Problems related to epidural analgesia for postoperative pain control

Epidural analgesia provides excellent analgesia after major surgery but it is not without adverse effects. This retrospective study aims to evaluate the efficacy of analgesia and the problems commonly encountered postoperatively. Elective surgical patients who had epidural catheters inserted perioperatively intended for postoperative analgesia over a 1-year period were studied. Anaesthetic charts and daily records of patient evaluation by the Acute Pain Service (APS) for pain relief, side effects and their subsequent management were analysed. A total of 471 patients had epidural catheters inserted for postoperative analgesia. Ninety per cent of patients received continuous local anaesthetic infusion (75% ropivacaine and 15% bupivacaine) and 10% received intermittent morphine boluses. There were few serious complications but 60% of patients required one or more interventions by the APS, mainly for inadequate analgesia. One-third of patients had their epidural analgesia terminated prematurely due to inadequate analgesia (14.2%), shortage of beds in the high-dependency unit (14%) and other complications. Only 19% of patients had no reported adverse effects. Although the incidence of serious complications was low, there was a high incidence of minor adverse effects especially during the first 48 hours. This emphasises the importance of close monitoring during the early postoperative period and the APS in the management of side effects, especially inadequate analgesia.