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

Authors Manassero A, Bossolasco M, Carrega M, Coletta G

Received 23 July 2020

Accepted for publication 27 August 2020

Published 10 September 2020 Volume 2020:13 Pages 111—119

DOI https://doi.org/10.2147/LRA.S272410

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Stefan Wirz


Alberto Manassero, Matteo Bossolasco, Mattia Carrega, Giuseppe Coletta

Department of Emergency and Critical Care, Division of Operating Room Management, S. Croce e Carle Hospital, Cuneo, Italy

Correspondence: Alberto Manassero C.so 4 Novembre 12, CN 12100, Italy
Tel +390171642025
Fax +390171642010
Email manassero.al@ospedale.cuneo.it

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.

Keywords: thoracic epidural, postoperative pain, epidural analgesia, spinal epidural abscess, epidural catheter

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