BJA Advance Access originally published online on October 22, 2008
British Journal of Anaesthesia 2008 101(6):832-840; doi:10.1093/bja/aen300
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Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data
Department of Anaesthesiology and Intensive Care, University Hospital Münster, D-48149 Münster, Germany
* Corresponding author. E-mail: poppind{at}uni-muenster.de
Background: Approximately 30–80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem.
Methods: We analysed prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system.
Results: Of 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0–100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02%; 1:4741) or epidural abscess (0.014%; 1:7142) after PCEA was 1:2857 (0.04%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block.
Conclusions: We demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA.
Keywords: anaesthetic techniques, regional; complications, neurological; epidural; pain, postoperative; safety
Parts of this study were presented as an abstract at the Annual Scientific Meeting of the European Society of Anaesthesiology 2007.
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