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Document Details : Title: Epidural analgesia decreases intra-abdominal pressure in postoperative patients with primary intra-abdominal hypertension Author(s): HAKOBYAN RV, MKHOYAN GG Journal: Acta Clinica Belgica Volume: 63 Issue: 2 Date: 2008 Pages: 86-92 DOI: 10.2143/ACB.63.2.1002549 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. |
