Epidural Analgesia Following Component Separation Hernia Repair: Is It Beneficial?

Abstract

Purpose: Optimal pain management strategies for patients undergoing component separation hernia repair are not de fined. Epidural analgesia (EA) has been shown to decrease pulmonary complications and duration of ileus and to im prove 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 hospi talization (LOS). Post-operative outcomes were compared between those that had epidurals and those that did not. Re sults: 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 com plications is unaffected by EA. Further studies are needed to delineate the benefit of EA in this patient population.