Objective: The objective of this study was to determine how intrathecal narcotic use impacts the postoperative\r\ncourse of patients undergoing major gynecologic oncologic procedures. The endpoints evaluated were toxicity and\r\npostoperative length of stay.\r\nMethods: This was a retrospective chart review of 598 patients who underwent major abdominal surgery and\r\nreceived intrathecal narcotics for post-operative pain control during a 49 month period at St. Vincent Hospital. Charts\r\nwere reviewed to determine the incidence of specific toxicities and postoperative length of stay.\r\nResults: The median length of stay for all patients was four days postoperatively, and 92.8% of patients fell\r\nwithin one standard deviation of the mean (mean of five days). Nausea occurred in 427 patients (71.4%). The total\r\nnumber of patients treated for pruritis was 280 (46.8%). Respiratory depression occurred in 14 patients (2.3%). Six\r\npatients (1.0%) were considered to have post-dural puncture headaches, and four (0.67%) required epidural blood\r\npatches. Hypotension was observed in 11 patients (1.8%) in the 30-minute period following intrathecal narcotic\r\nadministration, in 69 patients (11.5%) in the intraoperative period, and in 40 patients (6.7%) in the postoperative\r\nperiod. Twenty patients out of 535 (3.7%) experienced urinary retention, while 63 patients were inevaluable for\r\nurinary retention secondary to suprapubic catheter placement during radical hysterectomy (54) or discharge from\r\nhospital with a Foley catheter in place due to intraoperative cystotomy (9).\r\nConclusions: Intrathecal narcotics are a safe method of postoperative pain management with limited toxicity\r\nand do not appear to lengthen postoperative hospital stay.
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