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Abstract
Background and Aims There is considerable variation in practice among anesthetists at our center regarding intraoperative epidural analgesia. We intend to investigate association between site, concentrations, and dosing of local anesthetics(LA) used intraoperatively on blood pressures, motor block, pain scores and need for rescue analgesia.
Methods Ethical approval was taken from The Aga Khan University Ethics Review Committee(Ref#2020-3692-10675). 170 patients undergoing abdominal surgeries with epidurals as primary analgesic modality at a tertiary care center over twelve months were recruited.
Results Intraoperative hypotension was reported in 46.5%. Among factors evaluated for association with intraoperative hypotension, concentration of LA used was found to be statistically significant(p=0.02 and 0.04). Patients who received intraoperative epidural boluses were more commonly reported hypotensive on arrival in post anesthesia care unit(PACU) as compared to continuous infusion(17.8%vs4.8%, p=0.02). Motor block was observed in 41.5% patients given continuous infusion vs 17.4% given boluses(p=0.02). Bupivacaine, when used for intraoperative infusion caused more motor block(43.6%vs34.5%, p=0.04) and hypotension(6%vs0%, p=0.04) as compared to Ropivacaine. Patients given higher concentration of local anesthetic as intraoperative infusion(0.25%vs0.125% and 0.1%) had higher frequency of motor block(58.3%vs38.8% and 40%, p=0.05). Two-thirds of the patients had moderate to severe pain on arrival in PACU, and half of patients required rescue analgesia. However, no association was found between pain scores and need for rescue analgesia with epidural site, dosing regime, LA and its concentration used for infusion.
Intraoperative hypotension and associated factors. P value <0.05 was considered significant.
Parameters after arrival in PACU and their association with intraoperative epidural practices. P value <0.05 was considered significant
Conclusions Intraoperative management of epidurals is an essential but overlooked component of perioperative pain management. Guidelines should be formulated for intraoperative epidural analgesic regimens to improve postoperative outcomes.