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https://www.readbyqxmd.com/read/27909035/randomised-controlled-pilot-study-to-investigate-the-effectiveness-of-thoracic-epidural-and-paravertebral-blockade-in-reducing-chronic-post-thoracotomy-pain-topic-feasibility-study-protocol
#1
Joyce Yeung, Teresa Melody, Amy Kerr, Babu Naidu, Lee Middleton, Kostas Tryposkiadis, Jane Daniels, Fang Gao
INTRODUCTION: Open chest surgery (thoracotomy) is considered the most painful of surgical procedures. Forceful wound retraction, costochondral dislocation, posterior costovertebral ligament disruption, intercostal nerve trauma and wound movement during respiration combine to produce an acute, severe postoperative pain insult and persistent chronic pain many months after surgery is common. Three recent systematic reviews conclude that unilateral continuous paravertebral blockade (PVB) provides analgesia at least equivalent to thoracic epidural blockade (TEB) in the postoperative period, has a lower failure rate, and symptom relief that lasted months...
December 1, 2016: BMJ Open
https://www.readbyqxmd.com/read/27906944/the-safety-of-ct-guided-epidural-steroid-injections-in-an-older-patient-cohort
#2
Andrew J Fenster, Kevin Fernandes, Alan L Brook, Todd Miller
BACKGROUND: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult US population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure's safety profile in an older patient population. OBJECTIVE: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27906718/anesthesia-for-nonintubated-video-assisted-thoracic-surgery
#3
Hiroshi Sunaga, Justin D Blasberg, Paul M Heerdt
PURPOSE OF REVIEW: This review focuses primarily on nonintubated video-assisted thoracic surgery (NIVATS), and discusses advantages, indications, anesthetic techniques, and approaches to intraoperative crisis management. RECENT FINDINGS: Advancements in endoscopic, endovascular, and robotic techniques have expanded the range of surgical procedures that can be performed in a minimally invasive fashion. For thoracic operations in particular, video-assisted thoracic surgery (VATS) has largely replaced traditional thoracotomy, and continued technical development has made surgical access into the pleural space even less disruptive...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27871519/intrapleural-placement-of-a-thoracic-epidural-catheter-in-a-patient-with-spinal-stenosis
#4
Kiran Belani, Mario Montealegre-Gallegos, Brian Ferla, Robina Matyal
Due to the close proximity of the thoracic epidural space and parietal pleura, pleural puncture with intrapleural catheter placement is a potential complication of thoracic epidural anesthesia. The authors present a case of an obese patient with a history of spinal stenosis that underwent thoracotomy. Repeated failed attempts at epidural anesthesia were complicated by intrapleural placement of the catheter. The patient subsequently developed clinical signs of pneumothorax and required urgent thoracostomy.
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27847694/contribution-of-low-dose-computerized-tomography-with-digital-multiplanar-reconstructions-in-thoracic-epidurography-and-correlation-with-sensory-block-in-postoperative-analgesia
#5
Cyrus Motamed, Karin Chedevergne, Frederic Deschamps, Lambros Tselikas, Christian Jayr
BACKGROUND: The level of sensory block in postoperative epidural analgesia has been correlated with conventional contrast epidurography in only one study, while low-dose CT scan epidurography with multiplanar reconstruction may be a better tool for this purpose. OBJECTIVES: The primary objective of this study was to evaluate, by CT imaging and digital multiplanar reconstruction, the spread and distribution of contrast medium injected into the epidural space through a catheter inserted in a low thoracic position for postoperative analgesia...
October 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27843682/large-spontaneous-spinal-subdural-epidural-hematoma-after-epidural-anesthesia-for-caesarean-section-conservative-management-with-excellent-outcome
#6
Ioannis D Siasios, Kunal Vakharia, Kevin J Gibbons, Vassilios G Dimopoulos
BACKGROUND: Iatrogenic or spontaneous spinal hematomas are rarely seen and present with multiple symptoms that can be difficult to localize. Most spontaneous spinal hematomas are multifactorial, and the pathophysiology is varied. Here, we present a case of a scattered, multicomponent, combined subdural and epidural spinal hematoma that was managed conservatively. CASE DESCRIPTION: A 38-year-old woman came to the emergency department (ED) complaining of severe neck and back pain...
2016: Surgical Neurology International
https://www.readbyqxmd.com/read/27833495/postoperative-pain-management-of-liver-transplantation-in-cystic-fibrosis-is-it-time-to-start-us-guided-neuraxial-blocks
#7
M Piazza, G Martucci, A Arcadipane
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27832615/-changes-in-spinal-mri-findings-for-epidural-fluid-collection-in-the-treatment-of-intracranial-hypotension
#8
Norimitsu Nakagawa
We have experienced 30 cases of intracranial hypotension in the last three years. Spinal MRI was performed in all cases, and 27 patients demonstrated epidural fluid collection(EFC). Of these 30 patients, 6 were treated conservatively with bed rest and hydration, and 24 were treated with epidural blood patch(EBP). Twenty-two patients were cured, 4 were improved significantly, and 4 were improved partially. We examined spinal MR images of 22 patients after 3 months of treatment. The EFC wasn't visible in 11 cases;however, residual EFC was found in the 11 remaining cases...
November 2016: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/27831993/postoperative-symptomatic-anterior-spinal-epidural-hematoma-complete-drainage-using-corpectomy-and-a-bladder-catheter
#9
Rafael González-Diaz, Ismael Auñon-Martin, Francisco Javier Ortega-Garcia, Rui Miguel Reis da Rocha
STUDY DESIGN: A case report. OBJECTIVE: We describe a technique to drain a thoracic and cervical postoperative epidural hematoma causing paraplegia after anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA: Postoperative compressive spinal epidural hematoma (SEH) is a devastating complication and early diagnosis and treatment is essential. The most commonly accepted treatment is decompression and drainage of hematoma. METHODS: A 65-year-old male with a degenerative disc disease located at C4-C5, C5-C6, and C6-C7 levels with disc herniation underwent a standard anterior cervical decompression and fusion at C4-C5-C6-C7...
November 15, 2016: Spine
https://www.readbyqxmd.com/read/27830790/a-brain-spine-interface-alleviating-gait-deficits-after-spinal-cord-injury-in-primates
#10
Marco Capogrosso, Tomislav Milekovic, David Borton, Fabien Wagner, Eduardo Martin Moraud, Jean-Baptiste Mignardot, Nicolas Buse, Jerome Gandar, Quentin Barraud, David Xing, Elodie Rey, Simone Duis, Yang Jianzhong, Wai Kin D Ko, Qin Li, Peter Detemple, Tim Denison, Silvestro Micera, Erwan Bezard, Jocelyne Bloch, Grégoire Courtine
Spinal cord injury disrupts the communication between the brain and the spinal circuits that orchestrate movement. To bypass the lesion, brain-computer interfaces have directly linked cortical activity to electrical stimulation of muscles, and have thus restored grasping abilities after hand paralysis. Theoretically, this strategy could also restore control over leg muscle activity for walking. However, replicating the complex sequence of individual muscle activation patterns underlying natural and adaptive locomotor movements poses formidable conceptual and technological challenges...
November 9, 2016: Nature
https://www.readbyqxmd.com/read/27829181/effect-of-thoracic-epidural-block-on-infection-induced-inflammatory-response-a-randomized-controlled-trial
#11
Asha Tyagi, Anuradha Bansal, Shukla Das, Ashok Kumar Sethi, Aanchal Kakkar
PURPOSE: Epidural block decreases inflammation and oxidative stress in experimental models of sepsis as well as after surgery. There is, however, no clinical evidence evaluating its effect on infection-induced inflammatory process. The present trial evaluated the effect of thoracic epidural block (TEB) on systemic inflammatory response in patients with small intestinal perforation peritonitis. Outcome measures included systemic levels of interleukin (IL)-6, IL-10, procalcitonin, and C-reactive protein and postoperative Sepsis-Related Organ Failure Assessment scores...
October 18, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27823364/medical-management-of-spinal-epidural-empyema-in-five-dogs
#12
Susana R Monforte Monteiro, Antonella Gallucci, Nicolas Rousset, Paul M Freeman, Edward J Ives, Gualtiero Gandini, Nicolas Granger, An E Vanhaesebrouck
CASE DESCRIPTION 5 dogs were examined because of clinical signs of myelopathy, including signs of pain associated with the spinal region and rapidly progressive neurologic deficits. CLINICAL FINDINGS In all dogs, results of MRI were consistent with spinal epidural empyema. Concurrent infectious processes were identified at adjacent or distant sites in all dogs, including diskospondylitis, prostatitis, dermatitis, paraspinal infection following a penetrating injury, urinary tract infection, and pyothorax. Bacteria were isolated from 3 dogs; Escherichia coli was isolated from blood, urine, and prostatic wash samples from 1 dog; a Pasteurella sp was isolated from a percutaneous aspirate from an adjacent infected wound in a second dog; and a Corynebacterium sp was isolated from a thoracic fluid sample from a third dog...
November 15, 2016: Journal of the American Veterinary Medical Association
https://www.readbyqxmd.com/read/27821273/characteristics-of-thoracic-and-lumbar-movements-during-gait-in-lumbar-spinal-stenosis-patients-before-and-after-decompression-surgery
#13
Wataru Kuwahara, Masataka Deie, Naoto Fujita, Nobuhiro Tanaka, Kazuyoshi Nakanishi, Toru Sunagawa, Makoto Asaeda, Haruka Nakamura, Yoshifumi Kono, Mitsuo Ochi
BACKGROUND: Although gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear. METHODS: Ten patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale...
October 29, 2016: Clinical Biomechanics
https://www.readbyqxmd.com/read/27815809/prevalence-of-thoracic-spine-lesions-masquerading-as-cauda-equina-syndrome-yield-of-a-novel-magnetic-resonance-imaging-protocol
#14
Katherine Stolper, James Clark Haug, Chad Todd Christensen, Kathleen Michelle Samsey, Michael David April
Our objective was to describe the yield of actionable thoracic spine lesions for a novel magnetic resonance imaging (MRI) protocol including evaluation of the thoracic spine among patients presenting to the Emergency Department (ED) with symptoms consistent with epidural compression syndrome. Our ED and Department of Radiology together designed a novel rapid MRI protocol entailing 3D volumetric T2 weighted sequences through both the thoracic and lumbar spine obtained in the sagittal plane to assess for both lumbar and thoracic spine lesions...
November 4, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27813034/-horner-syndrome-following-combined-spinal-epidural-anesthesia
#15
Ömer Karaca, Sezen Kumaş Solak, Serdar Demirgan, Mehmet Bademci
Horner syndrome is rarely observed in connection with epidural anesthesia. It is characterized by ptosis, enophthalmos, miosis, anisocoria, and conjunctival hyperemia in the affected eye, as well as anhydrosis and flushing on the affected side of the face. It is usually a complication spontaneously resolved without permanent neurological deficits. Intraoral anesthesia; stellate ganglion, cervical or brachial plexus blocks; thoracic, lumbar or caudal epidural anesthesia, and intrapleural analgesia are the main causes for Horner syndrome related to anesthesia...
July 2016: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
https://www.readbyqxmd.com/read/27800076/-the-contribution-of-mri-in-the-management-of-slowly-progressive-nontraumatic-spinal-cord-compression
#16
Nfally Badji, Hamidou Deme, Geraud Akpo, Boucar Ndong, Mouhamadou Hamine Toure, Sokhna Ba Diop, El Hadji Niang
Slow spinal cord compressions are due to the development of an expansive lesion within the medullary canal. This is a very common condition whose diagnosis is primarily clinical. The magnetic resonance imaging occupies a central and currently irreplaceable position in diagnosis and localization as well as in etiological research. Etiology of cancer is predominant in Europe. This study aims to describe the MRI features of slow spinal cord compressions and to determine its etiologic profile. This is a retrospective study of 97 cases whose data were collected at the Department of Radiology, National University Hospital Centre (CHUN) of Fann, over a period of 30 months (from March 8, 2010 to September 29 2012)...
2016: Pan African Medical Journal
https://www.readbyqxmd.com/read/27800053/is-there-a-measurable-association-of-epidural-use-at-cystectomy-and-postoperative-outcomes-a-population-based-study
#17
R Christopher Doiron, Melanie Jaeger, Christopher M Booth, Xuejiao Wei, D Robert Siemens
INTRODUCTION: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice. METHODS: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR)...
September 2016: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/27799990/the-safety-and-decision-making-of-instrumented-surgery-in-infectious-spondylitis
#18
Kyeong Hee Baek, Young-Seok Lee, Dong Ho Kang, Chul Hee Lee, Soo Hyun Hwang, In Sung Park
OBJECTIVE: Infectious spondylitis is mostly managed by appropriate antibiotic treatment options, and some patients may require surgical interventions. However, surgical interventions that use spinal instrumentation to correct the mechanical instability may be associated with the risk of an increase in the recurrence rate. In this study, we investigated whether spinal instrumentation effects on recurrence of infectious spondylitis. METHODS: The study was conducted as a retrospective study by dividing the subjects into the noninstrumentation surgery and instrumentation surgery groups among a total of 95 patients who had received surgical interventions in infectious spondylitis from 2009 to 2014...
September 2016: Korean Journal of Spine
https://www.readbyqxmd.com/read/27790554/comparison-between-thoracic-epidural-block-and-thoracic-paravertebral-block-for-post-thoracotomy-pain-relief
#19
Soniya Biswas, Reetu Verma, Vinod Kumar Bhatia, Ajay Kumar Chaudhary, Girish Chandra, Ravi Prakash
INTRODUCTION: Postoperative pain after thoracotomy is being considered one of the most severe pain and if not treated well, can result in various respiratory and other complications. AIM: Present study was conducted with the aim to compare continuous thoracic epidural infusion with continuous paravertebral infusion for postoperative pain using Visual Analogue Scale (VAS) score and four point observer ranking. The secondary outcomes measured were pulmonary functions and any complication like hypotension, bradycardia, nausea, vomiting, urinary retention and neurological complications if any...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27782985/fully-awake-breast-reduction
#20
Simon A Filson, Danielle Yarhi, Yitzhak Ramon
: The authors present 25 cases and an in-depth 4-minute video of fully awake aesthetic breast reduction, which was made possible by thoracic epidural anesthesia. There are obvious and important advantages to this technique. Not only does this allow for intraoperative patient cooperation (i.e., patient self-positioning and opinion for comparison of breasts), meaning a shorter and more efficient intraoperative time, there also is a reduction in postoperative pain, complications, recovery, and discharge times...
November 2016: Plastic and Reconstructive Surgery
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