Comparison of programmed intermittent epidural bolus and continuous epidural infusion for post-operative analgesia after major abdominal surgery: A randomized controlled trial - 13/05/20
, Alec Peniche, MD, Elle Clelland, Michael Ladd, Adrian Delgado, Lee-Lynn Chen, MD, Claas Siegmueller, MD, MBA, PhD, Mark Latronica, MD, Ramana Naidu, MD, Pedram Aleshi, MD, Matthias Behrends, MDAbstract |
Study objective |
Few studies have compared continuous epidural infusion (CEI) against programmed intermittent epidural bolus (PIEB) epidural analgesia after major abdominal surgery. It has not been established whether the modality of epidural medication administration affects postoperative pain and other patient outcomes. The goal of this study was to compare the efficacy of PIEB against CEI in postoperative pain management after a broad range of surgeries with abdominal incisions, all managed in the context of an established enhanced recovery after surgery (ERAS) pathway.
Design |
Prospective, randomized, controlled trial.
Setting |
Postoperative acute care.
Patients |
120 patients scheduled for major surgery involving abdominal incisions with planned postoperative epidural analgesia were enrolled as study participants.
Interventions |
All subjects received a standardized epidural solution containing ropivacaine 0.0625% and fentanyl 2 μg/ml. The CEI group received this solution as a continuous infusion, while the PIEB group received this solution as programmed intermittent boluses.
Measurements |
The primary study outcome was the total local anesthetic used over the first 24 h post-operatively. Secondary outcomes included pain severity, pain interference, total opioid consumption, patient satisfaction, and adverse effects at 24, 48, and 72 h postoperatively.
Main results |
There was no difference in the primary outcome of total amount of local anesthetic administered in the first 24-hour postoperative period (PIEB: 123 mg [Interquartile Range (IQR): 114–136]; CEI: 126 mg [IQR: 120–134]). There were also no differences in average pain severity, total opioid consumption, patient satisfaction, number of PCEA requests and incidence of adverse events at 24, 48, and 72 h postoperatively.
Conclusions |
Our study suggests that within the context of an established ERAS program, PIEB and CEI modes of epidural analgesia can be equally efficacious and safe in providing postoperative analgesia after major abdominal surgery.
Le texte complet de cet article est disponible en PDF.Highlights |
• | PIEB and CEI epidural analgesia in ERAS pathway surgeries are equally effective. |
• | PIEB and CEI epidurals minimize opioid use and provide high patient satisfaction. |
• | PIEB and CEI epidurals have comparable safety profiles. |
Keywords : Programmed intermittent epidural bolus, Continuous epidural infusion, Epidural anesthesia, Postoperative analgesia
Plan
Vol 64
Article 109850- septembre 2020 Retour au numéro
Article précédent
- Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade: A randomized, double-blinded study of thoracic surgical patients evaluating hypoxic episodes in the early postoperative period
- Tiffany S. Moon, Scott Reznik, Taylor Pak, Kathryn Jan, Jessica Pruszynski, Agnes Kim, Katelynn M. Smith, Rachael Lu, Joy Chen, Irina Gasanova, Pamela E. Fox, Babatunde Ogunnaike
- Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic
- Franklin Dexter, Mohamed Elhakim, Randy W. Loftus, Melinda S. Seering, Richard H. Epstein
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?