Epidural vs. systemic analgesia in the Intensive Care Unit: retrospective study of patient outcomes.

BACKGROUND: Patients admitted to the Intensive Care Unit (ICU) often experience acute pain. Causes include major surgery, multisystem trauma, and pancreatitis. Most ICU patients who require pain management are treated with systemic analgesia, usually intravenous opioids. This study compared the rate of pain and delirium scores, as well as mortality and morbidity between ICU patients treated with systemic vs. epidural analgesia.

METHODS: This retrospective analysis included patients who were in the ICU from January 2011 to June 2021, admitted due to thoracic, abdominal, pelvic, or lower limb surgery; pancreatitis; multiple rib fractures, or multisystem trauma. Data included demographics, admission parameters and indication, VAS score, Richmond Agitation and Sedation Score, in-hospital morbidity, and mortality, medical history, and medications.

RESULTS: There was no significant difference in demographics, chronic medications, and past illness, excluding chronic obstructive pulmonary disease, peripheral vascular disease, and past cerebral vascular disease. ICU length of stay was shorter in the epidural group, but overall hospital length of stay was not. Except for increased need for dialysis in the systemic analgesia group, disease severity was similar in both groups. The epidural group had fewer days on mechanical ventilation and lower 28-day mortality, as well as fewer episodes of delirium, although pain scores were similar. There was no difference between groups in the need for physical restraints or antipsychotics for delirium.

CONCLUSIONS: Epidural analgesia reduced the number of delirium events and was associated with a shorter ICU stay, fewer ventilation days and a lower mortality rate. Further research is needed to confirm these findings.