title: Continuous intraoperative epidural infusions affect recovery room length of stay and analgesic requirements: a single-center observational study.
abstract: OBJECTIVE
  Continuous intraoperative epidural analgesia may improve post-operative pain control and decrease opioid requirements. We investigate the effect of epidural infusion initiation before or after arrival in the post-anesthesia care unit on recovery room duration and post-operative opioid use.
  
  
  METHODS
  We performed a retrospective chart review of abdominal, thoracic and orthopedic surgeries where an epidural catheter was placed prior to surgery at the University of Washington Medical Center during a 24 month period.
  
  
  RESULTS
  Patients whose epidural infusions were started prior to PACU arrival (Group 2: n = 540) exhibited a shorter PACU length of stay (p = .004) and were less likely to receive intravenous opioids in the recovery room (34 vs. 48%; p < .001) compared to patients whose infusions were started after surgery (Group 1: n = 374). Although the highest patient-reported pain scores were lower in Group 2 (5.3 vs. 6.0; p = .030), no differences in the pain scores prior to PACU discharge were observed.
  
  
  CONCLUSIONS
  Intraoperative continuous epidural infusions decrease PACU LOS as discharge criteria for patient-reported NRS pain scores are met earlier.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA. aalap.c.shah@gmail.com.|Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA. aalap.c.shah@gmail.com.
authors.forename: Aalap C
authors.initials: AC
authors.lastname: Shah
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Bala G
authors.initials: BG
authors.lastname: Nair
authors.affiliation: Institute for Translational Health Sciences (ITHS), University of Washington, Seattle, WA, USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Spiekerman
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Laurent A
authors.initials: LA
authors.lastname: Bollag
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011997:Recovery Room; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: Continuous epidural analgesia; Post-operative pain control; Pre-emptive analgesia