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Background and Aims Postoperative analgesia after TAH remains a challenge. In our hospital, we commonly use one of two protocols: parenteral analgesia with intravenous DIB or regional analgesia with epidural DIB supplemented with parenteral analgesia. The study compares the analgesia achieved in the first 48 hours and describes complications.
Methods We collected data from January-2022 to March-2023 using The Acute Pain Management Team database, with patient consent. 60 cases of oncological or non-oncological TAH were randomly selected, in a 1:1 proportion (parenteral vs epidural analgesia). The parenteral group received a 2mL/h DIB for 48h with metamizole and tramadol and the epidural group received a 5ml/h DIB for 27h with 0.1% ropivacaine. Both groups received intravenous acetaminophen 1g-qid and ketorolac 30mg-tid; morphine was used as rescue analgesic. Pain scores, rescue medication and complications at 24 and 48h were collected.
Results There are no demographic differences between both groups (table 1). Surgical diagnosis varied (p=0.001), as well as a tendency towards longer hospitalization in the epidural group (p=0.009). Post-operative visual analogue scores at rest and in movement were comparable in the first 48h, as well as total morphine consumption (p=0.354), nausea and vomiting (p=0.195).
Conclusions We conclude that intravenous DIB and epidural DIB are comparable in the management of postoperative pain of TAH. Morphine consumption and side effects were comparable, but significant paresthesia was seen in the epidural group. The authors recognize the small sample bias, but highlight the importance of good pain management with a less invasive technique. However, epidural technique should be considered for high-risk cases.
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