Burstal R, Wegener F, Hayes C, Lantry G
Department of Anaesthesia, John Hunter Hospital, Newcastle, N.S.W.
Anaesth Intensive Care. 1998 Apr;26(2):165-72. doi: 10.1177/0310057X9802600206.
A prospective survey of one thousand and sixty-two patients receiving epidural analgesia in surgical wards was undertaken over a two-year period. The duration of infusion ranged from one to fourteen days, with a mode of three days. There were 1131 episodes where a local anaesthetic and opioid mixture was used and 160 where opioids were used alone. Local anaesthetic was not used without opioids. 23% of catheters were removed prematurely because of catheter related problems including accidental dislodgement (13%) and skin site inflammation (5.3%). No epidural abscess or haematoma was identified. In 14% of the total number of episodes there was either no demonstrable block or complications occurred requiring a change of solution: 30% of this group were salvaged following intervention by the Acute Pain Service (APS). The incidence of respiratory depression was 0.24%. There was no case of delayed respiratory depression. Epidural analgesia can be used safely in surgical wards provided that regular review of the patients is undertaken. It must be anticipated however, that up to 20% of patients will not receive adequate analgesia for the first 48 hours postoperatively. The failure rate could be halved if accidental dislodgement of epidural catheters could be eliminated.
在两年时间里，对1062名在外科病房接受硬膜外镇痛的患者进行了一项前瞻性调查。输注持续时间为1至14天，中位数为3天。使用局部麻醉药和阿片类药物混合物的情况有1131例，单独使用阿片类药物的情况有160例。未在不使用阿片类药物的情况下单独使用局部麻醉药。23%的导管因与导管相关的问题而提前拔除，包括意外移位（13%）和皮肤部位炎症（5.3%）。未发现硬膜外脓肿或血肿。在所有病例中，14%的患者要么没有可证实的阻滞，要么出现了需要更换溶液的并发症：该组中30%的患者在急性疼痛服务（APS）干预后得到挽救。呼吸抑制的发生率为0.24%。没有延迟性呼吸抑制的病例。只要对患者进行定期检查，硬膜外镇痛可以在外科病房安全使用。然而，必须预计到，高达20%的患者在术后48小时内无法获得充分的镇痛。如果能消除硬膜外导管的意外移位，失败率可以减半。
