Faculty Collaboration Database

Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases. Perm J 2017;21:16-115

Date

10/17/2017

Pubmed ID

29035177

Pubmed Central ID

PMC5638641

DOI

10.7812/TPP/16-115

Scopus ID

2-s2.0-85049253938 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

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.

Author List

Karamanos E, Dream S, Falvo A, Schmoekel N, Siddiqui A

Author

Sophie Y. Dream MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abdominal Wall
Analgesia, Epidural
Analgesics
Cohort Studies
Elective Surgical Procedures
Female
Humans
Male
Middle Aged
Pain Management
Pain, Postoperative
Retrospective Studies