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British Journal of Anaesthesia, Vol 75, Issue 3 274-281, Copyright © 1995 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

A multifactorial analysis to explain inadequate surgical analgesia after extradural block

M. Curatolo, A. Orlando, A. M. Zbinden, P. Scaramozzino and F. S. Venuti
Institute of Anaesthesiology and Intensive Care, Inselspital, University of Bern, 3010 Bern, Switzerland; Institute of Anaesthesiology and Intensive Care, University of Messsina, Italy; Department of Economics, SOAS, University of London, UK

A multivariate analysis of inadequate extradural analgesia was carried out prospectively on 1051 patients undergoing lumbar extradural anaesthesia for surgery performed on structures innervated by T10-S5. Ninety-six patients (9%) experienced pain during surgery. Age, extradural fentanyl, diazepam sedation and duration of surgery had no significant influence. We found some weak evidence that the type of surgery affects the risk of feeling pain. The probability of pain increased with increasing weight, except in overweight women, and was significantly greater for both shorter and taller patients, relative to patients of average height. The probability of pain decreased with increasing dose of local anaesthetic, increasing spread of extradural analgesia, addition of adrenaline, and fentanyl or thiopentone sedation. In conclusion, patient-, surgery- and anaesthesia-related factors influence the risk of inadequate extradural analgesia. If such factors are taken into account, an increase in the success rate may be anticipated.
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