Are you a MASTER of postoperative analgesia?

Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW & Collins KS. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002; 359: 1276.

RHH Journal Club. March 20th, 2012. Dr Tom Bendinger

No free full-text available

Does the use of peri- and postoperative epidural analgesia reduce postoperative complications in a high-risk population?

Introduction:

Epidural block is widely used to manage major abdominal surgery and postoperative analgesia, but its risks and benefits are uncertain.

Aim: Comparison of intraoperative epidural anaesthesia and postoperative epidural analgesia for 72 h with general anaesthesia (site of epidural selected to provide optimum block) vs. general anaesthesia with opioid based postoperative analgesia.

Methods:

  • Multicentre (six countries, 25 hospitals) RCT
  • 915 patients were included (447 patients assigned epidural and 441control).
  • Inclusion criteria:
    1. major abdominal surgery
    2. high-risk (one of nine defined comorbid states)
  • The primary endpoint was death at 30 days or major postsurgical morbidity.

Results:

255 patients (57·1%) in the epidural group and 268 (60·7%) in the control group had at least one morbidity endpoint or died (p=0·29). Mortality at 30 days was low in both groups (epidural 23 [5·1%], control 19 [4·3%], p=0·67).

Only one of eight categories of morbid endpoints in individual systems (respiratory failure) occurred less frequently in patients managed with epidural techniques (23% vs 30%, p=0·02). Postoperative epidural analgesia was associated with lower pain scores during the first 3 postoperative days.

There were no major adverse consequences of epidural catheter insertion.

Conclusion:

Authors concluded that use of combined epidural and general anaesthesia and postoperative epidural analgesia did not reduced most adverse morbid outcomes in high-risk patients undergoing major abdominal surgery.

However they indicated that the usage of epidural improved postoperative analgesia and reduced respiratory failure.

Authors pointed that further, larger, multicentre trials may be needed to resolve outstanding issues about the use of epidural anaesthesia and analgesia.

 

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