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Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data - 3/8/2004


Br J Anaesth 2004; 93: 212-23

Introduction


These authors investigated the evidence from published data concerning the adverse respiratory and haemodynamic effects of three analgesic techniques after major surgery; i.m. analgesia, patient-controlled analgesia (PCA) and epidural analgesia.


Methods


The authors carried out a MEDLINE search for publications concerned with the management of postoperative pain, and, from the studies thereby identified, extracted information relating to variables indicative of respiratory depression and hypotension. Over 800 original papers and reviews were found, of which 212 fulfilled the inclusion criteria but only 165 provided usable data on adverse effects. This study utilized the pooled data obtained from these studies, representing the experience of nearly 20,000 patients.


Results


Considerable variability was found between studies concerning the criteria used for defining respiratory depression and hypotension. The overall mean (95% confidence interval [CI]) incidence of respiratory depression of the three analgesic techniques was: 0.3 (0.1% to 1.3%) using requirement for naloxone as an indicator; 1.1 (0.7% to 1.7%) using hypoventilation as an indicator; 3.3 (1.4% to 7.6%) using hypercarbia as an indicator; and 17.0 (10.2% to 26.9%) using oxygen desaturation as an indicator. For i.m. analgesia, the mean (95% CI) reported incidence of respiratory depression varied between 0.8% (0.2% to 2.5%) and 37.0% (22.6% to 45.9%) using hypoventilation and oxygen desaturation, respectively, as indicators. For PCA, the mean (95% CI) reported incidence of respiratory depression varied between 1.2% (0.7% to 1.9%) and 11.5% (5.6% to 22.0%), using hypoventilation and oxygen desaturation, respectively, as indicators. For epidural analgesia, the mean (95% CI) reported incidence of respiratory depression varied between 1.1% (0.6% to 1.9%) and 15.1% (5.6% to 34.8%), using hypoventilation and oxygen desaturation, respectively, as indicators. The mean (95% CI) reported incidence of hypotension for i.m. analgesia was 3.8% (1.9% to 7.5%), for PCA 0.4% (0.1% to 1.9%) and for epidural analgesia 5.6% (3.0% to 10.2%). Whereas the incidence of respiratory depression decreased over the period 1980-1999, the incidence of hypotension did not.


Conclusions


The authors conclude that, assuming that a mixture of analgesic techniques is used, an incidence of respiratory depression, as defined by a low ventilatory frequency, of less than 1% would be expected, and an incidence of hypotension related to analgesic technique of less than 5%.


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ArticleDate:20040803
SiteSection: Abstracts



 
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