Patient-controlled Epidural Analgesia: analysis of efficacy and complications in surgical oncology patients

Background and Goal of Study:Patient-controlled epidural analgesia (PCEA) is a well established technique for postoperative pain relief after major surgery but several risks have been observed. The purpose of this study is to survey the efficacy and safety of PCEA and determining incidence, type and severity of postoperative complications related to epidural analgesia and catheter insertion.

Materials and Methods: A retrospective study was conducted between May-September2016 in a single-center. We analyzed 250 elective surgical patients who received PCEA with ropivacaine 0.1% and sufentanil 0.5µg/ml at a 5-15ml.h-1 rate and loading dose of 5-15ml. Infusion rate was adjusted according to type of surgery and epidural level with the possibility of  3-5ml bolus (interval of 20min). Maximum dose in 4hours: 60ml(thoracic epidural) or 80ml(lumbar epidural). Patients were assessed by an acute pain service team postoperatively. The following variables were evaluated: type of surgery, incidence of side-effects/complications and quality of analgesia (qualitative scale pain of 5 items: no, mild, moderate, severe, unbearable). We have considered as good analgesia only no/mild pain situations, reasonable analgesia when presented at least one episode of moderate pain, and poor analgesia at least one episode of severe/unbearable pain. We used SPSS (PSAW Statistics 18) for statistical analysis. 

Results and Discussion: 
Epidural catheters remained in place 4.63days in average. 
Global rate of technique-related complications were 33.2%, most of them minor complications without clinical repercussion. 
From these 4.4% were directly related to the epidural catheter (disconnection, externalization, obstruction, leak of local anesthetic and machine fault). 
The most frequent complications were vomiting(9.6%) and pruritus(8%). Neurological complications represented 6.4% (6% paresthesias, 0.4% motor block) and cardiovascular complications 0,4% (hypotension). We also observed epidural failure(2.8%), urinary retention(0.8%), postdural puncture headache(0.4%) and inflammation and local infection(0.4%). Postoperative analgesia was effective in the majority of the patients. Assessment of resting/movement analgesia: good in 97.2%/76.4%; reasonable in 2%/21.2%; poor in 0.8%/2.4%.

Conclusions: PCEA was efective and safe in the postoperative period. Complications were few and not severe. A strict vigilance is recommended to achieve satisfactory analgesia and a low incidence of complications.

Patient-controlled epidural analgesia: analysis of efficacy and complications in surgical oncology patients