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Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients

PURPOSE: Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications. PATIENTS AND METHODS: Patients received continuous infusion TEA (...

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Autores principales: Manassero, Alberto, Bossolasco, Matteo, Carrega, Mattia, Coletta, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490049/
https://www.ncbi.nlm.nih.gov/pubmed/32982397
http://dx.doi.org/10.2147/LRA.S272410
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author Manassero, Alberto
Bossolasco, Matteo
Carrega, Mattia
Coletta, Giuseppe
author_facet Manassero, Alberto
Bossolasco, Matteo
Carrega, Mattia
Coletta, Giuseppe
author_sort Manassero, Alberto
collection PubMed
description PURPOSE: Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications. PATIENTS AND METHODS: Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml(−1) fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects. RESULTS: A total of 3126 patients received TEA. The median age was 65 years (range, 18–94) and the duration of catheter placement was 3.5 days (range, 2–8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded. CONCLUSION: Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.
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spelling pubmed-74900492020-09-24 Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients Manassero, Alberto Bossolasco, Matteo Carrega, Mattia Coletta, Giuseppe Local Reg Anesth Original Research PURPOSE: Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications. PATIENTS AND METHODS: Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml(−1) fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects. RESULTS: A total of 3126 patients received TEA. The median age was 65 years (range, 18–94) and the duration of catheter placement was 3.5 days (range, 2–8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded. CONCLUSION: Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique. Dove 2020-09-10 /pmc/articles/PMC7490049/ /pubmed/32982397 http://dx.doi.org/10.2147/LRA.S272410 Text en © 2020 Manassero et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Manassero, Alberto
Bossolasco, Matteo
Carrega, Mattia
Coletta, Giuseppe
Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients
title Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients
title_full Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients
title_fullStr Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients
title_full_unstemmed Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients
title_short Postoperative Thoracic Epidural Analgesia: Adverse Events from a Single-Center Series of 3126 Patients
title_sort postoperative thoracic epidural analgesia: adverse events from a single-center series of 3126 patients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490049/
https://www.ncbi.nlm.nih.gov/pubmed/32982397
http://dx.doi.org/10.2147/LRA.S272410
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