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morphin epidural

H Virgin, E Oddby, J G Jakobsson
INTRODUCTION: Epidural analgesia is commonly used for management of pain during childbirth. Need for emergent Caesarean section e.g. because of signs of foetal distress or lack of progress is however not an uncommon event. In females having an established epidural; general anaesthesia, top-up of the epidural or putting a spinal are all possible options. Dosing of the spinal anaesthesia in females having epidural is a matter of discussion. PRESENTATION OF CASE: We describe a healthy 32 years, 0 para mother in gestation week 36 having labour epidural analgesia but due to foetal distress scheduled for an emergent Caesarean section category 2 that developed upper extremity weakness and respiratory depression after administration of standard dose high density bupivacaine/morphine/fentanyl intrathecal anaesthesia...
October 3, 2016: International Journal of Surgery Case Reports
Andrew W Gorlin, David M Rosenfeld, Jillian Maloney, Christopher S Wie, Johnathan McGarvey, Terrence L Trentman
The conversion of high-dose intravenous (IV) opioids to an equianalgesic epidural (EP) or intrathecal (IT) dose is a common clinical dilemma for which there is little evidence to guide practice. Expert opinion varies, though a 100 IV:10:EP:1 IT conversion ratio is commonly cited in the literature, especially for morphine. In this study, the authors surveyed 724 pain specialists to elucidate the ratios that respondents apply to convert high-dose IV morphine, hydromorphone, and fentanyl to both EP and IT routes...
2016: Journal of Pain Research
Mareike Arnholz, Stephan Hungerbühler, Clarissa Weil, Alexandra F Schütter, Karl Rohn, Julia Tünsmeyer, Sabine B R Kästner
OBJECTIVE: Comparison of ultrasound-guided femoral and sciatic nerve block versus epidural anaesthesia with bupivacaine and morphine for orthopaedic surgery of the pelvic limb in dogs with respect to analgesic effectiveness, clinical utility and side effects. MATERIAL AND METHODS: The study included 22 dogs (American Society of Anesthesiologists, ASA grades I and II) undergoing orthopaedic surgery distal to the mid-femoral bone. The study was designed as a randomized, prospective, blinded clinical trial...
September 27, 2016: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
Caitlyn Rose Moss, Julia Christine Caldwell, Babatunde Afilaka, Khaled Iskandarani, Vernon Michael Chinchilli, Patrick McQuillan, Amanda Beth Cooper, Niraj Gusani, Dmitri Bezinover
BACKGROUND AND AIMS: Postoperative pain can significantly affect surgical outcomes. As opioid metabolism is liver-dependent, any reduction in hepatic volume can lead to increased opioid concentrations in the blood. The hypothesis of this retrospective study was that patients undergoing open hepatic resection would require less opioid for pain management than those undergoing open pancreaticoduodenectomy. MATERIAL AND METHODS: Data from 79 adult patients who underwent open liver resection and eighty patients who underwent open pancreaticoduodenectomy at our medical center between January 01, 2010 and June 30, 2013 were analyzed...
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
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
Dawn E Jaroszewski, M'hamed Temkit, MennatAllah M Ewais, Todd C Luckritz, Joshua D Stearns, Ryan C Craner, Brantley D Gaitan, Harish Ramakrishna, Christopher A Thunberg, Ricardo A Weis, Kelly M Myers, Marianne V Merritt, David M Rosenfeld
BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q)...
August 2016: Journal of Thoracic Disease
Sylvia H Wilson, Bethany J Wolf, Abdalrahman A Algendy, Clark Sealy, Harry A Demos, Julie R McSwain
BACKGROUND: Total hip arthroplasty (THA) is associated with significant postoperative pain. Both lumbar epidurals and lumbar plexus nerve blocks have been described for postoperative pain control, but it is unclear if one technique is more beneficial. METHODS: Using electronic medical records, a randomly selected, cohort of 58 patients with lumbar epidurals were compared with 58 patients with lumbar plexus nerve blocks following primary THA. The primary end point was 48-hour postoperative opiate consumption...
August 10, 2016: Journal of Arthroplasty
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
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
Varut Lohsiriwat
AIM: To evaluate the opioid-sparing effect of selective cyclooxygenase-2 (COX-2) inhibitors on short-term surgical outcomes after open colorectal surgery. METHODS: Patients undergoing open colorectal resection within an enhanced recovery after surgery protocol from 2011 to 2015 were reviewed. Patients with combined general anesthesia and epidural anesthesia, and those with acute colonic obstruction or perforation were excluded. Patients receiving selective COX-2 inhibitor were compared with well-matched individuals without such a drug...
July 15, 2016: World Journal of Gastrointestinal Oncology
Geoff Frawley, Jacinta Frawley, Joe Crameri
BACKGROUND: Pectus excavatum (PE) is the most common congenital chest wall deformity, occurring in 1 : 1000 children with a male to female ratio of 4 : 1. Several procedures have been described to manage this deformity, including cartilage resection with sternal osteotomy (the Ravitch procedure) and a minimally invasive repair technique (the Nuss procedure). While initially described as a nonthoracoscopic technique, the current surgical approach of the Royal Childrens Hospital involves thoracoscopic assistance...
November 2016: Paediatric Anaesthesia
Gareth E Zeiler, Eva Rioja, Charlie Boucher, Adrian S W Tordiffe
This case series describes the anaesthetic management of two sibling Bengal tiger (Panthera tigris tigris) cubs that were found to have spontaneous femur fractures due to severe nutritional secondary hyperparathyroidism. Both cubs received a combination of medetomidine (25 µg/kg) and ketamine (4 mg/kg) intramuscularly and were maintained with isoflurane in oxygen. An epidural injection of morphine (0.1 mg/kg) and ropivacaine (1.6 mg/kg) was administered to both tigers, which allowed a low end-tidal isoflurane concentration to be maintained throughout the femur fracture reduction operations...
2013: Journal of the South African Veterinary Association
Andrew J Cohen, Katie Brodie, Prithvi Murthy, Duncan T Wilcox, Mohan S Gundeti
OBJECTIVE: To compare perioperative and surgical outcomes in a two center, two surgeon open vs. robotic augmentation ileocystoplasty (AI). METHODS: We reviewed patients undergoing AI open vs. robotically between 2008 and 2014 at two centers. We compared the groups' preoperative characteristics, perioperative outcomes, complications, and interim functional outcomes. RESULTS: The cohort consisted of 17 and 15 patients with median follow up 45 and 46 months, in open and robotic groups respectively...
July 18, 2016: Urology
Yeliz Sağlık, Dilek Yazıcıoğlu, Osman Çiçekler, Haluk Gümüş
OBJECTIVE: To investigate the effects of general anaesthesia and general+epidural anaesthesia on the stress response which was evaluated with the adrenocorticotrophic hormone (ACTH), cortisol, insulin, and glucose levels and the haemodynamic parameters. METHODS: Forty two, American Society of Anesthesiologists physiologic status I-II, patients undergoing hip and knee arthroplasty were randomized into two groups; general anaesthesia (Group G) and general anaesthesia+epidural anaesthesia (Group E)...
June 2015: Turkish Journal of Anaesthesiology and Reanimation
V Singh, V P Singh, R R Shankar
Eighty female patients in the age group of 20-40 years, weighing 40 ± 15 Kg, in ASA physical status I and II, awaiting either elective or emergency caesarean delivery were selected for this study. Patients with cardiovascular disorders and those with significant systemic ailments were excluded from the study. They were randomly divided into two equal groups of 40 patients each. Group I was subdivided randomly into two equal sub-groups (1A and 1B) of 20 patients each and was selected for administration of epidural narcotics...
January 2001: Medical Journal, Armed Forces India
Michelle A O Kinney, Adam K Jacob, Melissa A Passe, Carlos B Mantilla
Background. Postthoracotomy pain syndrome (PTPS) is unfortunately very common following thoracotomy and results in decreased quality of life. The purpose of this retrospective study was to determine perioperative patient, surgical, and analgesic characteristics associated with the development of PTPS. Methods. Sixty-six patients who presented to the Mayo Clinic Rochester Pain Clinic were diagnosed with PTPS 2 months or more after thoracotomy with postoperative epidural analgesia. These patients were matched with sixty-six control patients who underwent thoracotomy with postoperative epidural analgesia and were never diagnosed with PTPS...
2016: Pain Research and Treatment
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
Neha Baduni, Manoj Kumar Sanwal, Homay Vajifdar, Radhika Agarwala
BACKGROUND AND AIMS: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects. MATERIAL AND METHODS: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries...
April 2016: Journal of Anaesthesiology, Clinical Pharmacology
Casey L Shelley, Stepheny Berry, James Howard, Martin De Ruyter, Melissa Thepthepha, Niaman Nazir, Tracy McDonald, Annemarie Dalton, Michael Moncure
BACKGROUND: Rib fractures are common in trauma admissions and are associated with an increased risk of pulmonary complications, intensive care unit admissions, and mortality. Providing adequate pain control in patients with multiple rib fractures decreases the risk of adverse events. Thoracic epidural analgesia is currently the preferred method for pain control. This study compared outcomes in patients with multiple acute rib fractures treated with posterior paramedian subrhomboidal (PoPS) analgesia versus thoracic epidural analgesia (TEA)...
September 2016: Journal of Trauma and Acute Care Surgery
Bin Hu, Tiao Lin, Shi-Gui Yan, Song-Lin Tong, Jian-Hao Yu, Jian-Jie Xu, Yi-Ming Ying
BACKGROUND: Total knee arthroplasty (TKA) is one of the most commonly performed procedures while postoperative analgesia still remains challenging. The efficacy and safety of local infiltration analgesia (LIA) versus regional blockade (RB; epidural analgesia and/or peripheral nerve block) for pain management after TKA are controversial. OBJECTIVES: The purpose of this meta-analysis was to determine whether LIA compared with RB would provide better postoperative pain control, consume less morphine, facilitate early functional recovery, entail a differential risk of side effects and complications, and allow a shorter length of stay...
May 2016: Pain Physician
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