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Effect of Neuraxial Analgesic Procedures on Intraoperative Hemodynamics During Routine Clinical Care of Gynecological and General Surgeries: A Case–Control Query of Electronic Data

Effect of Neuraxial Analgesic Procedures on Intraoperative Hemodynamics During Routine Clinical Care of Gynecological and General Surgeries: A Case–Control Query of Electronic Data

Authors :
Gallegos G
Morgan CJ
Scott G
Benz D
Ness TJ
Source :
Journal of Pain Research, Vol Volume 13, Pp 1163-1172 (2020)
Publication Year :
2020
Publisher :
Dove Medical Press, 2020.

Abstract

Gabriel Gallegos,1 Charity J Morgan,2 Garrett Scott,1 David Benz,1 Timothy J Ness1 1Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA; 2Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35205, USACorrespondence: Timothy J NessDepartment of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, BMR2-208, 901 19 th St. S, Birmingham, AL 35205 Tel +1 205-975-9643Fax +1 205-934-7437Email tness@uabmc.eduBackground: The purpose of this study was to determine whether neuraxial analgesic procedures affect intraoperative hemodynamics and/or postoperative outcomes. Previous studies have examined effects in small samples of patients in highly controlled research environments. This study examined “real-world” data from a large sample of subjects receiving routine clinical cares.Methods: A matched case–control analysis of electronic medical records from a large, academic hospital was performed. Patients who underwent neuraxial procedures preoperatively for postoperative analgesia for abdominal surgery (n=1570) were compared with control patients matched according to age, sex, ASA class and type of surgical procedure. Intraoperative hemodynamic measures, fluids and pressor utilization were quantified. Postoperative outcomes were determined based on the changes in laboratory values, the ordering of imaging studies and admission to an intensive care unit during the seven days following surgery as well as 30-day mortality.Results: Medical records of 1082 patients who received an epidural catheter placement and 488 patients who received a lumbar intrathecal morphine injection were compared with an equal number of matched control patients. Preoperative placement of an epidural catheter for the management of postoperative pain was demonstrated to be associated with significant reductions in mean arterial pressure intraoperatively and poorer postoperative outcomes (more intensive care unit [ICU] admissions, more myocardial injuries) when compared with controls. A similar analysis of preoperatively administered intrathecal morphine injections was not associated with intraoperative alterations in blood pressure and had improved outcomes (less ICU admissions) in comparison with controls.Conclusion: In a “real-world” sample, intrathecal morphine administration proved to be highly beneficial as a neuraxial analgesic procedure as it was not associated with intraoperative hypotension and was associated with improved clinical outcomes, in contrast to opposite findings associated with epidural catheter placement. There should be a careful consideration of elective neuraxial method utilized for postoperative pain control, with the present study raising significant concerns related to the use of epidural analgesia and its potential effect on clinical outcomes.Keywords: neuraxial analgesia, hypotension, perioperative outcomes

Details

Language :
English
ISSN :
11787090
Volume :
ume 13
Database :
Directory of Open Access Journals
Journal :
Journal of Pain Research
Publication Type :
Academic Journal
Accession number :
edsdoj.9408c554f4424277a57eb4d0dc29e3c6
Document Type :
article