1277 Audit: Patient-Controlled Epidural Analgesia vs. Continuous Infusion

Aim Investigating and quantifying continuous infusions require post-operatively. Determining the agent of choice in epidural top-ups. Investigating Diamorphine dosing in epidural infusions peri-operatively and post-operatively. Method Retrospective cross-sectional study. A comprehensive literature review utilizing PubMed, where exclusion criteria involved including only ‘free full text’ and publications released in the last decade. Data from operations requiring continuous analgesic infusion from the previous year was collected via spreadsheet software, and statistically analysed. Results In a study of 70 surgical patients receiving peri-operative and post-operative epidural analgesia, the average duration of epidural use was 3 days, with an average of 1.77 top-ups per patient. Of these patients, 36 required top-ups, primarily using Levobupivacaine (53.98%) and Diamorphine (46.02%). Levobupivacaine frequency increased with more top-ups, whilst fewer top-ups were required with Diamorphine. In intra-operative continuous epidural infusion, Diamorphine doses of 10mg were most common, with 15mg as the second preferred dose, correlating with lower top-up frequencies. Conclusions Introducing patient-controlled epidural analgesia (PCEA) in our surgical department would allow manual Levobupivacaine dosing to be replaced by patient self-administration, reducing clinician input by 54%. This hybrid approach, termed 'continuous infusion with demand dosing,' involves a background infusion set by the anaesthetist and supplemented by patient demand. PCEAs offer immediate pain relief and a dose-sparing effect of ∼47% of local anaesthetic. Transitioning from continuous epidural infusions to PCEA could significantly reduce healthcare staff intervention in post-operative pain management by at least 50%, simplifying the process and potentially introducing a Diamorphine dosing protocol for enhanced safety and consistency.