INTRODUCING EPIDURAL FENTANYL FOR ON-WARD PAIN RELIEF AFTER MAJOR SURGERY

Background: Epidural opioids have been recommended for analgesia after major surgery In this report we describe how we introduced a low-cost , on-ward, nurse-based acute pain service using epidural fentanyl afte r major surgery in the University Hospitals of Oulu and Kuopio. Method s:In order to evaluate the feasibility of epidural fentanyl infusion a dministered by ward nurses, we prospectively assessed pain and side ef fects during fentanyl infusion (median duration 41 h) after major surg ery in 305 consecutive patients in Kuopio. Results: 92% of the patient s on the ward who had received epidural fentanyl infusion at 31 - 54 m u g . h(-1) reported at most three episodes of severe pain (/ Numerica l Rating Scale > 3 / 10) during the initial postoperative days, but th ere were some patients (8%) who reported several episodes (> 3) of mor e severe pain (Numerical Rating Scale > 3). Three patients (0.9%) show ed a diminished respiratory rate (<10 / min), but only one of them (0. 3%) was somnolent. One other patient (0.3%) was not arousable until th e cessation of infusion. Nausea and pruritus were minor problems in ou r patients, but a majority needed a urinary catheter. Conclusion: With well-trained nurses, careful monitoring and appropriate protocols, ep idural fentanyl infusion proved to be a feasible method for pain relie f after major surgery on a surgical ward.