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Epidural analgesia after abdominal surgery

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https://www.readbyqxmd.com/read/28404067/continuous-wound-infiltration-versus-epidural-analgesia-after-hepato-pancreato-biliary-surgery-pop-up-a-randomised-controlled-open-label-non-inferiority-trial
#1
Timothy H Mungroop, Denise P Veelo, Olivier R Busch, Susan van Dieren, Thomas M van Gulik, Tom M Karsten, Steve M de Castro, Marc B Godfried, Bram Thiel, Markus W Hollmann, Philipp Lirk, Marc G Besselink
BACKGROUND: Epidural analgesia is the international standard for pain treatment in abdominal surgery. Although some studies have advocated continuous wound infiltration with local anaesthetics, robust evidence is lacking, especially on patient-reported outcome measures. We aimed to determine the effectiveness of continuous wound infiltration in hepato-pancreato-biliary surgery. METHODS: In this randomised controlled, open label, non-inferiority trial (POP-UP), we enrolled adult patients undergoing hepato-pancreato-biliary surgery by subcostal or midline laparotomy in two Dutch hospitals...
October 2016: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28403113/incidence-of-persistent-postoperative-pain-after-hepatectomies-with-2-regimes-of-perioperative-analgesia-containing-ketamine
#2
COMPARATIVE STUDY
Paula Masgoret, Carmen Gomar, Beatriz Tena, Pilar Taurá, José Ríos, Miquel Coca
Studies designed to assess persistent postoperative pain (PPP) incidence after hepatectomies are lacking. Our aim was to assess PPP incidence 6 months after hepatectomies with intravenous (IV) or epidural (EPI) analgesia containing ketamine.Prospective observational comparative study between 2 cohorts of patients submitted to hepatectomy. Patients received 1 of 2 analgesic regimes containing ketamine: EPI group or IV group. Visual analog scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), and quantitative sensorial testing (QST: to determine area of hyperalgesia/allodynia) were assessed preoperatively and postoperatively at 2 h, 24 h, 7 days, 1 month, and 6 months...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28389801/comparison-of-the-effects-of-patient-controlled-epidural-and-intravenous-analgesia-on-postoperative-bowel-function-after-laparoscopic-gastrectomy-a-prospective-randomized-study
#3
Jin Sun Cho, Hyoung-Il Kim, Ki-Young Lee, Taeil Son, Sun Joon Bai, Haegi Choi, Young Chul Yoo
BACKGROUND: Although laparoscopic surgery significantly reduces surgical trauma compared to open surgery, postoperative ileus is a frequent and significant complication after abdominal surgery. Unlike laparoscopic colorectal surgery, the effects of epidural analgesia on postoperative recovery after laparoscopic gastrectomy are not well established. We compared the effects of epidural analgesia to those of conventional intravenous (IV) analgesia on the recovery of bowel function after laparoscopic gastrectomy...
April 7, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28298776/a-comparative-study-for-post-operative-analgesia-in-the-emergency-laparotomies-thoracic-epidural-ropivacaine-with-nalbuphine-and-ropivacaine-with-butorphanol
#4
Saravana Babu, Bikram Kumar Gupta, Gyanendra Kumar Gautam
BACKGROUND: Adequate postoperative pain therapy for emergency abdominal surgeries is important far beyond the perioperative period because sensitization to painful stimuli can cause postoperative morbidity. A prospective, double-blind, randomized study was carried out to compare the quality of postoperative analgesia and side-effect profile between epidurally administered butorphanol and nalbuphine as an adjuvant to 0.2% ropivacaine. MATERIALS AND METHODS: A total of eighty patients, 43 men and 37 women between the age of 18 and 65 years of American Society of Anesthesiologists (ASA) Class I E and II E, who underwent intestinal perforation repair surgery were randomly allocated into two groups ropivacaine with butorphanol (RB) and ropivacaine with nalbuphine (RN), comprising of 40 patients each...
January 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28260769/morbidity-and-mortality-after-pancreatoduodenectomy-a-five-year-experience-in-bangabandhu-sheikh-mujib-medical-university
#5
B C Das, A S Khan, N E Elahi, M S Uddin, B C Debnath, Z R Khan
Mortality and morbidity was assessed after adoption of a systematic care for patient with pancreatoduodenectomy starting from patient selection and preparation, operative technique, and postoperative care. In this prospective study seventy patients who underwent pancreatoduodenectomy for periampullary carcinoma with curative intent between January 2010 and December 2014 were carefully analyzed prospectively. Patients were selected those who had ampullary carcinoma, lower bile duct carcinoma and small size carcinoma head of pancreas without local invasion and distant metastasis, and the patient who did not have any major disabling comorbid diseases...
January 2017: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/28258664/surgical-and-not-analgesic-technique-affects-postoperative-inflammation-following-colorectal-cancer-surgery-a-prospective-randomized-study
#6
W Siekmann, C Eintrei, A Magnuson, A Sjölander, P Matthiessen, P Myrelid, A Gupta
AIM: Epidural analgesia reduces the surgical stress response. However, its effect on pro- and anti-inflammatory cytokines in the genesis of inflammation following major abdominal surgery remains unclear. Our main objective was to elucidate whether perioperative epidural analgesia prevents the inflammatory response following colorectal cancer surgery. METHODS: 96 patients scheduled for open or laparoscopic surgery were randomized to epidural analgesia (group E) or patient controlled intravenous analgesia (group P)...
March 4, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28185289/effect-of-epidural-compared-to-patient-controlled-intravenous-analgesia-on-outcomes-for-patients-undergoing-liver-resection-for-neoplastic-disease
#7
Shelby Allen, Amy DeRoche, Lu Adams, Karen Valerie Slocum, Clancy J Clark, Nora F Fino, Perry Shen
BACKGROUND: Epidural analgesia is routinely used for postoperative pain control following abdominal surgeries, yet data regarding the safety and efficacy of epidural analgesia is controversial. METHODS: Pain-related and clinical perioperative data were extracted and correlated with baseline clinicopathologic data and method of analgesia (epidural vs. intravenous patient-controlled analgesia) in patients who underwent hepatectomy from 2012 to 2014. Chronic pain was defined by specific narcotic requirements preoperatively...
March 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28185011/continuous-intraoperative-epidural-infusions-affect-recovery-room-length-of-stay-and-analgesic-requirements-a-single-center-observational-study
#8
Aalap C Shah, Bala G Nair, Charles F Spiekerman, Laurent A Bollag
PURPOSE: Continuous intraoperative epidural analgesia may improve post-operative pain control and decrease opioid requirements. We investigate the effect of epidural infusion initiation before or after arrival in the post-anesthesia care unit on recovery room duration and post-operative opioid use. METHODS: We performed a retrospective chart review of abdominal, thoracic and orthopedic surgeries where an epidural catheter was placed prior to surgery at the University of Washington Medical Center during a 24 month period...
February 9, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28181346/comparison-of-caudal-ropivacaine-morphine-and-paravertebral-catheter-for-major-upper-abdominal-surgery-in-infants
#9
Makoto Sato, Takafumi Iida, Chika Kikuchi, Tomoki Sasakawa, Takayuki Kunisawa
BACKGROUND: The caudal epidural block is one of the most commonly used regional anesthetic techniques in children. Administration of morphine via caudal injection enables analgesia, even for upper abdominal surgery. The thoracic paravertebral block has also been successfully used to treat perioperative pain during upper abdominal procedures in pediatric patients. AIM: In the current study, we compared the two regional techniques for upper abdominal surgery in infants to determine whether one of them was preferable to the other...
February 8, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28100519/paravertebral-block-in-paediatric-abdominal-surgery-a-systematic-review-and-meta-analysis-of-randomized-trials
#10
E A Page, K L Taylor
The increased popularity of paravertebral block (PVB) can be attributed to its relative safety and comparable efficacy when compared with epidural analgesia. It has thus been recommended for open cholecystectomy and other less painful surgeries such as inguinal herniorraphy and appendectomy. We performed a systematic review of PVB in paediatric abdominal conditions to assess its clinical efficacy and side effects compared with other analgesic therapies.A search of Medline, Embase, and Web of Science and hand-searching references from inception date to May 2016 was done...
February 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28079812/the-efficacy-of-elastomeric-patient-control-module-when-connected-to-a-balloon-pump-for-postoperative-epidural-analgesia-a-randomized-noninferiority-trial
#11
RANDOMIZED CONTROLLED TRIAL
Myung Hwa Kim, Yon Hee Shim, Min-Soo Kim, Yang-Sik Shin, Hyun Joo Lee, Jeong Soo Lee
When considering the principles of a pain control strategy by patients, reliable administration of additional bolus doses is important for providing the adequate analgesia and improving patient satisfaction. We compared the efficacy of elastomeric patient-control module (PCM) with conventional PCM providing epidural analgesia postoperatively.A noninferiority comparison was used. Eighty-six patients scheduled for open upper abdominal surgery were randomized to use either an elastomeric or conventional PCM connected to balloon pump...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27986184/the-canadian-gynaecologic-oncology-perioperative-management-survey-baseline-practice-prior-to-implementation-of-enhanced-recovery-after-surgery-eras-society-guidelines
#12
Alon D Altman, Gregg S Nelson
OBJECTIVE: To survey the current practice of Society of Gynecologic Oncology of Canada (GOC) members about preoperative, intraoperative, and postoperative phases of care. The survey was carried out prior to publication of the Enhanced Recovery After Surgery (ERAS) Society gynaecologic/oncology guidelines. METHODS: A survey was developed by the GOC and distributed to all surgical members between September and December 2015. RESULTS: The survey was completed by 77 of 92 practising gynaecologic oncologists (84%), representing 19 centres in 16 cities across Canada...
December 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27919589/preincisional-and-postoperative-epidural-morphine-ropivacaine-ketamine-and-naloxone-treatment-for-postoperative-pain-management-in-upper-abdominal-surgery
#13
Hou-Chuan Lai, Chung-Bao Hsieh, Chih-Shung Wong, Chun-Chang Yeh, Zhi-Fu Wu
OBJECTIVE(S): Previous studies have shown that preincisional epidural morphine, bupivacaine, and ketamine combined with epidural anesthesia (EA) and general anesthesia (GA) provided pre-emptive analgesia for upper abdominal surgery. Recent studies reported that ultralow-dose naloxone enhanced the antinociceptive effect of morphine in rats. This study investigated the benefits of preincisional and postoperative epidural morphine + ropivacaine + ketamine + naloxone (M + R + K + N) treatment for achieving postoperative pain relief in upper abdominal surgery...
September 2016: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
https://www.readbyqxmd.com/read/27870743/epidural-local-anesthetics-versus-opioid-based-analgesic-regimens-for-postoperative-gastrointestinal-paralysis-vomiting-and-pain-after-abdominal-surgery-a-cochrane-review
#14
Joanne Guay, Mina Nishimori, Sandra L Kopp
BACKGROUND: The aim of this review was to compare the effects of postoperative epidural analgesia with local anesthetics to postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of gastrointestinal anastomotic leak, hospital length of stay, and cost after abdominal surgery. METHODS: Trials were identified by computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 12), Medical Literature Analysis and Retrieval System Online (MEDLINE) (from 1950 to December, 2014) and Excerpta Medica dataBASE (EMBASE) (from 1974 to December 2014) and by checking the reference lists of trials retained...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27847694/contribution-of-low-dose-computerized-tomography-with-digital-multiplanar-reconstructions-in-thoracic-epidurography-and-correlation-with-sensory-block-in-postoperative-analgesia
#15
Cyrus Motamed, Karin Chedevergne, Frederic Deschamps, Lambros Tselikas, Christian Jayr
BACKGROUND: The level of sensory block in postoperative epidural analgesia has been correlated with conventional contrast epidurography in only one study, while low-dose CT scan epidurography with multiplanar reconstruction may be a better tool for this purpose. OBJECTIVES: The primary objective of this study was to evaluate, by CT imaging and digital multiplanar reconstruction, the spread and distribution of contrast medium injected into the epidural space through a catheter inserted in a low thoracic position for postoperative analgesia...
October 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27833479/efficacy-of-dexmedetomidine-as-an-adjuvant-to-ropivacaine-in-pediatric-caudal-epidural-block
#16
Manoj Kamal, Sadik Mohammed, Saroj Meena, Geeta Singariya, Rakesh Kumar, Dilip Singh Chauhan
CONTEXT: Caudal analgesia is a reliable and an easy method to provide intraoperative and postoperative analgesia for infraumbilical surgeries in pediatric population but with the disadvantage of short duration of action after single injection. Many additives were used in combination with local anesthetics in the caudal block to prolong the postoperative analgesia. AIM: We compared the analgesic effects and side effects of dexmedetomidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27800053/is-there-a-measurable-association-of-epidural-use-at-cystectomy-and-postoperative-outcomes-a-population-based-study
#17
R Christopher Doiron, Melanie Jaeger, Christopher M Booth, Xuejiao Wei, D Robert Siemens
INTRODUCTION: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice. METHODS: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR)...
September 2016: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/27746533/comparative-study-of-epidural-bupivacaine-with-butorphanol-and-bupivacaine-with-tramadol-for-postoperative-pain-relief-in-abdominal-surgeries
#18
N Swathi, N Ashwini, Mukesh I Shukla
INTRODUCTION: To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries. AIMS: To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine. MATERIALS AND METHODS: A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27716081/thoracic-epidural-analgesia-reduces-gastric-microcirculation-in-the-pig
#19
Rikard Ambrus, Rune B Strandby, Niels H Secher, Kim Rünitz, Morten B S Svendsen, Lonnie G Petersen, Michael P Achiam, Lars B Svendsen
BACKGROUND: Thoracic epidural analgesia (TEA) is used for pain relief during and after abdominal surgery, but the effect of TEA on the splanchnic microcirculation remains debated. We evaluated whether TEA affects splanchnic microcirculation in the pig. METHODS: Splanchnic microcirculation was assessed in nine pigs prior to and 15 and 30 min after induction of TEA. Regional blood flow was assessed by neutron activated microspheres and changes in microcirculation by laser speckle contrast imaging (LSCI)...
October 6, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27687384/effect-of-thoracic-epidural-analgesia-on-recovery-of-bowel-function-after-major-upper-abdominal-surgery
#20
Jin Hee Ahn, Hyun Joo Ahn
STUDY OBJECTIVE: We investigated whether thoracic epidural analgesia (TEA) shortens the first gas-out time compared to intravenous patient-controlled analgesia (iv-PCA) and promotes earlier discharge after major upper abdominal surgery. DESIGN: Prospective observational study. SETTING: A tertiary care university hospital. PATIENTS: Fifty-six patients undergoing major upper abdominal surgery. INTERVENTIONS: TEA (n=28) was performed using a paramedian approach at T6-7 or T7-8...
November 2016: Journal of Clinical Anesthesia
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