Anest. intenziv. Med. 2012;23(1):33-41

Quality of epidural analgesia and incidence of early complications after major surgeryAnaesthesiology - Original Paper

Leštianský Boris^1,*, Jelínek Milan¹, Klimeš Jiří¹, Zvoníčková Dagmar¹, Pavlík Tomáš², Šrámek Vladimír¹, Hakl Marek¹

¹ Anesteziologicko-resuscitační klinika LF MU a FN u sv. Anny v Brně

² Institut biostatistiky a analýz Masarykovy univerzity

Objective:
The goal of the study was to determine the relationship between chronic vertebral history, difficult epidural insertion, quality of postoperative epidural analgesia and incidence of early complications after major surgery on the first postoperative day.

Design:
Anonymous, questionnaire, non-interventional, observational study.


Setting:
ICUs of the 1st Dept. of General Surgery, Vascular Surgery and Orthopaedics; the Acute Pain Service and the Dept. of Anaesthesiology and Intensive Care Medicine, Masaryk University and University Hospital of St. Anna, Brno, Czech Republic.

Materials and methods:
The total 62 patients came mainly from two groups: thoracotomy (n = 21), insertion height T₅-T₆ (76.2%), and laparotomy (n = 24), insertion height T₁₀-T₁₁ (62.5%). The secondary group was the arthroplasty group (n = 17), insertion height L₄-L₅ (100%). The study protocol included peri-operative data (vertebral history, type of procedure, complications during puncture and catheterization of the epidural space) and postoperative evaluation (the quality of pain relief and incidence of early complications). The main groups underwent combined anaesthesia (general anaesthesia: O₂ + air + sevoflurane, epidural: 15-20 mg bupivacaine pre-operatively, then10 mg per hour continuously).

Results:
The quality of analgesia (using VAS: 0-3 sufficient, 4-5 uncomfortable, over 5 ~ inadequate analgesia) in the thoracotomy group was sufficient in 57.1%, discomfort in 23.8% and poor in 19.1%. In this group were observed these early complications: sensory deficit in 14.3%, motor deficit in 14.3% and hypotension in 9.6%. In the laparotomy group we observed a higher incidence of difficulties to puncture the epidural space (p = 0.027) in connection with vertebral pathology (p = 0.051). Sufficient analgesia in the laparotomy group was achieved in 75% cases, discomfort occurred in 25% and no patient had poor pain relief (0%). Early complications included sensory deficit in 29.2%, contralateral motor blockade in 4.2% and hypotension in 4.2%. A relationship between a history of chronic vertebral complaints and early complications was not demonstrated in the arthroplasty group (p = 0.637).

Conclusion:
We found good quality of epidural analgesia. The incidence of early complications was also satisfactory. Although the incidence of vertebral pathology in the laparotomy group was relatively high, its impact on the quality of postoperative analgesia was not demonstrated. No severe neurological complications were observed.

Keywords: vertebral pathology; epidural puncture difficulties; early complications; quality of epidural analgesia

Received: September 30, 2011; Accepted: January 15, 2012; Published: February 1, 2012  Show citation