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Epidural analgesia after abdominal surgery

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https://www.readbyqxmd.com/read/29994937/is-epidural-analgesia-still-a-viable-option-for-enhanced-recovery-after-abdominal-surgery
#1
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...
July 9, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29952997/the-analgesic-efficacy-of-transverse-abdominis-plane-block-versus-epidural-analgesia-a-systematic-review-with-meta-analysis
#2
REVIEW
Moira Baeriswyl, Frank Zeiter, Denis Piubellini, Kyle Robert Kirkham, Eric Albrecht
BACKGROUND: The aim of the study was to compare the analgesic efficacy of epidural analgesia and transverse abdominis plane (TAP) block. TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Only trials comparing TAP block with epidural analgesia were included...
June 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29864216/continuous-intravenous-perioperative-lidocaine-infusion-for-postoperative-pain-and-recovery-in-adults
#3
REVIEW
Stephanie Weibel, Yvonne Jelting, Nathan L Pace, Antonia Helf, Leopold Hj Eberhart, Klaus Hahnenkamp, Markus W Hollmann, Daniel M Poepping, Alexander Schnabel, Peter Kranke
BACKGROUND: The management of postoperative pain and recovery is still unsatisfactory in a number of cases in clinical practice. Opioids used for postoperative analgesia are frequently associated with adverse effects, including nausea and constipation, preventing smooth postoperative recovery. Not all patients are suitable for, and benefit from, epidural analgesia that is used to improve postoperative recovery. The non-opioid, lidocaine, was investigated in several studies for its use in multimodal management strategies to reduce postoperative pain and enhance recovery...
June 4, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29781846/preperitoneal-or-subcutaneous-wound-catheters-as-alternative-for-epidural-analgesia-in-abdominal-surgery-a-systematic-review-and-meta-analysis
#4
Timothy H Mungroop, Marinde J Bond, Philipp Lirk, Olivier R Busch, Markus W Hollmann, Denise P Veelo, Marc G Besselink
OBJECTIVE: To assess whether the location of wound catheters (ie, preperitoneal vs. subcutaneous) impacts outcomes, when compared with alternatives such as epidural analgesia. BACKGROUND: Continuous wound infiltration is an alternative for epidural analgesia in abdominal surgery but studies have shown conflicting results. This difference could be explained by different efficacy of preperitoneal versus subcutaneous placement of the infiltrative catheters. METHODS: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines until April 3, 2017...
May 17, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29774961/influence-of-caudal-epidural-analgesia-on-cortisol-concentrations-and-pain-related-behavioral-responses-in-mares-during-and-after-ovariectomy-via-colpotomy
#5
Aileen L Rowland, Kati G Glass, Sicilia T Grady, Kevin J Cummings, Katrin Hinrichs, Ashlee E Watts
OBJECTIVE: To determine the influence of epidural detomidine and morphine on serum corticosteroid concentrations and pain-related behavioral responses in mares during and after ovariectomy via colpotomy. STUDY DESIGN: Blinded prospective study. ANIMALS: Nine university-owned mares. METHODS: Five of 9 horses received caudal epidural detomidine hydrochloride (0.01 mg/kg) and morphine sulfate (0.1 mg/kg) prior to surgery...
May 18, 2018: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/29742784/-contra-is-postoperative-epidural-analgesia-the-gold-standard
#6
Hans Jürgen Gerbershagen
As strategy for postoperative pain therapy, epidural analgesia (EDA) is superior to systemic opiate analgesia after abdominal and thoracic surgery. In addition, EDA may significantly reduce the incidence of complications in some large operations, such as, e.g. cardiac (myocardial infarction, atrial fibrillation) and pulmonary complications (pneumonia, atelectasis), and even reduce mortality. Intestinal motility can also be improved. However, these positive effects do not appear in all interventions and not to the same degree...
April 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29742783/-pro-epidural-analgesia-remains-the-gold-standard-for-abdominal-and-thoracic-surgery
#7
Hannah Listing, Daniel Pöpping
Pain relief with epidural analgesia is superior compared to systemic opioid analgesia after major abdominal and thoracic surgery. It remains a safe procedure, as long as it is embedded in a concept covering the whole perioperative period. This includes the knowledge of the anesthesiologist how to operate the process of catheter insertion as well as to treat complications like the hypotension, associated with the application of epidural local anesthetics. A close postoperative monitoring by an acute pain service team is a responsible task and should be available 24/7...
April 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29699695/results-of-a-national-survey-about-perioperative-care-in-gastric-resection-surgery
#8
Marcos Bruna, Carla Navarro, Celia Báez, José Manuel Ramírez, María Ángeles Ortiz
INTRODUCTION: Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. METHODS: A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. RESULTS: Antibiotic and antithrombotic prophylaxis are always used by 96...
April 23, 2018: Cirugía Española
https://www.readbyqxmd.com/read/29643619/comparison-of-continuous-epidural-infusion-of-0-125-ropivacaine-with-1-%C3%AE-g-ml-fentanyl-versus-0-125-bupivacaine-with-1-%C3%AE-g-ml-fentanyl-for-postoperative-analgesia-in-major-abdominal-surgery
#9
Shruti Shrikant Patil, Amala G Kudalkar, Bharati A Tendolkar
Background and Aim: The present study was carried out to compare the efficacy of continuous epidural infusion of two amide local anesthetics, ropivacaine and bupivacaine with fentanyl for postoperative analgesia in major abdominal surgeries. Material and Methods: A total of 60 patients scheduled for major abdominal surgery were randomized into two study Groups B and R with thirty patients in each group. All patients were administered general anesthesia after placing epidural catheter...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29369958/epidural-hematoma-following-cessation-of-a-direct-oral-anticoagulant-a-case-report
#10
Jessica E Burjorjee, Rachel Rooney, Melanie Jaeger
OBJECTIVE: In this case report, we describe a case of epidural hematoma following epidural analgesia in a patient with recent cessation of a direct oral anticoagulant (DOAC). CASE REPORT: An 89-year-old woman requiring upper abdominal surgery presented with multiple comorbidities, including a prior cerebrovascular accident resulting in a left-sided hemiparesis and atrial fibrillation requiring anticoagulation with rivaroxaban. In accordance with our departmental guidelines at the time of procedure, rivaroxaban was discontinued 4 days preoperatively...
April 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29332115/ultrasound-guided-transversus-abdominis-plane-block-postoperative-analgesia-in-children-with-spinal-dysraphism
#11
Eralp Çevikkalp, Koray Erbüyün, Serpil Erbüyün, Gülay Ok
Pediatric regional anesthesia is widely used to relieve postoperative pain after abdominal surgery. Commonly used techniques of regional anesthesia include lumbar epidural and caudal block. However, the use of central neuraxial blockade has limitations. It is contraindicated in patients with clotting abnormalities, spinal dysraphism with tethered cord syndrome, meningomyelocele, and following spinal surgery with instrumentation. Ultrasound guided transversus abdominis plane block is a new method of regional anesthesia that can be used in settings where central neuraxial blockade is contraindicated...
January 2018: Saudi Medical Journal
https://www.readbyqxmd.com/read/29284833/preemptive-epidural-analgesia-for-postoperative-pain-relief-revisited-comparison-of-combination-of-buprenorphine-and-neostigmine-with-combination-of-buprenorphine-and-ketamine-in-lower-abdominal-surgeries-a-double-blind-randomized-trial
#12
Sanjay Choubey, Raj Bahadur Singh
Context: Postoperative pain relief provides subjective comfort to patient in addition to blunting of autonomic and somatic reflex responses to pain, subsequently enhancing restoration of function by allowing the patient to breathe, cough, and move easily. Aims: The aim is to evaluate and compare the effects of neostigmine + buprenorphine and ketamine + buprenorphine for preemptive epidural analgesia for postoperative pain relief in patients undergoing abdominal surgeries under general anesthesia (GA)...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29211841/perioperative-benefit-and-outcome-of-thoracic-epidural-in-esophageal-surgery-a-clinical-review
#13
P Feltracco, A Bortolato, S Barbieri, E Michieletto, E Serra, A Ruol, S Merigliano, C Ori
Surgery for esophageal cancer is a highly stressful and painful procedure, and a significant amount of analgesics may be required to eliminate perioperative pain and blunt the stress response to surgery. Proper management of postoperative pain has invariably been shown to reduce the incidence of postoperative complications and accelerate recovery. Neuraxial analgesic techniques after major thoracic and upper abdominal surgery have long been established to reduce respiratory, cardiovascular, metabolic, inflammatory, and neurohormonal complications...
May 1, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29194065/delayed-respiratory-depression-secondary-to-opioid-overdose-after-multimodal-analgesia-with-transversus-abdominis-plane-blocks-in-postanesthesia-care-unit-a-case-report
#14
Michael O'Rourke, Emily S Schmidt, Jonathan E Metry, Michael B Majewski
Pain control after open abdominal surgery often includes multimodal analgesia with thoracic epidural or transversus abdominis plane (TAP) block. After liposomal bupivacaine was approved for TAP blocks in 2015, it became an alternative to indwelling catheters. However, the pharmacokinetics and safety of its use during the perioperative period have not been thoroughly investigated, especially in conjunction with parenteral opioids. We present a case report of an elderly patient having urgent laparoscopic converted to open abdominal surgery, who experienced postoperative respiratory depression in the recovery room after multimodal therapy with liposomal bupivacaine TAP blocks, intravenous (IV) opioids, and ketorolac...
April 1, 2018: A&A practice
https://www.readbyqxmd.com/read/29074363/ultrasound-guided-femoral-and-obturator-nerves-block-in-the-psoas-compartment-in-dogs-anatomical-and-randomized-clinical-study
#15
Hamaseh Tayari, Giulio Tazioli, Gloria Breghi, Angela Briganti
OBJECTIVE: To evaluate intraoperative and postoperative efficacy of ultrasound (US)-guided femoral (FN) and obturator (ON) nerves block, in the iliopsoas muscle compartment (IPM), using an in-plane technique. STUDY DESIGN: Anatomical research and randomized, prospective, 'blinded' clinical study. ANIMALS: Six dog cadavers and 20 client-owned dogs undergoing tibial plateau levelling osteotomy (TPLO) surgery. METHODS: In phase 1, anatomical dissections and US imaging of the IPM were performed to design an US-guided nerve block involving the FN and ON simultaneously...
September 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29045482/influence-on-number-of-top-ups-after-implementing-patient-controlled-epidural-analgesia-a-cohort-study
#16
Ganapathy van Samkar, Henning Hermanns, Philipp Lirk, Markus W Hollmann, Markus F Stevens
Postoperative epidural analgesia often needs rate readjustment using top-ups. Patient-controlled epidural analgesia (PCEA) is said to reduce the requirement of epidural top-ups when compared to continuous epidural analgesia (CEA). We compared CEA and PCEA in major thoracic and abdominal surgery, in a cohort study. The primary endpoint was the required number of epidural top-ups. Secondary endpoints were pain scores, side effects and workload differences. We analysed 199 patients with CEA and 187 with PCEA. Both groups had similar pain scores...
2017: PloS One
https://www.readbyqxmd.com/read/28956744/efficacy-and-safety-of-a-continuous-wound-catheter-in-open-abdominal-partial-hepatectomy
#17
Lu Che, Xin Lu, Li-Jian Pei
Objective To investigate the efficacy and safety of continuous local anesthetic wound infiltration following open abdominal partial hepatectomy. Methods We performed a prospective, non-randomized, concurrent and controlled study. Patients undergoing open abdominal partial hepatectomy, according to their willingness, accepted one of the following managements for the postoperative pain: continuous wound catheter (CWC) infiltration, patient-controlled epidural analgesia (PCEA), patient-controlled intravenous analgesia of morphine (PCIAM), and patient-controlled intravenous analgesia of sufentanil (PCIAS)...
September 27, 2017: Chinese Medical Sciences Journal, Chung-kuo i Hsüeh K'o Hsüeh Tsa Chih
https://www.readbyqxmd.com/read/28938298/safety-and-efficacy-of-epidural-analgesia
#18
REVIEW
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...
December 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
#19
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
#20
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...
April 2018: Anesthesia and Analgesia
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