Date of Award
Master of Science (MS)
Post-operative pain control continues to be a concern among anesthesia providers and patients alike. The ability to control the pain by utilizing different treatment modalities has been a point of interest by anesthesia providers in order to provide the best care possible to their patients. The use of epidural anesthesia/analgesia (EA) has increased in the last two decades; however, it still seems to be underutilized for several major abdominal surgeries such as total abdominal hysterectomy (TAH). The purpose of this study was to determine if the use of epidural anesthesia or analgesia in the postoperative period provides better pain control than intravenous opioids alone in patients undergoing abdominal hysterectomy.
The research framework was guided by Dorthea Orem’s (1991) self-care deficit theory regarding the ability of the patient to begin independent functioning following surgery. Pain is a major inhibitor in the optimal functioning of patients, and has a wide array of effects on the systems of the body. The use of large amounts of IV opioids and their side effects also inhibits optimal independence. The use of epidural anesthesia/analgesia has the ability of creating pain relief without taking away the patient’s ability to function with their activities of daily living. Prior research suggests that the use of EA has many positive effects beyond superior pain control for the patient undergoing surgery, promoting their independence. The numeric rating scale (NRS) was utilized as the indicator of a patient’s pain following surgery. Optimal independence was measured by the patient’s ability to function and meet discharge criteria to go home following surgery. Days to discharge post-operatively were recorded to examine if there was a difference in the patients who received EA and those who received IV opioids only. Demographic variables included age, American Association of Anesthesiologists (ASA) classification, reason for surgery, height, weight, number of pregnancies, and amount of time documented for anesthesia, surgery and recovery.
The study was descriptive and inferential in nature, and entailed a retrospective chart review of 40 randomly selected patients’ medical records. The records were taken from a 99-bed Midwestern acute care hospital that utilized the use of EA for postoperative pain control with TAH patients. Significance level was set to be at 0.05 or less.
The results of the study only found one area of interest to be statistically significant between the (EA) group and the intravenous (IV) group. With a t-test, the reported pain level 15 minutes post-operatively between the EA and IV groups was statistically significant at level 0.05, (p = 0.00, df = 38, and t = 4.64). All other data collected and analyzed with respect to the use or non-use of (EA) was determined to be not statistically significant. Trends were seen; however, in the mean reported values of pain with the use of EA at 6 hours, 12 hours, and 24 hours post-operatively. A t-test showed there was no relationship between the use of EA and non-use of EA in postoperative length of stay. Pearson’s Product Moment Correlation and Chi-square were used to evaluate an association between demographic variables and levels of reported pain, and length of stay post-operatively, but did not show any statistical significance.
Hanson, Dane C., "Comparison of Epidural Analgesia Vs. Intravenous Opioids in Providing Post-Operative Pain Control and Decreased Length of Stay in Patients Undergoing Abdominal Hysterectomy" (2005). Theses and Dissertations. 3161.