POSTOPERATIVE PULMONARY COMPLICATIONS AND MORBIDITY AFTER ABDOMINAL ANEURYSMECTOMY - A COMPARISON OF POSTOPERATIVE EPIDURAL VERSUS PARENTERAL OPIOID ANALGESIA

Patients undergoing aortic aneurysm repair have a high prevalence of c oexisting cardiac and pulmonary disease, and the postoperative recover y is especially delayed by pulmonary complications. A review of all el ective abdominal aneurysm repairs over a 29-month period was undertake n to evaluate the effectiveness of postoperative epidural analgesia in decreasing morbidity and mortality, and specifically pulmonary compli cations. Patients were placed into two groups; Group 1 (34 patients) u sed an epidural catheter for postoperative pain control, and Group II (31 patients) used standard parenteral opioid analgesia. The two group s were similar in preoperative combined factors including known risk f actors for atherosclerotic cardiovascular disease, preexisting cardiac or pulmonary disease, and preexisting renal insufficiency. A statisti cally significant decrease (P =< 0.05) was found in both cardiac (P = 0.0002) and pulmonary (P = 0.019) complications in comparison, favorin g Group I patients. A significant decrease was also seen in the time t o liquid intake (P = 0.044), time out of bed to a chair (P = 0.002), l ength of stay in the Intensive Care Unit (P = 0.024), and overall hosp ital charges (P = 0.046) in favor of Group I patients. Although no sig nificant difference (P => 0.05) was seen in decreasing time to ambulat ion (P = 0.054), average time required on the ventilator (P = 0.053), or hospital days (P = 0.181), all of these did show a trend in favor o f epidural catheter utilization. There were no complications or infect ions related to the use of the epidural catheter during this study per iod. In conclusion, the use of an epidural catheter for postoperative pain control has been shown to decrease time of intubation, time in th e ICU, number of cardiac and pulmonary complications, which should lea d to an overall decrease in hospital charges after elective repair of abdominal aortic aneurysms.