Epidural analgesia decreases intraabdominal pressure in postoperative patients with primary intra-abdominal hypertension

Acta Clin Belg. Mar-Apr 2008;63(2):86-92. doi: 10.1179/acb.2008.63.2.005.

Abstract

Introduction: Surgical decompression is a lifesaving procedure in patients with severe intraabdominal hypertension. However, it involves subsequent management of an open abdomen. Therefore, it is not recommended for moderate intra-abdominal hypertension. Our literature search did not show any studies relating the efficacy of epidural analgesia in decreasing elevated intraabdominal pressure (IAP) in critically-ill surgical patients with primary intra-abdominal hypertension.

Material and methods: Through a blinded prospective study, we investigated postoperative critically-ill surgical and trauma patients with primary intra-abdominal hypertension, who received postoperative thoracic epidural analgesia (n = 58) or intravenous opioid analgesia (n = 130). Patients in the epidural group received ropivacaine 0.2% 10 ml, followed by an infusion of 5 ml/h for 96 hours. Patients in the opioid group could receive morphine hydrochloride (0.1 mg/kg IV for every 4-6 hours as needed) with or without ketorolac trometamol (up to 90 mg/day IV). IAP was measured transvesically, for every 6 hours. Additionally, measurements immediately before and 1 hour after the initiation of epidural analgesia were taken. Abdominal Perfusion Pressure (APP) was calculated for each IAP measurement as APP = MAP - IAP where MAP is the mean arterial pressure.

Results: In the epidural group we found a consistent decrease in IAP from 16.82 +/- 4.56 to 6.30 +/- 3.11 mmHg and an increase in APP from 60.26 +/- 21.893 to 76.10 +/- 17.54 mmHg between baseline values until the second day of epidural analgesia, which remained stable afterwards. There were no significant differences of IAP and APP in the opioid group.

Conclusion: Continuous thoracic epidural analgesia decreases IAP and improves APP without haemodynamic compromise in postoperative critically-ill patients with primary intra-abdominal hypertension.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Abdomen / physiopathology*
  • Analgesia, Epidural / methods*
  • Compartment Syndromes / complications
  • Compartment Syndromes / physiopathology
  • Compartment Syndromes / therapy*
  • Critical Illness / therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pain, Postoperative / physiopathology
  • Pain, Postoperative / therapy*
  • Pressure
  • Prospective Studies
  • Treatment Outcome