ESRA19-0669 Comparison of the efficacy of epidural diamorphine and fentanyl in combination with local anaesthetic for post-operative pain relief

Background and aims Epidural analgesia is provided by variety of drugs. Use of epidural local anaesthetic alone may result in excessive motor blockade and epidural opioids alone have not demonstrated advantage over parenteral opioids. Evidence suggests there is no significant difference between epidural diamorphine and fentanyl for post-operative analgesia. The audit aimed to assess the efficacy of our current epidural drug combination (bupivacaine 0.1%, diamorphine 5mcg/ml) compared to an alternative (levobupivacaine 0.125%, fentanyl 4mcg/ml). Methods 50 patients were analysed in each group. All patients received patient-controlled epidural analgesia via continuous infusion. Data was collected retrospectively from epidural charts. Median, worst pain score at rest and movement over 0–24 hours and 24–48 hours were analysed. Data was also collected for any side effects, requirement of additional top-ups and patient satisfaction. Results Operations varied from hepato-biliary, vascular and major colorectal surgery. During the first 24 hours pain scores were comparable in both groups, with most patients having none to mild pain. At 48 hours the fentanyl group had a significantly higher number of patients experiencing severe pain on movement compared to the diamorphine. There were fewer patients who required epidural top-up in recovery in the fentanyl group compared to the diamorphine. the ward top-ups and side effects were similar in both groups. Patient satisfaction was same in both groups with majority of patients rating good pain relief. Conclusions With the prescribed doses, diamorphine appears to provide better pain control than fentanyl for epidural analgesia in this small cohort of patients. Effect on patient outcome and length of stay remains to be investigated.