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Postoperative pain relief and hospital stay after total oesophagectomy
S142
Poster 235 BLUE Mon-Tues POSTOPERATIVEPAIN REUEF AND HOSPITAL STAY AFTER TOTAL OESOPHAGECTOMY Ico.smedstad. W.S.Baattie*, N.Buckfey*, Dept. of Ana-
McMaatef Unkralty, Hamllton, Ontario, Canada
Exhibit Hall Abs No
278
AIM OF INV@J&Qg@J: The use of epidural for long term post surgical pain relief hSS been SSSOC&tSd with redUCed Wumboembokrn, cardbvaacular morbfdky and ln&tbn rates. We revkwttd the chmtsof all.pat@nts proteinc@abokm, whounderwenttaEaloesopha~y~ourinow~since1986;tossewhetherthemethodof~~~ivepain relief influenced length ofstay intheICU, intensiveCare Unit, and total wfve hospkaf stay.
METHODS: Fourteen charts were reviewed. One case, who died within 2 hoursof surgery, was exduded from analysis. EigM patisnts recebd intravenousmorphbs fw pain rallaf In the ICU, and intramuscular narcotics on the wards. FhrepatienEBrecelvedepkl~morpMneintheIWandforaperiodd0-4daysafterdiedrargetotheward. The Weaasea&thelen@hofstayintheICUby decisionastoeplduralpkementwasuptothaattandlng~. subtracting the discharge date from the operatfve date. m stay, from date of surgery to date of discharge or death, was counted. RESULTS: The 2 groups dM not diier regardingage, sex, preoperativecondkion. Epirnorphpatientsstayed in the stayed8.7 f 4.2 in the ICU and 32.6 f 13.0 ICU 4.2 f 3.8 (S.D.) days,in hospka122.2f 7.8 days:and IV rnorphb daysinhospkai. 3patisnts(2inIVgroupandl inepimorph)suffemdware poatoperathrecompkatlons and died in hospital. If these are excluded,epirnorphpatientsspent2.5 + 0.6 days In ICU and 18.8 + 1.3 days in hospital; IV morphine patients6.0 + 4.3 days in ICU and 27.2 f 7.8 days in hospital. ~NCl_lJsl~ Preliminaryfindingssuggestthat choics of postoperativepain relii has an impact on length of stay in both intensive care units and hospkaf. When thesa findings are ap@d to our per diem rates, the resuks suggest substantlaf cost reduction ($13,207 f $684 for epimorph;$21,249 + $4,162 for IV morph, pcO.05).
Iatrathecrl Narcotic Analgesia (ITA) vs. Patient Controlled Analgesia (PCA) for _ Portoperative Pain Control after Major Abdominal Surgery. 2. Hoh*, and G. Abraham*, UCLA Pain Management Center, Unmia,
Los Angeles, California.
Poster 236 BLUE Mon-Tues Exhibit Hall Abs No
j
279
AIM OF INVESTIGATION: To prospectively compare the efficacy for I -i postoperative pain relief, incidence of side effects, cost effectiveness. and number of days in ICU in patients who underwent major -abdominal surgery: METHOD8 30 patients who underwent major abdominal surgery were randomized to either the PCA group or the ITA group. Pain levels on rest and movement were assessed on a O-10 scale (0 = no pain; 10 being the worst pain). Side effects such as nausea, itching, and drowsiness were monitored daily on a O3 scale (0 = no side effect; 3 = side effect not responsive to treatment). Cost effectiveness was determined by differences in number of ICU hours and cost of postoperative analgesia by examining the patient’s billing during the first 48 hours. RESULTS: Patients who received ITA have significantly more analgesia with movement than patients with PCA. Side effects such asitching occurred with both groups except that itching was more severe with ITA. ICU stay was shorter with the ITA group than PCA group. Cost was higher with the PCA group because of the cost of machine rental and pharmacy fee. CONCLUSION: Both ITA and PCA provide adequate analgesia in patients undergoing major abdominal surgery, although ITA seems to provide more pain relief with movement. ITA seems to be a more cost effective method at least during the first 24-48 hours of postoperative analgesia.
Poster 235 BLUE Mon-Tues POSTOPERATIVEPAIN REUEF AND HOSPITAL STAY AFTER TOTAL OESOPHAGECTOMY Ico.smedstad. W.S.Baattie*, N.Buckfey*, Dept. of Ana-
McMaatef Unkralty, Hamllton, Ontario, Canada
Exhibit Hall Abs No
278
AIM OF INV@J&Qg@J: The use of epidural for long term post surgical pain relief hSS been SSSOC&tSd with redUCed Wumboembokrn, cardbvaacular morbfdky and ln&tbn rates. We revkwttd the chmtsof all.pat@nts proteinc@abokm, whounderwenttaEaloesopha~y~ourinow~since1986;tossewhetherthemethodof~~~ivepain relief influenced length ofstay intheICU, intensiveCare Unit, and total wfve hospkaf stay.
METHODS: Fourteen charts were reviewed. One case, who died within 2 hoursof surgery, was exduded from analysis. EigM patisnts recebd intravenousmorphbs fw pain rallaf In the ICU, and intramuscular narcotics on the wards. FhrepatienEBrecelvedepkl~morpMneintheIWandforaperiodd0-4daysafterdiedrargetotheward. The Weaasea&thelen@hofstayintheICUby decisionastoeplduralpkementwasuptothaattandlng~. subtracting the discharge date from the operatfve date. m stay, from date of surgery to date of discharge or death, was counted. RESULTS: The 2 groups dM not diier regardingage, sex, preoperativecondkion. Epirnorphpatientsstayed in the stayed8.7 f 4.2 in the ICU and 32.6 f 13.0 ICU 4.2 f 3.8 (S.D.) days,in hospka122.2f 7.8 days:and IV rnorphb daysinhospkai. 3patisnts(2inIVgroupandl inepimorph)suffemdware poatoperathrecompkatlons and died in hospital. If these are excluded,epirnorphpatientsspent2.5 + 0.6 days In ICU and 18.8 + 1.3 days in hospital; IV morphine patients6.0 + 4.3 days in ICU and 27.2 f 7.8 days in hospital. ~NCl_lJsl~ Preliminaryfindingssuggestthat choics of postoperativepain relii has an impact on length of stay in both intensive care units and hospkaf. When thesa findings are ap@d to our per diem rates, the resuks suggest substantlaf cost reduction ($13,207 f $684 for epimorph;$21,249 + $4,162 for IV morph, pcO.05).
Iatrathecrl Narcotic Analgesia (ITA) vs. Patient Controlled Analgesia (PCA) for _ Portoperative Pain Control after Major Abdominal Surgery. 2. Hoh*, and G. Abraham*, UCLA Pain Management Center, Unmia,
Los Angeles, California.
Poster 236 BLUE Mon-Tues Exhibit Hall Abs No
j
279
AIM OF INVESTIGATION: To prospectively compare the efficacy for I -i postoperative pain relief, incidence of side effects, cost effectiveness. and number of days in ICU in patients who underwent major -abdominal surgery: METHOD8 30 patients who underwent major abdominal surgery were randomized to either the PCA group or the ITA group. Pain levels on rest and movement were assessed on a O-10 scale (0 = no pain; 10 being the worst pain). Side effects such as nausea, itching, and drowsiness were monitored daily on a O3 scale (0 = no side effect; 3 = side effect not responsive to treatment). Cost effectiveness was determined by differences in number of ICU hours and cost of postoperative analgesia by examining the patient’s billing during the first 48 hours. RESULTS: Patients who received ITA have significantly more analgesia with movement than patients with PCA. Side effects such asitching occurred with both groups except that itching was more severe with ITA. ICU stay was shorter with the ITA group than PCA group. Cost was higher with the PCA group because of the cost of machine rental and pharmacy fee. CONCLUSION: Both ITA and PCA provide adequate analgesia in patients undergoing major abdominal surgery, although ITA seems to provide more pain relief with movement. ITA seems to be a more cost effective method at least during the first 24-48 hours of postoperative analgesia.