective Audit of 1062 Patients

1998 ◽  
Vol 26 (2) ◽  
pp. 165-172 ◽  
Author(s):  
R. Burstal ◽  
F. Wegener ◽  
C. Hayes ◽  
G. Lantry
Keyword(s):  
Epidural Analgesia ◽  
Respiratory Depression ◽  
Acute Pain ◽  
Local Anaesthetic ◽  
Epidural Abscess ◽  
Prospective Audit ◽  
Prospective Survey ◽  
Skin Site ◽  
Epidural Catheters ◽  
Regular Review

A prospective survey of one thousand and sixty-two patients receiving epidural analgesia in surgical wards was undertaken over a two-year period. The duration of infusion ranged from one to fourteen days, with a mode of three days. There were 1131 episodes where a local anaesthetic and opioid mixture was used and 160 where opioids were used alone. Local anaesthetic was not used without opioids. 23% of catheters were removed prematurely because of catheter related problems including accidental dislodgement (13%) and skin site inflammation (5.3%). No epidural abscess or haematoma was identified. In 14% of the total number of episodes there was either no demonstrable block or complications occurred requiring a change of solution: 30% of this group were salvaged following intervention by the Acute Pain Service (APS). The incidence of respiratory depression was 0.24%. There was no case of delayed respiratory depression. Epidural analgesia can be used safely in surgical wards provided that regular review of the patients is undertaken. It must be anticipated however, that up to 20% of patients will not receive adequate analgesia for the first 48 hours postoperatively. The failure rate could be halved if accidental dislodgement of epidural catheters could be eliminated.

Managing epidural catheters in critical care beds: An observation analysis in the Republic of Ireland

2018 ◽  
Vol 29 (7-8) ◽  
pp. 228-236
Author(s):  
Cormac Mullins ◽  
Lauren O’Loughlin ◽  
Ulrich Albus ◽  
JR Skelly ◽  
Jeremy Smith
Keyword(s):  
Critical Care ◽  
Epidural Analgesia ◽  
Acute Pain ◽  
Acute Pain Service ◽  
Bed Occupancy ◽  
Midline Laparotomy ◽  
Republic Of Ireland ◽  
Number Of Patients ◽  
The Republic ◽  
Epidural Catheters

In certain hospitals, epidural analgesia is restricted to critical care beds. Due to critical care bed strain, it is likely that many patients are unable to avail of epidural analgesia. The aims of the study were to retrospectively review the number of patients admitted to critical care beds for epidural analgesia over a two-year period 2015–16, to determine the duration of epidural analgesia, to identify the average critical care bed occupancy during this period, to get updated information on the implementation of acute pain service in the Republic of Ireland and the availability of ward-based epidural analgesia. One hundred and sixty patients had a midline laparotomy, 40 of which had an epidural (25%). Forty-two patients were admitted to a critical care bed for epidural analgesia. Aside from epidural analgesia, 12% had other indications for ICU admission. Median duration epidural analgesia was 1.64 days (IQR 0.98–2.14 days). ICU bed occupancy rates were 88.7% in 2015 and 85.1% in 2016. Acute pain service and ward-based epidural analgesia were available in 46 and 42% of hospitals, respectively. Restricting epidural use to a critical care setting is likely to result in reduced access to epidural analgesia. The implementation of acute pain service and availability of ward-based epidural analgesia in the Republic of Ireland are suboptimal.

Association of an acute pain service with postoperative outcomes following pancreaticoduodenectomy

2019 ◽  
Vol 30 (10) ◽  
pp. 309-314
Author(s):  
Engy T Said ◽  
Jacklynn F Sztain ◽  
Matthew W Swisher ◽  
Erin I Martin ◽  
Divya Sood ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Epidural Analgesia ◽  
Acute Pain ◽  
Multimodal Analgesia ◽  
Hospital Length ◽  
Opioid Consumption ◽  
Acute Pain Service ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Thoracic Epidural

The aim of this retrospective study was to evaluate the effect of implementing the combination of thoracic epidural analgesia and multimodal analgesia by a dedicated acute pain service on opioid consumption and postoperative outcomes in patients undergoing pancreaticoduodenectomy. Opioid consumption during postoperative days 0–3 was compared in the acute pain service versus non-acute pain service cohort. Between matched cohorts, the median (quartiles) total opioid consumption during postoperative days 0–3 was 114mg morphine equivalents (54.7, 212.4mg morphine equivalents) in the non-acute pain service cohort and 47.4mg morphine equivalents (38.1, 100.8mg morphine equivalents) in the acute pain service cohort; the median difference was 44.8mg morphine equivalents (95% CI 14.2–90.2mg morphine equivalents, p = 0.002). The median difference in hospital length of stay was 2.0 days (95% confidence interval 0.8–4.0, p = 0.01), favouring the acute pain service cohort. A dedicated acute pain service implementing thoracic epidural analgesia in conjunction with multimodal analgesia was associated with decreased opioid consumption and hospital length of stay.

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