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Abstract
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Background and Aims Patient controlled epidural analgesia (PCEA) aims to give patients increased autonomy, while tailoring dose to minimize adverse effects. Our Acute Pain Service (APS) developed an institutional protocol for PCEA with ropivacaine 1 mg/mL, optional morphine 20 mcg/mL, bolus 4 mL, lockout 30 min, and infusion 4-8 mL/h. A quality and safety assessment was performed nine months after implementation.
Methods Data collected by the APS was retrospectively reviewed for pain control and local anesthetic consumption at postoperative days one and two, adverse events, and patient satisfaction. Electronic health records were also screened for adverse events. The audit was considered exempt from Ethics Committee approval.
Results PCEA was used in 81 patients following upper and lower digestive, thoracic, gynecologic, urologic, and retroperitoneal surgery. Epidural morphine was used in 83%. Median numeric rating scale for static pain on day one was 0 (IQR 2), and for dynamic pain 3 (IQR 2). Median static pain on day two was 0 (IQR 1), and dynamic pain 3 (IQR 2). Mean volume infused was 107 mL (SD 55 ml) at day one and 117 mL (SD 58 ml) at day two. Hypotension (23%) and nausea and vomiting (19%) were the commonest adverse events. Off-hours anesthesiologist intervention was required in 20% of patients. Of 69 patients inquired, 96% were satisfied with the analgesia.
Postoperative pain (numeric rating scale)
Local anesthetic consumption (volume in mL)
Conclusions An institutional protocol facilitates adequate continuous improvement. An organized APS and stakeholders’ education are crucial for implementation. Pain control and patient satisfaction were good. Future adjustments to the protocol might decrease adverse events.