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Epidural analgesia after abdominal surgery

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https://www.readbyqxmd.com/read/28938298/safety-and-efficacy-of-epidural-analgesia
#1
Elke M E Bos, Markus W Hollmann, Philipp Lirk
PURPOSE OF REVIEW: Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. RECENT FINDINGS: Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia...
September 21, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28928569/comparison-of-epidural-analgesia-with-transversus-abdominis-plane-analgesia-for-postoperative-pain-relief-in-patients-undergoing-lower-abdominal-surgery-a-prospective-randomized-study
#2
Sadasivan Shankar Iyer, Harshit Bavishi, Chadalavada Venkataram Mohan, Navdeep Kaur
BACKGROUND: Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques. MATERIALS AND METHODS: Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28922227/incidence-and-risk-factors-of-coagulation-profile-derangement-after-liver-surgery-implications-for-the-use-of-epidural-analgesia-a-retrospective-cohort-study
#3
Pierre Jacquenod, Grégoire Wallon, Mathieu Gazon, Benjamin Darnis, Pierre Pradat, Victor Virlogeux, Olivier Farges, Frédéric Aubrun
BACKGROUND: Hepatic surgery is a major abdominal surgery. Epidural analgesia may decrease the incidence of postoperative morbidities. Hemostatic disorders frequently occur after hepatic resection. Insertion or withdrawal (whether accidental or not) of an epidural catheter during coagulopathic state may cause an epidural hematoma. The aim of the study is to determine the incidence of coagulopathy after hepatectomy, interfering with epidural catheter removal, and to identify the risk factors related to coagulopathy...
September 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28921903/risk-factors-for-postoperative-ileus-after-colorectal-cancer-surgery
#4
E G Rybakov, Y A Shelygin, E A Khomyakov, I V Zarodniuk
AIM: To assess the rate and independent risk factors of postoperative ileus (POI) after colorectal cancer surgery. METHODS: Three hundred consecutive patients underwent colorectal surgery for cancer at the State Scientific Centre of coloproctology, Moscow, Russia, between November 2015 and August 2016. POI was diagnosed as an absence of intestinal function for 72 hours or more after operation and confirmed by plain radiography. Uni- and multivariate logistic regression of the tumour-, patient- and treatment-related factors was performed...
September 16, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28856110/the-analgesic-efficiency-of-ultrasound-guided-rectus-sheath-analgesia-compared-with-low-thoracic-epidural-analgesia-after-elective-abdominal-surgery-with-a-midline-incision-a-prospective-randomized-controlled-trial
#5
Hany Mahmoud Yassin, Ahmed Tohamy Abd Elmoneim, Hatem El Moutaz
BACKGROUND: Ultrasound-guided rectus sheath blockade has been described to provide analgesia for midline abdominal incisions. We aimed to compare thoracic epidural analgesia (TEA) and rectus sheath analgesia (RSA) with respect to safety and efficacy. METHODS: Sixty patients who underwent elective laparotomies through a midline incision were assigned randomly to receive either continuous TEA (TEA group, n = 31) or intermittent RSA (RSA group, n = 29). The number of patients who required analgesia, the time to first request analgesia, the interval and the cumulative morphine doses consumption during 72 hours postoperatively, and pain intensity using visual analog score (VAS) at rest and upon coughing were reported in addition to any side effects related to both techniques or administered drugs...
June 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/28853010/coagulation-after-cytoreductive-surgery-and-hyperthermic-intraperitoneal-chemotherapy-a-retrospective-cohort-analysis
#6
Heather Hurdle, Graeme Bishop, Andrew Walker, Afra Moazeni, Elizabeth Oddone Paloucci, Walley Temple, Lloyd Mack, Molly Shing
PURPOSE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) benefit patients with peritoneal carcinomatosis. Nevertheless, this therapy is associated with considerable postoperative pain due to the extensive abdominal incision. While epidural analgesia offers efficacious pain control, CRS and HIPEC therapy is associated with perioperative coagulopathy that may impact its use. The purpose of this retrospective study is to characterize the postoperative coagulopathy in this patient subset and to develop a model that will help predict those at risk...
August 29, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28742435/the-role-of-transversus-abdominis-plane-blocks-in-enhanced-recovery-after-surgery-pathways-for-open-and-laparoscopic-colorectal-surgery
#7
Alexander J Kim, Robert Jason Yong, Richard D Urman
INTRODUCTION: The concepts of Enhanced Recovery After Surgery (ERAS(®)) have steadily increased in usage, with benefits in patient outcomes and hospital length of stay. One important component of successful implementation of ERAS protocol is optimized pain control, via the multimodal approach, which includes neuraxial or regional anesthesia techniques and reduction of opioid use as the primary analgesic. Transversus abdominis plane (TAP) block is one such regional anesthesia technique, and it has been widely studied in abdominal surgery...
September 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28727597/bilateral-continuous-erector-spinae-plane-block-contributes-to-effective-postoperative-analgesia-after-major-open-abdominal-surgery-a-case-report
#8
Carlos Eduardo Restrepo-Garces, Ki Jinn Chin, Patricia Suarez, Alejandro Diaz
The erector spinae plane (ESP) block is a regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. Originally described for thoracic analgesia when performed at the T5 transverse process, the ESP block can provide abdominal analgesia if performed at lower thoracic levels because the erector spinae muscles extend to the lumbar spine. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia...
July 19, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28619696/postoperative-pain-management-in-spanish-hospitals-a%C3%A2-cohort-study-using-the-pain-out-registry
#9
Mauricio Polanco-García, Jaume García-Lopez, Neus Fàbregas, Windfried Meissner, Margarita M Puig
Pain after surgery remains a problem worldwide, although there are no published data on postoperative outcomes in Spain. We evaluated 2,922 patients on the first day after surgery in 13 tertiary care Spanish hospitals, using the PAIN-OUT questionnaire. The aims were to: assess postoperative outcomes and anesthetic/analgesic management in Orthopedics (ORT) and General Surgery (GEN) patients; explore the influence of the analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes and analgesic management according to surgical procedure...
June 12, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28614364/serum-levels-of-bupivacaine-after-pre-peritoneal-bolus-vs-epidural-bolus-injection-for-analgesia-in-abdominal-surgery-a-safety-study-within-a-randomized-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Timothy H Mungroop, Ganapathy van Samkar, Bart F Geerts, Susan van Dieren, Marc G Besselink, Denise P Veelo, Philipp Lirk
BACKGROUND: Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia. METHODS: This was a comparative study within a randomized controlled trial (NTR4948)...
2017: PloS One
https://www.readbyqxmd.com/read/28535549/epidural-dexamethasone-influences-postoperative-analgesia-after-major-abdominal-surgery
#11
RANDOMIZED CONTROLLED TRIAL
Jeong-Min Hong, Kyung-Hoon Kim, Hyeon Jeong Lee, Jae-Young Kwon, Hae-Kyu Kim, Hyae-Jin Kim, Ah-Reum Cho, Wang-Seok Do, Hyo Sung Kim
BACKGROUND: Epidurally administered dexamethasone might reduce postoperative pain. However, the effect of epidural administration of dexamethasone on postoperative epidural analgesia in major abdominal surgery has been doubtful. OBJECTIVES: To investigate the effects and optimal dose of epidural dexamethasone on pain after major abdominal surgery. STUDY DESIGN: A prospective randomized, double-blind study. SETTING: University hospital...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28526462/-sudden-motor-and-sensorial-loss-due-to-retroperitoneal-hematoma-during-postoperative-periods-a-case-report
#12
Pelin Şen, Havva Gül Gültekin, İsmail Caymaz, Ömer Özel, Ayda Türköz
A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected...
May 16, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28492998/enhanced-recovery-after-surgery-can-we-rely-on-the-key-factors-or-do-we-need-the-bel-ensemble
#13
Jonas Jurt, Juliette Slieker, Pierre Frauche, Valerie Addor, Josep Solà, Nicolas Demartines, Martin Hübner
BACKGROUND: The success of enhanced recovery (ERAS) pathways depends on the actual application of the intended protocol (adherence), but its full implementation remains challenging. In order to potentially streamline the pathway, it is indispensable to know the impact of individual items and the entire protocol on clinical outcomes. METHODS: Retrospective analysis including all consecutive colorectal ERAS patients since implementation (May 2011) until February 2014; demographics, adherence and outcomes were retrieved from a prospectively maintained database...
May 10, 2017: World Journal of Surgery
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
COMPARATIVE STUDY
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
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