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Evaluation of the effectiveness of postoperative analgesia after major abdominal surgery

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Published: Apr 10, 2025
DOI: https://doi.org/10.12681/healthresj.39935
Keywords:
Postoperative multimodal analgesia pain management major abdominal surgery continuous wound infusion epidural analgesia intravenous analgesia patient-controlled analgesia
Giannoula Ntavoni
Deputy Director of 1st Regional Healthcare Authority of Attica, Greece
Georgios Vasilopoulos
Professor, Department of Nursing, University of West Attica, Greece
Georgia Toylia
Associate Professor, Department of Nursing, University of West Attica, Greece
Vasiliki Linardatou
RN, MSc, MSHCM, PhD, Coordinator of Emergency & Critical Care Nursing Specialty Training Program, 1st Regional Health Authority of Attica, Head of Nursing Education Office–Nursing Specialties, General Hospital of Athens "G. Gennimatas", Athens, Greece
Olga Kadda
RN, PhD, Liaison Nurse, Department of Electrophysiology and Pacing, Onassis Cardiac Surgery Centre, Greece
Pantelis Stergiannis
Assistant Professor, Department of Nursing, National and Kapodistrian University of Athens, Greece
Pavlos Myrianthefs
Professor of Pulmonary and Critical Care Medicine, National and Kapodistrian University of Athens, Greece
Antonia Kalogianni
Associate Professor, Department of Nursing, University of West Attica, Greece
Abstract

Background: Postoperative pain (PP) relief improves patient comfort, facilitates recovery, reduce length of hospital stay (LOS) and chronic pain. The complexity of PP in major abdominal surgery (MAS) is an indication for the use of multimodal analgesia (MA).


Aim: To evaluate the effectiveness of different methods of postoperative analgesia in patients undergoing MAS.


Method and Mattwerial: A prospective, comparative observational study was conducted. The study population was all patients who underwent elective MAS between September 2019 and July 2023, in a general public hospital in Attica. Patients were divided into three groups based on analgesia: a) Group A: analgesia via an epidural catheter in the lumbar or thoracic region. b) Group B: analgesia with continuous wound infusion of anesthetic with an On-Q system c) Group C: iv analgesia. Patients of B and C groups also received patient controlled analgesic morphine (PCA). The effectiveness of analgesia was assessed at rest and cough by the numerical rate scale (NRS) and morphine consumption. In addition, blood pressure, oxygenation status, vomiting, recovery of bowel function and the LOS were recorded. The statistical program SPSS 26.0 was used for the analysis.


Results: The study sample consisted of 89 adult patients who underwent planned MAS and were allocated to the analgesia groups [Group A N=44(49.4%), Group B N=30(33.7%), Group C N=15 (16.9%)]. The mean age of the sample was 62.7 years (SD=17.8 years). The pain score in Group A was significantly higher compared to Group B throughout the follow-up period. Rest pain decreased over time in all three analgesia groups (p<0.001 for A, p<0.001 for B and p=0.001 for C). However, the degree of reduction differed significantly between the 3 groups, p=0.013. The mean systolic blood pressure was significantly higher on the 1st postoperative day in Group C compared to both Group A and Group B.


Conclusions: Continuous wound infusion analgesia with On-Q pump as a component of MA was more effective in the management of acute PP in patients with MAS than epidural and intravenous MA. It also reduces overall opioid consumption and can be a safe and effective alternative solution in the management of acute PP in patients with MAS.

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References
Rawal N. Current issues in postoperative pain management. European journal of anaesthesiology. 2016;33(3):160-71.
Chung D, Lee YJ, Jo MH, Park HJ, Lim GW, Cho H, et al. The ON-Q pain management system in elective gynecology oncologic surgery: Management of postoperative surgical site pain compared to intravenous patient-controlled anal-gesia. Obstetrics & gynecology science. 2013;56(2):93-101.
Zalon ML. Mild, moderate, and severe pain in patients recovering from major abdominal surgery. Pain manage-ment nursing: official journal of the American Society of Pain Management Nurses. 2014;15(2):e1-12.
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiolo-gists' Committee on Regional Anesthesia, Executive Com-mittee, and Administrative Council. The journal of pain: of-ficial journal of the American Pain Society. 2016;17(2):131-57.
Khan RS, Ahmed K, Blakeway E, Skapinakis P, Nihoyan-nopoulos L, Macleod K, et al. Catastrophizing: a predictive factor for postoperative pain. American journal of surgery. 2011;201(1):122-31.
Rai A, Meng H, Weinrib A, Englesakis M, Kumbhare D, Grosman-Rimon L, et al. A Review of Adjunctive CNS Med-ications Used for the Treatment of Post-Surgical Pain. 2017;31(7):605-15.
Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a quali-tative systematic review. Anesthesiology. 2009;111(3):657-77.
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for Perioperative Care in Elec-tive Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019 Mar;43(3):659-695
Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. MASTER Anaethesia Trial Study Group. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002 Apr 13;359(9314):1276-82.
Stanley G, Appadu B, Mead M, Rowbotham DJ. Dose re-quirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery. British journal of anaesthesia. 1996;76(4):484-6.
Woodhouse A, Mather LE. The effect of duration of dose delivery with patient-controlled analgesia on the incidence of nausea and vomiting after hysterectomy. British journal of clinical pharmacology. 1998;45(1):57-62.
Salicath JH, Yeoh EC, Bennett MH. Epidural analgesia ver-sus patient-controlled intravenous analgesia for pain fol-lowing intra-abdominal surgery in adults. Cochrane Data-base Syst Rev. 2018 Aug 30;8(8):CD010434.
Hamilton TW, Athanassoglou V, Mellon S, Strickland LH, Trivella M, Murray D, et al. Liposomal bupivacaine infiltra-tion at the surgical site for the management of postopera-tive pain. Cochrane Database Syst Rev. 2017 Feb 1;2(2):CD011419.
Hughes MJ, Ventham NT, McNally S, Harrison E, Wigmore S. Analgesia after open abdominal surgery in the setting of enhanced recovery surgery: a systematic review and meta-analysis. JAMA Surg. 2014 Dec;149(12):1224-30.
Mahama F, Ninnoni JPK. Assessment and Management of Postoperative Pain among Nurses at a Resource-Constraint Teaching Hospital in Ghana. 2019;2019:9091467.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003 Aug;97(2):534-540.
Subramanian P, Ramasamy S, Ng KH, Chinna K, Rosli R. Pain experience and satisfaction with postoperative pain control among surgical patients. Int J Nurs Pract. 2016 Jun;22(3):232-8.
Capdevila X, Moulard S, Plasse C, Peshaud JL, Molinari N, Dadure C, Bringuier S. Effectiveness of Epidural Analgesia, Continuous Surgical Site Analgesia, and Patient-Controlled Analgesic Morphine for Postoperative Pain Management and Hyperalgesia, Rehabilitation, and Health-Related Qual-ity of Life After Open Nephrectomy: A Prospective, Ran-domized, Controlled Study. Anesth Analg. 2017 Jan;124(1):336-345.
Zheng X, Feng X, Cai XJ. Effectiveness and safety of contin-uous wound infiltration for postoperative pain manage-ment after open gastrectomy. World J Gastroenterol. 2016 Feb 7;22(5):1902-10.
Mungroop TH, Veelo DP, Busch OR, van Dieren S, van Gulik TM, Karsten TM, et al. Continuous wound infiltration ver-sus epidural analgesia after hepato-pancreato-biliary sur-gery (POP-UP): a randomised controlled, open-label, non-inferiority trial. Lancet Gastroenterol Hepatol. 2016 Oct;1(2):105-113.
Araújo R; PAMA Trial. [Pain Management, Local Infection, Satisfaction, Adverse Effects and Residual Pain after Major Open Abdominal Surgery: Epidural versus Continuous Wound Infusion (PAMA Trial)]. Acta Med Port. 2017 Oct 31;30(10):683-690. Portuguese. doi: 10.20344/amp.8600. Epub 2017 Oct 31. PMID: 29268061
Bertoglio S, Fabiani F, Negri PD, Corcione A, Merlo DF, Cafiero F, et al. The postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anesthetics after colorectal cancer surgery: a randomized controlled multi-center study. Anesth Analg. 2012 Dec;115(6):1442-50.
Ilangovan L, G S, Meenakshisundaram S, Selvaraj K, Sethu-raman RM, M S IH, P B H. Assessment of continuous epi-dural analgesia versus continuous surgical transverse ab-dominis plane block for postoperative analgesia in gyneco-logical surgeries. Cureus. 2023;15(12).
Mouawad NJ, Leichtle SW, Kaoutzanis C, Welch K, Winter S, Lampman R, et al. Pain control with continuous infusion preperitoneal wound catheters versus continuous epidural analgesia in colorectal surgery: A randomized controlled trial.Am J Surg. 2018 Απρ;215(4):570-576.
Minville V, Gerard A, Buc E, Dupre A, Kwiatkowski F, Con-stantin JM, et al. Epidural versus continuous preperitoneal analgesia during fast-track open colorectal surgery: a ran-domized controlled trial. Anesthesiology. 2013 Mar;118(3):622-30.
Beaussier M, El'Ayoubi H, Schiffer E, Rollin M, Parc Y, Ma-zoit JX, et al. Continuous preperitoneal infusion of ropiva-caine provides effective analgesia and accelerates recovery after colorectal surgery: a randomized, double-blind, pla-cebo-controlled study. Anesthesiology. 2007 Sep;107(3):461-8.
Lee B, Kim K, Ahn S, Shin HJ, Suh DH, No JH, Kim YB. Con-tinuous wound infiltration system for postoperative pain management in gynecologic oncology patients. Arch Gy-necol Obstet. 2017 May;295(5):1219-1226. doi: 10.1007/s00404-017-4342-8. Epub 2017 Mar 14. PMID: 28293
Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropi-vacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth. 2008 Dec;101(6):841-7. doi: 10.1093/bja/aen309. PMID: 19004914
Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD. Use of the ON-Q pain management system is associated with decreased postoperative analgesic re-quirement: double blind randomized placebo pilot study. J Am Coll Surg. 2006 Feb;202(2):297-305. doi: 10.1016/j.jamcollsurg.2005.10.022. PMID: 16427556.
Ahmed A, Latif N, Khan R. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2013;29(4):472-477. doi:10.4103/0970-9185.119137
Viderman D, Tapinova K, Nabidollayeva F, Tankacheev R, Abdildin YG. Intravenous versus epidural routes of patient-controlled analgesia in abdominal surgery: systematic re-view with meta-analysis. J Clin Med. 2022;11(9):2579. doi: 10.3390/jcm11092579.
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