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Epidural analgesia after abdominal surgery

Mrinalini Balki, Archana Malavade, Xiang Y Ye, Umamaheswary Tharmaratnam
PURPOSE: This study examined the concordance between epidural electrical stimulation test (EEST) and local anesthetic (LA) test dose to indicate correct thoracic epidural catheter position. The relationship between the test results and epidural postoperative analgesia was also assessed. METHODS: This prospective observational cohort study was done in patients receiving thoracic epidural analgesia for abdominal surgery. After insertion, the epidural catheter was tested using a nerve stimulator to elicit a motor response...
February 6, 2019: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Alessandro De Cassai, Stefano Dal Cin, Francesco Zarantonello, Irina Ban
The erector spinae plane block (ESP) is a novel interfascial block described in 2016 by Forero. Although it has been used to provide analgesia for planned abdominal and thoracic surgery, it has never been used as a rescue technique for abdominal surgery. Pain control can be a challenge for anaesthesiologists in laparotomic surgery when epidural analgesia is contraindicated. We report two cases in which the ESP block has been successfully used as a rescue technique to provide pain relief after laparotomic surgery...
January 2019: Saudi Journal of Anaesthesia
John Hausken, Åsmund Avdem Fretland, Bjørn Edwin, Marit Helen Andersen, Vegar Johansen Dagenborg, Gudrun Maria Waaler Bjørnelv, Ronny Kristiansen, Kjetil Røysland, Gunnvald Kvarstein, Tor Inge Tønnessen
OBJECTIVE: We conducted a randomized, controlled, noninferiority trial to investigate if intravenous, multimodal, patient-controlled analgesia (IV-PCA) could be noninferior to multimodal thoracic epidural analgesia (TEA) in patients undergoing open liver surgery. SUMMARY BACKGROUND DATA: The increasing use of minimally invasive techniques and fast track protocols have questioned the position of epidural analgesia as the optimal method of pain management after abdominal surgery...
January 21, 2019: Annals of Surgery
Jeremy A Warren, Alfredo M Carbonell, Lauren K Jones, Aaron Mcguire, William R Hand, Vito A Cancellaro, Joseph A Ewing, William S Cobb
BACKGROUND: Major abdominal surgery often requires postoperative opioid analgesia. However, there is growing recognition of the potential for abuse. We previously reported a significant reduction in opioid consumption after implementation of an enhanced recovery after surgery (ERAS) protocol following ventral hernia repair (VHR) focusing on opioid reduction. Epidural use was routine for post-operative pain control in this protocol. Recently we have transitioned to transversus abdominis plane (TAP) block instead of epidural analgesia...
January 7, 2019: Journal of the American College of Surgeons
Dita Aditianingsih, Chaidir Arif Mochtar, Susilo Chandra, Raden Besthadi Sukmono, Ilham Wahyudi Soamole
Background: Postoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action...
October 2018: Anesthesiology and Pain Medicine
Satoru Kikuchi, Shinji Kuroda, Masahiko Nishizaki, Takashi Matsusaki, Kazuya Kuwada, Yoshikazu Kimura, Shunsuke Kagawa, Hiroshi Morimatsu, Toshiyoshi Fujiwara
PURPOSE: Epidural analgesia (EDA) is an imperative modality for postoperative pain relief after major open abdominal surgery. However, whether EDA has benefits in laparoscopic surgery has not been clear. In this study, the effects of EDA and patient-controlled intravenous analgesia (PCIA) after laparoscopic distal gastrectomy (LDG) were compared. METHODS: This was a retrospective study that included 82 patients undergoing LDG for gastric cancer. Patients received either EDA (n=67) or PCIA (n=15) for postoperative pain relief...
December 3, 2018: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Ebru Canakci, Ahmet Gultekin, Zubeyir Cebeci, Bulent Hanedan, Anil Kilinc
Introduction and Objective: TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques...
2018: Pain Research & Management: the Journal of the Canadian Pain Society
Luming Zhen, Xiao Li, Xue Gao, Haidong Wei, Xiaoming Lei
OBJECTIVES: Sufentanil has been widely used in epidural PCA, while its use in intravenous PCA has rarely been reported. Based on its use in target controlled infusion, we reckoned that the effect-site concentration of sufentanil would be steady if background infusion is given in intravenous PCA. This prospective, single center, randomized study with a three arm parallel group design aims to find out the appropriate dose of sufentanil when used in intravenous PCA with background infusion in abdominal surgeries...
2018: PloS One
Rovnat Babazade, Wael Saasouh, Amanda J Naylor, Natalya Makarova, Chiedozie I Udeh, Alparslan Turan, Belinda L Udeh
STUDY OBJECTIVE: Intravenous patient-controlled opioid analgesia (IVPCA), epidural analgesia and transversus abdominis plane (TAP) infiltrations are frequently used postoperative pain management modalities. The aim of this study was to conduct a cost-effectiveness analysis comparing the use of epidural, IVPCA, and TAP infiltrations with liposomal bupivacaine for analgesia in the first 72 h postoperatively in patients undergoing major lower abdominal surgery. DESIGN: Retrospective cost effectiveness analysis...
October 13, 2018: Journal of Clinical Anesthesia
Flora M Li, Trefan B Archibald, Laurent A Bollag
Dual epidural catheter (DEC) therapy improves postoperative pain control in scoliosis correction surgery, esophagectomies, and labor. Reports about the use of a second epidural catheter to improve pain control after abdominal surgeries are sparse. We describe the successful use of unplanned DEC therapy in 2 complex pain patients who underwent large exploratory laparotomies. In both patients, the addition of the second catheter led to improved pain control and mobility and reduced side effects from adjuvant intravenous analgesics...
October 5, 2018: A&A practice
Liping Wang, Xuan Li, Hong Chen, Jie Liang, Yu Wang
Background: Effective postoperative analgesia is essential for rehabilitation after surgery. Many studies have compared different methods of postoperative pain management for open abdominal surgery. However, the conclusions were inconsistent and controversial. In addition, few studies have focused on gastric cancer (GC) resection. This study aimed to determine the effects of patient-controlled epidural analgesia (PCEA) on postoperative pain management and short-term recovery after GC resection compared with those of patient-controlled intravenous analgesia (PCIA)...
2018: Journal of Pain Research
Tabish Aijaz, Kenneth D Candido, Utchariya Anantamongkol, Gleb Gorelick, Nebojsa Nick Knezevic
Background: Thoracic epidural analgesia (TEA) provides superior postoperative pain control compared to parenteral opioids after major thoracic and abdominal surgeries. However, some studies with respect to benefits of continuous TEA have shown mixed results. The purpose of this study was to determine the rate of successful TEA catheter insertion into the epidural space using contrast fluoroscopy and the impact of placement location on postoperative analgesia and opioid use. Patients and methods: After Advocate health care institutional review board approval, we conducted a prospective, open-label, single intervention study on patients undergoing thoracic or upper abdominal surgery...
2018: Local and Regional Anesthesia
Jon H Salicath, Emily Cy Yeoh, Michael H Bennett
BACKGROUND: Intravenous patient-controlled analgesia (IVPCA) with opioids and epidural analgesia (EA) using either continuous epidural administration (CEA) or patient-controlled (PCEA) techniques are popular approaches for analgesia following intra-abdominal surgery. Despite several attempts to compare the risks and benefits, the optimal form of analgesia for these procedures remains the subject of debate. OBJECTIVES: The objective of this review was to update and expand a previously published Cochrane Review on IVPCA versus CEA for pain after intra-abdominal surgery with the addition of the comparator PCEA...
August 30, 2018: Cochrane Database of Systematic Reviews
Carlos Almeida, José Pedro Assunção
BACKGROUND AND OBJECTIVES: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. CASE REPORT: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/μl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy...
November 2018: Revista Brasileira de Anestesiologia
David Miller, Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, Cliff L Shelton, Phil Alderson, Andrew F Smith
BACKGROUND: The use of anaesthetics in the elderly surgical population (more than 60 years of age) is increasing. Postoperative delirium, an acute condition characterized by reduced awareness of the environment and a disturbance in attention, typically occurs between 24 and 72 hours after surgery and can affect up to 60% of elderly surgical patients. Postoperative cognitive dysfunction (POCD) is a new-onset of cognitive impairment which may persist for weeks or months after surgery.Traditionally, surgical anaesthesia has been maintained with inhalational agents...
August 21, 2018: Cochrane Database of Systematic Reviews
Francesco Donatelli, Matteo Nafi, Lina Pietropaoli, Marta Di Nicola, Ilaria R Piva, Chelsia Gillis, Sashika Selladurai, Roberto Fumagalli, Franco Marinangeli, Francesco Carli
BACKGROUND: Postoperative hyperglycemia is associated with increased rate of surgical site infection, renal failure, and cardiovascular events. The study of insulin sensitivity state before surgery could help in treating postoperative hyperglycemia and preventing iatrogenic hypoglycemia. We studied the postoperative insulin secretion in patients who have a low insulin sensitivity (IR) before surgery compared to patients with normal preoperative insulin sensitivity (IS). MATERIALS AND METHODS: Forty-two consecutive patients, undergoing abdominal surgery, underwent preoperative sequential hyperglycemic-euglycemic clamp (SHEC) in order to measure insulin secretion and to screen patients with low insulin sensitivity (IR) or with normal insulin sensitivity (IS)...
August 20, 2018: Acta Anaesthesiologica Scandinavica
A L M Tavy, A F J de Bruin, K van der Sloot, E C Boerma, C Ince, P G Noordzij, D Boerma, M van Iterson
BACKGROUND: The effect of thoracic epidural analgesia (TEA) on splanchnic blood flow during abdominal surgery remains unclear. The purpose of this study was to examine whether the hemodynamic effects of TEA resulted in microcirculatory alterations to the intestinal serosa, which was visualized using incident dark-field (IDF) videomicroscopy. METHODS: An observational cohort study was performed. In 18 patients, the microcirculation of the intestinal serosa was visualized with IDF...
December 2018: World Journal of Surgery
Elke M E Bos, Maartje E Schut, Marcel de Quelerij, Cor J Kalkman, Markus W Hollmann, Philipp Lirk
BACKGROUND: The clinical use of epidural analgesia has changed over past decades. Minimally invasive surgery and emergence of alternative analgesic techniques have led to an overall decline in its use. In addition, there is increasing awareness of the patient-specific risks for complications such as spinal haematoma and abscess. Local guidelines for management of severe neurological complications during or after epidural analgesia, ie, "epidural alert systems", have been introduced in hospitals to coordinate and potentially streamline early diagnosis and treatment...
November 2018: Acta Anaesthesiologica Scandinavica
Amalia M A van den Berg, Peep F M Stalmeier, Gert Jan Scheffer, Rosella P Hermens, Martin J L Bucx
BACKGROUND: Shared decision-making (SDM) and decision-support tools have attracted broad support in healthcare as they improve medical decision-making. Experts disagree on how these can help patients evaluate their present situation and possible outcomes of therapy, and how they might reduce decisional conflict. Little is known about their implementation, especially in anaesthesiology. OBJECTIVE: To obtain a more fundamental understanding of pre-operative SDM and evaluate the use of a decision-support tool for postoperative analgesia after major thoracic and abdominal surgery...
July 30, 2018: European Journal of Anaesthesiology
Raphael Weiss, Daniel M Pöpping
PURPOSE OF REVIEW: Although thoracic epidural analgesia (TEA) is considered often as gold standard in multimodal analgesia with regard to major abdominal surgery, there is an ongoing debate if it is still a viable option for enhanced recovery because of its potential severe complications. RECENT FINDINGS: In addition to the unsurpassed analgesic quality, a TEA offers several advantages. Studies have shown that a TEA does have a positive effect on perioperative morbidity and mortality, bowel function, the occurrence of ileus and patient mobility...
October 2018: Current Opinion in Anaesthesiology
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