Patients experience quicker pain relief if epidural anaesthesia started in operating room: Study

Chicago: According to research presented at the online Anaesthesia Quality and Patient Safety Meeting of the American Society of Anaesthesiologists, starting a patient-controlled epidural anaesthesia (PCEA) infusion while the patient is still in the operating room (OR) as opposed to the recovery room following the procedure may help provide better pain control.

A catheter, a small tube used in epidural pain management, is inserted into the patient's spine. Especially for procedures that could cause a significant degree of pain, an epidural may be utilised during or after surgery. If utilised after surgery, the patient can push a button to activate the device and self-administer painkillers as needed.

Once the patient has arrived in the post-anesthesia care unit (PACU), a number of problems, such as a shortage of supplies or a busy pharmacy, can cause the setup of the epidural infusion to be delayed. Researchers proposed a study to adopt a new procedure to begin epidural infusions in the OR in order to overcome these potential delays.

"Effective pain management after surgery is a crucial issue in health care, and this streamlined approach for initiating epidural infusions in the OR reduces delays in the patient getting pain relief," said Murphy Owens, MD, a lead author of the study and anesthesiology resident at Weill Cornell Medicine, New York, adding, "Additionally, research shows that using a PCEA can reduce patients' need for opioids to manage their pain."

When researchers started the project in December 2022, very few epidural infusions were started in the OR. Two months after launching the project, 90 per cent were started in the OR. The research team surveyed 16 anesthesiologists and 13 nurses about their experience with the new workflow compared to the previous one. Fifty six per cent of the anesthesiologists and 79 per cent of the nurses said patients were more comfortable when they arrived in the PACU.

Another 56 per cent of anesthesiologists and 79 per cent of nurses said patients required fewer IV or oral opioids while 50 per cent of anesthesiologists and 79 per cent of nurses said they were more satisfied with the new workflow.

The project focused on streamlining the process for epidurals placed for major abdominal surgeries, chest surgeries (such as lung cancer resections), urologic surgeries and gynaecological surgeries, or other surgeries where postoperative pain is expected to be substantial.