Epidural analgesia decreases intraabdominal pressure in postoperative patients with primary intra-abdominal hypertension.

INTRODUCTION

Surgical decompression is a lifesaving procedure in patients with severe intraabdominal hypertension. However, it involves subsequent management of an open abdomen. Therefore, it is not recommended for moderate intra-abdominal hypertension. Our literature search did not show any studies relating the efficacy of epidural analgesia in decreasing elevated intraabdominal pressure (IAP) in critically-ill surgical patients with primary intra-abdominal hypertension.

MATERIAL AND METHODS

Through a blinded prospective study, we investigated postoperative critically-ill surgical and trauma patients with primary intra-abdominal hypertension, who received postoperative thoracic epidural analgesia (n = 58) or intravenous opioid analgesia (n = 130). Patients in the epidural group received ropivacaine 0.2% 10 ml, followed by an infusion of 5 ml/h for 96 hours. Patients in the opioid group could receive morphine hydrochloride (0.1 mg/kg IV for every 4-6 hours as needed) with or without ketorolac trometamol (up to 90 mg/day IV). IAP was measured transvesically, for every 6 hours. Additionally, measurements immediately before and 1 hour after the initiation of epidural analgesia were taken. Abdominal Perfusion Pressure (APP) was calculated for each IAP measurement as APP = MAP - IAP where MAP is the mean arterial pressure.

RESULTS

In the epidural group we found a consistent decrease in IAP from 16.82 +/- 4.56 to 6.30 +/- 3.11 mmHg and an increase in APP from 60.26 +/- 21.893 to 76.10 +/- 17.54 mmHg between baseline values until the second day of epidural analgesia, which remained stable afterwards. There were no significant differences of IAP and APP in the opioid group.

CONCLUSION

Continuous thoracic epidural analgesia decreases IAP and improves APP without haemodynamic compromise in postoperative critically-ill patients with primary intra-abdominal hypertension.