title: Epidural analgesia and postoperative orthostatic haemodynamic changes: observational study.
abstract: BACKGROUND
  In thoracic and abdominal surgery, epidural analgesia provides excellent pain relief, but associated postural hypotension can delay mobilisation.
  
  
  OBJECTIVE
  To assess postoperative orthostatic haemodynamic changes in patients receiving epidural analgesia after major surgery.
  
  
  METHODS
  Prospective observational study. Physiological intervention.
  
  
  METHODS
  Montreal General Hospital tertiary teaching hospital.
  
  
  METHODS
  Patients scheduled for thoracic or abdominal surgery with thoracic epidural analgesia using a mixture of bupivacaine 0.1% and fentanyl 3 μg ml(-1).
  
  
  METHODS
  Arterial blood pressure and heart rate were measured in supine, sitting and standing position before surgery and daily for the first 3 postoperative days.
  
  
  METHODS
  Orthostatic hypotension, defined as a drop in SBP of more than 20  mmHg during the orthostatic tests, was investigated as a predictor of inability to mobilise during the postoperative period.
  
  
  RESULTS
  One hundred and sixty-one patients were enrolled in the study. Hypotension was detected in 59 (37%) of the patients on postoperative day 1, 20 (12%) on day 2 and four (2.5%) on day 3. On day 1, 43% of the patients walked, 39% only sat and 17% were bedridden. Supine SBP less than 90  mmHg, haemodynamic changes during the orthostatic tests, dizziness or nausea, did not predict inability to walk. Only blood loss more than 500  ml and supine mean BP less than 70  mmHg were negative predictors of mobilisation on day 1.
  
  
  CONCLUSIONS
  Epidural analgesia is associated with arterial hypotension in the postoperative period. However, haemodynamic assessment does not predict inability to walk after thoracic and abdominal surgery. Early mobilisation should be tried irrespective of BP or orthostatic changes in postoperative patients with epidural analgesia.
authors: Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.
authors: Elena
authors: E
authors: Gramigni
authors: David
authors: D
authors: Bracco
authors: Franco
authors: F
authors: Carli
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007024:Hypotension, Orthostatic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D011187:Posture; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures
chemical_list: D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine