TITLE:
Epidural Analgesia Following Component Separation Hernia Repair: Is It Beneficial?
AUTHORS:
Emily L. Albright, Curtis E. Bower, Daniel L. Davenport, John S. Roth
KEYWORDS:
Hernia Repair; Separation of Components; Pain Management; Length of Stay
JOURNAL NAME:
Surgical Science,
Vol.4 No.7,
June
28,
2013
ABSTRACT:
Purpose: Optimal pain management strategies for patients undergoing component
separation hernia repair are not defined. Epidural analgesia (EA) has been shown
to decrease pulmonary complications and duration of ileus and to improve
pain control in other patient populations. In this study we examined outcomes
of patients receiving EA after separation of components (SOC). Methods: After obtaining
IRB approval, a retrospective review was performed of patients undergoing
ventral hernia repair with SOC from January 2006 to October 2010 at the
University of Kentucky. Patients were identified from hospital operative
records. Pre-operative patient characteristics and operative data were obtained
from the medical record. Information was collected relating to use of EA,
complications, and length of hospitalization (LOS). Post-operative outcomes were
compared between those that had epidurals and those that did not. Results: One hundred seventeen patients were identified that underwent SOC,
34 of whom had EA. These two groups were similar in relation to age, BMI, and
co-morbidities. Three patients in the epidural group had complications limiting
epidural duration—two with hypotension and one with refractory pruritus. There was no
difference in pneumonia, deep vein thrombosis (DVT), wound infection, urinary
tract infection (UTI), recurrence, or mortality (Table 1). There was an increase in LOS (6.68 vs. 6.06 days, p 0.01) in
patients with EA. Conclusions: The use of EA results in increased LOS in patients undergoing SOC.
EA associated morbidity occurs infrequently. The incidence of post-operative complications
is unaffected by EA. Further studies are needed to delineate the benefit of EA
in this patient population.