Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data

Br J Anaesth. 2008 Dec;101(6):832-40. doi: 10.1093/bja/aen300. Epub 2008 Oct 22.


Background: Approximately 30-80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem.

Methods: We analysed prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system.

Results: Of 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0-100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02%; 1:4741) or epidural abscess (0.014%; 1:7142) after PCEA was 1:2857 (0.04%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block.

Conclusions: We demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesia, Epidural / adverse effects
  • Analgesia, Epidural / standards
  • Analgesia, Epidural / statistics & numerical data
  • Analgesia, Patient-Controlled / adverse effects
  • Analgesia, Patient-Controlled / methods
  • Analgesia, Patient-Controlled / standards
  • Analgesia, Patient-Controlled / statistics & numerical data
  • Catheterization, Peripheral / adverse effects
  • Epidural Abscess / etiology
  • Female
  • Germany
  • Hematoma, Epidural, Spinal / etiology
  • Humans
  • Male
  • Meningitis, Bacterial / etiology
  • Middle Aged
  • Nerve Block / adverse effects
  • Nerve Block / standards
  • Nerve Block / statistics & numerical data
  • Pain Clinics / standards
  • Pain Clinics / statistics & numerical data
  • Pain Measurement / methods
  • Pain, Postoperative / prevention & control*
  • Pain, Postoperative / psychology
  • Patient Satisfaction*
  • Prospective Studies
  • Quality of Health Care*
  • Treatment Outcome