Epidural Analgesia, Postoperative Pain
Conditions
Keywords
Epidural Analgesia, Postoperative Pain
Brief summary
Epidural analgesia is the recommended analgesic technique in patients having surgery with severe postoperative pain such as thoracic and upper abdominal surgery. However, from the previous study, the incidence of inadequate pain control in patients receiving epidural analgesia is very high 48.6% in our hospital.
Detailed description
A high incidence of inadequate epidural analgesia may result from variety of epidural techniques and epidural drug administrations. The protocol based practice has been developed from acute pain service which founded for more than 10 years. By using protocol based practice, the investigators believed that the incidence of inadequate epidural analgesia will be less compared with the current practice.
Interventions
DRUGCurrent practice
Epidural insertion and epidural drug administration depend on anesthetist in charge
DRUGProtocol based
Epidural insertion and epidural drug administration depend on anesthetist in research team using protocol based 1. insertion at mid-level of surgical insertion 2. insertion depth is 3-5 cm in space, not more than 5 cm 3. using benzoin tincture and transparent dressing to fix catheter 4. test dose with 2%xylocaine with adrenaline 1:200,000 3ml If not cover desired dermatome: 2% lidocaine with adr added 3 ml every 5 min (up to 2 times) 5. After induction and patients' hemodynamic are stable. Load 2 mg morphine with 0.0625% bupivacaine + morphine 0.02 mg/ml 3 ml then continuous infusion with rate according to initial local anesthetic requirement for incisional area coverage
Sponsors
Mahidol University
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Intervention model description
Historical control study (Before and after study) Data in current practice was derived from acute pain record before Jan 2019
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* All patients age ≥ 18 years old undergo surgery with epidural catheter insertion at Siriraj hospital.
Exclusion criteria
* Coagulopathy * Allergy to study drugs: local anesthetics and opioids * History of chronic pain
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall incidence of inadequate epidural analgesia | 72 hours | To compare the overall incidence of inadequate epidural analgesia until considered removal between protocol-based and current practice by using the definition of inadequate analgesia as pain score of 4 or more out of 10 on numeric rating scale (0; no pain, 10; worst imaginable pain) at rest. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Side effects | 72 hours | To compare the incidence of undesirable side effects of epidural catheter between groups: sedation, respiratory depression, hypotension, motor weakness, postoperative nausea and vomiting and pruritus |
Countries
Thailand
Outcome results
None listed