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Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction operation
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Postop. Pain Management I
140. Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction operation
158. Patient satisfaction on management of postoperative pain by Acute Pain Management Services in developing country—an audit
Blumenthal S Balgrist University Hospital, Zurich, Switzerland
Qamarul Hoda M Department of Anesthesia, The Aga Khan University Hospital, Department of Anaesthesia, Karachi, Pakistan
Background: Major spine surgery with a dorsal or ventrodorsal approach causes severe postoperative pain. The use of continuous epidural analgesia through one1-3 or two4 epidural catheters placed intraoperatively by the surgeon, has been shown to provide efficient postoperative pain control. In this prospective open study we compared the effi-cacy of continuous intravenous morphine with double epidural catheter technique with ropivacaine after scoliosis correction. Methods: 20 ASA II or III patients were prospectively randomized to either the morphine group (M) or the epidural group (E). At the end of the scoliosis correction, patients in the E group received two epidural catheters, one directed cranially and one caudally. Correct placement was checked radiographically. Analgesia was performed until the first postop-erative morning with remifentanil targetcontrol infusion for all patients. By that time remi-fentanil was stopped and continuous intravenous analgesia with morphine or double epi-dural analgesia with ropivacaine 0.3% was initiated. Pain (using a visual analogue scale ⫽ VAS 0-100), motor block of lower extremities, sensory level, sedation, PONV and pruritus were assessed every six hours and bowel function was assessed every 12 hours until t72 (end of study). Mann-Whitney test with Bonferroni correction and Fisher exact test were used for statistics. A P ⬍ 0.05 was considered significant. Results: The VAS score in the E group was significantly lower at t18 3 ⫾ 7 vs. 17 ⫾ 11, t24 6 ⫾ 11 vs. 20 ⫾ 13, t42 4 ⫾ 14 vs. 11 ⫾ 9, t48 5 ⫾ 7 vs. 21 ⫾ 13, respectively. Bowel activity was significantly better in the E group at t24, t36, t60 and t72. PONV and pruritus occurred less frequently in the E group. Conclusions: Although both methods provide an efficient postoperative analgesia in this context, double epidural catheter technique provides better postoperative analgesia, an earlier return of bowel function, less side-effects and a higher patient satisfaction.
References 1. 2. 3. 4.
Anaesthesia. 2000;55:367-390. Paediatr Anaesth. 2001;11:199-203. Anaesth Analg. 1995;80:511-514. Can J Anesth. 2002;49:173-177.
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Introduction: It is important to control postoperative pain to expedite patient’s mobility and recovery. Postoperative pain is usually under treatedfor number of reasons.1 The acute pain service is a relatively recent innovation, developed to control postoperative pain.2 This survey determines the level of patient’s satisfaction on postoperative pain controled by acute pain management service (APMS) at Aga Khan University Hospital by using continuous opoid infusion, Patient Controlled Intravenous Analgesia (PCIA) and Epidural Analgesia Techniques. Method: It is a prospective observational study. All postoperative patients managed and followed by APMS over three months period were included in this study. After discontinuation of pain management therapy a questionnaire form was filled by the patient (in Urdu or English) regarding their experience of postoperative pain control. Data was entered in computer and relative frequency of each variable was determined. Results: 226 postoperative patients were managed by APMS over three months period. Out of these 217 (96%) patients were included in the study. 9 (3.9%) cases were excluded. 126 (58%) were managed by continuous intravenous infusion, 61 (28%) had epidural infusion, and 30 (14%) postoperative patients were managed by PCIA. Level of satisfaction with pain control was described as excellent in 114 (53%), good 88 (41%), satisfactory 9 (4%) and poor by 4 (1.8%) patients. 105 (48%) patients had side effects, nausea 46 (21%), vomiting 12 (5.5%), drowsiness 21 (10%) and 2 (0.9%) had itching. Regarding recommendation of the service to their relatives and friends 212 (97.7%) patients said they would. 115 (49.8%) experienced minimal or no pain, 117 (49.9%) complained of mild pain, 3 (0.08%) moderate and 3 (0.08%) severe pain. Method of pain control was discussed preoperatively in 108 (49.8%) patients. Information about pain relief was provided by anaesthetists, surgeon and pain nurse in 194 (89.4%), 17 (7.8%) and 4 (1.8%) cases respectively. Response of APMS doctor to patient call was rated as excellent in 125 (57.6%), good 84 (38.7%), satisfactory 4 (1.8%) and poor by 1 (0.5%) patients. Conclusion: We conclude that management of postoperative pain by dedicated group of people in the form of a team can effectively reduce the complications and at the same time improves patient satisfaction.
References 1. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: Evidence from published data. BJA. 2002 Sep;89(3):409-423. 2. Ready LB. Acute postoperative pain. In: Miller RD, eds. Anaesthesia, 4th. New York: Churchill Livingstone, 1994:2327-2344.
•
Postop. Pain Management I
140. Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction operation
158. Patient satisfaction on management of postoperative pain by Acute Pain Management Services in developing country—an audit
Blumenthal S Balgrist University Hospital, Zurich, Switzerland
Qamarul Hoda M Department of Anesthesia, The Aga Khan University Hospital, Department of Anaesthesia, Karachi, Pakistan
Background: Major spine surgery with a dorsal or ventrodorsal approach causes severe postoperative pain. The use of continuous epidural analgesia through one1-3 or two4 epidural catheters placed intraoperatively by the surgeon, has been shown to provide efficient postoperative pain control. In this prospective open study we compared the effi-cacy of continuous intravenous morphine with double epidural catheter technique with ropivacaine after scoliosis correction. Methods: 20 ASA II or III patients were prospectively randomized to either the morphine group (M) or the epidural group (E). At the end of the scoliosis correction, patients in the E group received two epidural catheters, one directed cranially and one caudally. Correct placement was checked radiographically. Analgesia was performed until the first postop-erative morning with remifentanil targetcontrol infusion for all patients. By that time remi-fentanil was stopped and continuous intravenous analgesia with morphine or double epi-dural analgesia with ropivacaine 0.3% was initiated. Pain (using a visual analogue scale ⫽ VAS 0-100), motor block of lower extremities, sensory level, sedation, PONV and pruritus were assessed every six hours and bowel function was assessed every 12 hours until t72 (end of study). Mann-Whitney test with Bonferroni correction and Fisher exact test were used for statistics. A P ⬍ 0.05 was considered significant. Results: The VAS score in the E group was significantly lower at t18 3 ⫾ 7 vs. 17 ⫾ 11, t24 6 ⫾ 11 vs. 20 ⫾ 13, t42 4 ⫾ 14 vs. 11 ⫾ 9, t48 5 ⫾ 7 vs. 21 ⫾ 13, respectively. Bowel activity was significantly better in the E group at t24, t36, t60 and t72. PONV and pruritus occurred less frequently in the E group. Conclusions: Although both methods provide an efficient postoperative analgesia in this context, double epidural catheter technique provides better postoperative analgesia, an earlier return of bowel function, less side-effects and a higher patient satisfaction.
References 1. 2. 3. 4.
Anaesthesia. 2000;55:367-390. Paediatr Anaesth. 2001;11:199-203. Anaesth Analg. 1995;80:511-514. Can J Anesth. 2002;49:173-177.
13
Introduction: It is important to control postoperative pain to expedite patient’s mobility and recovery. Postoperative pain is usually under treatedfor number of reasons.1 The acute pain service is a relatively recent innovation, developed to control postoperative pain.2 This survey determines the level of patient’s satisfaction on postoperative pain controled by acute pain management service (APMS) at Aga Khan University Hospital by using continuous opoid infusion, Patient Controlled Intravenous Analgesia (PCIA) and Epidural Analgesia Techniques. Method: It is a prospective observational study. All postoperative patients managed and followed by APMS over three months period were included in this study. After discontinuation of pain management therapy a questionnaire form was filled by the patient (in Urdu or English) regarding their experience of postoperative pain control. Data was entered in computer and relative frequency of each variable was determined. Results: 226 postoperative patients were managed by APMS over three months period. Out of these 217 (96%) patients were included in the study. 9 (3.9%) cases were excluded. 126 (58%) were managed by continuous intravenous infusion, 61 (28%) had epidural infusion, and 30 (14%) postoperative patients were managed by PCIA. Level of satisfaction with pain control was described as excellent in 114 (53%), good 88 (41%), satisfactory 9 (4%) and poor by 4 (1.8%) patients. 105 (48%) patients had side effects, nausea 46 (21%), vomiting 12 (5.5%), drowsiness 21 (10%) and 2 (0.9%) had itching. Regarding recommendation of the service to their relatives and friends 212 (97.7%) patients said they would. 115 (49.8%) experienced minimal or no pain, 117 (49.9%) complained of mild pain, 3 (0.08%) moderate and 3 (0.08%) severe pain. Method of pain control was discussed preoperatively in 108 (49.8%) patients. Information about pain relief was provided by anaesthetists, surgeon and pain nurse in 194 (89.4%), 17 (7.8%) and 4 (1.8%) cases respectively. Response of APMS doctor to patient call was rated as excellent in 125 (57.6%), good 84 (38.7%), satisfactory 4 (1.8%) and poor by 1 (0.5%) patients. Conclusion: We conclude that management of postoperative pain by dedicated group of people in the form of a team can effectively reduce the complications and at the same time improves patient satisfaction.
References 1. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: Evidence from published data. BJA. 2002 Sep;89(3):409-423. 2. Ready LB. Acute postoperative pain. In: Miller RD, eds. Anaesthesia, 4th. New York: Churchill Livingstone, 1994:2327-2344.