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Epidural analgesia after abdominal surgery

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
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
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
José Miguel Cardoso, Miguel Sá, Hugo Reis, Liliana Almeida, José Carlos Sampaio, Célia Pinheiro, Duarte Machado
INTRODUCTION AND OBJECTIVES: Quadratus Lumborum block was recently described and has already shown good results as an analgesic technique in abdominal surgeries, having the potential to significantly reduce opioids consumption and be a valid alternative to epidural catheter. We performed a type II Quadratus Lumborum block for analgesia in a septic patient having a sub-total gastrectomy. CASE REPORT: An 80 year-old, ASA III, male patient, weighting 50kg, with a history of arterial hypertension and hypercholesterolemia, diagnosed with sepsis due to purulent peritonitis was submitted to an open laparotomy...
September 26, 2016: Revista Brasileira de Anestesiologia
JiHee Hong, Sung Won Jung
BACKGROUND: Thoracic epidural anesthesia (TEA) is frequently used to maintain intraoperative analgesia. After injecting the initial bolus dose of epidural local anesthetics (LA), intermittent injection of LA through an epidural catheter is required to maintain the intraoperative analgesia. For intermittent epidural administration, usually 2 - 5 mL of LA has been used. However, no studies have suggested an optimal volume of LA of TEA for intermittent epidural administration of TEA. OBJECTIVE: We focused on identifying an optimal volume of LA of TEA using epidurography of the thoracic level with 2 different volumes of contrast dye...
September 2016: Pain Physician
Wei-Feng Liu, Hai-Hua Shu, Guo-Dong Zhao, Shu-Ling Peng, Jin-Fang Xiao, Guan-Rong Zhang, Ke-Xuan Liu, Wen-Qi Huang
OBJECTIVE: This multicenter, randomized, placebo-controlled study evaluated the efficacy and side effects of parecoxib during patient-controlled epidural analgesia (PCEA) after abdominal hysterectomy. METHODS: A total of 240 patients who were scheduled for elective abdominal hysterectomy under combined spinal-epidural anesthesia received PCEA plus postoperative intravenous parecoxib 40 mg or saline every 12 h for 48 h after an initial preoperative dose of parecoxib 40 mg or saline...
2016: PloS One
Le Shen, Yu-Guang Huang
<p>Enhanced recovery after surgery (ERAS) is to achieve early recovery for patients undergoing major surgery through multimodal perioperative care pathways. Treatment of postoperative pain is of great importance for ERAS. From 2012 to now,the ERAS Society has published seven international guidelines for the abdominal or pelvic surgeries. Each of these guidelines recommended a standardized postoperative multimodal analgesia protocol to improve pain relief and postoperative recovery. Upon these guidelines,thoracic epidural analgesia should be the primary choice for postoperative analgesia of either abdominal and pelvic surgeries...
August 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Lorenzo Ball, Giulia Pellerano, Laura Corsi, Nadia Giudici, Anna Pellegrino, Daniela Cannata, Gregorio Santori, Domenico Palombo, Paolo Pelosi, Angelo Gratarola
BACKGROUND: We compared a bundle of interventions including wound infiltration and continuous infusion with local anaesthetics plus a single morphine bolus (CWI-M) with continuous epidural infusion (CEI) as postoperative analgesia. METHODS: Fifty-one adults undergoing open abdominal aortic aneurysm repair were randomised in this non-inferiority open-label trial. In the CEI group, patients received thoracic epidural levobupivacaine 0.12% plus sufentanil 0.4 g·ml-1 infusion for 48h...
August 30, 2016: Minerva Anestesiologica
Emmanuel Melloul, Martin Hübner, Michael Scott, Chris Snowden, James Prentis, Cornelis H C Dejong, O James Garden, Olivier Farges, Norihiro Kokudo, Jean-Nicolas Vauthey, Pierre-Alain Clavien, Nicolas Demartines
BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. METHODS: A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline...
October 2016: World Journal of Surgery
Joanne Guay, Mina Nishimori, Sandra Kopp
BACKGROUND: Gastrointestinal paralysis, nausea and vomiting and pain are major clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting (PONV), while preventing or reducing postoperative ileus, may reduce postoperative morbidity, duration of hospitalization and hospital costs. This review was first published in 2001 and was updated by new review authors in 2016. OBJECTIVES: To compare effects of postoperative epidural analgesia with local anaesthetics versus postoperative systemic or epidural opioids in terms of return of gastrointestinal transit, postoperative pain control, postoperative vomiting, incidence of anastomotic leak, length of hospital stay and costs after abdominal surgery...
2016: Cochrane Database of Systematic Reviews
B Jebaraj, P Khanna, D K Baidya, S Maitra
BACKGROUND: Dexamethasone is a potent anti-inflammatory, analgesic, and antiemetic drug. Individual randomized controlled trials found a possible benefit of epidural dexamethasone. The purpose of this meta-analysis is to estimate the benefit of epidural dexamethasone on postoperative pain and opioid consumption and to formulate a recommendation for evidence-based practice. MATERIALS AND METHODS: Prospective, randomized controlled trials comparing the analgesic efficacy of epidural local anesthetic and dexamethasone combination, with local anesthetic alone for postoperative pain management after abdominal surgery, were planned to be included in this meta-analysis...
July 2016: Saudi Journal of Anaesthesia
Etrusca Brogi, Roy Kazan, Shantale Cyr, Francesco Giunta, Thomas M Hemmerling
PURPOSE: The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. SOURCE: We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Soichiro Yamashita, Takako Yokouchi, Makoto Tanaka
STUDY OBJECTIVES: To evaluate whether intraoperative high-dose remifentanil infusion increased local anesthetic consumption in postoperative epidural analgesia and postoperative pain scores compared with low-dose remifentanil infusion. DESIGN: Prospective, randomized controlled study. SETTING: Operating room, university hospital. PATIENTS: Thirty female patients scheduled for elective gynecological abdominal surgery...
August 2016: Journal of Clinical Anesthesia
Mauritz M Roeb, Alexander Wolf, Stefan S Gräber, Winfried Meiner, Thomas Volk
BACKGROUND: The PAIN-OUT registry collected data from more than 30,000 patients on pain on the first postoperative day in hospitals worldwide. Utilising the database we compared systemic with epidural analgesia (EA) on postoperative pain and related side-effects in patients after abdominal surgeries. METHODS: Abdominal surgeries (AS) were identified via ICD9-Code and sub-grouped into laparoscopic (LS) and open surgery (OS). After identifying patients in this subset with and without EA propensity-score matching was performed, based on demographics and comorbidities...
June 1, 2016: Clinical Journal of Pain
Sabry Ayad, Rovnat Babazade, Hesham Elsharkawy, Vinayak Nadar, Chetan Lokhande, Natalya Makarova, Rashi Khanna, Daniel I Sessler, Alparslan Turan
Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery...
2016: PloS One
(no author information available yet)
A case is reported from the Safety Reporting System in Anaesthesia and Resuscitation database. The event occurred in a patient undergoing abdominal surgery in whom an epidural catheter was inserted for analgesia. After the intervention, the patient was transferred to the recovery unit where the patient controlled analgesia (PCA) is programmed. Due to an error, the PCA was connected to a peripheral venous line, which was detected early without harm to the patient. Communication and analysis of this incident served to introduce a new drug delivery protocol through PCA pumps, including the obligation to prescribe the PCA in the electronic system, a dual computerised check immediately before connecting PCA, labelling the medication bag as well as the proximal and distal lines, standardisation of daily visits to patients, and monthly monitoring of results...
August 2016: Revista Española de Anestesiología y Reanimación
A Ahmed, T Baig
INTRODUCTION AND AIM: Epidural analgesia is an effective technique for postoperative pain relief following thoracoabdominal surgeries. Lower limb motor weakness is a well-known complication of epidural analgesia with local anesthetics and delays postoperative rehabilitation. Our aim in conducting this observational study was to assess the frequency of lower limb motor weakness in patients receiving epidural analgesia following upper abdominal surgery and the factors associated with it...
April 2016: Saudi Journal of Anaesthesia
Julie C R Misquith, Rammoorthi Rao, Karl Sa Ribeiro
INTRODUCTION: Anaesthesia and upper abdominal surgeries alter lung compliance and functional residual capacity resulting from atelectasis. Upper abdominal surgeries also cause a decrease in peak expiratory flow rates, cough reflex due to pain limited inspiration. AIM: This study aimed to study the effect of thoracic epidural analgesia (TEA) on the peak expiratory flow rates in patients undergoing upper abdominal surgeries. MATERIALS AND METHODS: A total of 44 patients posted for elective surgery were enrolled...
February 2016: Journal of Clinical and Diagnostic Research: JCDR
Thomas von Hösslin, Paul Imboden, Andreas Lüthi, Marta J Rozanski, Thomas W Schnider, Miodrag Filipovic
BACKGROUND: Thoracic epidural analgesia is a well established technique for postoperative pain relief after major abdominal and thoracic surgery. Safety remains a major concern because of serious adverse events including epidural haematoma, abscess and permanent neurological deficit. OBJECTIVE: The aim of this study was to evaluate the incidence and the long-term outcome of serious adverse events associated with thoracic epidural analgesia. DESIGN: Retrospective cohort study...
October 2016: European Journal of Anaesthesiology
Tülin Akarsu Ayazoğlu, Aynur Özensoy, Fatih Doğu Geyik, Muhittin Çalım, Uğur Duman, Mehmet Akif Candan
OBJECTIVES: The aim of this study is to investigate the effects of combined epidural analgesia with total intravenous anaesthesia and only total intravenous anaesthesia on the different clinical parameters. METHODS: Sixty high risk patients undergoing a major abdominal surgical procedure were included in this prospective, double blind, randomized study. Induction of anaesthesia was performed with IV remifentanil 0.5µg/kg and propofol titrated to achieve bispectral index score between 40 and 50...
2015: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
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