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Epidural analgesia is the recommended analgesic technique in patients having surgery with severe postoperative pain such as thoracic and upper abdominal surgery. However, from the previous study, the incidence of inadequate pain control in patients receiving epidural analgesia is very high 48.6% in our hospital.
A high incidence of inadequate epidural analgesia may result from variety of epidural techniques and epidural drug administrations. The protocol based practice has been developed from acute pain service which founded for more than 10 years. By using protocol based practice, the investigators believed that the incidence of inadequate epidural analgesia will be less compared with the current practice.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Current practice | Other | Epidural insertion and epidural drug administration depend on anesthetist in charge |
|
| Protocol based | Experimental | Epidural insertion and epidural drug administration depend on anesthetist in research team using protocol based |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Current practice | Drug | Epidural insertion and epidural drug administration depend on anesthetist in charge |
|
| Measure | Description | Time Frame |
|---|---|---|
| Overall incidence of inadequate epidural analgesia | To compare the overall incidence of inadequate epidural analgesia until considered removal between protocol-based and current practice by using the definition of inadequate analgesia as pain score of 4 or more out of 10 on numeric rating scale (0; no pain, 10; worst imaginable pain) at rest. | 72 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Side effects | To compare the incidence of undesirable side effects of epidural catheter between groups: sedation, respiratory depression, hypotension, motor weakness, postoperative nausea and vomiting and pruritus | 72 hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Pawinee Pangthipampai, M.D. | Siriraj Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Siriraj hospital | Bangkok | 10700 | Thailand |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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Historical control study (Before and after study) Data in current practice was derived from acute pain record before Jan 2019
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| Protocol based | Drug | Epidural insertion and epidural drug administration depend on anesthetist in research team using protocol based
|
|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |