Post-operative pain management: transition from epidural to oral analgesia

Although managing pain in the acute surgical setting is a priority, there is a dearth of evidence to guide clinicians on how best to approach the discontinuation and transition of patients from epidural analgesia to oral analgesia post-operatively. This article describes an audit at a regional trust which examined data on patients' observations charts, as well as patients' self-reports of pain. The authors found that reducing epidural opioid concentrations post-operatively is useful in analgesic transition, using bupivacaine only for weaning has limited value, and that the timing of oral analgesia administration is important. They conclude that comprehensive pain assessment and better documentation are necessary to improve pain management practices. While the results demonstrate the advantage of reducing epidural opioid concentrations, decisions should be based on the needs of individual patients and not form part of a routine task.