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  • EP090 Comparison of efficacy between programmed intermittent epidural bolus and continuous epidural infusion for thoracic epidural analgesia after open upper abdominal surgery, a randomized controlled trial

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EP090 Comparison of efficacy between programmed intermittent epidural bolus and continuous epidural infusion for thoracic epidural analgesia after open upper abdominal surgery, a randomized controlled trial
  1. Pongkwan Jinaworn1,2,
  2. Rattanaporn Burimsittichai1,2,
  3. Kirada Apisutimaitri1,2,
  4. Titipon Payongsri1,2,
  5. Panas Lertprapai1,2,
  6. Vissuta Upala1,2 and
  7. Panatchakorn Pitugchaiyawong2
  1. 1Anesthesiology, Chulalongkorn University, Bangkok, Thailand
  2. 2Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission

Background and Aims Programmed intermittent epidural bolus (PIEB) has shown to reduce local anesthetic consumption compared to continuous epidural infusion (CEI) during labor analgesia. This study aimed to compare the efficacy of PIEB versus CEI in thoracic epidural analgesia (TEA) for providing postoperative pain control after open upper abdominal surgery.

Methods After receiving ethics committee approval, 120 adults who underwent open upper abdominal surgery were randomly allocated to receive epidural solution either as PIEB(4ml/40min) or as CEI(6ml/h) via thoracic epidural catheter for 60h postoperatively. Patient-controlled epidural analgesia (PCEA) for additional boluses as needed was standardized across both groups. The primary outcome was 24-hour epidural drug consumption. Secondary outcomes included epidural drug consumption on postoperative hour 24-60h, time to first PCEA demand, pain scores, rescue analgesics, side effects, recovery, and satisfaction.

Results The PIEB group demonstrated a significant reduction in mean 24-hour epidural drug consumption compared to the CEI group (173.46±32ml vs 200.75±46ml, respectively; mean difference -27.29ml; 95%CI -39.74 to -14.84; P<0.001). Additionally, the median time to first PCEA demand was significantly longer in the PIEB group (188 minutes, IQR 30-778) versus the CEI group (44 minutes, IQR 21-120) (P=0.002). There were no significant differences between the groups in terms of pain scores, rescue analgesic consumption, side effects, recovery outcomes, or patient satisfaction.

Abstract EP090 Figure 1
Abstract EP090 Figure 1

PCEA trigger free probability Kaplan-Meier plot

Abstract EP090 Figure 2
Abstract EP090 Figure 2

Mean pain score (NRS) at rest comparison between groups over time (60h)

Abstract EP090 Figure 3
Abstract EP090 Figure 3

Mean pain score (NRS) during cough comparison between groups over time (60h)

Conclusions PIEB reduced epidural drug consumption in the first 24-hour after open upper abdominal surgery compared to CEI, suggesting PIEB may provide more efficacy in early postoperative period. Further research is needed to assess the optimal regimen of epidural drug delivery in TEA.

  • Programmed intermittent epidural bolus
  • continuous epidural infusion
  • thoracic epidural analgesia
  • patient controlled epidural analgesia.

https://doi.org/10.1136/rapm-2024-ESRA.163

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