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Epidural analgesia

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https://www.readbyqxmd.com/read/28527646/high-dose-amino-acid-administration-achieves-an-anabolic-response-in-type-2-diabetic-patients-that-is-independent-of-glycaemic-control-a-randomized-clinical-trial
#1
Chelsia Gillis, Patricia S Roque, Jürgen Bläss, Albert Urwyler, Harald Schepperle, Guido Kunz, Thomas Peters, Thomas Schricker, Linda Wykes, Andrea Kopp Lugli
BACKGROUND & AIMS: Surgical stress provokes protein catabolism and hyperglycaemia that is enhanced in patients with type 2 diabetes (T2DM), and increases perioperative morbidity. This study hypothesized that perioperative administration of high dose intravenous (IV) amino acids (AA) will augment protein balance in T2DM patients receiving tight plasma glucose control via continuous IV insulin compared to standard plasma glucose control via subcutaneous (SC) insulin sliding scale. METHODS: Eighteen patients with well-controlled T2DM (HbA1C% < 7...
May 3, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28526487/ultrasound-guided-thoracic-paravertebral-injection-in-dogs-a-cadaveric-study
#2
Diego A Portela, Luis Campoy, Pablo E Otero, Manuel Martin-Flores, Robin D Gleed
OBJECTIVE: To describe ultrasound-visualized anatomy and the spread characteristics of a dye injected in the thoracic paravertebral (TPV) space under ultrasound guidance. STUDY DESIGN: Anatomic cadaver study. ANIMALS: Seven dog cadavers. METHODS: One cadaver was used to observe, identify, and describe the relevant TPV anatomy. In the remaining six, the left fifth TPV space was randomly assigned to be injected with either a low volume (LV; 0...
February 16, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28526462/-sudden-motor-and-sensorial-loss-due-to-retroperitoneal-hematoma-during-postoperative-periods-a-case-report
#3
Pelin Şen, Havva Gül Gültekin, İsmail Caymaz, Ömer Özel, Ayda Türköz
A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected...
May 16, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28526158/revisiting-oxycodone-analgesia-a-review-and-hypothesis
#4
REVIEW
Xiulu Ruan, Ken F Mancuso, Alan D Kaye
Oxycodone, a semisynthetic opioid analgesic, is widely used in clinical practice. Oxycodone and morphine seem to be equally effective and equipotent; however, morphine is 10 times more potent than oxycodone when given epidurally. This article provides an updated review of the basic pharmacology of oxycodone with a special focus on pharmacokinetic/pharmacodynamics properties. The controversy regarding oxycodone-mediated effects for visceral pain via agonism and the possible role of peripheral opioid analgesia are discussed in the present investigation in an attempt to propose a plausible explanation to the perplexing question of oxycodone analgesia...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28525512/parecoxib-supplementation-to-morphine-analgesia-decreases-incidence-of-delirium-in-elderly-patients-after-hip-or-knee-replacement-surgery-a-randomized-controlled-trial
#5
Dong-Liang Mu, Da-Zhi Zhang, Dong-Xin Wang, Geng Wang, Chun-Jing Li, Zhao-Ting Meng, Ya-Wei Li, Chao Liu, Xue-Ying Li
BACKGROUND: Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery. METHODS: In a randomized, double-blind, 2-center trial, patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline)...
June 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28525509/analgesic-choice-in-management-of-rib-fractures-paravertebral-block-or-epidural-analgesia
#6
Mahdi Malekpour, Ammar Hashmi, James Dove, Denise Torres, Jeffrey Wild
BACKGROUND: Rib fractures are commonly encountered in the setting of trauma. The aim of this study was to assess the association between the clinical outcome of rib fracture and epidural analgesia (EA) versus paravertebral block (PVB) using the National Trauma Data Bank (NTDB). METHODS: Using the 2011 and 2012 versions of the NTDB, we retrieved completed records for all patients above 18 years of age who were admitted with rib fractures. Primary outcome was in-hospital mortality...
June 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28525497/enhanced-recovery-after-surgery-for-suspected-ovarian-malignancy-a-survey-of-perioperative-practice-among-gynecologic-oncologists-in-australia-and-new-zealand-to-inform-a-clinical-trial
#7
Kristina Lindemann, Peey-Sei Kok, Martin Stockler, Peter Sykes, Alison Brand
OBJECTIVES: The objective of this survey was to review the current standard of perioperative care of patients with suspected advanced ovarian cancer in Australia and New Zealand in order to determine the level of equipoise for specific interventions. METHODS: In May 2016, a web-based questionnaire (SurveyMonkey Inc, Palo Alto, CA) was sent to all gynecologic oncologists in Australia and New Zealand (n = 56). Descriptive statistics were used. RESULTS: Response rate was 75%...
June 2017: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/28525409/preserved-analgesia-with-reduction-in-opioids-through-the-use-of-an-acute-pain-protocol-in-enhanced-recovery-after-surgery-for-open-hepatectomy
#8
Michael C Grant, Philip M Sommer, Cathy He, Sylvia Li, Andrew J Page, Alexander B Stone, Deborah Hobson, Elizabeth Wick, Christopher L Wu
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways are designed to restore baseline physiology, mitigate surgical stressors, and hasten recovery. Paramount to this approach is optimal pain control through multimodal analgesia and limiting reliance on opioid-based medications. Recent studies have fostered growing controversy surrounding the use of epidural analgesia in the ERAS setting, especially for higher-risk procedures. We examine the analgesic end points associated with the use of epidural within the ERAS framework for open hepatectomy...
May 18, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28524911/cancer-related-acute-pain-a-systematic-review-of-evidence-based-interventions-for-putting-evidence-into-practice
#9
Thiruppavai Sundaramurthi, Natalie Gallagher, Bethany Sterling
BACKGROUND: Identifying and implementing evidence-based interventions for cancer-related acute pain can decrease adverse effects and improve quality of life. 
. OBJECTIVES: This article presents current evidence supporting interventions to reduce cancer-related acute pain. 
. METHODS: PubMed and CINAHL® databases were searched to identify studies addressing interventions to manage acute pain in patients with cancer. The interventions are categorized according to the Putting Evidence Into Practice classification schema...
June 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28515516/changes-in-cardiac-index-during-labour-analgesia-a-double-blind-randomised-controlled-trial-of-epidural-versus-combined-spinal-epidural-analgesia-a-preliminary-study
#10
Stephanie Yacoubian, Corrina M Oxford, Bhavani Shankar Kodali
BACKGROUND AND AIMS: Combined spinal-epidural (CSE) analgesia for labour and delivery is occasionally associated with foetal bradycardia. Decreases in cardiac index (CI) and/or uterine hypertonia are implicated as possible aetiological factors. No study has evaluated CI changes following combined spinal analgesia for labour and delivery. This prospective, double-blind, randomised controlled trial evaluates haemodynamic trends during CSE and epidural analgesia for labour. METHODS: Twenty-six parturients at term requesting labour analgesia were randomised to receive either epidural (E) or CSE analgesia...
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28514779/low-back-pain-in-pregnancy-investigations-management-and-role-of-neuraxial-analgesia-and-anaesthesia-a-systematic-review
#11
Herman Sehmbi, Rohan D'Souza, Anuj Bhatia
BACKGROUND: Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. METHODS: We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery...
May 18, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28506404/-dural-sinus-thrombosis-following-epidural-analgesia-for-delivery-a-clinical-case
#12
Marco Aurelio Dornelles, Luis M Pereira
BACKGROUND AND OBJECTIVES: Neurological complications of spinal anesthesia are rare conditions. Headache caused by low pressure of the cerebrospinal fluid is one of the most frequent, which occurs after post-dural puncture. A comprehensive history and physical exam must be carried out before making the diagnosis of Post-Dural Puncture Headache (PDPH) and additional tests are necessary to exclude the possibility of developing serious neurological complications such as Dural Sinus Thrombosis (DST)...
May 12, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28504988/the-labor-analgesia-requirements-in-nulliparous-women-randomized-to-epidural-catheter-placement-in-a-high-or-low-intervertebral-space
#13
Albert Moore, Valerie Villeneuve, Bruno Bravim, Aly El-Bahrawy, Eva El-Mouallem, Ian Kaufman, Roupen Hatzakorzian, William Li Pi Shan
BACKGROUND: We hypothesized that an epidural catheter placed in a lower vertebral interspace will require less medication for labor analgesia. METHODS: Nulliparous women requesting neuraxial labor analgesia were randomized to epidural catheter placement at the ultrasound-confirmed L1-2 or L4-5 interspace. Patient-controlled epidural analgesia and breakthrough manual epidural boluses of 10 mL of 0.125% bupivacaine with 50 µg of fentanyl or 8 mL of 2% lidocaine were utilized...
May 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28504498/-pediatric-case-report-spinal-epidural-abscess
#14
Mauricio Pons, Leila Pérez, Facundo Juárez
Spinal epidural abscess is an uncommon pathology. It has an incidence of one case per 100 000 individuals. An increase is observed due to the raise of risk factors such as diabetes mellitus, spinal abnormalities, tattoos, acupuncture, epidural analgesia, and a greater availability of imaging methods. It is a purulent collection located between the dura and the medullary canal. The most common germs are Staphylococcus aureus and Gram-negative bacteria. Without timely treatment, it evolves to medullary compression and permanent neurological sequelae...
June 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28499552/puerperal-ventral-epidural-hematoma-after-epidural-labor-analgesia
#15
I Gruzman, I Shelef, A Y Weintraub, A Zlotnik, O Erez
Serious complications in obstetric anesthesia are a rare occurrence. High neuraxial block, respiratory arrest in labor and delivery, and an unrecognized spinal catheter are among the most frequently reported serious complications. A serious complication occurs in approximately 1:3000 obstetric patients. Neuraxial hematoma after obstetric epidural analgesia or anesthesia is extremely rare. We present a case of a puerperal spinal epidural hematoma following epidural labor analgesia. The patient presented with foot drop, which resolved after conservative treatment...
March 31, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28499376/benefits-of-preparing-for-childbirth-with-mindfulness-training-a-randomized-controlled-trial-with-active-comparison
#16
Larissa G Duncan, Michael A Cohn, Maria T Chao, Joseph G Cook, Jane Riccobono, Nancy Bardacke
BACKGROUND: Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education. METHODS: This study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2...
May 12, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28499362/active-delivery-of-the-anterior-arm-and-incidence-of-second-degree-perineal-tears-a-clinical-practice-evaluation
#17
Nicolas Mottet, Marine Bonneaud, Astrid Eckman-Lacroix, Rajeev Ramanah, Didier Riethmuller
BACKGROUND: Evaluate the feasibility of active delivery of the anterior arm during spontaneous delivery. This maneuver could decrease incidence of second-degree perineal tears because it reduces fetal biacromial diameter. METHODS: An observational comparative prospective study was conducted at our teaching maternity from July 2012 to March 2013. The study included 199 nulliparous women ≥18 years, who met the following criteria: singleton pregnancy, vaginal delivery with occiput anterior presentation, on epidural analgesia, from 37 weeks of gestation onward...
May 12, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28498237/enhanced-recovery-after-surgery-for-advanced-ovarian-cancer-a-systematic-review-of-interventions-trialed
#18
Kristina Lindemann, Peey-Sei Kok, Martin Stockler, Ken Jaaback, Alison Brand
OBJECTIVES: We sought to summarize the evidence for interventions aiming at enhanced recovery after surgery (ERAS) in ovarian cancer through a systematic review. METHODS: We searched MEDLINE, EMBASE, and The Cochrane Library for studies testing ERAS interventions in patients undergoing surgery for ovarian cancer. Study selection and data extraction were done independently by 2 reviewers with disagreements resolved by discussion with a senior, third reviewer. RESULTS: We identified 25 studies including 1648 participants with ovarian cancer...
May 12, 2017: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/28494909/remifentanil-as-an-alternative-to-epidural-analgesia-for-vaginal-delivery-a-meta-analysis-of-randomized-trials
#19
Myeongjong Lee, Fang Zhu, Jessica Moodie, Zhe Zhang, Davy Cheng, Janet Martin
OBJECTIVES: Although epidural analgesia is considered the gold standard for labor pain management, its use may be restricted in some conditions due to clinical contraindications or availability, and suitable alternatives may be required. The objective of this meta-analysis was to determine whether evidence from randomized trials suggests remifentanil PCA (R-PCA) results in significant differences in maternal satisfaction, analgesic efficacy, and safety compared with conventional epidural analgesia (EA)...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28492998/enhanced-recovery-after-surgery-can-we-rely-on-the-key-factors-or-do-we-need-the-bel-ensemble
#20
Jonas Jurt, Juliette Slieker, Pierre Frauche, Valerie Addor, Josep Solà, Nicolas Demartines, Martin Hübner
BACKGROUND: The success of enhanced recovery (ERAS) pathways depends on the actual application of the intended protocol (adherence), but its full implementation remains challenging. In order to potentially streamline the pathway, it is indispensable to know the impact of individual items and the entire protocol on clinical outcomes. METHODS: Retrospective analysis including all consecutive colorectal ERAS patients since implementation (May 2011) until February 2014; demographics, adherence and outcomes were retrieved from a prospectively maintained database...
May 10, 2017: World Journal of Surgery
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