7.6.1 Measuring the quality of continuous epidural infusions for delivering postoperative analgesia after major abdominal surgery (402)

Fiona Duncan, Nurse Specialist, Honorary Research Fellow, Salford Centre for Nursing, Midwifery and Collaborative Research, University of Salford, Greater Manchester, United Kingdom

Abstract:

The introduction of Acute Pain Services (APS) has led to an increased use of specialized pain relief methods, which have the potential to improve patient wellbeing and reduce postoperative morbidity. Epidural analgesia has become the ‘gold standard’ technique for the management of postoperative pain, particularly in the high risk patient undergoing major abdominal surgery. However, recent evidence about the safety and outcome of epidural analgesia is conflicting. Epidurals are not without associated problems for the patients such as hypotension, respiratory depression and rare serious adverse events, so their safe administration requires skilled monitoring. We have collected and analysed data (January - December 2006) on all visits to patients with epidurals (n=480) as part of a larger study and found that 20 -30 % patients are in severe pain (above 6 on a 0 - 10 Visual Analogue Score) on our first visit. This figure is similar to other published reports. Yet the percentage of patients with a high pain score was less than 5% when we conducted a randomized controlled study in 2004. We believe our 2006 data captures the realities of delivering postoperative epidural pain relief in everyday practice. This session will be in three parts. First, the key results of data analysis from both the 2004 and 2006 studies will be presented, including the identification of independent variables associated with effective analgesia. Secondly, the current evidence supporting the effectiveness and safety of postoperative epidural analgesia will be debated. Finally, there will be a brief exploration of the difference between the controlled and real-time data collection in an APS, and the implications for clinical practice.

Biography:

Fiona Duncan qualified as a nurse from Edinburgh Royal Infirmary in 1978 and specialised in intensive care. She then entered hospice nursing working in the U.K. and abroad. Since 1994 she has been an acute pain nurse. She currently combines this clinical post with study at Salford University and is in her 3rd year as a bursaried PhD student. Her current research interests are the effectiveness of postoperative epidural analgesia, and the role of computer technology to assess acute pain treatment modalities.