Postoperative pulmonary complications and morbidity after abdominal aneurysmectomy: a comparison of postoperative epidural versus parenteral opioid analgesia.
Patients undergoing aortic aneurysm repair have a high prevalence of coexisting cardiac and pulmonary disease, and the postoperative recovery is especially delayed by pulmonary complications. A review of all elective abdominal aneurysm repairs over a 29-month period was undertaken to evaluate the effectiveness of postoperative epidural analgesia in decreasing morbidity and mortality, and specifically pulmonary complications. Patients were placed into two groups; Group 1 (34 patients) used an epidural catheter for postoperative pain control, and Group II (31 patients) used standard parenteral opioid analgesia. The two groups were similar in preoperative combined factors including known risk factors for atherosclerotic cardiovascular disease, preexisting cardiac or pulmonary disease, and preexisting renal insufficiency. A statistically significant decrease (P = < 0.05) was found in both cardiac (P = 0.0002) and pulmonary (P = 0.019) complications in comparison, favoring Group I patients. A significant decrease was also seen in the time to liquid intake (P = 0.044), time out of bed to a chair (P = 0.002), length of stay in the Intensive Care Unit (P = 0.024), and overall hospital charges (P = 0.046) in favor of Group I patients. Although no significant difference (P = > 0.05) was seen in decreasing time to ambulation (P = 0.054), average time required on the ventilator (P = 0.053), or hospital days (P = 0.181), all of these did show a trend in favor of epidural catheter utilization. There were no complications or infections related to the use of the epidural catheter during this study period. In conclusion, the use of an epidural catheter for postoperative pain control has been shown to decrease time of intubation, time in the ICU, number of cardiac and pulmonary complications, which should lead to an overall decrease in hospital charges after elective repair of abdominal aortic aneurysms.
Major
C P
CP
Department of Surgery, Chattanooga Unit, University of Tennessee College of Medicine, USA.
Greer
M S
MS
Russell
W L
WL
Roe
S M
SM
D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D017722:Hospital Charges; D006801:Humans; D007263:Infusions, Parenteral; D007902:Length of Stay / Q000191:economics; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D017409:Sufentanil / Q000008:administration & dosage
D000701:Analgesics, Opioid; D009020:Morphine; D017409:Sufentanil; D005283:Fentanyl