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CONTINUOUS INFUSION EPIDURAL ANALGESIA VERSUS INTRAVENOUS PATIENT CONTROLLED ANALGESIA IN THE ELDERLY AFTER MAJOR ABDOMINAL SURGERY
Author(s): ,
Gonçalves, D.*
Affiliations:
Centro Hospitalar de Leiria, Anaesthesiology, Leiria, Portugal
,
Fonseca, R.
Affiliations:
Centro Hospitalar de Leiria, Anaesthesiology, Leiria, Portugal
,
Lavado, J.
Affiliations:
Centro Hospitalar de Leiria, Anaesthesiology, Leiria, Portugal
,
Campos, A.
Affiliations:
Centro Hospitalar de Leiria, Anaesthesiology, Leiria, Portugal
,
Dixe, M.
Affiliations:
Instituto Politécnico de Leiria, Escola Superior de Saúde de Leiria, Leiria, Portugal
Valente, E.
Affiliations:
Centro Hospitalar de Leiria, Anaesthesiology, Leiria, Portugal
ESRA Academy. Gonçalves D. Sep 13, 2017; 190983; 368 Topic: Analgesia after Major Abdominal Surgery
Décia Gonçalves
Décia Gonçalves

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Abstract
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Background and Aims:

Epidural analgesia remains the gold-standard for postoperative pain control in patients undergoing major abdominal surgery. However, it can lead to complications, has contraindications, and occasionally is technically difficult to perform. Intravenous patient controlled analgesia (IV-PCA) has been suggested as an alternative.

This retrospective study compared the effectiveness on postoperative pain and safety related to continuous infusion epidural analgesia (CIEA) and IV-PCA, after major abdominal surgery in the elderly patient.

Methods:

After the approval of local Ethics Committee, we conducted a retrospective review of patients who had received CIEA (local anesthetics and opioids) and IV-PCA (morphine) after major abdominal surgery during 2016.

Demographic characteristics, American Society of Anesthesiologists physical status, numeric pain rating scale in rest, movement, coughing, and surgical wound and analgesia related side effects were all analyzed, during 48-hour postoperative period.

Results:

92 patients older than 65 years were analysed (58 received CIEA and 34 received IV-PCA). The mean pain values referred at 24 and 48 hours in the 4 categories was lower in the CIEA group, and the difference was statistically significant in the evaluation of resting pain (in the first 24hours, p=0.01), surgical wound (both 24 and 48hours, p=0.001) and coughing (p=0.002 and p=0.032, respectively).

The incidence of side effects (mostly nausea/vomiting, headache and pruritus) was 34.5% in patients undergoing CIEA and 11.8% in patients undergoing IV-PCA.

Conclusions:

We found that IV-PCA was inferior to CIEA for analgesic efficacy after major abdominal surgery in elderly patients, however there were fewer reported side effects.

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