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Prospective observational study of postoperative epidural analgesia for major abdominal surgery.

Duncan, F 2009, Prospective observational study of postoperative epidural analgesia for major abdominal surgery. , PhD thesis, University of Salford.

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    Abstract

    The number of surgical procedures is increasing worldwide. The Audit Commission set a target that only 5% of patients should experience severe post-operative pain. Major abdominal surgery is a cause of severe post-operative pain. Epidural analgesia is regarded as the "gold standard" for treating this category of post-operative pain. A randomised controlled trial conducted by the author suggested that it was possible to have 95% of patients pain controlled, but with a high incidence of hypotension. Hypotension can restrict rather than enhance a patient's recovery after surgery. Building on this work, this thesis will explore whether it is possible to provide good analgesia without serious side effects in the workplace. Methods This study reports the results of a prospective observational study (n = 480) designed to both describe the technique and examine the association of various factors with pain scores and the incidence of hypotension. Classical statistics and statistical process control methods, a unique feature of the study, were employed to analyse and learn from the data. Results Twenty-eight percent of patients reported severe pain. Lower pain scores were associated with female gender and elective surgery. An association exists between increasing age and decreasing pain scores on the first day. The incidence of hypotension was 56%. Low pain scores strongly correlated with hypotension. Many failures occurred due to technical problems. Recommendations It is important for nursing professionals to know the true risk/benefit profile of postoperative epidural analgesia as it is ward nursing staff who are primarily responsible for monitoring the effectiveness of the technique, the patients' safety, and intervening to improve poor quality pain control. The results of this study suggest that epidural analgesia is far from the gold standard for postoperative analgesia. An urgent debate needs to take place to establish its true place in the management of postoperative pain.

    Item Type: Thesis (PhD)
    Contributors: Haigh, C(Supervisor)
    Schools: Colleges and Schools > College of Health & Social Care
    Colleges and Schools > College of Health & Social Care > School of Health Sciences > Centre for Health Sciences Research
    Colleges and Schools > College of Health & Social Care > School of Nursing, Midwifery, Social Work & Social Sciences
    Depositing User: Institutional Repository
    Date Deposited: 03 Oct 2012 14:34
    Last Modified: 19 Feb 2014 14:16
    URI: http://usir.salford.ac.uk/id/eprint/26643

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