A COMPARISON OF EPIDURALS AND ABDOMINAL WALL NERVE BLOCK CATHETERS: QUANTIFYING CLINICIAN ACUTE PAIN SERVICE WORK USING PAGES

 

Introduction

o    Epidural catheters for open abdominal incisions have been challenged by abdominal wall nerve blocks and multimodal analgesia as the gold standard[1]

o    While several studies have compared the clinical efficacy of epidurals and abdominal wall blocks [2–4], few studies consider the amount of work required to care for these patient populations postoperatively.

o    Aim: Compare estimates of clinical work by an acute pain service in caring for patients with either epidurals or abdominal wall blocks.

o    Hypothesis: Epidural catheters, because of their location in the neuraxial space, will take more clinical work than abdominal wall catheters.

Materials and Methods

o    Population: open abdominal surgery patients with epidural or abdominal wall nerve block catheters

o    Measure: Pages compiled for these patients, categorized with estimated time to respond (conservative + realistic) based on consensus of senior physicians and prior analysis of similar service at our institution  [5] (Table 1)

o    Analysis: Estimated times to care for epidural vs abdominal wall nerve blocks compared using U-Mann-Whitney

Discussion

o    There were more pages received overall regarding patients with epidural analgesia; however, there was not a significant difference between the median time spent per day of treatment between epidurals and nerve block catheters

o    This suggests, despite more daily pages,  there is a minimal difference in daily time spent on caring for these patients postoperatively

o    Overall incidence of pages regarding epidurals or nerve block catheters was low with less than one page per treatment day

o    Largest amount of care time was spent on daily rounding.

o    Nerve block catheters used longer than epidurals in this patient population.

o    Further investigation is warranted whether, by extension, nerve blocks necessitate more care time cumulatively