Pain control during interventional biliary procedures: epidural anesthesia vs i.v. sedation.
OBJECTIVE
We performed a study designed to compare epidural anesthesia with IV sedation for the control of pain during interventional biliary procedures.


METHODS
Two hundred sixty-three biliary procedures were performed in 126 patients during a 3-year period. The transhepatic approach was used for all the procedures. Epidural anesthesia was used in 140 procedures and IV sedation was used in 123. Both epidural anesthesia and IV sedation were used in 31 patients who required multiple procedures. The efficacy of each method for control of pain was determined by a subjective rating of the patients' pain during the procedure: from 0 (no pain) to +3 (severe). The ratings were compiled and compared for each of the methods to ascertain which technique best achieved the desired effect. The pain control used depended on the urgency of the procedures and the availability of an anesthesiologist to administer epidural anesthetic. When an anesthesiologist was unavailable, IV sedation was used. The type and amount of drug administered depended on the patient's preference and history.


RESULTS
Of the 140 procedures done with epidural anesthesia, patients had no pain to mild pain in 127 (91%) and moderate to severe pain in 13 (9%). All instances of moderate to severe pain were the result of unsuccessful attempts to establish or maintain anesthesia. Of the 123 procedures done with IV sedation, patients had no pain to mild pain in 62 (50%) and moderate to severe pain in 61 (50%). Complications were more frequent when IV sedation was used. Six (5%) occurred, and all were related to hypotension. The hypotensive episodes occurred early in the study, before monitoring of patients was improved; now, continuous updates on vital signs are provided throughout the interventional procedure. With epidural anesthesia, hypotension developed in only one patient (< 1%) and the patient responded to fluid administration.


CONCLUSIONS
When it is successful, epidural anesthesia can completely eliminate moderate to severe pain in patients undergoing biliary procedures. IV sedation is only 50% effective in this regard. The greater efficacy of epidural anesthesia, coupled with the significantly lower prevalence of hypotension, justifies the additional cost and time associated with epidural anesthesia for pain management in biliary procedures.
Harshfield
D L
DL
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock 72205.
Teplick
S K
SK
Brandon
J C
JC
D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D016292:Procedural Sedation; D006801:Humans; D007262:Infusions, Intravenous; D010147:Pain Measurement; D015641:Radiography, Interventional
D000701:Analgesics, Opioid