Postoperative pain control by epidural analgesia after transabdominal surgery - Efficacy and problems encountered in daily routine

Background: The efficacy of postoperative epidural pain treatment has been well documented in controlled studies. However, the literature concerning r esults of daily routine use of this method often only emphasises certain as pects of it. Methods: A prospective study of 168 patients scheduled for major surgery wi th transabdominal access was performed in order to evaluate efficacy, side effects, complications and rate of acceptance of postoperative epidural pai n treatment. The epidural catheter was placed before surgery and the patien ts received epidural analgesia by a bupivacaine/morphine mixture for 3 days postoperatively, continued by another 3 days with bolus injections of morp hine only. Results: Only few complications followed the insertion of the epidural cath eter, but in about 16% of the patients the epidural catheter or the drugs a dministered by it made reinsertion or change in the type of analgesia neces sary during the first 3 postoperative days. Despite the possibility for ind ividualising the treatment and p.r.n. analgesics, pain relief when coughing and moving during day 1-3 was insufficient in 30-50% of the patients. Seri ous side effects were rate, but pruritus was frequent, as were the symptoms of nausea and vomiting. The patients were generally satisfied with the tre atment; however, a small group had unacceptable pain when the epidural cath eter was inserted. Conclusion: Analgesia was insufficient when coughing and moving in an unacc eptably large number of the patients. Also the number of epidural catheter related problems was high. Ln order to make early intervention possible, th e patients and epidural catheters should be observed daily and systematical ly by members of the staff competent to detect possible problems.