Analgesia Post Abdominal Surgery: Intravenous vs. Continuous Thoracic Epidural Pain Management

Abstract

Introduction/Background: This study evaluates the effects of continuous thoracic epidural analgesia (TEA) vs. intravenous pain control methods on the narcotics requirement for common laparoscopic abdominal surgeries. The introduction of new guidelines at Tampa General Hospital for the year 2017 afforded the opportunity for a sequential case series analysis of these two methods of pain management. Methods: A sequential case-series on patients undergoing laparoscopic or robot assisted abdominal surgery was performed. Patients were recruited upon request of surgeons using the same nurses and resident support team. Data were obtained from retrospective chart review following local IRB approval and evaluated for the effects of intravenous analgesia compared to continuous T9-10 epidural analgesia. Primary outcomes were intraoperative, 24 h and post-24 h opioid use in morphine milligram equivalents (MME). Length of hospital stay and VAS pain scores were also collected. Results: There was no significant difference in terms of age, gender, and BMI between groups. When compared patients who received epidural reported significantly lower pain scores in the first 24 h after surgery (p<0.05) and for the remainder of their hospital stay (p<0.05). Significant decreases in narcotic requirement was noted in the PACU (p<0.001), the first 24 h after surgery (p<0.001), and aggregate use per day (p<0.01). Conclusions: Continuous thoracic epidural analgesia is a viable alternative to intravenous pain control for patients undergoing common laparoscopic surgeries. Further research is required to determine the risks and benefits of TEA for laparoscopic colorectal surgery.