Epidural anesthesia in operating room gives patients quicker pain relief: Study

Initiating a patient-controlled epidural anesthesia (PCEA) infusion when the patient is still in the operating room (OR), as opposed to the recovery room after the procedure, may help provide better pain control, according to research presented at the American Society of Anesthesiologists’ online Anesthesia Quality and Patient Safety meeting.

A catheter, a small tube used in epidural pain management, is inserted into the patient’s spine. Epidurals may be used during or after surgery, especially for procedures that are likely to cause a great deal of pain. If used after surgery, the patient can press a button to activate the device and self-administer pain medications as needed.

Once a patient reaches the post-anesthesia care unit (PACU), a number of problems, such as a lack of supplies or a busy pharmacy, can cause delays in setting up an epidural infusion. The researchers proposed a study to adopt a new procedure for initiating epidural infusions in the OR to address these potential delays.

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“Effective pain management after surgery is a critical issue in health care, and this streamlined approach to starting epidural infusions in the OR minimizes the patient’s delay in getting pain relief,” said Murphy Owens, MD, lead author of the study and professor of anesthesiology at Weill Cornell Medicine in New York. “Additionally, research shows that using PCEA can reduce patients’ need for opioids to manage their pain.” May be.”

When the researchers started the project in December 2022, very few epidural infusions had been started in the OR. Two months after starting the project, 90 percent had 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 percent of anesthesiologists and 79 percent of nurses said patients were more comfortable when they arrived in the PACU.

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

The project focuses on streamlining the process of epidurals placed for major abdominal surgery, thoracic surgery (such as lung cancer resection), urological surgery and gynecological surgery, or other surgeries where postoperative pain is expected to be significant.