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https://www.readbyqxmd.com/read/29351097/effect-of-epidural-infusion-bolus-delivery-rate-on-the-duration-of-labor-analgesia-a-randomized-clinical-trial
#1
Elizabeth M S Lange, Cynthia A Wong, Paul C Fitzgerald, Wilmer F Davila, Suman Rao, Robert J McCarthy, Paloma Toledo
BACKGROUND: Programmed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain. METHODS: Nulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial...
January 19, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29339580/advantages-of-soft-subdural-implants-for-the-delivery-of-electrochemical-neuromodulation-therapies-to-the-spinal-cord
#2
Marco Capogrosso, Jérôme Gandar, Nathan Greiner, Eduardo Martin Moraud, Nikolaus Wenger, Polina Shkorbatova, Pavel E Мusienko, Ivan Minev, Stephanie P Lacour, Gregoire Courtine
We recently developed soft neural interfaces enabling the delivery of electrical and chemical stimulation to the spinal cord. These stimulations restored locomotion in animal models of paralysis. Soft interfaces can be placed either below or above the dura mater. Theoretically, the subdural location combines many advantages, including increased selectivity of electrical stimulation, lower stimulation thresholds, and targeted chemical stimulation through local drug delivery. However, these advantages have not been documented, nor have their functional impact been studied in-silico or in a relevant animal model of neurological disorders using a multimodal neural interface...
January 17, 2018: Journal of Neural Engineering
https://www.readbyqxmd.com/read/29338142/patient-controlled-epidural-analgesia-with-and-without-basal-infusion-using-ropivacaine-0-15-and-fentanyl-2%C3%AE-ml-for-labour-analgesia-a-prospective-comparative-randomised-trial
#3
Paraskevi K Matsota, Kalliopi H Drachtidi, Chrysanthi Z Batistaki, Agathi V Karakosta, Ioanna C Koukopoulou, Eugenia I Koursoumi, Georgia G Kostopanagiotou
BACKGROUND: Patient-Controlled Epidural Analgesia (PCEA) is a common practice for labour pain relief. This study aimed to compare two different settings of a PCEA device using the same solution to obtain labour analgesia. METHODS: Fifty two parturients were randomly allocated to receive ropivacaine 0.15% and fentanyl 2γ/mL via a PCEA device either as a background infusion of 5mL/h plus 5mL demand bolus doses with 10 min lockout (group B/D, n=26) or as only demand bolus doses of 5mL with 10 min lockout (group D, n=26)...
January 16, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29323741/stainless-steel-wear-debris-of-a-scoliotic-growth-guidance-system-has-little-local-and-systemic-effect-in-an-animal-model
#4
Vaneet Singh, Jeremy Rawlinson, Nadim Hallab
Options to treat early-onset scoliosis include guided-growth systems with sliding action between rods and pedicle screws. The wear was previously measured in an in vitro test, and in this in vivo rabbit model, we evaluated the local and systemic biological response to the stainless steel debris. Compared to the previous study, a relatively higher volume of representative wear particles with a median particle size of 0.84 µm were generated. Bolus dosages were injected into the epidural space at L4-L5 for a minimum of 36 rabbits across three treatment groups (negative control, 1...
January 11, 2018: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
https://www.readbyqxmd.com/read/29285586/intracranial-ewing-sarcoma-four-pediatric-examples
#5
Michael J Yang, Ros Whelan, Jennifer Madden, Jean M Mulcahy Levy, B K Kleinschmidt-DeMasters, Todd C Hankinson, Nicholas K Foreman, Michael H Handler
BACKGROUND: Ewing sarcoma typically arises in bone and is unrelated to intraparenchymal small blue cell embryonal central nervous system (CNS) tumors previously designated primitive neuroectodermal tumors (PNETs). When the CNS is impacted, it is usually secondary to local extension from either the epidural space, skull, or intracranial or spinal metastases. Primary examples within the cranial vault are rare, usually dural-based, and are largely case reports in the literature. We detail four pediatric patients with solitary, primary intracranial Ewing sarcoma, all manifesting the archetypal EWRS1 gene rearrangement that confirms diagnosis...
December 28, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29284871/comparative-study-of-clonidine-with-ropivacaine-versus-ropivacaine-alone-in-epidural-anesthesia-for-lower-limb-orthopedic-surgery
#6
Mahendra Singh, Amitesh Pathak, Aamir Laique Khan, Amit Srivastava, Devendra Negi
Background: Epidural anesthesia has been well established as a safe and effective technique not only for perioperative anesthesia but also for postoperative analgesia. Various adjuvants have been added to local anesthetic agent in an effort to prolong this duration. Aims: The aim of this study was to compare and evaluate the anesthesia and analgesic property of ropivacaine to its combination with clonidine for lower limb orthopedic surgery under epidural. Materials and Methods: In a prospective, randomized, double-blind study, eighty adult patients undergoing lower limb surgeries received either 0...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29284849/comparison-of-the-efficacy-and-safety-of-morphine-and-fentanyl-as-adjuvants-to-bupivacaine-in-providing-operative-anesthesia-and-postoperative-analgesia-in-subumblical-surgeries-using-combined-spinal-epidural-technique
#7
Owais Mushtaq Shah, Kharat Mohammad Bhat
Introduction: The combined spinal epidural (CSE) technique involves intentional subarachnoid blockade and epidural catheter placement during the same procedure to combine their individual best features, to reduce the total drug dosage and avoid their respective disadvantages. The addition of opioids to local anesthetics (bupivacaine) for CSE anesthesia (CSEA) is increasingly common to enhance the block. Neuraxial fentanyl is more potent and has shorter duration of action than morphine which provides prolonged anesthesia and analgesia, however at the cost of increased incidence of adverse effects like delayed respiratory depression...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29279744/postoperative-spinal-epidural-hematoma-the-danger-caused-by-the-misuse-of-thrombin-containing-local-hemostatics
#8
Dong Ki Ahn, Won Shik Shin, Go We Kim, Ki Hyuk Koo
Study Design: Retrospective case-control study. Purpose: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). Overview of Literature: Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states. Methods: Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used)...
December 2017: Asian Spine Journal
https://www.readbyqxmd.com/read/29274452/visualization-of-needle-tip-localization-by-ultrasound-guidance-with-contrast-bubble-in-lumbar-selective-nerve-root-block-clinical-pilot-study
#9
Sorayouth Chumnanvej, Kitipat Kittayapirom, Siriluk Chumnanvej
BACKGROUND: Epidural steroid injection for low back and leg pain has been shown to result in a positive clinical outcome. Lumbosacral selective nerve root block (SNRB) via a transforaminal approach is commonly performed under fluoroscopic guidance. However, ultrasound guidance is an alternative to overcome the radiological disadvantages. This study examined the accuracy of needle-tip localization under ultrasound guidance with a contrast bubble, compared with fluoroscopic guidance. OBJECTIVE: The primary objectives were to envisage the needle-tip localization with an air bubble by ultrasound and also to determine the accuracy of needle-tip location in transforaminal lumbar SNRB for low back and leg pain patients who were not surgical candidates...
December 20, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29274080/observational-study-using-ultrasound-to-assess-midline-labor-epidural-analgesia-placement-and-analgesic-efficacy
#10
Carolyn F Weiniger, Benjamin Cobb, Rachel R Wang, Brendan Carvalho
OBJECTIVES: Labor epidural analgesia failure may relate to nonmidline placement of epidural catheters. We hypothesized that greater deviations of the epidural catheter insertion point from the ultrasound (US)-determined midline would be associated with less effective labor analgesia. METHODS: A prospective ethically approved cohort study was conducted. Fifty-two healthy average-sized women receiving labor epidural analgesia, inserted by the landmark technique, were approached after delivery...
December 23, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29236967/postoperative-analgesia-after-pulmonary-resection-with-a-focus-on-video-assisted-thoracoscopic-surgery
#11
Marzia Umari, Valentina Carpanese, Valeria Moro, Gaia Baldo, Stefano Addesa, Enrico Lena, Stefano Lena, Umberto Lucangelo
Video-assisted thoracoscopic surgery is a widespread technique that has been linked to improved postoperative respiratory function, reduced hospital length of stay and a higher level of tolerability for the patients. Acute postoperative pain is of considerable significance, and the late development of neuropathic pain syndrome is also an issue. As anaesthesiologists, we have investigated the available evidence to optimize postoperative pain management. An opioid-sparing multimodal approach is highly recommended...
December 8, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29236577/a-focal-cooling-method-for-the-cervical-spinal-cord-a-percutaneous-approach-to-the-dorsal-neck-in-dogs
#12
Kanichiro Kaneko, Yasuharu Noishiki, Kengo Funakoshi, Tomoyuki Saito
For the treatment of acute cervical spinal cord injuries, a local epidural cooling system using a percutaneous technique was proposed. In this animal study, regional low temperature was obtained stably in the cervical epidural space (CED) without decreasing temperatures at the rectum and the thoracic epidural space. Three stainless steel tubes were inserted percutaneously using the lateral approach into 3 serial interspinous spaces of the neck of 12 beagles under radiographic guidance. Two temperature probes were inserted into the CEDs at the level of the middle cooling tube...
December 13, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/29225780/the-decision-to-delivery-interval-in-emergency-caesarean-sections-impact-of-anaesthetic-technique-and-work-shift
#13
Anette Hein, David Thalen, Ylva Eriksson, Jan G Jakobsson
Background: One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS). A Decision to Delivery Interval (DDI) <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA), spinal anaesthesia (SPA) with opioid supplementation, or "top-up" of labour epidural analgesia (tEDA) with local anaesthesia and fentanyl mixture) and work shift for ECS at Danderyds Hospital, Sweden...
2017: F1000Research
https://www.readbyqxmd.com/read/29210330/subcutaneous-local-anesthetic-infusion-could-eliminate-use-of-epidural-analgesia-after-the-nuss-procedure
#14
Sandra K Kabagambe, Laura F Goodman, Y Julia Chen, Benjamin A Keller, James C Becker, Gary W Raff, Rebecca A Stark, Jacob T Stephenson, Amy Rahm, Diana L Farmer, Shinjiro Hirose
AIM: To compare outcomes of continuous subcutaneous infusion of local anesthetic and epidural analgesia following the Nuss procedure. PATIENTS & METHODS: A retrospective chart review compared patients managed with subcutaneous local anesthetic infusion (n = 12) versus thoracic epidural (n = 19) following the Nuss procedure from March 2013 to June 2015. RESULTS: There was no difference in hospital length of stay or days on intravenous narcotics...
January 2018: Pain Management
https://www.readbyqxmd.com/read/29206837/pyogenic-vertebral-osteomyelitis-of-the-elderly-characteristics-and-outcomes
#15
Johan Courjon, Adrien Lemaignen, Idir Ghout, Audrey Therby, Nadia Belmatoug, Aurélien Dinh, Guillaume Gras, Louis Bernard
BACKGROUND: The incidence of pyogenic vertebral osteomyelitis (PVO) has increased over the past two decades. One possible cause of this increase is the aging of the population, which results in more comorbidities in high income countries. OBJECTIVE: To better characterize the clinical presentation and outcome of PVO in the elderly. DESIGN: We conducted a post-hoc analysis of a previously published trial that studied treatment duration in PVO and compared the presentation and outcomes according to age...
2017: PloS One
https://www.readbyqxmd.com/read/29202726/large-reductions-in-cesarean-delivery-rates-in-china-a-qualitative-study-on-delivery-decision-making-in-the-era-of-the-two-child-policy
#16
Eileen Wang, Therese Hesketh
BACKGROUND: In 2010, China's cesarean delivery (CD) rates increased to one of the highest in the world, a significant proportion of which were without medical indication. However, recent studies have indicated some declines, coinciding with national and local efforts to promote vaginal birth, as well as the relaxation of the one-child policy. Considering these trends, we aimed to qualitatively explore attitudes towards childbirth and experiences of delivery decision-making among women and physicians...
December 4, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29194770/differences-in-epidural-pathology-between-cervical-and-thoracolumbar-intervertebral-disk-extrusions-in-dogs
#17
L Züger, A Fadda, A Oevermann, F Forterre, M Vandevelde, D Henke
BACKGROUND: Although the basic pathophysiology is the same in both cervical and thoracolumbar intervertebral disk (IVD) extrusions, there are considerable clinical differences that have only been partially explained. HYPOTHESIS/OBJECTIVES: The epidural inflammatory response differs between cervical and thoracolumbar IVD extrusions. ANIMALS: Fifty-five dogs with cervical and 80 dogs with thoracolumbar IVD extrusions. METHODS: Clinical data and histopathologic variables were investigated...
November 30, 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29189286/epidural-anesthesia-to-facilitate-organ-blood-flow-during-the-first-penile-transplantation-in-the-united-states-a-case-report
#18
Katarina J Ruscic, Grettel J Zamora-Berridi, Francis J McGovern, Curtis Cetrulo, Jonathan M Winograd, Kyle R Eberlin, Branko Bojovic, Dicken S Ko, T Anthony Anderson
Regional anesthesia has been used to help create local sympathectomy and improve blood flow in plastic surgery procedures involving tissue grafts and flaps. However, anesthetic techniques that reduce systemic vascular resistance must be used with caution in patients with aortic stenosis (AS). Combined neuraxial and general anesthesia with careful titration of the local anesthetic dose can be a safe approach for patients with AS undergoing microvascular procedures. We present the anesthetic management of the first North American penile transplant, on an obese patient with moderate AS...
November 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29184439/ultrasound-guided-rectus-sheath-block-caudal-analgesia-or-surgical-site-infiltration-for-pediatric-umbilical-herniorrhaphy-a-prospective-double-blinded-randomized-comparison-of-three-regional-anesthetic-techniques
#19
Lance M Relland, Joseph D Tobias, David Martin, Giorgio Veneziano, Ralph J Beltran, Christopher McKee, Tarun Bhalla
Background: Umbilical hernia repair is a common pediatric surgical procedure. While opioid analgesics are a feasible option and have long been a mainstay in the pharmacological intervention for pain, the effort to improve care and limit opioid-related adverse effects has led to the use of alternative techniques, including regional anesthesia. The current study prospectively compares the analgesic efficacy of three techniques, including caudal epidural blockade, peripheral nerve blockade, and local wound infiltration, in a double-blinded study...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29180895/postoperative-pain-management-in-the-postanesthesia-care-unit-an-update
#20
REVIEW
Jie Luo, Su Min
Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients' participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities...
2017: Journal of Pain Research
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