Premature termination of epidural analgesia—A prospective analysis to improve quality

Summary 

Background and objective

Epidural analgesia (EA) is a gold-standard in post-operative pain control. Therefore, modern treatment concepts targeting early patient recovery regularly implement EA. Due to its increasing impact, EA should meet high quality standards in respect to application and maintenance. Though, daily practice often reveals EA-related problems, our investigation aimed to improve EA quality by assessing incidence and reasons of undeliberate, premature termination of post-operative EA.

Methods

In the first step all patients with post-operative EA were retrospectively studied covering a 6-month period (group 1). We analysed incidences and reasons of undeliberate termination of EA. Thereafter we modified our treatment protocols (preferential thoracic EA, continuous peripheral blocks, low concentrated local anaesthetic solutions, standardized co-medication). This was followed by a prospective analysis of all EA patients for another 6 months (group 2).

Results

777 patients were included (group 1 n=400, group 2 n=377). Undeliberate termination of post-operative EA was documented in 24.3% of group 1 patients (group 2: 14.1%; p<0.05). In all patients, pain was the leading reason of premature termination (group 1: 52%; group 2: 68%), followed by motor block (group 1: 21%; group 2: 7.5%) and catheter dislocation (group 1: 10%; group 2: 16.7%).

Discussion

Modified treatment protocols reduced the rate of premature termination of EA from 24% to 14%. Particularly, we noted less motor impairment but still this rate is disappointing. The increasing rate of catheter dislocations underlines that a continuous analysis of all treatment aspects must be compulsatory.

Keywords: Regional anaesthesia, Epidural analgesia, Post-operative pain therapy, Quality assurance