Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery.

Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were measured at supine rest, during orthostatic stress, and after walking prior to and 24, 48, and 72 h and 48 h postoperatively compared to preoperatively (P < or = 0.008); 16 vs 6 patients presented resting systolic BP values < 100 mm Hg (lower range, 70 mm Hg) post- versus preoperatively (P = 0.048). During orthostatic stress the decrease in systolic BP and concomitant increase in HR was similar post- versus preoperatively (BP, P > 0.3; HR, P > 0.34) and 12 vs 8 patient; (P = 0.45) experienced a systolic BP decrease > 20 mm Hg post- versus preoperatively. After walking, systolic BP was significantly lower postoperatively compared with preoperatively (P < or = 0.01). Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients.

[Acute pain service--another in-hospital specialty?]. / Akut smerteservice--endnu en udspecialisering i hospitalet?

Realizing that achievement in postoperative pain treatment was not satisfactory, central health authorities in USA, United Kingdom and Australia have published guidelines for managing acute pain. Establishing acute pain services is thought to be one of the means of improving pain relief in the individual patient. Development and research are secured and achieved results may be presented currently. At this moment, introduction of acute pain services is at a preliminary stage in Denmark, and consequently an overview of results obtained from abroad is given including pain treatment techniques, management and safety measures, as well as visions concerning the impact of optimal pain relief upon convalescence. We conclude that the introduction of acute pain services is bound to optimize postoperative patient care and might well prove to be a significant factor in reducing postoperative morbidity.