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Epidural analgesia

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https://www.readbyqxmd.com/read/29223694/atraumatic-versus-conventional-lumbar-puncture-needles-a-systematic-review-and-meta-analysis
#1
Siddharth Nath, Alex Koziarz, Jetan H Badhiwala, Waleed Alhazzani, Roman Jaeschke, Sunjay Sharma, Laura Banfield, Ashkan Shoamanesh, Sheila Singh, Farshad Nassiri, Wieslaw Oczkowski, Emilie Belley-Côté, Ray Truant, Kesava Reddy, Maureen O Meade, Forough Farrokhyar, Malgorzata M Bala, Fayez Alshamsi, Mette Krag, Itziar Etxeandia-Ikobaltzeta, Regina Kunz, Osamu Nishida, Charles Matouk, Magdy Selim, Andrew Rhodes, Gregory Hawryluk, Saleh A Almenawer
BACKGROUND: Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. METHODS: In this systematic review and meta-analysis, we independently searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomised controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication...
December 6, 2017: Lancet
https://www.readbyqxmd.com/read/29221974/criteria-for-postoperative-mechanical-ventilation-after-thymectomy-in-patients-with-myasthenia-gravis-a-retrospective-analysis
#2
Keerthi Chigurupati, Shrinivas Gadhinglajkar, Rupa Sreedhar, Muraleedharan Nair, Madathipat Unnikrishnan, Manjusha Pillai
OBJECTIVE: To determine the criteria for postoperative mechanical ventilation after thymectomy in patients with Myasthenia Gravis. DESIGN: Retrospective study. SETTING: Teritiary care centre. PARTICIPANTS: 77 Myasthenia gravis patients operated for thymectomy were studied. INTERVENTIONS: After obtaining clearance from Institutional ethics committee, medical records of 77 patients with MG, who were operated for thymectomy between January 2005 and December 2015 were reviewed in a retrospective manner...
June 27, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29219940/factors-influencing-postpartum-fatigue-in-vaginal-birth-women-testing-a-path-model
#3
Ching-Hsing Hsieh, Chien-Lan Chen, Tan-Ju Han, Pei-Ju Lin, Hui-Chun Chiu
BACKGROUND: Postpartum fatigue is a very common complaint among postpartum women. Although current evidence indicates that several factors (e.g., parity, epidural analgesia, perineal trauma, perineal pain, and longer second stage of labor) are associated with postpartum, not enough is known about the relationships among these physical factors simultaneously and how they contribute to the development of postpartum fatigue. Increased awareness of the complex relationships among these factors will help nurses assess, prevent, and alleviate postpartum fatigue...
December 6, 2017: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/29211841/perioperative-benefit-and-outcome-of-thoracic-epidural-in-esophageal-surgery-a-clinical-review
#4
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...
December 2, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29210330/subcutaneous-local-anesthetic-infusion-could-eliminate-use-of-epidural-analgesia-after-the-nuss-procedure
#5
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...
December 6, 2017: Pain Management
https://www.readbyqxmd.com/read/29208509/the-use-of-an-intraarticular-catheter-on-fast-track-primary-knee-arthroplasty-is-it-a-step-forward
#6
L Cáceres-Sánchez, J B García-Benítez, V Coronado-Hijón, M Montero-Pariente
OBJECTIVE: This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. MATERIAL AND METHOD: Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen)...
December 2, 2017: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/29207811/comparative-evaluation-of-ropivacaine-and-fentanyl-versus-ropivacaine-and-fentanyl-with-clonidine-for-postoperative-epidural-analgesia-in-total-knee-replacement-surgery
#7
Shivali Panwar, Preeti S Govind, Parag Jyoti Duarah, Hari Kishan Mahajan, Smita Anil Korde
Introduction: Clonidine an alpha 2 adrenoceptor agonist possesses analgesic properties and has been used as an adjuvant in epidural analgesia. The addition of clonidine to other analgesics may result in enhanced analgesia through additive mechanisms or synergistic mechanisms. The enhanced analgesia may lead to a decrease in the dosage of analgesic drugs along with reduction of side effects. Aim: The purpose of this study was to evaluate the effect of adding clonidine to epidural ropivacaine and fentanyl mixture in terms of quality of analgesia and side effects in patients of total knee replacement surgery...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29205784/thoracic-epidural-analgesia-in-donor-hepatectomy-an-analysis
#8
Archna Koul, Deepanjali Pant, Swetha Rudhravaram, Jayashree Sood
BACKGROUND: To analyze whether supplementation of general anaesthesia with thoracic epidural analgesia (TEA) for right lobe donor hepatectomy is a safe modality of pain relief in terms of changes in postoperative coagulation profile, incidence of epidural catheter related complications and timing of removal of epidural catheter. METHODS: Retrospective analysis of the record of 104 patients who received TEA for right lobe donor hepatectomy was done. Platelet count, INR, ALT and AST were recorded postoperatively till the removal of the epidural catheter...
December 2, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/29198625/transversus-abdominis-plane-block-improves-perioperative-outcome-after-esophagectomy-versus-epidural
#9
Gal Levy, Mark A Cordes, Alexander S Farivar, Ralph W Aye, Brian E Louie
BACKGROUND: Pain control is challenging during esophagectomy. An epidural is commonly used, but the sympathetic blockade can have unintended consequences such as hypotension or delayed return of bowel function. A transversus abdominis plane (TAP) block has the potential to control upper abdominal pain without these adverse consequences. We aimed to compare bilateral TAP blocks with patient-controlled analgesia (PCA) for immediate management after esophagectomy with a cohort using a thoracic (T5 to T8) epidural...
December 1, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29197080/determination-of-the-optimal-programmed-intermittent-epidural-bolus-volume-of-bupivacaine-0-0625-with-fentanyl-2-%C3%AE-g-ml-1-at-a-fixed-interval-of-forty-minutes-a-biased-coin-up-and-down-sequential-allocation-trial
#10
P Zakus, C Arzola, R Bittencourt, K Downey, X Y Ye, J C Carvalho
The optimum time interval for 10 ml boluses of bupivacaine 0.0625% + fentanyl 2 μg.ml-1 as part of a programmed intermittent epidural bolus regimen has been found to be 40 min. This regimen was shown to be effective without the use of supplementary patient-controlled epidural analgesia boluses in 90% of women during the first stage of labour, although with a rate of sensory block to ice above T6 in 34% of women. We aimed to determine the optimum programmed intermittent epidural bolus volume at a 40 min interval to provide effective analgesia in 90% of women (EV90 ) during the first stage of labour, without the use of patient-controlled epidural analgesia...
December 2, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29194144/thoracic-epidural-analgesia-and-mortality-in-acute-pancreatitis-a-multicenter-propensity-analysis
#11
Matthieu Jabaudon, Nouria Belhadj-Tahar, Thomas Rimmelé, Olivier Joannes-Boyau, Stéphanie Bulyez, Jean-Yves Lefrant, Yannick Malledant, Marc Leone, Paer-Selim Abback, Fabienne Tamion, Hervé Dupont, Brice Lortat-Jacob, Philippe Guerci, Thomas Kerforne, Raphael Cinotti, Laurent Jacob, Philippe Verdier, Thierry Dugernier, Bruno Pereira, Jean-Michel Constantin
OBJECTIVE: Recent preclinical and clinical data suggest that thoracic epidural analgesia, a technique primarily aimed at decreasing pain, might exert anti-inflammatory effects, enhance splanchnic and pancreatic blood flow during acute pancreatitis; however, the influence of epidural analgesia on mortality remains under investigated in this setting. This study was therefore designed to assess the impact of epidural analgesia on mortality in ICU patients with acute pancreatitis. DESIGN: Multicenter retrospective, observational, cohort study...
November 30, 2017: Critical Care Medicine
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
#12
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...
November 30, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29189517/can-early-oral-prolonged-release-oxycodone-with-or-without-naloxone-reduce-the-duration-of-epidural-analgesia-after-cystectomy-a-three-arm-randomized-double-blind-placebo-controlled-trial
#13
Marc P Schneider, Lukas M Löffel, Marc A Furrer, Fiona C Burkhard, Bettina Kleeb, Michele Curatolo, Patrick Y Wuethrich
Thoracic epidural analgesia (TEA) enhances recovery after bowel surgery. Early postoperative prolonged-release oral formulation of oxycodone or oxycodone/naloxone is potentially useful as a second analgesic step to reduce the duration of TEA. We hypothesized that oxycodone would decrease the duration of TEA and combined with naloxone preserve gastrointestinal function. Ninety patients undergoing open cystectomy and urinary diversion were enrolled in this randomized double-blind, three-arm, parallel-group, placebo-controlled single-center trial between September 2015 and February 2017...
November 20, 2017: Pain
https://www.readbyqxmd.com/read/29189495/lumbar-spine-anatomy-in-women-sustaining-unintentional-dural-puncture-during-labor-epidural-placement-a-descriptive-study-using-magnetic-resonance-imaging-and-ultrasound
#14
Nicholas M Barrett, Cristian Arzola, Timo Krings, Kristi Downey, Jose C A Carvalho
BACKGROUND AND OBJECTIVES: Unintentional dural puncture is one of the most frequent complications of the epidural technique. One previous study suggested that atypical sonoanatomy of the ligamentum flavum/dura mater unit may be a risk factor for this complication. In this study, we describe the anatomy of the lumbar spine, assessed by magnetic resonance imaging (MRI) and ultrasound, in women sustaining unintentional dural puncture during epidural catheter placement for labor analgesia...
November 15, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29189291/effect-of-thoracic-epidural-ropivacaine-versus-bupivacaine-on-lower-urinary-tract-function-a-randomized-clinical-trial
#15
Stefan A Girsberger, Marc P Schneider, Lukas M Löffel, Fiona C Burkhard, Patrick Y Wuethrich
BACKGROUND: Thoracic epidural analgesia with bupivacaine resulted in clinically relevant postvoid residuals due to detrusor underactivity. This study aimed to compare the risk of bladder dysfunction with ropivacaine versus bupivacaine using postvoid residuals and maximum flow rates. Our hypothesis was that ropivacaine would result in lower postvoid residuals, because ropivacaine has been shown to have less effect on motor blockade. METHODS: In this single-center, parallel-group, randomized, double-blind superiority trial, 42 patients undergoing open renal surgery were equally allocated to receive epidural bupivacaine 0...
November 21, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29189266/epidural-space-identification-with-loss-of-resistance-technique-for-epidural-analgesia-during-labor-a-randomized-controlled-study-using-air-or-saline-new-arguments-for-an-old-controversy
#16
Nicolas Brogly, Emilia Guasch, Estibaliz Alsina, Carla García, Laura Puertas, Ana Dominguez, Jesús Diez, Jorge Gómez, Fernando Gilsanz
BACKGROUND: The best technique to identify the epidural space for labor analgesia is still unclear despite the publication of various randomized controlled studies and meta-analyses. Our aim was to assess the superiority of the saline loss of resistance (SLOR) technique over the air loss of resistance (ALOR) technique with respect to the quality of the block. METHODS: Consenting parturients admitted to our obstetric suite for spontaneous or induced labor were randomized to receive epidural analgesia using either the ALOR or SLOR technique...
November 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29184440/administration-of-epidural-labor-analgesia-is-not-associated-with-a-decreased-risk-of-postpartum-depression-in-an-urban-canadian-population-of-mothers-a-secondary-analysis-of-prospective-cohort-data
#17
Marissa Nahirney, Amy Metcalfe, Katie H Chaput
Background: Postpartum depression (PPD) is a common complication of pregnancy, affecting approximately 13% of mothers internationally. Previous research has examined whether epidural analgesia used for pain control during labor and birth is associated with a lower risk of PPD, but reports conflicting results and may have suffered from methodological shortcomings. Our study aimed to prospectively assess whether epidural analgesia is associated with a lower risk of PPD (at either 6 weeks or 6 months postpartum) after attempting to adequately adjust for selection bias and confounding variables...
2017: Local and Regional Anesthesia
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
#18
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
#19
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
https://www.readbyqxmd.com/read/29169795/paravertebral-block-for-thoracic-surgery
#20
REVIEW
Francine D'Ercole, Harendra Arora, Priya A Kumar
Local anesthetic injected into a wedge-shaped space lateral to the spinal nerves as they emerge from the intervertebral foramina produces somatosensory and sympathetic nerve blockade effective for anesthesia and for managing pain of unilateral origin from the chest and abdomen. Paravertebral blockade (PVB) is versatile and may be applied unilaterally or bilaterally. Unlike thoracic epidural, the PVB technique may be used to avoid contralateral sympathectomy, thereby minimizing hypotension and leading to better preservation of blood pressure...
October 4, 2017: Journal of Cardiothoracic and Vascular Anesthesia
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