Epidural vs. Systemic Analgesia in the Intensive Care Unit
Status:
Not yet recruiting
Trial end date:
2024-08-01
Target enrollment:
Participant gender:
Summary
Many patients admitted to the general intensive care unit suffer from pain, whether acute or
chronic. Those patients include post-operative patients, multi trauma, acute pancreatitis and
patients with multiple rib fractures. Most patients in the intensive care unit, whether
intubated and ventilated or not, are treated with systemic analgesic drugs, usually given
intravenously, enterally, or trans dermally (fentanyl patches).
Continuous epidural anesthesia has been shown in several studies to have an advantage over
systemic analgesia in specific conditions, such as pancreatitis, multiple rib fractures and
upper abdominal surgeries. Some of its benefits include improved gastrointestinal motility
(reduction of ileus rates), decreased thromboembolic events (DVT) and better quality of pain
control. In intubated and ventilated patients, continuous epidural anesthesia may reduce the
amount of required systemic sedation. Reducing the amount of sedation may contribute to a
decrease in delirium rates, shortening the time to extubation and reducing other adverse
effects associated with high requirements of sedation drugs (such as a decrease in blood
pressure).
Most of the studies comparing systemic analgesia to epidural analgesia examined a population
of patients hospitalized in the surgical ward, post breast, abdominal or orthopedic surgeries
of the pelvis and lower extremities, or due to other conditions such as pancreatitis or
multiple rib fractures. There are almost no studies that have examined the effectiveness of
epidural analgesia in patients admitted to the intensive care unit, including sedated and
ventilated patients, compared with systemic analgesia.
From 2011 until today, our intensive care unit has admitted about 300 patients who were
treated with continuous epidural analgesia. In this study we would like to compare them to
another group of patients (about 300 patients as well), who were admitted to the unit for
similar etiologies (post-operative, multi- trauma, pancreatitis, etc.), and to observe
differences between the groups. We would like to examine differences in mortality within 28
days, as well as differences in morbidity, such as the level of analgesia and delirium rates
between groups.