BJA Advance Access originally published online on March 10, 2006
British Journal of Anaesthesia 2006 96(5):633-639; doi:10.1093/bja/ael049
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Measuring the quality of continuous epidural block for abdominal surgery
University Department of Anaesthesia and Ninewells Hospital and Medical School Dundee DD1 9SY, UK
*Corresponding author. E-mail: g.a.mcleod{at}dundee.ac.uk
Background. In view of the wide variation in pain experience between patients, a clinical standard—the time from the end of surgery to the first experience of pain—was applied to 1359 consecutive patients in order to investigate whether the initial quality of epidural block has an effect on the overall quality of postoperative pain relief.
Methods. Clinical data were recorded in 58 118 out of 72 412 h in 1359 patients, and transferred to a database. Data collected included pain scores on a four-point verbal rating scale; nausea and vomiting; motor block; sedation scores; systolic blood pressure <100 and <90 mm Hg; ventilatory frequency <10 and <8 bpm; and hourly epidural infusion rate.
Results. As the time to first experience of pain increased from nil to >24 hours, the time from the first to last experience of pain shortened from 34 (19–50) h to 3 (1–12) h (p<0.001) and the proportion of patients receiving an epidural bolus decreased from 53 to 8% (p<0.001). Increases in the initial pain free time increased the proportion of patients with systolic BP<100 mmHg from 59 to 77%, (p<0.001) and increased the proportion of patients with respiratory rate <10 bpm from 13 to 26%, (p<0.001).
Conclusion. Extending pain relief for more than 12 h beyond the end of abdominal surgery significantly improves the overall quality of postoperative pain relief, but is associated with an increase in side-effects.
1Present address: John Radcliffe Hospital, Oxford, UK.
2Present address: Royal Hospital for Sick Children, Edinburgh, UK
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