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Epidural analgesia and postoperative orthostatic haemodynamic changes: observational study
Elena Gramigni1, David Bracco, Franco Carli
1Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.
European Journal of Anaesthesiology
|February 26, 2013
Summary
Epidural analgesia effectively manages pain after surgery but can cause hypotension, delaying patient mobilization. This study found that while hypotension is common post-surgery, it doesn't predict mobility issues, suggesting early mobilization is beneficial.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Epidural analgesia is a cornerstone for postoperative pain management in thoracic and abdominal surgeries.
- Postural hypotension is a known side effect that can impede patient mobilization.
- Assessing orthostatic hemodynamic changes is crucial for understanding recovery after major surgery.
Purpose of the Study:
- To evaluate postoperative orthostatic hemodynamic alterations in patients undergoing major surgery with epidural analgesia.
- To determine if hemodynamic changes predict the inability to mobilize post-surgery.
- To inform clinical practice regarding early mobilization in patients receiving epidural analgesia.
Main Methods:
- Prospective observational study involving physiological interventions.
- 161 patients undergoing thoracic or abdominal surgery with thoracic epidural analgesia (bupivacaine/fentanyl).
- Arterial blood pressure and heart rate measured in supine, sitting, and standing positions pre- and post-operatively for 3 days.
Main Results:
- Postoperative hypotension was observed in 37% on day 1, decreasing to 2.5% by day 3.
- Orthostatic hypotension (drop in SBP > 20 mmHg) did not reliably predict inability to walk.
- Only significant blood loss (>500 ml) and low supine mean blood pressure (<70 mmHg) were negative predictors of mobilization on postoperative day 1.
Conclusions:
- Epidural analgesia is frequently associated with postoperative arterial hypotension.
- Hemodynamic assessments, including orthostatic tests, are insufficient predictors of postoperative mobility.
- Early mobilization attempts are recommended for patients with epidural analgesia, regardless of blood pressure or orthostatic changes.
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