Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases
Karamanos E, Dream S, Falvo A, Schmoekel N, and Siddiqui A. Use of epidural analgesia as an adjunct in elective abdominal wall reconstruction: A review of 4983 cases. Perm J 2017; 21:16-115.
CONTEXT: Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common.
OBJECTIVE: To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction.
DESIGN: All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method. Preoperative comorbidities, American Society of Anesthesiologists status, operative findings, postoperative pain management, and venothromboembolic prophylaxis were extracted from the database. Logistic regressions were performed to assess the impact of epidural use.
MAIN OUTCOME MEASURES: Severity of pain on postoperative days 1 and 2.
RESULTS: During the study period, 4983 patients were identified. Of those, 237 patients (4.8%) had an epidural analgesic placed. After adjustment for differences between groups, use of epidural analgesia was associated with significantly lower rates of 30-day presentation to the Emergency Department (adjusted odds ratio [AOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87, adjusted p = 0.01). Use of epidural analgesia resulted in higher odds of abscess development (AOR = 5.89, CI = 2.00-17.34, adjusted p < 0.01) and transfusion requirement (AOR = 2.92, CI = 1.34-6.40, adjusted p < 0.01). Use of epidural analgesia resulted in a significantly lower pain score on postoperative day 1 (3 vs 4, adjusted p < 0.01).
CONCLUSION: Use of epidural analgesia in patients undergoing abdominal wall reconstruction may result in longer hospital stay and higher incidence of complications while having no measurable positive clinical impact on pain control.
Medical Subject Headings
Abdominal Wall; Analgesia, Epidural; Analgesics; Cohort Studies; Elective Surgical Procedures; Female; Humans; Male; Middle Aged; Pain Management; Pain, Postoperative; Reconstructive Surgical Procedures; Retrospective Studies