Patient-controlled Epidural Analgesia with Bupivacaine and Fentanyl on Hospital Wards

Abstract

Background The efficacy and safety of patient-controlled epidural analgesia (PCEA) for postoperative analgesia on hospital wards was studied. Methods Postoperative analgesia was provided for 1,030 patients with PCEA using 0.05% bupivacaine and fentanyl, 4 microg/ml, in a standardized manner. Patients were seen at least twice a day by the staff of the anesthesia pain management service. Prospectively gathered data included verbal pain scores at rest and activity (0-10); consumption of bupivacaine and fentanyl; and incidences of pruritus, nausea, sedation, hypotension, motor block, and respiratory depression. Descriptive statistics were used. Risk factors for side effects were determined using logistic regression. Results The study included 552 women and 477 men who underwent a median (mode) of 3 (2) days of PCEA. Their mean age was 59 +/- 16 yr and their mean weight was 76 +/- 19 kg. There were 454 abdominal, 165 gynecologic, 126 urologic, 108 vascular, 90 thoracic, 83 orthopedic, and 4 plastic surgical procedures. Median (mode) pain scores were 1 (0) at rest and 4 (5) with activity on postoperative day 1. Incidences of side effects were 16.7% (pruritus), 14.8% (nausea), 13.2% (sedation), 6.8% (hypotension), 2% (motor block), and 0.3% (respiratory depression). Reasons for termination of PCEA were elective (82%), displaced epidural catheter (12%), anticoagulation (3%), infection (1%), side effects (1%), inadequate analgesia (1%), and other (<1%). Risk factors for side effects were female sex, patient weight <73 kg, patient age <58 yr, bupivacaine and fentanyl consumption >9 ml/h, use of analgesic adjuncts, and lumbar placement of epidural catheters. Conclusion Patient-controlled epidural analgesia provides effective and safe postoperative analgesia on hospital wards.