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https://www.readbyqxmd.com/read/29327462/propensity-score-matched-outcomes-after-thoracic-epidural-or-paravertebral-analgesia-for-thoracotomy
#1
W J Blackshaw, A Bhawnani, S H Pennefather, O Al-Rawi, S Agarwal, M Shaw
It is not known which regional analgesic technique is most effective or safest after open lung resection. We retrospectively examined outcomes in 828 patients who received thoracic epidural analgesia and 791 patients who received paravertebral block after lung resection between 2008 and 2012. We analysed outcomes for 648 patients, 324 who had each analgesic technique, matched by propensity scores generated with peri-operative data. There were 22 out of 324 (7%) postoperative respiratory complications after thoracic epidural and 23 out of 324 (7%) after paravertebral block, p = 0...
January 12, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29325956/rapid-onset-thoracic-myelopathy-due-to-an-epidural-sarcoid-like-lesion-in-a-pediatric-patient
#2
Michael A Galgano, Carlos R Goulart, Karen Chisholm, Melissa Hazen, Scellig Stone
Isolated intraspinal neurosarcoidosis is a rare clinical entity, with most reports describing intramedullary involvement in adults. We detail the case of a nine-year-old girl with rapid onset compressive myelopathy secondary to a thoracic epidural lesion. Although pathological diagnosis was challenging, a presumptive diagnosis of isolated extradural neurosarcoidosis was made in light of the patient's investigations and dramatic response to corticosteroids. Though less likely than neoplasia, rheumatologic processes such as inflammatory granulomatous disease warrant consideration in similar cases...
January 8, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29322981/expansile-manubriotomy-for-ventral-cervicothoracic-junction-disease
#3
Sudhir Dubey, Amit Agrawal
Cervicothoracic junction can be approached anteriorly, anterolaterally, posterolaterally, and posteriorly. The anterior approaches in this region best address the ventral vertebral body disease but may cause significant morbidity. Twelve patients with their disease process located ventral to the spinal cord in the cervicothoracic junction underwent expansile manubriotomy and corpectomy. Eleven patients underwent fusion. One patient underwent an oblique corpectomy. All patients had their disease process from T1 to T3 vertebral levels...
January 2018: Neurology India
https://www.readbyqxmd.com/read/29288395/morphometric-study-of-the-posterior-longitudinal-ligament-at-the-lumbar-spine
#4
Céline Salaud, Stéphane Ploteau, Olivier Hamel, Olivier Armstrong, Antoine Hamel
PURPOSE: There are only two descriptions of posterior longitudinal ligament (PLL) at the lumbar spine level but its morphologic characteristics are different to cervical and thoracic levels. METHOD: Spine explantation (from Th12 to L5) followed by resection of the neural arch and the dural sheath in 13 fresh cadavers was performed. The PLL was isolated from other epidural structures and its width was measured and compared to the vertebral body width at each vertebral levels...
December 29, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/29261600/three-dimensional-thoracic-epidural-educational-model
#5
Martha Claire Johnson, Sasha Portnova, Matthew Lester
No abstract text is available yet for this article.
January 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29259148/successful-recovery-from-spontaneous-spinal-epidural-hematoma-in-a-patient-undergoing-hemodialysis
#6
Arata Hibi, Takahisa Kasugai, Keisuke Kamiya, Keisuke Kamiya, Satoru Kominato, Chiharu Ito, Toshiyuki Miura, Katsushi Koyama
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) occurs in the spinal epidural space in the absence of traumatic or iatrogenic causes, and is considered to be a neurological emergency, as spinal cord compression may lead to neurological deficit. Prompt diagnosis of SSEH can be difficult due to the variety of presenting symptoms, which may resemble those of stroke. Patients who undergo hemodialysis (HD) are at risk of bleeding due to anticoagulation during dialysis and uremia. However, SSEH in HD patients undergoing HD has rarely been reported...
December 20, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/29240502/should-thoracic-epidurals-be-routinely-sited-in-patients-having-cardiac-surgery
#7
Zhihao Oon, Adam Woo
No abstract text is available yet for this article.
December 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29236967/postoperative-analgesia-after-pulmonary-resection-with-a-focus-on-video-assisted-thoracoscopic-surgery
#8
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
#9
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/29221974/criteria-for-postoperative-mechanical-ventilation-after-thymectomy-in-patients-with-myasthenia-gravis-a-retrospective-analysis
#10
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/29211841/perioperative-benefit-and-outcome-of-thoracic-epidural-in-esophageal-surgery-a-clinical-review
#11
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
#12
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/29206300/effects-of-mtor-nf-%C3%AE%C2%BAb-signaling-pathway-and-high-thoracic-epidural-anesthesia-on-myocardial-ischemia-reperfusion-injury-via-autophagy-in-rats
#13
Wei-Qiang Huang, Jian-Lin Wen, Ri-Qi Lin, Peng Wei, Feng Huang
We investigated the role of mammalian target of rapamycin/nuclear factor-kappa B (mTOR/NF-κB) signaling pathway in high thoracic epidural anesthesia (HTEA) against myocardial ischemia-reperfusion (I/R) injury in rats. The rat model of myocardial I/R injury was established. Ninety rats were divided into the normal, sham, I/R, eHTEA, the PDTC and HTEA + PDTC groups. ELISA was applied to detect cardiac function indexes. HE staining was conducted to observe histopathological changes of myocardial tissues, and TTC staining was performed to detect the myocardial infarction size...
December 5, 2017: Journal of Cellular Physiology
https://www.readbyqxmd.com/read/29205784/thoracic-epidural-analgesia-in-donor-hepatectomy-an-analysis
#14
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/29205143/epidural-abscess-imitating-recurrent-pilonidal-sinus-a-case-report
#15
C Koutserimpas, N Nikitakis, A Skarpas, M Lada, E Papachristou, G Velimezis
Pilonidal sinus or pilonidal cyst is a common benign disease, affecting mostly young working men. We present the first case of an epidural abscess imitating pilonidal sinus. A 33-year old male, suffering from previously undiagnosed and untreated diabetes mellitus (DM), presented to our emergency department (ER), one month after open surgical treatment of pilonidal sinus, due to weakness and fever. After re-operation of the pilonidal cyst and due to post-operative pus production and continuation of fever a computer tomogr aphy (CT )scan was performed revealing an epidural abscess extending from the thoracic vertebrae 12 (T-12) to the sacrococcygeal area...
May 2017: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/29198854/efficacy-and-safety-of-transversus-abdominis-plane-blocks-versus-thoracic-epidural-anesthesia-in-patients-undergoing-major-abdominal-oncologic-resections-a-prospective-randomized-controlled-trial
#16
Tamer M Shaker, Joseph T Carroll, Mathew H Chung, Tracy J Koehler, Brian R Lane, Andrea M Wolf, G Paul Wright
BACKGROUND: The purpose of this study was to compare patient outcomes for thoracic epidural anesthesia (TEA) with transversus abdominis plane (TAP) blocks. METHODS: A prospective, randomized trial was performed for patients undergoing abdominal oncologic surgeries. RESULTS: There were 32 TAP and 35 TEA subjects. The TEA group demonstrated increased episodes of hypotension in the first 24 h (3 v 0.6, p = 0.02). There was no difference in 24-48 h fluid balance between the groups...
November 16, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29198625/transversus-abdominis-plane-block-improves-perioperative-outcome-after-esophagectomy-versus-epidural
#17
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/29194144/thoracic-epidural-analgesia-and-mortality-in-acute-pancreatitis-a-multicenter-propensity-analysis
#18
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
#19
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-3-arm-randomized-double-blind-placebo-controlled-trial
#20
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
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