Effectiveness of Epidural Anesthesia for Thoracic and Abdominal Surgery

Completed

Conditions: Analgesia Disorder
Anesthetic Complication Epidural
Adverse Reaction to Epidural Anesthesia

Registration Number: NCT02315261

Lead Sponsor: Siriraj Hospital

Brief Summary: This study aims to evaluate the effectiveness of the epidural analgesia in patients having elective thoracic and abdominal surgery under general anesthesia combined with epidural analgesia in Siriraj Hospital.

Detailed Description: Epidural analgesia is the recommended perioperative analgesia in patients having major surgery in order to significantly reduced pain scores, minimize patient distress and can accelerate postoperative recovery especially with the major operation This technique has been reported to provide better pain control and less postoperative fatigue compared with patients receiving general anesthesia alone.Additionally, it is recommended in patients having major surgery to allow patients to mobilize quickly and have effective mobilization.This technique has been shown to be highly efficient at preventing postoperative ileus and various complications. Moreover, epidural analgesic technique is demonstrated to be safer and have fewer side effects than using intravenous opioids alone.

However, the epidural technique is not universally successful and the number of patients experiencing inadequate analgesia with this technique is approximately 12-32%. The failure of epidural analgesia is still a frequent clinical problem and needs active management including a new block or other analgesic medication in order to rescue postoperative pain. Previous study showed that the incidence of patients having epidural analgesia with postoperative moderate pain was 20.9% and that with severe pain was 7.8%. In Siriraj Hospital, recent study showed that 19.6% of patients having elective upper abdominal surgery under general anesthesia combined with epidural analgesia reported severe first pain scores in post anesthetic care unit.27 As a result of severe pain, patients needed a number of intervention and management from acute pain service, and finally spent longer time in post anesthetic care unit.

Inadequate pain control in patients receiving epidural analgesia frequently occurred in clinical practice but the number of the success rate or the failure rate have not been reported in our hospital. This study aims to evaluate the effectiveness of the epidural analgesia in patients having elective thoracic and abdominal surgery under general anesthesia combined with epidural analgesia in Siriraj Hospital.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 364

Inclusion Criteria

patients aged more than 18 years old scheduled to have thoracic or abdominal surgery under general anesthesia combined with epidural analgesia in Siriraj hospital

Exclusion Criteria

inability to communicate or inform pain score
cesarean section or labor analgesia
additional analgesic techniques (spinal analgesia, paravertebral nerve block, intercostal block, transversus abdominis plane block, rectus sheath block, ilioinguinal block, iliohypogastric block
emergency surgery
fail epidural block after test dose of local anesthetics

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Number of Patients Reporting Postoperative Verbal Rating Scale Pain at Rest More Than 7	at postoperative 24 hours	Verbal Rating Scale Pain will routinely be assessed at postoperative 24 hours by the ward nurse. Minimum and maximum scores possible are 0 and 10. The higher values represent patients having more pain. Severe pain is defined as Verbal Rating Scale pain at rest more than 7.

Secondary Outcome Measures

Name	Time	Method
Number of Patients Requiring Rescue Analgesic Medication	during the period of retaining of epidural catheter up to 3 days after operation	Number of patients requiring at least one rescue analgesic medication including epidural catheter, oral and intravenous route after the operation
Duration Retaining Epidural Catheter	the period of retaining of epidural catheter up to 3 days after operation	Duration retaining epidural catheter in hospital
All Adverse Effects and Postoperative Complications.	the period of retaining of epidural catheter up to 3 days after operation	All Adverse Effects and Postoperative Complications included the number of patients having postoperative nausea and vomiting; hypotension; accidental dural puncture and post-dural puncture headache.