BJA Advance Access published online on May 28, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh180
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Department of Anaesthesia, St George's Hospital, London SW17 0QT, UK
* To whom correspondence should be addressed. E-mail: jeremy.cashman{at}stgeorges.nhs.uk.
Background. This study examines the evidence from published data concerning the adverse respiratory and haemodynamic effects of three analgesic techniques after major surgery; i.m. analgesia, patient-controlled analgesia (PCA), and epidural analgesia. Methods. A MEDLINE search of the literature was conducted for publications concerned with the management of postoperative pain. Information relating to variables indicative of respiratory depression and of hypotension was extracted from these studies. Over 800 original papers and reviews were identified. Of these papers, 212 fulfilled the inclusion criteria but only 165 provided usable data on adverse effects. Pooled data obtained from these studies, which represent the experience of a total of nearly 20 000 patients, form the basis of this study. Results. There was considerable variability between studies in the criteria used for defining respiratory depression and hypotension. The overall mean (95% CI) incidence of respiratory depression of the three analgesic techniques was: 0.3 (0.1-1.3)% using requirement for naloxone as an indicator; 1.1 (0.7-1.7)% using hypoventilation as an indicator; 3.3 (1.4-7.6)% using hypercarbia as an indicator; and 17.0 (10.2-26.9)% using oxygen desaturation as an indicator. For i.m. analgesia, the mean (95% CI) reported incidence of respiratory depression varied between 0.8 (0.2-2.5) and 37.0 (22.6-45.9)% using hypoventilation and oxygen desaturation, respectively, as indicators. For PCA, the mean (95% CI) reported incidence of respiratory depression varied between 1.2 (0.7-1.9) and 11.5 (5.6-22.0)%, using hypoventilation and oxygen desaturation, respectively, as indicators. For epidural analgesia, the mean (95% CI) reported incidence of respiratory depression varied between 1.1 (0.6-1.9) and 15.1 (5.6-34.8)%, using hypoventilation and oxygen desaturation, respectively, as indicators. The mean (95% CI) reported incidence of hypotension for i.m. analgesia was 3.8 (1.9-7.5)%, forPCA0.4 (0.1-1.9)%, and for epidural analgesia 5.6 (3.0-10.2)%. Whereas the incidence of respiratory depression decreased over the period 1980-99, the incidence of hypotension did not. Conclusions. Assuming a mixture of analgesic techniques, Acute Pain Services should expect an incidence of respiratory depression, as defined by a low ventilatory frequency, of less than 1%, and an incidence of hypotension related to analgesic technique of less than 5%.
Clinical Investigation
Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data
2 Pain Clinic, St Richard's Hospital, Chichester PO19 4E, UK
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M F Khan, O B Omole, and G J O Marincowitz Postoperative analgesia following caesarean deliveries in a rural health district of South Africa Trop Doct, October 1, 2009; 39(4): 217 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kumar, S. S. Kale, R. Dutta, and A. Kumar Post-thoracotomy paraplegia due to epidural migration of bone wax Eur. J. Cardiothorac. Surg., April 1, 2009; 35(4): 734 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Guenther, T. Manzke, H. Wrigge, M. Dutschmann, J. Zinserling, C. Putensen, and A. Hoeft The Counteraction of Opioid-Induced Ventilatory Depression by the Serotonin 1A-Agonist 8-OH-DPAT Does Not Antagonize Antinociception in Rats In Situ and In Vivo Anesth. Analg., April 1, 2009; 108(4): 1169 - 1176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Popping, P. K. Zahn, H. K. Van Aken, B. Dasch, R. Boche, and E. M. Pogatzki-Zahn 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 Br. J. Anaesth., December 1, 2008; 101(6): 832 - 840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. Krane Patient-Controlled Analgesia: Proxy-Controlled Analgesia? Anesth. Analg., July 1, 2008; 107(1): 15 - 17. [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Weber, V. L. Ghafoor, and P. Phelps Implementation of standard order sets for patient-controlled analgesia Am. J. Health Syst. Pharm., June 15, 2008; 65(12): 1184 - 1191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. T. S. Pattinson Opioids and the control of respiration Br. J. Anaesth., June 1, 2008; 100(6): 747 - 758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kopka, E. Wallace, G. Reilly, and A. Binning Observational study of perioperative PtcCO2 and SpO2 in non-ventilated patients receiving epidural infusion or patient-controlled analgesia using a single earlobe monitor (TOSCA) Br. J. Anaesth., October 1, 2007; 99(4): 567 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Overdyk, R. Carter, R. R. Maddox, J. Callura, A. E. Herrin, and C. Henriquez Continuous Oximetry/Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea During Patient-Controlled Analgesia Anesth. Analg., August 1, 2007; 105(2): 412 - 418. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rudin, J. F. Lundberg, M. Hammarlund-Udenaes, P. Flisberg, and M. U. Werner Morphine Metabolism After Major Liver Surgery Anesth. Analg., June 1, 2007; 104(6): 1409 - 1414. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kotze, W. Hinton, D. C. G. Crabbe, and B. J. Carrigan Audit of epidural analgesia in children undergoing thoracotomy for decortication of empyema Br. J. Anaesth., May 1, 2007; 98(5): 662 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. R. Maddox and F. J. Overdyk Transdermal patient-controlled analgesia Am. J. Health Syst. Pharm., January 1, 2007; 64(1): 25 - 25. [Full Text] [PDF]
|
|
|
|
|
|
S. Monsel, G. Rodesch, P.-A. Laloe, G. Kuhlman, and M. Fischler Neurologic Dysfunction After Major Thoracic Surgery in a Patient with Severe Arteriosclerotic Disease Receiving Epidural Analgesia Anesth. Analg., January 1, 2007; 104(1): 204 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. McLeod, K. Dell, C. Smith, and J. A. W. Wildsmith Measuring the quality of continuous epidural block for abdominal surgery Br. J. Anaesth., May 1, 2006; 96(5): 633 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Overdyk, R. Carter, and R. Maddox New JCAHO Pain Standard Bigger Threat to Patient Safety Than Envisioned. Anesth. Analg., May 1, 2006; 102(5): 1596 - 1596. [Full Text] [PDF]
|
|
|
|
|
|
H. Vila Jr and J. B. Downs New JCAHO Pain Standard Bigger Threat to Patient Safety Than Envisioned Anesth. Analg., May 1, 2006; 102(5): 1596 - 1597. [Full Text] [PDF]
|
|
|
|
|
|
D. L. Anghelescu, L. L. Burgoyne, L. L. Oakes, and D. A. Wallace The Safety of Patient-Controlled Analgesia by Proxy in Pediatric Oncology Patients Anesth. Analg., December 1, 2005; 101(6): 1623 - 1627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Dolin and J. N. Cashman Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritis, and urinary retention. Evidence from published data Br. J. Anaesth., November 1, 2005; 95(5): 584 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Power Recent advances in postoperative pain therapy Br. J. Anaesth., July 1, 2005; 95(1): 43 - 51. [Full Text] [PDF]
|
|