The impact of epidural analgesia compared to systemic opioid-based analgesia with regard to length of hospital stay and recovery of bowel function: retrospective evaluation of 1555 patients undergoing thoracotomy

Journal of Cardiothoracic Surgery

Thomas Hachenberg¹  Georgios Stamatis³  Kolja Eicker²  Christopher Darr²  Gerhard Weinreich⁴  Sandra Kampe² 

[1] Department of Anesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany;Department of Anesthesiology and Pain Medicine, Ruhrlandklinik, West German Lung Center – University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, Essen, 45239, Germany;Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center – University Hospital Essen, University Duisburg-Essen, Essen, Germany;Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany

关键词: Bowel function;    Hospital stay;    Oxycodone;    Epidural analgesia;    Postoperative analgesia;    Major thoracic surgery;   

Others  :  1136152
DOI  :  10.1186/s13019-014-0175-8

 received in 2014-08-05, accepted in 2014-10-28,  发布年份 2014

【 摘 要 】

Background

To assess the protocols of epidural analgesia versus systemic opioid-based analgesia retrospectively in 1555 thoracotomies in our thoracic centre during 2011–2013.

Methods

Pain therapy is aggressive and standardized in our thoracic centre thoughout the complete postoperative stay. Patients receive either standardized epidural analgesia with ropivacaine + sufentanil 4–8 mls/h (500 mls bag) and are bridged when the epidural bag is finished to a standardized controlled-release oxycodone protocol with non opioid every 6 hours (EDA Group), or patients receive immediately postoperative standardized oral analgesic protocol with controlled-released oxycodone and non opioid every 6 h (Opioid Group). All patients are visited daily by a pain specialist throughout the whole stay.

Results

Data of 1555 thoracotomies from 2011–2013 were analysed, 838 patients in the EDA Group and 717 patients in the Opioid Group. There was no difference with regard to sex or age between groups. 7.5% of patients in the EDA Group and 13% in the Oxy Group had a preexisting pain therapy (p = 0.001). In the EDA Group epidural analgesia was performed for 4.6 ± 1.5 days. Length of hospital stay was the same in both groups (EDA: 9.9.6 ± 4.9 vs Opioid: 9.6 ± 5.8 days). 84.7% of patients in the EDA Group and 79.1% of patients of the Oxy Group were dismissed with oral opioid (p < 0.004). When patients were dismissed with opioid medication patients in the EDA Group were dismissed with higher oxycodone opioid doses than patients in the Opioid Group (29.5 ± 15.2 mg vs 26.9 ± 15.2 mg, p = 0.01). There was no difference with regard to dejection time between the two groups (EDA: 3.8 ± 2.2 days vs Opioid: 3.7 ± 1.6 days, n.s.).

Conclusion

We first present data monitoring postoperative analgesic protocols after thoracotomies throughout the whole stay in hospital until dismission. Our retrospective data indicate that patients with epidural analgesia stay as long in hospital as patients with systemic opioid based therapy. Patients with initial epidural analgesia are dismissed with higher oxycodone opioid doses than patients with initial opioid based postoperative analgesia. We found no difference in recovery of bowel function.

Study limitations

The study design is retrospectively and results might be biased.

【 授权许可】

   
2014 Kampe et al.; licensee BioMed Central Ltd.

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