| Título: | Is continuous infiltration of local anaesthetic/PCA an acceptable alternate pain management strategy in morbidly obese patients undergoing gastric bypass surgery? A retrospective comparison with epidural analgesia |
| Autores: |
Pathiraja, Chaminda; Wakefield G.E Centre, Wellington Silva, Nilan; Wakefield G.E Centre, Wellington Sharpe, Graham; Wakefield G.E Centre, Wellington Woojner, Jacek; Wakefield G.E Centre, Wellington Stubbs, Richard; Wakefield G.E Centre, Wellington |
| Fecha: | 2010-11-29 |
| Publicador: | Sri Lankan journal of Anaesthesiology |
| Fuente: |
 |
| Tipo: |
info:eu-repo/semantics/article Peer-Reviewed Item info:eu-repo/semantics/publishedVersion |
| Tema: |
Anaesthesiology morbidly; gastric surgery; epidural analgesia; continuous local infiltration |
| Descripción: | Background: Not like in general population, in obese siting the epidural catheter is a time consuming process and needs high level of nursing care during the postoperative period. In our institution we have done more than 1000 gastric bypasses over the last decade, most of them with postoperative epidural analgesia. Because of draw backs with epidural technique, recently we changed our practice to continuous infiltration/PCA technique. This is an attempt to see whether new technique is offering the same quality of analgesia to our gastric bypass patients during their postoperative stay. Methods: All the patients who had either epidural or PCA/continuous infiltration as their primary mode of analgesia, following gastric bypass surgery during the period of 1st June 2008 and 28th February 2009 were taken in to consideration. Pain was rated by the patient using VAS score at 0,2,6,12,24,36,48,72,96 hours and overall patient satisfaction at end of 96 hours. Side effects were also noted. Results: Out of 98 patients, only 87 patients (epidural 62, continuous infiltration / PCA 25) were considered in this study. Rest had either PCA alone (8 patients) or combination of epidural / PCA (intentionally - 1,convertion of epidural to PCA - 2). Epidural group consisted of 21 (33.9%) males, 41 (66.1) females, age 48.2+/-10.4 (23-69 years), BMI 48.9+/-9.66 (34-86) and PCA/infiltration group 3 (12%) males, 22 (88%) females, age 47.36 + /- 12.08 (19-71) BMI 46.6 + /-7. 65 (36-65). Continuous infiltration / PCA provided same degree of pain relief as epidural infusion. Except for nausea and vomiting (60%), other side effects were less with continuous infiltration/PCA (pruritus, urinary retention, wound infection). 11.3% of epidurals group developed hypotension and 36% of infiltration / PCA group mentioned oozing as a side effect. In epidural group 13% rated it as excellent, 37% as very good, 50% as good while in infiltration/PCA group 36% related as excellent ,48% as very good and 16% as good. Conclusion: Continuous infiltration/PCA technique provides equally effective postoperative analgesia after gastric bypass surgery, compared to epidural infusion, with comparatively less side effects and more patient satisfaction.Key words: morbidly; gastric surgery; epidural analgesia; continuous local infiltration DOI: 10.4038/slja.v18i2.2440Sri Lankan Journal of Anaesthesiology 18(2): 66-71 (2010) |
| Idioma: | Inglés |
1 A National Resuscitation Council por Hapuarachchi, Shirani; Consultant Anaesthetist , Neuro Surgical Department, The National Hospital of Sri Lanka | 6 Surviving severe sepsis – early recognition and treatment por Khan, Fazal Hameed; Professor, Department of Anaesthesia, Akuh, Karachi |
2 Theatre efficiency por Abayadeera, Anuja; Senior Lecturer in Anaesthesiology Faculty of Medicine, University of Colombo | 7 Stabilization and transport of head injured por Kularatne, Manjula; Consultant Anaesthetist, Teaching Hospital Colombo South |
3 Use of phenylephrine as vasopressor of choice to prevent hypotension following spinal anaesthesia in LSCS por Pinto, V; Consultant Anaesthetist, Senior lecturer, Department of Anesthesiology, Faculty of Medicine, University of Peradeniya,Jaysundara, NS; Temporary Lecturers, Department of Anesthesiology, Faculty of Medicine University of Peradeniya,Abeysundara, AB; Registrar in Anesthesiology, General Hospital Kandy,Ekanayake, SU; Temporary Lecturers, Department of Anesthesiology, Faculty of Medicine University of Peradeniya, Sri Lanka | 8 Quality assurance in critical care por Hoda, Muhammad Qamarul; Professor, Department of Anaesthesia, Aga Khan University, Karachi |
4 Fainting attacks on the dental chair: "functional" or RAS? por Nageswaran, H; Foundation Year 2, Luton and Dunstable Foundation Trust, Lewsey Road, Luton, UK,Peiris, T Malathie; Consultant Anaesthetist, Luton and Dunstable Foundation Trust, Lewsey Road, Luton | 9 Ventilatory strategies in chronic obstructive pulmonary disease por Habaragamuwa, BWP; Senior Registrar in Anaesthesiology, The National Hospital |
5 Critical care management of head injury – current concepts por Hoda, Muhammad Qamarul; Professor and Clinical Director ICU Aga Khan University, Karachi | 10 Haemorrhage and coagulation a practical approach por Lyons, Gordon; Consultant Obstetric Anaesthetist St James’ University Hospital, Leeds, United Kingdom |