Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-08T07:26:28.941Z Has data issue: false hasContentIssue false
  • English
  • Français

A survey of postoperative epidural and intravenous analgesia in Greece

Published online by Cambridge University Press:  01 November 2007

P. Tzavellas ,
K. Papilas ,
I. Grigoropoulou ,
C. Zolindaki ,
P. Kouki ,
H. Chrona  and
G. Kostopanagiotou
P. Tzavellas*
Affiliation:
General Hospital of Nikea Pireaus, Department of Anaesthesiology, Iraklion, Athens, Greece
K. Papilas
Affiliation:
Attikon Hospital, Athens, Greece
I. Grigoropoulou
Affiliation:
Attikon Hospital, Athens, Greece
C. Zolindaki
Affiliation:
General Hospital of Nikea Pireaus, Department of Anaesthesiology, Iraklion, Athens, Greece
P. Kouki
Affiliation:
Thriasion Hospital, Elefsina, Greece
H. Chrona
Affiliation:
General Hospital of Nikea Pireaus, Department of Anaesthesiology, Iraklion, Athens, Greece
G. Kostopanagiotou
Affiliation:
University of Athens, Attikon Hospital, School of Medicine, Second Department of Anesthesiology, Athens, Greece
*
Correspondence to: Tzavellas Pantelis, Department of Anaesthesiology, General Hospital of Nikea Pireaus, 16 Folegandrou Street, Iraklion, Athens 14122, Greece. E-mail: ptzavellas@yahoo.gr; Tel: +30 2102755082; Fax: +30 2102796576
Get access

Summary

Background and objective

Epidural and intravenous analgesia are widely used for postoperative pain management. Efficacy and safety is enhanced with the establishment of acute pain services. We studied the terms of application of these techniques in Greek hospitals and compared practices between anaesthetic departments with or without acute pain services.

Methods

We performed a postal survey regarding departmental policy on the application of epidural and intravenous analgesia, patient monitoring, audit and educational activities, acute pain service teams and proposals for improvement. Pain services were classified according to predetermined quality criteria. Hospitals with or without acute pain services were compared.

Results

Response rate was 46.3% (51 of 110 departments). Epidural analgesia was used in 49 departments, equally applied as intermittent boluses or continuous infusion. Twenty-two of the 39 departments that were using continuous infusion, used exclusively a lumbar approach. Intravenous analgesia was used by 42 (82%) departments; 13 used exclusively continuous infusion. All eight departments that had an established acute pain service fulfilled the predefined quality criteria compared with only ten of the remaining 43 (P < 0.001).

Conclusion

Our study discloses important issues regarding the use of intravenous and epidural analgesia and postoperative patient monitoring in Greek hospitals. Implementation of acute pain services that are satisfying the quality criteria may help to improve patient care.

Keywords

PAIN MEASUREMENTPAIN, postoperative, patient controlledANAESTHESIA EPIDURALACUTE PAIN SERVICESHEALTHCARE SURVEY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 942 - 950
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Sweeney, BP, Crayling, M. Opoids, transporters and the blood–brain barrier. Eur J Anaesthesiol 2005; 22: 489–491.CrossRefGoogle Scholar
2.Dolin, SJ, Cashman, JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth 2005; 95: 584–591.CrossRefGoogle ScholarPubMed
3.Cashman, JN, Dolin, SJ. Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth 2004; 93: 212–223.CrossRefGoogle ScholarPubMed
4.Werner, MU, Soholm, L, Rotboll-Nielsen, P, Kehlet, H. Does an acute pain service improve postoperative outcome? Anesth Analg 2002; 95: 1361–1372.CrossRefGoogle ScholarPubMed
5.Powel, A, Davies, H, Bannister, J, Macrae, WA. Rhetoric and reality on acute pain services in the UK: a national postal questional survey. Br J Anaesth 2004; 92: 689–693.CrossRefGoogle Scholar
6.Harmer, M. When is a standard not a standard? When it is a recommendation. Anaesthesia 2001; 56: 611–612.CrossRefGoogle Scholar
7.Stamer, U, Mpasios, N, Stuber, F, Maier, C. A survey of acute pain services in Germany and a discussion of international survey data. Reg Anesth Pain Med 2002; 27: 125–131.Google Scholar
8.Rawal, N. Organization, function, and implementation of acute pain service. Anesthesiol Clin North Am. 2005; 23: 211–225.CrossRefGoogle ScholarPubMed
9.American Society of Anesthesiologists Task Force on Pain Management. Acute pain section. Practice guidelines for acute pain management in the perioperative setting. Anesthesiology 1995; 82: 1071–1081.CrossRefGoogle Scholar
10.Walker, SM, Goudas, LC, Cousins, MJ, Carr, DB. Combination spinal analgesic chemotherapy: a systematic review. Anesth Analg 2002; 95: 674–715.CrossRefGoogle ScholarPubMed
11.Cook, TM, Eaton, JM, Goodwin, APL. Epidural analgesia following upper abdominal surgery: United Kingdom practice. Acta Anaesthesiol Scand 1997; 41: 18–24.CrossRefGoogle ScholarPubMed
12.Holmstrom, B, Rawal, N, Arner, S. The use of central regional anesthesia techniques in Sweden: results of a nation-wide survey. Acta Anaesthesiol Scand 1997; 41: 565–572.CrossRefGoogle ScholarPubMed
13.Rawal, N, Allvin, R, Euro Pain Study Group on Acute Pain. Epidural and intrathecal opioids for postoperative management in Europe – a 17-nation questionnaire study of selected hospitals. Acta Anaesthesiol Scand 1996; 40: 1119–1126.CrossRefGoogle ScholarPubMed
14.Bromage, PB. Clinical studies of spread of epidural analgesia. In: Bromage, PB, ed. Epidural Analgesia. Philadelphia, USA: WB Saunders, 1978: 131–148.Google Scholar
15.Sinatra, RS. Acute pain management and acute pain services. In: Cousins, MJ, Bridenbaugh, PO, eds. Neural Blockade in Clinical Anesthesia and Pain Management. Philadelphia, USA: Lippincott–Raven Publishers, 1998: 793–835.Google Scholar
16.Ferrante, MF, VadeBoncouer, TR. Epidural analgesia with combinations of local anesthetics and opioids. In: Ferrante, MF, VadeBoncouer, TR, eds. Postoperative Pain Management. New York, USA: Churchill Livingstone, 1993: 305–333.Google Scholar
17.ESRA Guidelines. Postoperative pain management. 2004: http://www.esraeurope.org/Google Scholar
18.Kahn, L, Baxter, FJ, Dauphin, A et al. . A comparison of thoracic and lumbar epidural techniques for postthoracoabdominal esophagectomy analgesia. Can J Anesth 1999; 46: 415–424.CrossRefGoogle ScholarPubMed
19.Hodgson, PS. Thoracic epidural anaesthesia and analgesia for abdominal surgery: effects on gastrointestinal function and perfusion. Balliere’s Clin Anaesthesiol 1999; 13: 9–22.Google Scholar
20.Veering, BT, Cousins, MJ. Cardiovascular and pulmonary effects of epidural anaesthesia. Anaesth Intensive Care 2000; 28: 620–635.CrossRefGoogle ScholarPubMed
21.Magnusdottir, H, Kirno, K, Ricksten, SE et al. . High thoracic epidural anesthesia does not inhibit sympathetic nerve activity in the lower extremities. Anesthesiology 1999; 91: 1299–1304.CrossRefGoogle Scholar
22.Liu, SS, Allen, HW, Olsson, GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: prospective experience with 1030 surgical patients. Anesthesiology 1998; 88: 688–695.CrossRefGoogle Scholar
23.Chisakuta, AM, George, KA, Hawthorne, CT. Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery: a comparison of thoracic and lumbar routes. Anaesthesia 1995; 50: 72–75.CrossRefGoogle ScholarPubMed
24.Dolin, SJ, Cashman, JN, Bland, JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002; 89: 409–423.CrossRefGoogle ScholarPubMed
25.Parker, RK, Holtmann, BP, White, PF. Patient-controlled analgesia: does a concurrent opioid infusion improve pain management after surgery? JAMA 1991; 266: 1947–1952.CrossRefGoogle ScholarPubMed
26.Grass, JA. Patient-controlled analgesia. Anesth Analg 2005; 101: S44–S61.CrossRefGoogle ScholarPubMed
27.Macintyre, PE. Intravenous patient-controlled analgesia: one size does not fit all. Anesthesiol Clin North Am 2005; 23: 109–123.CrossRefGoogle Scholar
28.Miaskowski, C, Crews, J, Ready, B et al. . Anesthesia-based pain services improve the quality of postoperative pain management. Pain 1999; 80: 23–29.CrossRefGoogle ScholarPubMed
29.Carr, DB, Jacox, A, Chapman, CR et al. . Acute pain management: operative or medical procedures and trauma. Clinical Practice Guideline. AHCPR Pub. No. 92–0032. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, 1992.Google Scholar
30.Gear, RW, Miaskowski, C, Gordon, NC et al. . The kappa opioid nalbuphine produces gender- and dose-dependent analgesia and antianalgesia in patients with postoperative pain. Pain 1999; 83: 339–345.CrossRefGoogle ScholarPubMed
31.Rawal, N, Langford, RM. Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCL iontophoretic transdermal system. Eur J Anaesthesiol 2007; 24: 299–308.CrossRefGoogle ScholarPubMed
32.Kehlet, H, Dahl, JB. The value of ‘multi-modal’ or ‘balanced analgesia’ in postoperative pain treatment. Anesth Analg 1993; 77: 1048–1056.Google ScholarPubMed
33.Marret, E, Kurdi, O, Zufferey, P, Bonnet, F. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology 2005; 102: 1249–1260.CrossRefGoogle ScholarPubMed
34.Macario, M, Weinger, M, Carney, S et al. . Which clinical anesthesia outcomes are important to avoid: the perspective of patients. Anesth Analg 1999; 89: 652–658.CrossRefGoogle ScholarPubMed
35.Nagi, H. Acute pain services in the United Kingdom. Acute Pain 2004; 5: 89–107.CrossRefGoogle Scholar
36.Goucke, CR, Owen, H. Acute pain management in Australia and New Zealand. Anaesth Intensive Care 1995; 23: 715–717.CrossRefGoogle ScholarPubMed
37.Puig, MM, Montes, A, Marrugar, J. Management of postoperative pain in Spain. Acta Anaesthesiol Scand 2001; 4: 465–469.CrossRefGoogle Scholar
38.Goldstein, DH, VanDenKerkhof, EG, Blaine, WC. Acute pain management services have progressed albeit insufficiently in Canadian academic hospitals. Can J Anesth 2004; 3: 231–235.CrossRefGoogle Scholar
39.Ready, BL, Loper, KA, Nessly, M, Wild, L. Postoperative epidural morphine is safe on surgical wards. Anesthesiology 1991; 75: 452–456.CrossRefGoogle ScholarPubMed
40.Ready, BL, Oden, R, Chadwick, HS et al. . Development of an anesthesiology-based postoperative pain management service. Anesthesiology 1988; 68: 100–106.CrossRefGoogle ScholarPubMed
41.Breivik, H. Acute pain services – safety aspects. In: Van Zundert, A, ed. Scandinavian Perspectives in Regional Anaesthesia and Pain Control. Barcelona, Spain: Permanyer Publications, 1994: 80–91.Google Scholar
42.Rawal, N. Acute pain services – safety aspects. In: Van Zundert, A, ed. Scandinavian Perspectives in Regional Anaesthesia and Pain Control. Barcelona, Spain: Permanyer Publications, 1994: 92–98.Google Scholar
43.McLeod, GA, Davies, HTO, Munnoch, N. Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures. Anaesthesia 2001; 56: 75–81.CrossRefGoogle ScholarPubMed
44.Rawal, N, Allvin, R. European Acute Pain Working Party. Acute pain services in Europe: a 17-nation survey of 105 hospitals. Eur J Anaesth 1998; 15: 354–363.CrossRefGoogle ScholarPubMed
45.Carr, DB, Miaskowski, C, Dedrick, SC, Williams, GR. Management of perioperative pain in hospitalized patients: a national survey. J Clin Anesth 1998; 10: 77–85.CrossRefGoogle ScholarPubMed
46.Oliver, HG, Wilder-Smith, OHG, Möhrle, JJ, Martin, NC. Acute pain management after surgery or in the emergency room in Switzerland: a comparative survey of Swiss anaesthesiologists and surgeons. Eur J Anaesth 2002; 6: 189–201.Google Scholar
47.Rawal, N. Organization of acute pain services – a low cost model. Pain 1994; 57: 117–123.CrossRefGoogle ScholarPubMed