¿Qué hemos aprendido de la notificación de incidentes de seguridad en el Bloque Quirúrgico?: estudio descriptivo transversal de 2 años de actividad de un grupo analizador multidisciplinar / What have we learned from reporting safety incidents in the Surgical Block?: Cross-sectional descriptive study of two-years of activity of a multidisciplinary analytical group

Antecedentes y objetivos: Los sistemas de notificación de incidentes (SNI) se consideran una herramienta que facilita el aprendizaje y la cultura de seguridad. Utilizando la experiencia adquirida con SENSAR, evaluamos la viabilidad y la actividad de un grupo multidisciplinar analizador de incidentes en el paciente quirúrgico notificados a un sistema general comunitario, el del Observatorio para la Seguridad del Paciente (OSP). Material y método: Estudio observacional descriptivo transversal planificado a 2 años. Previa formación en el análisis, se crea un grupo multidisciplinar en cuanto a especialidades y categorías profesionales, que analizarían los incidentes en el paciente quirúrgico notificados al OSP. Se clasifican los incidentes y se analizan sus circunstancias. Resultados: Entre los meses de marzo de 2015 y 2017 se notificaron 95 incidentes (4 por no profesionales). Los facultativos notificaron más que la enfermería, 54 (56,8%) vs. 37 (38,9%). La unidad que más notificó fue Anestesia con 46 (48,4%) (p=0,025). Los tipos de incidentes se relacionaron principalmente con el procedimiento asistencial (30,5%); el momento, con el preoperatorio (42,1%) y el lugar, con el área quirúrgica (48,4%), detectándose diferencias significativas en función de la filiación del notificante (p=0,03). No daño, o morbilidad menor, presentaron el 88% de los incidentes. Se identificaron errores en el 79%. El análisis de los incidentes dirigió las medidas a tomar. Conclusiones: La actividad que mantuvo el grupo multidisciplinar de análisis durante el periodo de estudio propició el conocimiento del sistema entre los profesionales y permitió identificar elementos de mejora en el Bloque Quirúrgico a diferentes niveles

Background and objectives: Incident Reporting Systems (IRS) are considered a tool that facilitates learning and safety culture. Using the experience gained with SENSAR, we evaluated the feasibility and the activity of a multidisciplinary group analyzing incidents in the surgical patient notified to a general community system, that of the Observatory for Patient Safety (OPS). Material and method: Cross-sectional observational study planned for two years. After training in the analysis, a multidisciplinary group was created in terms of specialties and professional categories, which would analyze the incidents in the surgical patient notified to the OPS. Incidents are classified and their circumstances analyzed. Results: Between March 2015 and 2017, 95 incidents were reported (4 by non-professionals). Doctors reported more than nurses, at 54 (56.84%) vs. 37 (38.94%). The anaesthesia unit reported most at 46 (48.42%) (P=.025). The types of incidents mainly related to the care procedure (30.52%); to the preoperative period (42.10%); and to the place, the surgical area (48.42%). Significant differences were detected according to the origin of the notifier (P=.03). No harm, or minor morbidity, constituted 88% of the incidents. Errors were identified in 79%. The analysis of the incidents directed the measures to be taken. Conclusions: The activity undertaken by the multidisciplinary analytical group during the period of study facilitated knowledge of the system among the professionals and enabled the identification of areas for improvement in the Surgical Block at different levels

What have we learned from reporting safety incidents in the Surgical Block?: Cross-sectional descriptive study of two-years of activity of a multidisciplinary analytical group. / ¿Qué hemos aprendido de la notificación de incidentes de seguridad en el Bloque Quirúrgico?: estudio descriptivo transversal de 2 años de actividad de un grupo analizador multidisciplinar.

BACKGROUND AND OBJECTIVES: Incident Reporting Systems (IRS) are considered a tool that facilitates learning and safety culture. Using the experience gained with SENSAR, we evaluated the feasibility and the activity of a multidisciplinary group analyzing incidents in the surgical patient notified to a general community system, that of the Observatory for Patient Safety (OPS). MATERIAL AND METHOD: Cross-sectional observational study planned for two years. After training in the analysis, a multidisciplinary group was created in terms of specialties and professional categories, which would analyze the incidents in the surgical patient notified to the OPS. Incidents are classified and their circumstances analyzed. RESULTS: Between March 2015 and 2017, 95 incidents were reported (4 by non-professionals). Doctors reported more than nurses, at 54 (56.84%) vs. 37 (38.94%). The anaesthesia unit reported most at 46 (48.42%) (P=.025). The types of incidents mainly related to the care procedure (30.52%); to the preoperative period (42.10%); and to the place, the surgical area (48.42%). Significant differences were detected according to the origin of the notifier (P=.03). No harm, or minor morbidity, constituted 88% of the incidents. Errors were identified in 79%. The analysis of the incidents directed the measures to be taken. CONCLUSIONS: The activity undertaken by the multidisciplinary analytical group during the period of study facilitated knowledge of the system among the professionals and enabled the identification of areas for improvement in the Surgical Block at different levels.

Encuesta nacional sobre dolor en las urgencias hospitalarias / National survey on acute pain in emergency services

Objective: To determine the epidemiology and management of acute pain in the emergency services (ES) of Spanish hospitals. Method: Survey "on line" to doctors responsible for the ES from a sample of different types of hospital across the country. Aspects of pain epidemiology, assessment, institutional resources, types of treatments and specific training aspects in pain practitioners in the field of ES are investigated. Results: With a response rate of 37 % is estimated that 42.8 % of patients come to the ES with pain as the main reason. Musculoskeletal pain is the most represented and more intense. Is usually assessed by scales in 58.3 % of hospitals, although only 23.9 % have specific documentation to do so. Major opioids are used in 16.9 % of patients with pain, weak opioids in 25.4 % and acetaminofen/NSAID 72.3 %. Possess analgesic protocols refer 46.3 %, and acute pain services or institutional pain programs (APS-IPP) 13.4 %. Only 20.9 % of the hospitals have specific training activity in this area. With few differences between them, hospitals with APS-IPP tend to evaluate and document the pain, using more opioids and protocols, while providing more training. Conclusion: Pain is still present and is underevaluated in the ES. At the institutional and individual level there is ample room for improvement in this field must consider new strategies, attitudes and organizational solutions (AU)

Objetivo: Conocer aspectos epidemiológicos y del manejo del dolor agudo en los servicios de urgencia (SU) de los hospitales españoles. Método: Encuesta on line a los responsables médicos de los SU de una muestra de diferentes tipos de hospitales de todo el territorio nacional. Se investigan aspectos relativos a la epidemiología del dolor, evaluación, recursos institucionales, tipos de tratamientos y aspectos formativos específicos en dolor de los profesionales en el ámbito de los SU.Resultados: Con una tasa de respuesta del 37 % se estima que el 42,8 % de los pacientes acuden a los SU con dolor como principal motivo. El dolor músculo-esquelético es el más representado y de mayor intensidad. Se evalúa habitualmente mediante escalas en el 58,3 % de los hospitales, aunque sólo el 23,9 % tienen documentación específica para hacerlo. Opioides mayores se utilizan en el 16,9 % de los pacientes con dolor, opioides débiles en el 25,4 % y paracetamol/AINE en el 72,3 %. Refieren poseer protocolos analgésicos el 46,3 % y unidades de dolor agudo o programas institucionales de dolor (UDA-PID) el 13,4 %. Sólo el 20,9 % de los hospitales realiza actividad formativa específica en este ámbito. Con escasas diferencias entre centros, los hospitales con UDA-PID tienden a evaluar y documentar más el dolor, utilizan más los opioides mayores, los protocolos y facilitan más la formación. Conclusión: El dolor sigue estando presente y es infravalorado en los SU. A nivel institucional e individual existe un amplio margen de mejora en este campo que habrá de contemplar estrategias, actitudes y soluciones organizativas (AU)

Analgesia epidural para el trabajo de parto en gestante con esclerosis múltiple / Epidural analgesia during labour of a patient with multiple sclerosis

La Esclerosis Múltiple (EM), es una enfermedad del SNC siendo 2 veces más frecuente su aparición en mujeres, el 70% de ellas en edad fértil. Desde el punto de vista anestésico nos encontramos ante una enfermedad con elevada susceptibilidad neurológica que podría agravarse tanto por la propia cirugía, la técnica anestésica como por la medicación utilizada. Por otra parte se plantea como atender la demanda de analgesia para el trabajo de parto en mujeres con EM, que es el grupo de edad con mayor incidencia de la enfermedad. Presentamos el caso de una mujer de 37 años diagnosticada de esclerosis múltiples 3 años antes, forma recidivante, remitente. La paciente es ingresada en dilatación con 37 semanas de amenorrea, presentando una buena evolución del trabajo de parto y encontrándose el feto en situación longitudinal y presentación cefálica. Avisan al Servicio de Anestesia para valoración de la indicación de epidural para analgesia del parto. La gestante previamente había acudido a consulta de preanestesia donde se le había informado del riesgo beneficio de la técnica y en concreto en su caso, habiendo entendido perfectamente las posibles complicaciones derivadas de la misma y firmado el consentimiento informado. Nosotros hemos preferido utilizar una técnica locoregional, vía epidural considerando también el riesgo potencial de cesárea urgente, para evitar, dado el caso la realización de una técnica intraraquídea o una anestesia general, con las posibilidades de desencadenar un brote que tienen estas técnicas. Además de aportar confort a la paciente durante el trabajo de parto, proporcionar analgesia durante el mismo, disminuye por este motivo el estrés de la gestante pudiendo paralelamente evitar la aparición de un brote (AU)

Multiple sclerosis (MS) is a disease of the central nervous system (CNS), and twice as prevalent in women, 70% of whom are of fertile age. From an anaesthetics point of view, due to it being a disease with a high neurological susceptibility it can be aggravated by, the surgery itself, the anaesthetic technique and the medication used. On the other hand, it is about how to meet the demand for analgesia during labour by women with MS, which is the age group with a higher incidence of the disease. We present the case of a 37 year-old woman who was diagnosed 3 years before with a remitting, recurring Multiple Sclerosis. The patient was admitted in dilation in the 37th week of gestation. Labour was progressing well and the foetus was in a longitudinal lie and cephalic presentation. The Anaesthesia Department was informed to assess the indication of an epidural for analgesia during labour. The patient had been seen previously in a pre-anaesthesia clinic were she was informed of the risks and benefits of the technique and in her case in particular. Having understood the possible complications arising from this, she had signed the informed consent. We prefer to use the local/regional epidural technique, bearing in mind the potential risk of an urgent caesarean. This is also to avoid, as is the cases when performing an intra-spinal technique or general anaesthesia, the possibilities of triggering a rash, which can occur with these techniques. Besides giving comfort to the patient during labour, it provides analgesia, and for this reason reduces stress in the patient, as well as being able to prevent a rash appearing (AU)

[Cost-effectiveness analysis of patient-controlled analgesia compared to continuous elastomeric pump infusion of tramadol and metamizole]. / Análisis coste-efectividad de la PCA postoperatoria frente a la infusión continua elastomérica de tramadol y metamizol.

OBJECTIVES: Little information is available on the cost-effectiveness of postoperative patient-controlled analgesia (PCA). The present study compared PCA to continuous infusion by elastomeric pump. MATERIAL AND METHODS: Fifty ASA 1 or 2 patients undergoing major gynecologic surgery were enrolled for a randomized controlled trial to evaluate the effectiveness and costs derived from intravenous PCA with metamizole and tramadol compared to continuous infusion of the same analgesic solution by elastomeric pump in the 48 hours following surgery. Patient satisfaction and side effects were also recorded. RESULTS: The analgesic effectiveness and side effects of the 2 regimens were similar, although 61% of patients in the elastomeric pump group needed morphine for rescue analgesia compared to 33% in the PCA group (P < .05). In the PCA group, 81% of the patients said they would repeat the analgesic treatment compared to only 56% in the elastomeric pump group (P = .05). The mean number of nursing interventions was 16 for the PCA group and 19 for the elastomeric pump group. The mean cost of the treatment (not including the PCA pump, provided by the manufacturer) was Euros 41.35 for the PCA group and Euros 56.22 for the elastomeric pump group. CONCLUSIONS: The analgesic efficacy of the 2 regimens was similar. However, patient satisfaction was greater with PCA and use of an elastomeric pump was more expensive. In the setting of the present study, postoperative PCA proved to be more advantageous than continuous elastomeric pump infusion.

Análisis coste-efectividad de la PCA postoperatoria frente a la infusión continua elastomérica de tramadol y metamizol / Cost-effectiveness of patient-controlled analgesia compared to continuous elastomeric pump infusion of tramadol and metamizole

OBJETIVOS: Existen pocos datos relativos al coste-efectividad de los sistemas de analgesia controlada por el paciente (PCA) en el postoperatorio. El presente estudio compara desde esta perspectiva la PCA con una infusión elastomérica continua. MATERIAL Y MÉTODO: Estudio prospectivo, controlado y aleatorizado en 50 pacientes ASA I o II sometidas a cirugía mayor ginecológica, que evalúa durante las primeras 48 horas de postoperatorio la efectividad, los efectos secundarios, la satisfacción y los costes derivados de la administración de una pauta PCA i.v de metamizol y tramadol (Grupo PCA), frente a la infusión elastomérica continua de la misma solución analgésica (Grupo Elastómero). RESULTADOS: La efectividad analgésica y los efectos secundarios de las pautas fueron similares, aunque más pacientes del Grupo Elastómero precisaron rescates analgésicos con morfina (61% frente al 33% del grupo PCA; p < 0,05). El 81% de las pacientes del Grupo PCA repetirían el tratamiento analgésico frente a sólo el 56% del grupo Elastómero -p = 0,05-). El número medio de intervenciones de enfermería fue de 16 y 19 para los grupos PCA y Elastómero respectivamente. Los gastos medios de los tratamientos (no incluida la bomba PCA facilitada por la industria) ascendieron en el grupo PCA a 41,35 euros frente a los 56,22 euros del grupo Elastómero. CONCLUSIONES: Ambas pautas presentaron una eficacia analgésica parecida aunque la PCA resultó más satisfactoria, a la vez que el elastómero fue más caro. En las condiciones particulares de nuestro estudio la PCA postoperatoria resultó más ventajosa que la infusión continua elastomérica (AU)

OBJECTIVES: Little information is available on the cost-effectiveness of postoperative patient-controlled analgesia (PCA). The present study compared PCA to continuous infusion by elastomeric pump. MATERIAL AND METHODS: Fifty ASA 1 or 2 patients undergoing major gynecologic surgery were enrolled for a randomized controlled trial to evaluate the effectiveness and costs derived from intravenous PCA with metamizole and tramadol compared to continuous infusion of the same analgesic solution by elastomeric pump in the 48 hours following surgery. Patient satisfaction and side effects were also recorded. RESULTS: The analgesic effectiveness and side effects of the 2 regimens were similar, although 61% of patients in the elastomeric pump group needed morphine for rescue analgesia compared to 33% in the PCA group (P<.05). In the PCA group, 81% of the patients said they would repeat the analgesic treatment compared to only 56% in the elastomeric pump group (P=.05). The mean number of nursing interventions was 16 for the PCA group and 19 for the elastomeric pump group. The mean cost of the treatment (not including the PCA pump, provided by the manufacturer) was €41.35 for the PCA group and €56.22 for the elastomeric pump group. CONCLUSIONS: The analgesic efficacy of the 2 regimens was similar. However, patient satisfaction was greater with PCA and use of an elastomeric pump was more expensive. In the setting of the present study, postoperative PCA proved to be more advantageous than continuous elastomeric pump infusion (AU)

[Prospective study of prevalence and risk factors for painful phantom limb in the immediate postoperative period of patients undergoing amputation for chronic arterial ischemia]. / Estudio prospectivo de la prevalencia y factores de riesgo de miembro fantasma doloroso en el postoperatorio inmediato de pacientes sometidos a amputación por isquemia arterial crónica.

OBJECTIVE: To determine the prevalence and risk factors associated with postoperative phantom limb pain (PLP) in patients amputated for chronic ischemia of a lower limb. PATIENTS AND METHOD: Prospective, longitudinal, epidemiological study of patients amputated for chronic grade IV ischemia. PLP, defined as the perception of pain > or = 3 on a verbal scale of 0 to 10, was assessed in the first week after surgery. Candidate risk factors analyzed were patient characteristics, course of ischemic disease, and features of surgery or anesthetic technique. RESULTS: The prevalence of PLP was 26% (14 patients) in a total of 53 amputations performed on the same number of patients over one year. Mean patient age was 68.4 +/- 11.2 years, and 45 (84.9%) were diabetics. Phantom limbs were felt by 9 patients (17%), and a painful stump was reported by 5 (10%). The most common PLP symptoms were a burning sensation and painful paresthesia. Risk factors identified, in order of statistical significance, were prior amputation (p < 0.0002), oral antidiabetic therapy (p < 0.02) and type of amputation (p = 0.05). Logistic regression analysis of variables revealed increased risk of PLP in patients with a prior amputation (odds ratio [OR] 8.1) and those receiving oral antidiabetic therapy (OR 3.9). Insulin treatment was a protective factor (OR 0.5). CONCLUSIONS: The prevalence of PLP among patients with chronic ischemia of the lower limb in our setting is considerable, although low in comparison to the prevalence reported for other settings. Identifying risk factors such as those described in this study helps to establish the profile of patients toward whom to direct measures to prevent PLP.

Estudio prospectivo de la prevalencia y factores de riesgo de miembro fantasma doloroso en el postoperatorio inmediato de pacientes sometidos a amputación por isquemia arterial crónica / Prospective study of the prevalence and risk factors of early postoperative phantom limb pain after amputation for chronic arterial ischemia

Objetivo: Determinar la prevalencia y los factores de riesgo asociados a la presentación de miembro fantasma doloroso (MFD) postoperatorio en pacientes amputados por isquemia crónica del miembro inferior. Pacientes y método: Estudio epidemiológico, longitudinal y prospectivo en pacientes amputados por isquemia crónica grado IV. Evaluados en la primera semana del postoperatorio, definimos MFD como la percepción dolorosa (dolor 3, en una escala verbal de 0 a 10). Los posibles factores de riesgo los agrupamos en torno a las características de los pacientes, evolución de la propia enfermedad isquémica y las relativas a la intervención y la anestesia. Resultados: En un total de 53 amputaciones realizadas en un año sobre un número equivalente de pacientes con una edad media de 68,4ñ11,2 años, de los cuales 45 (84,9 por ciento) eran diabéticos, determinamos una prevalencia de MFD del 26 por ciento (14 pacientes). Miembro fantasma se presentó en 9 (17 por ciento), mientras que muñón doloroso se observó en 5 (10 por ciento). Las formas más frecuentes de presentación del MFD fueron el dolor quemante y las parestesias dolorosas. Los factores de riesgo identificados en orden de potencia estadística fueron: las amputaciones previas (p < 0,0002), el tratamiento con antidiabéticos orales (p < 0,02) y el tipo de amputación (p = 0,05). El estudio multivariable mediante regresión logística determinó un incremento del riesgo relativo de MFD en pacientes con amputación previa [odds ratio (OR)] de 8,1 veces y de 3,9 para los que recibían tratamiento con antidiabéticos orales. El tratamiento con insulina se reveló como un factor protector (OR: 0,5). Conclusiones: La prevalencia en nuestro medio del MFD en pacientes con isquemia crónica de extremidades inferiores, aun siendo baja en relación con otras situaciones clínicas, no es nada despreciable. La identificación de factores de riesgo, como los descritos, nos permite establecer el perfil del paciente hacia quien dirigir los mayores esfuerzos preventivos de esta complicación. (AU)

[Multivariate study of risk factors for arterial hypotension in pregnant patients at term undergoing Caesarean section under subarachnoid anesthesia]. / Estudio multivariable de factores de riesgo de hipotensión arterial en gestantes a término intervenidas de cesárea bajo anestesia subaracnoidea.

OBJECTIVES: The most common and potentially dangerous complication of spinal anesthesia for cesarean section is arterial hypotension. The aim of this study was to analyze maternal and gestational factors that might affect risk of arterial hypotension in full-term parturients undergoing cesarean section. MATERIAL AND METHOD: We enrolled full-term parturients scheduled for elective cesarean section under spinal anesthesia. Spinal puncture was performed at L2-L3 using an atraumatic Sprotte-type needle. We administered 12.5 mg of hyperbaric 0.5% bupivacaine and 12.5 micrograms of fentanyl. Arterial hypotension was defined as a decrease in systolic pressure of at least 20% or a decrease to a pressure below 100 mmHg. Multivariate analysis was performed to identify factors related to the presentation of hypotension appearing in the interval between spinal puncture and birth. RESULTS: The incidence of arterial hypotension was 33.3%. Statistical analysis revealed that integrity of the amniotic sac, parity and elective cesarean were significantly associated with a higher incidence of arterial hypotension (p < 0.03). CONCLUSIONS: Identifying risk for multiparous parturients with intact amniotic sacs scheduled for elective cesarean can be worthwhile if greater preventive measures are taken in such patients to reduce the incidence and intensity of arterial hypotension.

Estudio multivariable de factores de riesgo de hipotensión arterial en gestantes a término intervenidas de cesárea bajo anestesia subaracnoidea / Multivariate study of risk factors for hypotension during full-term delivery by cesarean section under spinal anesthesia

Objetivos. La complicación más frecuente, y potencialmente peligrosa, de la anestesia subaracnoidea en la cesárea es la hipotensión arterial. El objetivo del estudio es analizar los factores maternos y de la gestación que pueden determinar el riesgo de hipotensión arterial en mujeres gestantes a término que finalizan su embarazo mediante intervención cesárea. Material y método. Se incluyeron aquellas gestantes a término programadas para cesárea que se realizaron bajo anestesia subaracnoidea. La punción dural se practicó en L2-L3 con aguja atraumática tipo Sprotte y se administraron conjuntamente 12,5 mg de bupivacaína hiperbárica al 0,5 por ciento y 12,5 µg de fentanilo, definiendo como hipotensión arterial al descenso de la TAS igual o superior al 20 por ciento, o un valor inferior a 100 mmHg. Se realizó un análisis discriminante multivariable para determinar los factores relacionados con la presentación de hipotensión arterial en el tiempo transcurrido entre la punción subaracnoidea y el nacimiento del feto. Resultados. La incidencia de hipotensión arterial fue del 33,3 por ciento. El análisis estadístico determinó de forma significativa que la integridad de la bolsa amniótica, la paridad y el carácter electivo de la cesárea se asociaron con la mayor incidencia de hipotensión arterial (p < 0,03).Conclusiones. La identificación como grupo de riesgo de las mujeres multíparas con bolsa amniótica íntegra y programadas para cesárea electiva puede conllevar un beneficio si se intensifican en estas pacientes las medidas preventivas que disminuyen la incidencia e intensidad de la hipotensión arterial (AU)

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[Sleep apnea syndromes in adults and its anesthesiologic repercussions]. / El síndrome de apnea del sueño en el adulto y sus repercusiones anestesiológicas.

Adult sleep apnea syndrome is a common condition characterized by repeated apneic events during sleep, producing hypoxia, a potentially neurovegetative response and loss of normal sleep structure. Important pathophysiological repercussions can ensue. Adults with sleep apnea syndrome have particular upper airway sensitivity to sedatives, muscle relaxants, anesthetic agents and narcotic analgesics, potentially compromising the anesthetic management of such patients, among whom serious respiratory complications have been reported. This review describes current data for prevalence, etiopathogenesis, pathophysiological consequences, and the diagnosis and treatment of various forms of the syndrome. Also described is the approach to anesthetic care before, during and after surgery related to the specific condition or not.

[Incidence of post-dural puncture headache using the 24G "pencil tip" needle. Prospective study in 100 young patients]. / Incidencia de cefalea pospunción dural con la utilización de la aguja "punta de lápiz" 24G. Estudio prospectivo en 100 pacientes jóvenes.

We studied the incidence of headache after dural punction using a "pencil-tip" 24G needle in 100 patients aged 15 to 55 years (mean 31.4 years) undergoing surgical interventions that allowed early physical activity. The study variables were age, sex, anesthetic agent, and previous history of headache. All patients received 1,500 ml of Ringer lactate during the peroperative period and after 48 hours the presence of headache was investigated. Headache was not observed in any case. We conclude that the pencil-tip 24G needle has been effective in the prevention of headache after dural punction particularly in young patients, who are traditionally considered to be at risk.

[Epidural perfusion with fentanyl in the treatment of postoperative pain]. / Perfusión epidural de fentanilo en el tratamiento del dolor postoperatorio.

In 40 patients with high abdominal surgery the analgesia achieved with continuous epidural phentanyl infusion was evaluated. Treatment was started when the patients had pain, with the injection of 150 micrograms of phentanyl in 18 ml of saline and going on with the infusion. The patients were divided in 4 groups. Each received a different infusion dose. The variables pain, alertness, pO2, pCO2 and hemodynamic status at the beginning of infusion and after 6, 18 and 24 hours were evaluated. All patients had an adequate postoperative analgesia. In the statistical analysis the only significant difference was an increase in pCO2 after 24 h in the patients who received the highest doses. The incidence of nausea and vomiting was 10%, with 13.04% of urinary retention Clinical respiratory depression was not observed. We think that administration of 150 micrograms of epidural phentanyl followed by a continuous epidural infusion of the drug (0.5 microgram/kg/hour in 5 ml of saline) is an adequate technique of postoperative analgesia.