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Sample records for analgesia epidural para

  1. Adrenalina como coadyuvante epidural para analgesia postoperatoria Epinephrine as epidural adjuvant for postoperative analgesia

    Directory of Open Access Journals (Sweden)

    B. Mugabure Bujedo

    2010-09-01

    Full Text Available La adrenalina ha sido ampliamente utilizada junto con anestésicos locales, tanto a nivel periférico como central, desde que Heinrich Braun fuera el pionero en experimentar con ella al inicio de 1900. Un siglo de uso atestigua su seguridad general como coadyuvante, a pesar de que todavía poseemos un conocimiento parcial de su modo de actuar, consiguiendo una prolongación del bloqueo nervioso, una reducción de las concentraciones plasmáticas de los anestésicos locales, una reducción del sangrado quirúrgico y una potenciación del efecto analgésico. El convencimiento durante largo tiempo de que la adrenalina muestra todos estos efectos beneficiosos, así como los negativos, únicamente por vasoconstricción, es demasiado simplista y actualmente insuficiente. El objetivo principal de esta revisión se centrará en demostrar como la adrenalina epidural es capaz de mejorar la analgesia postoperatoria cuando forma parte de una mezcla junto a bupivacaína o ropivacaína y fentanilo.Epinephrine has been combined with neuraxial and peripheral local anesthetics since Heinrich Braun first experimented with its use in the early 1900s. A century of use attests to the general safety of adjuvant epinephrine, yet we have only modest understanding of its intended effects, which include prolonging block duration, reducing plasma concentrations of local anesthetics, reducing surgical bleeding and intensifying anesthesia and analgesia. The long-held belief that epinephrine exerts most of these effects, including any associated complications, by causing vasoconstriction is doubtlessly too simplistic and has been recently challenged. The main part of this chapter will therefore focus on the advantages and disadvantages of epinephrine in epidural analgesia and on optimizing postoperative analgesia by adding epinephrine and/or fentanyl to an epidural mixture with dilute bupivacaine or ropivacaine.

  2. Analgesia epidural torácica para el tratamiento de la angina inestable Thoracal epidural analgesia for the management of unstable angina

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    M. Castro

    2005-07-01

    Full Text Available La miocardiopatía isquémica en pacientes con angina inestable refractaria al tratamiento médico constituye un escenario clínico complicado. Una anatomía desfavorable o un riesgo quirúrgico excesivamente alto pueden desaconsejar la realización de una angioplastia o de una cirugía de derivación coronaria. En este artículo se pretende revisar la utilización de la analgesia/anestesia epidural torácica para el tratamiento y estabilización de este tipo de pacientes, a través de una breve descripción de la fisiopatología de la isquemia cardiaca, estudios experimentales en animales y humanos, uso en cirugía cardiaca y efectos secundarios.Ischemic cardiomyopathy in patients with unstable angina refractory to medical therapy is a difficult medical condition. Unfavorable anatomy or excessive surgical risk can advise against the performance of angioplasty or coronary bypass surgery. This study has reviewed the use of thoracal epidural analgesia/anesthesia for the management and stabilization of this type of patients, with a brief description of the physiopathology of cardiac ischemia, experimental studies in animals and human beings, use of cardiac surgery and side effects.

  3. Estudio observacional de la analgesia epidural para trabajo de parto: Complicaciones de la técnica en 5.895 embarazadas Observational study of epidural analgesia used in labour: Complications of this technique in 5,895 pregnant women

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    M. Calvo

    2005-04-01

    Full Text Available Objetivos: a Conocer la incidencia de las complicaciones relacionadas con la técnica de analgesia regional durante la realización de la técnica, durante la dilatación y en el postparto; y b conocer si las complicaciones del postparto relacionadas con la técnica analgésica son más frecuentes cuando se realiza la técnica combinada epidural-subaracnoidea (CES en comparación con la analgesia epidural. Material y método: Hemos realizado un estudio observacional descriptivo y analítico. Como sujetos del estudio hemos incluido a todas las mujeres que solicitaron la administración de analgesia regional a la Unidad de Analgesia Epidural de nuestro hospital (5.895 embarazadas y cumplían los criterios de inclusión, en un periodo de tiempo que empieza en el 1 de enero del año 2002 y termina el 1 de enero del año 2003. Las técnicas empleadas para el control del dolor del trabajo del parto fueron la analgesia epidural y la técnica combinada epidural-subaracnoidea. Resultados: La complicación que más frecuentemente apareció durante la realización de la técnica fueron las parestesias (43,5% seguido de la punción hemática (5,9%. La punción no intencionada de la duramadre ha ocurrido en el 0,6%. Las complicaciones que más frecuentemente aparecieron durante el periodo de dilatación fue el prurito (11,4% y la analgesia lateralizada (9%. La complicación más frecuente del periodo postparto fue el dolor de espalda (9,8% y la cefalea (2%. Las complicaciones en general han sido significativamente más frecuentes en las embarazadas a las que se les aplicó la técnica CES, en comparación con la analgesia epidural convencional. Conclusiones: Las complicaciones que pueden aparecer debido a este modo de analgesia van desde unas poco frecuentes y potencialmente peligrosas si pasan desapercibidas (como la inyección intravascular de anestésicos locales o el bloqueo espinal total a otras más frecuentes como las parestesias, con una repercusi

  4. EPIDURAL ANALGESIA IN LABOR - CONTROVERSIES.

    Science.gov (United States)

    Bilić, Nada; Djaković, Ivka; Kličan-Jaić, Katarina; Rudman, Senka Sabolović; Ivanec, Željko

    2015-09-01

    Labor pain is one of the most severe pains. Labor is a complex and individual process with varying maternal requesting analgesia. Labor analgesia must be safe and accompanied by minimal amount of unwanted consequences for both the mother and the child, as well as for the delivery procedure. Epidural analgesia is the treatment that best meets these demands. According to the American Congress of Obstetrics and Gynecology and American Society of Anesthesiologists, mother's demand is a reason enough for the introduction of epidural analgesia in labor, providing that no contraindications exist. The application of analgesics should not cease at the end of the second stage of labor, but it is recommended that lower concentration analgesics be then applied. Based on the latest studies, it can be claimed that epidural analgesia can be applied during the major part of the first and second stage of labor. According to previous investigations, there is no definitive conclusion about the incidence of instrumental delivery, duration of second stage of labor, time of epidural analgesia initiation, and long term outcomes for the newborn. Cooperation of obstetric and anesthesiology personnel, as well as appropriate technical equipment significantly decrease the need of instrumental completion of a delivery, as well as other complications encountered in the application of epidural analgesia. Our hospital offers 24/7 epidural analgesia service. The majority of pregnant women in our hospital were aware of the advantages of epidural analgesia for labor, however, only a small proportion of them used it, mainly because of inadequate level of information. PMID:26666104

  5. Analgesia epidural para el trabajo de parto en gestante con esclerosis múltiple Epidural analgesia during labour of a patient with multiple sclerosis

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    M.J. Mayorga Buiza

    2010-07-01

    Full Text Available La Esclerosis Múltiple (EM, es una enfermedad del SNC siendo 2 veces más frecuente su aparición en mujeres, el 70% de ellas en edad fértil. Desde el punto de vista anestésico nos encontramos ante una enfermedad con elevada susceptibilidad neurológica que podría agravarse tanto por la propia cirugía, la técnica anestésica como por la medicación utilizada. Por otra parte se plantea como atender la demanda de analgesia para el trabajo de parto en mujeres con EM, que es el grupo de edad con mayor incidencia de la enfermedad. Presentamos el caso de una mujer de 37 años diagnosticada de esclerosis múltiples 3 años antes, forma recidivante, remitente. La paciente es ingresada en dilatación con 37 semanas de amenorrea, presentando una buena evolución del trabajo de parto y encontrándose el feto en situación longitudinal y presentación cefálica. Avisan al Servicio de Anestesia para valoración de la indicación de epidural para analgesia del parto. La gestante previamente había acudido a consulta de preanestesia donde se le había informado del riesgo beneficio de la técnica y en concreto en su caso, habiendo entendido perfectamente las posibles complicaciones derivadas de la misma y firmado el consentimiento informado. Nosotros hemos preferido utilizar una técnica locoregional, vía epidural considerando también el riesgo potencial de cesárea urgente, para evitar, dado el caso la realización de una técnica intraraquídea o una anestesia general, con las posibilidades de desencadenar un brote que tienen estas técnicas. Además de aportar confort a la paciente durante el trabajo de parto, proporcionar analgesia durante el mismo, disminuye por este motivo el estrés de la gestante pudiendo paralelamente evitar la aparición de un brote.Multiple sclerosis (MS is a disease of the central nervous system (CNS, and twice as prevalent in women, 70% of whom are of fertile age. From an anaesthetics point of view, due to it being a

  6. Síndrome de Horner y bloqueo del plexo braquial ipsilateral en un caso de analgesia epidural para el trabajo del parto Horner´s sydrome and ipsilateral brachial plexus block during an epidural analgesia labour procedure

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    J. Avellanosa; Vera, J.; P. Morillas; E. Gredilla; F. Gilsanz

    2006-01-01

    El Síndrome de Horner es una complicación de la anestesia epidural que aparece más frecuentemente en pacientes obstétricas debido a los cambios fisiológicos y anatómicos propios del embarazo; sin embargo, su incidencia es baja, y sólo se han descrito dos casos previos asociando un bloqueo del plexo braquial. Presentamos el caso de una gestante de 23 años que precisó analgesia epidural para el trabajo de parto. Tras comprobar la correcta colocación del catéter se administró una dosis inicial e...

  7. Epidural analgesia for cardiac surgery

    NARCIS (Netherlands)

    V. Svircevic; M.M. Passier; A.P. Nierich; D. van Dijk; C.J. Kalkman; G.J. van der Heijden

    2013-01-01

    Background A combination of general anaesthesia (GA) with thoracic epidural analgesia (TEA) may have a beneficial effect on clinical outcomes by reducing the risk of perioperative complications after cardiac surgery. Objectives The objective of this review was to determine the impact of perioperativ

  8. Epidural analgesia during labor vs no analgesia: A comparative study

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    Wesam Farid Mousa

    2012-01-01

    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  9. Epidural labour analgesia using Bupivacaine and Clonidine

    OpenAIRE

    Syal, K; R K Dogra; A Ohri; Chauhan, G.; Goel, A.

    2011-01-01

    Background: To compare the effects of addition of Clonidine (60 μg) to Epidural Bupivacaine (0.125%) for labour analgesia, with regard to duration of analgesia, duration of labour, ambulation, incidence of instrumentation and caesarean section, foetal outcome, patient satisfaction and side effects. Patients & Methods: On demand, epidural labour analgesia was given to 50 nulliparous healthy term parturients (cephalic presentation), divided in two groups randomly. Group I received bupivacain...

  10. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    important finding refers to the labouring woman’s relationship with the midwife, which represents an essential influencing factor on the woman’ experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance. Conclusion...... birth. Findings: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another......: After initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman’s type of emotional reaction to epidural analgesia and her possible intricate worries. 2014 Australian...

  11. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is...

  12. Síndrome de Horner y bloqueo del plexo braquial ipsilateral en un caso de analgesia epidural para el trabajo del parto Horner´s sydrome and ipsilateral brachial plexus block during an epidural analgesia labour procedure

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    J. Avellanosa

    2006-10-01

    Full Text Available El Síndrome de Horner es una complicación de la anestesia epidural que aparece más frecuentemente en pacientes obstétricas debido a los cambios fisiológicos y anatómicos propios del embarazo; sin embargo, su incidencia es baja, y sólo se han descrito dos casos previos asociando un bloqueo del plexo braquial. Presentamos el caso de una gestante de 23 años que precisó analgesia epidural para el trabajo de parto. Tras comprobar la correcta colocación del catéter se administró una dosis inicial en bolo de 8 ml de ropivacaína 0,2% y 50 μgr de fentanilo, y se iniciσ una perfusión de ropivacaína a 0,125% y fentanilo a 1,2 μg/ml a 10 mg/h. Tras cuatro horas de perfusión, la paciente alcanza dilatación completa y pasa a quirófano para realizar prueba de parto. Allí se administró una dosis de refuerzo por vía epidural con 10 ml de ropivacaína 0,5% y 50 μg de fentanilo. A los 15 minutos, la paciente comenzó a manifestar un cuadro de disestesias en hemicara derecha y miembro superior derecho. A continuación, estando ya la paciente en la zona de recuperación la paciente refirió bloqueo motor y sensitivo de miembros inferiores asociado a pérdida de fuerza de miembro superior derecho y ptosis palpebral, miosis con ligero enrojecimiento de ojo derecho, siendo diagnosticado como síndrome de Horner con bloqueo del plexo braquial ipsilateral, desapareciendo espontáneamente en las tres horas siguientes.Horner´s syndrome is an uncommon side effect after epidural analgesia which occurs more frecuently in pregnant women due to physiological and anatomical changes; however, it has a low incidence, and the association with ipsilateral brachial plexus block has only been published twice before. We report the case of a 23-year-old woman who required epidural analgesia for labor. After verifying correct placement of the catheter, an initial dose of 8 ml of ropivacaine 0,2% with 50 μg of fentanyl was injected. A continuous infusion of

  13. Ensayo clínico aleatorizado, controlado, doble ciego, para evaluar la analgesia posparto con morfina epidural: efectividad analgésica de dos dosis diferentes, comparadas con placebo Randomized double-blind controlled clinical trial for the evaluation of post-partum analgesia using epidural morphine: analgesic effectiveness of different dose regimes compared with placebo

    OpenAIRE

    Darío José Perea Solano; José Ricardo Navarro; Pedro Herrera; Viviana Castillo; Andrea González; Andrés García; Jaime Gálvis

    2012-01-01

    Introducción: Estudios previos han demostrado que el manejo convencional del dolor posparto (acetaminofén, AINE) es insuficiente. En nuestro medio se desaprovecha el uso del catéter epidural que es colocado como parte del manejo analgésico de las gestantes en el trabajo de parto. Objetivo: Determinar la eficacia de dosis de 2 mg y de 3 mg de morfina epidurales frente a placebo, empleadas para analgesia durante el posparto vaginal en pacientes que recibieron nalgesia epidural para su trabajo d...

  14. Neonatal respiratory depression associated with epidural analgesia

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    Alberto Gálvez Toro

    2013-06-01

    Full Text Available Background: Epidural analgesia is the most effective analgesics used during childbirth but is not without its problems.In the Hospital San Juan de la Cruz of Ubeda from November 2011 we have detected 3 cases of newborn infants with signs of respiratory depression. Appeared in them: normal cardiotocographic records during childbirth, use of epidural associated with fentanyl, termination by vacuum and elevated temperature in one case.ObjectivesKnow if the neonatal adaptation to extrauterine life may be influenced by the use of epidural analgesia in childbirth. Review what role can have the rise in maternal temperature and the use of epidural fentanyl with the appearance of newborn respiratory distress.MethodsLiterature Review conducted in February of 2012 in Pubmed and the Cochrane Library, using the key words: childbirth, epidural analgesia, neonatal respiratory depression.ResultsOn the respiratory depression associated with fentanyl, a Cochrane review found indicating that newborns of mothers with an epidural, had a lower pH and were less need for administration of naloxone.On PubMed we find a review study that indicates that the respiratory depression caused by the administration of opioids via neuroaxial is rare, placing it below 1 per 1000, and a clinical case that concluded that doses of fentanyl exceeding 300 µg (approx. 5 µg/kg for 4 hours previous to childbirth, have a high risk of neonatal respiratory depression at birth.The same Cochrane review indicates that the women with epidural analgesia had increased risk of maternal fever of at least 38 ° C and a recent cohort study relates this increase in temperature with a greater likelihood of neonatal adverse events (from 37.5 ° C.ConclusionsThe studies found considered safe epidurals to the neonate and the mother, except when certain conditions are met. The literature and our clinical experience have been reports linking neonatal respiratory depression with increasing temperature (37

  15. Epidural analgesia in labor: specific characteristics, dilemmas and controversies

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    Kutlešić Marija

    2012-01-01

    Full Text Available Introduction. Epidural analgesia has become the most popular method for labor pain relief. Analgesia in Labor: Yes or No? Labor pain is a complex phenomenon with sensory, cognitive, motivational, emotional, social, and cultural variables. Pain and anxiety lead to adrenergic hyperactivity, hyperventilation, hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity, so pain relief is recommended and even indicated in cases of maternal comorbidity. Analgesia in Labor: Method of Choice. The quality of epidural analgesia is better than the one achieved by parenteral or inhalation agents, with increased uteroplacental blood flow and improved fetal-maternal oxygenation. Epidural Analgesia in Labor: What is Specific? The increased weight, lumbar lordosis, soft tissue edema and engorgement of epidural veins make it more difficult to perform epidural block in pregnancy. Epidural puncture should be performed by medial approach, at L2 - 3 or L3 - 4 level by loss of resistance technique between contractions. Epidural Analgesia in Labor: What With? Local anesthetics, bupivacaine, levobupivacaine, ropivacaine, are used and they can be combined with small doses of opioids (fentanyl or sufentanyl. Epidural Analgesia in Labor: How? Available techniques are epidural, spinal and combined spinal - epidural analgesia. Epidural Analgesia in Labor: Controversies. The most important controversy is the influence of epidural analgesia on operative or instrumental delivery rate. Low concentrations of local anesthetic in combination with small doses of opioids, together with active management of labor by an obstetrician, would lead to increased spontaneous delivery rate. Conclusion. Although there still are some difficulties, complications and controversies, epidural analgesia provides safe and effective labor pain control.

  16. Single dose spinal analgesia: Is it a good alternative to epidural analgesia in controlling labour pain?

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    Tarek AbdElBarr

    2014-07-01

    Conclusions: Based on the results of our study we concluded that single dose spinal analgesia is a good alternative to epidural analgesia in controlling labour pain i.e. spinal compared to epidural is more easy performed, faster, less expensive, and provide effective analgesia.

  17. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  18. Effect of epidural analgesia on labor and its outcomes

    International Nuclear Information System (INIS)

    Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. Methods: This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Conclusion: Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia. (author)

  19. Labor Epidural Analgesia and Breastfeeding: A Systematic Review.

    Science.gov (United States)

    French, Cynthia A; Cong, Xiaomei; Chung, Keun Sam

    2016-08-01

    Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively. PMID:27121239

  20. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

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    Varaprasad

    2015-07-01

    Full Text Available BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of sedation were studied. RESULTS: There was no significant differ ence between the two groups in maternal satisfaction, analgesia and neonatal outcome .

  1. Does epidural clonidine improve postoperative analgesia in major vascular surgery?

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    Jelena Vuković

    2012-02-01

    Full Text Available Aim To determine the quality and duration of the analgesic and haemodynamic effects of clonidine when used as an additional analgesic for postoperative epidural analgesia in major vascularsurgery. Methods The prospective, single-blinded study involved 60 patients randomised into three groups (20 patients each: Group BM—bupivacaine 0.125% and morphine 0.1 mg/ml; Group BC—bupivacaine 0.125% and clonidine 5 μg/ml; Group MC—morphine 0.1 mg/ml and clonidine 5 μg/ml continuously infused at 5 ml/h. The quality and duration of the analgesia measured by the Visual Analogue Scale (VAS at rest and on movement, additional analgesia requirements, sedation scores, haemodynamic parameters and side effects(respiratory depression, motor block, toxic effects, nausea and pruritus were recorded. Results The average VAS scores at rest and on movement were significantly lower in Group MC at two, six and 24 hours following the start of epidural infusion (P<0.05. The duration of the analgesic effect after finishing the epidural infusion was significantly longer in Group MC (P<0.05. Patients from Group MC were intubated longer. Additional analgesia consumption, sedation scoresand haemodynamic profiles were similar in all three groups. Prurituswas more frequent in morphine groups (P<0.05, but other sideeffects were similar in all three groups.Conclusion Under study conditions, clonidine added to morphine,not 0.125% bupivacaine, provided significantly better pain scoresat two, six and 24 hours following the start of epidural infusionand the longest-lasting analgesia following the discontinuationof epidural infusion. However, patients from the Group MC weremechanically ventilated longer than patients from other two groups.Continuous monitoring of the patient is necessary after theadministration of clonidine for epidural analgesia.

  2. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  3. THORACIC EPIDURAL ANAESTHESIA AND ANALGESIA IN PATIENTS UNDERGOING ESOPHAGOPLASTY

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    Laura Magdalena Nicolescu

    2011-05-01

    Full Text Available Epidural anesthesia and analgesia is widely used to manage major abdominal surgery, but its effects in managing patients submitted to esophagoplasty are still debated. The aim of this study was to assess the influence of thoracic epidural anaesthesia on postoperative respiratory function, digestive complications and postoperative stress in patients with esophagoplasty. Twenty-six patients were admitted in a prospective study. The patients were divided into two groups: fourteen were in group A, and received general anaesthesia for esophagoplasty, and twelve were in group B, and received general anaesthesia combined with epidural thoracic anaesthesia and postoperative epidural thoracic analgesia for the same surgery procedure. When compare the two groups, the outcomes were better in group B: the rate of postoperative pneumonia was lowered from 35,7% to 16,7%, the postoperative mecanical ventilation under six hours was increased from 21,43% to 100%, the incidence of adult respiratory detrease syndrome was decreased from 28,5% to 8,3%, the digestive recovery after four days was increased from 57,1% to 75%. The cortizolemia was also lowered at six hours from 52mg% to 23mg%, and at 24 hours, from 22 to 11mg%. Identically, the sanguine lactate at four hours decreased from 6 to 3 mEq%. In conclusion, this study suggest that patients undergoing esophagoplasty will receive substantial benefit from combined general and epidural anesthesia with continuing postoperative epidural analgesia.

  4. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Liv M

    2012-07-01

    Full Text Available Abstract Background Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity, mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost

  5. Fetal circulation during epidural analgesia for caesarean section.

    OpenAIRE

    Lindblad, A; Marsál, K; Vernersson, E; Renck, H

    1984-01-01

    Fetal blood flow was examined during epidural analgesia in six women with uncomplicated pregnancies undergoing elective caesarean section. A non-invasive, ultrasonic technique was used to measure blood flow in the fetal descending aorta and intra-abdominal part of the umbilical vein before induction of analgesia with etidocaine and bupivacaine and 15 and 30 minutes afterwards. No appreciable change in fetal blood flow was observed.

  6. Meningite após técnica combinada para analgesia de parto: relato de caso Meningitis después de técnica combinada para analgesia de parto: relato de caso Meningitis after combined spinal-epidural analgesia for labor: case report

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vásquez

    2002-06-01

    nuca. En el 13º día los síntomas pasaron a ser más intensos. Fue realizada punción lumbar. La historia clínica y el examen del líquor fueron compatibles con meningitis bacteriana. CONCLUSIONES: La técnica combinada (raqui-peridural para analgesia de parto está próxima de lo ideal. Cuidados con la técnica de anti-sepsia son necesarios para realización de bloqueos espinales. La complicación presentada ocurrió sin la aparente falla en la realización de la técnica, siendo una cuestión que es inherente al riesgo - beneficio que la técnica proporciona.BACKGRAUND AND OBJECTIVES: Meningitis is a serious complication, although rare in regional anesthesia. This report aimed at presenting a case which evolved to meningitis after combined labor spinal-epidural analgesia. CASE REPORT: Laboring patient, 25 years old, second gestation and previous c-section. Combined labor spinal-epidural analgesia was induced with double-puncture. Twenty-four hours later she presented with headache at rest, fever and mild chills, which regressed with symptomatic medication. Headache worsened in the 5th day. There were vomiting and neck pain in the 10th day. Symptoms became more severe in the 13th day. Lumbar puncture was performed. Clinical history and CSF analysis were compatible with bacterial meningitis. CONCLUSIONS: Combined labor spinal-epidural analgesia is very close to being the ideal technique. Care must be taken with the sterile technique to induce spinal blockade. The reported complication has occurred without an apparent technique failure and is inherent to technique’s risk-benefit ratio.

  7. Epidural morphine analgesia in Guillain Barré syndrome.

    OpenAIRE

    Genis, D; Busquets, C; Manubens, E; Dávalos, A; Baró, J; Oterino, A

    1989-01-01

    Severe pain is a frequent symptom in the Guillain Barré syndrome and can be intense, long lasting and with no response to the usual analgesics, including parenteral opiates. Epidural analgesia using morphine chloride in low doses has satisfactorily relieved pain in this disease in nine patients.

  8. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia

    OpenAIRE

    Lin Y; Li Q; Yang R; Liu J

    2016-01-01

    Yunan Lin, Qiang Li, Jinlu Liu, Ruimin Yang, Jingchen Liu Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: This study aims to investigate differences between continuous epidural infusion (CEI) and programmed intermittent epidural bolus (IEB) analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates.Methods: Two hundred ...

  9. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    OpenAIRE

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D; Porath, Martina; Berg, Hans J. van den; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A.H.M.; Logtenberg, Sabine L M

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an intermediate to high obstetric risk with an intention to deliver vaginally. To exclude a clinically relevant difference in satisfaction with pain relief of more than 10%, we needed to include 1136 women....

  10. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may be...

  11. Analgesia postoperatoria con tramadol epidural tras histerectomía abdominal Epidural postoperative analgesia with tramadol after abdominal hysterectomy

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    E. González-Pérez

    2006-08-01

    Full Text Available Introducción: El dolor postoperatorio es un tipo especial de dolor agudo cuyo control inadecuado conduce a reacciones fisiopatológicas anormales. Objetivos: Evaluar la utilidad del tramadol por vía epidural en la analgesia postoperatoria de las pacientes a quienes se les practicó histerectomía abdominal. Material y método: Se estudiaron 90 pacientes que conformaron tres grupos: Grupo I: recibió 100 mg de tramadol epidural cada 6 h. Grupo II: recibió 1,2 g de metamizol por vía intramuscular cada 6 h. Grupo III: recibió 100 mg de tramadol por vía intramuscular cada 6 h. Se evaluó el comportamiento de la presión arterial media y la frecuencia cardíaca. Evaluamos la intensidad del dolor por medio de una Escala Visual Analógica. Fue utilizado metamizol sódico, 2 g endovenoso, como analgesia de rescate. Resultados: Se presentaron variaciones significativas de la frecuencia cardíaca y presión arterial media en el grupo I (P0,05, por lo que sólo 2 pacientes requirieron analgesia de rescate, mientras que el grupo II mostró las mayores variaciones (PIntroduction: Postoperative pain is a special type of acute pain whose inadequate control leads to abnormal reactions. Objectives: To evaluate the utility of tramadol by the epidural route in the postoperative analgesia of patients undergoing abdominal hysterectomy. Material and method: 90 patients studied who conformed three groups: Group I: received 100 mg of epidural tramadol every 6 h. Group II: received 1.2 g of intramuscular metamizol every 6 h. Group III: received 100 mg of intramuscular tramadol every 6 h. Blood pressure and heart rate were measured. Pain intensity was evaluated by a visual analogical scale. Metamizol 2 g was used as rescue analgesia. Results: Significant variations of heart rate and mean blood pressure were found in group I (p < 0.05 whereas in group II and III they were very significant (p < 0.01. The intensity of postoperative pain reached lower values in group I

  12. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    LENUS (Irish Health Repository)

    Fanning, Rebecca A

    2012-02-01

    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  13. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk; Harazuk, Jørgen; Pedersen, Niels A; Søballe, Kjeld

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion on...

  14. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  15. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas

    DEFF Research Database (Denmark)

    Eriksen, Lena Mariann; Nøhr, Ellen Aagaard; Kjaergaard, Hanne

    2011-01-01

    Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between...

  16. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne; Jensen, Pia Søe; Kehlet, Henrik

    2005-01-01

    Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist on the...... effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery....

  17. To study the acceptance of epidural analgesia for painless labor at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Neena Gupta

    2014-08-01

    Full Text Available Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labor. Epidural analgesia is the most effective method of pain relief during labor. But unfortunately in India incidence of painless labor by epidural analgesia is very rare even in these days. The aim of our study was to study the acceptance of epidural analgesia at a tertiary care centre. Methods: The present study was conducted in department of obstetrics and gynaecology UISEMH, Kanpur over the period from May 2012 to May 2013. The study was conducted on 98 patients who were counselled regarding the adoption of epidural analgesia as painless labour and out of these 50 patients opted for epidural analgesia. Results: In our present study the acceptance was greater in primigravida (72.43% as compared to multigravida (20%. In our society social reason was the common cause for non-acceptance in primigravida (87.5%. The majority of patients belonged to middle socioeconomic status (52% and more number of educated patients opted for epidural analgesia. Conclusions: It was found that increased awareness can lead to increased acceptance of epidural analgesia. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1087-1089

  18. A COMPARATIVE STUDY OF EPIDURAL BUPIVACAINE WITH CLONIDINE AND EPIDURAL BUPIVACAINE FOR POST OPERATIVE ANALGESIA

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    Durga Prasad

    2015-10-01

    Full Text Available BACKGROUND: Clonidine, an α 2 - adrenoreceptor agonist, administered epidurally, is gaining popularity for its analgesic, sympatholytic, hemodynamic stabilizing and sedative properties without significant side effects. METHODS: This present study “ A Comparative Study o f Epidural Bupivac aine w ith Clonidine a nd Epidural Bupivacaine f or Post - o perative Analgesia ” was conducted in 70 cases of ASA grade I and II, between the age groups of 30 - 75yrs undergoing abdominal, gynecological and orthopedic surgeries under epidural anaesthesia. At the e nd of surgery, patients were shifted to recovery room. When patients complained of pain with VAS > 4/10, they were allocated to receive either of B: Plain Bupivacaine 0.125% 10ml (n = 35. B+C: Clonidine 150 mcg (1ml + 0.125% Bupivacaine 9ml (n = 35. The following parameters were monitored: A. Onset of analgesia . B. Duration of analgesia . C. VAS and Quality of analgesia . D. ardio - respiratory effects: Pulse rate, blood pressure, respiratory rate. E. Side effects like: nausea, vomiting, pruritus, hypotensio n, sedation and respiratory depression were studied. ONSET OF ANALGESIA: The time of onset of analgesia in group (B+C was significantly less (12.7 ± 0.87 (S.D min when compared to g roup (B (16 ± 3.34 (S.D min. DURATION OF ANALGESIA: The duration of a nalgesia in group (B+C (225.2 ± 45.74 (SD min was significantly more when compared to group (B (119 ± 29.29 (SD min. VISUAL ANALOGUE SCORE: In comparison of group B and group B+C, highly significant difference in VAS was seen from 15min till 3.5hrs in between the groups. The quality of analgesia in Group B+C was VAS 3 - 4 (good to excellent pain relief, as compared to Group B, where VAS was 2 - 3 (fair to good pain relief. SEDATION: In Group B+C from 30min till 2hrs, 100% of patients were asleep (sedat ion score 3. Even in patients with sedation score 3, patients were calm, quiet and asleep but when questions were asked, they answered with

  19. Study of efficacy, safety and cardiotocographic changes during epidural analgesia with ropivacaine in labour

    OpenAIRE

    Sharma, Jyoti; Gandhi, Mansi U; Bhavsar, Mrugank M

    2013-01-01

    Background: Epidural analgesia during labour provides effective pain relief along with better maternal and neonatal outcome. Our aim of the study is to check safety and efficacy of Ropivacaine during labour analgesia. We have also compared cardiotocographic changes in labour with versus without epidural analgesia.Material & Methods: 60 Antenatal cases in between 37-41 weeks of pregnancy in active labour were selected for study. They were randomly divided into 2 groups: Study Group (Group-...

  20. The knowledge and attitudes of nonanesthesia nurses regarding postoperative epidural analgesia.

    Science.gov (United States)

    Sandie, C L; Heindel, L J

    1999-10-01

    The provision of epidural analgesia for postoperative pain control offers many patient benefits and has become commonplace on many nursing units. Since nurses are responsible for the day-to-day management of patients receiving epidural analgesia, their knowledge, attitudes, and practices regarding this technique are pivotal to its success. Therefore, the purpose of the present descriptive study was to examine the knowledge base, attitudes, and clinical practice of registered nurses (N = 85) regarding postoperative epidural analgesia as managed by an acute pain service (APS). Information was obtained from a survey distributed via a convenience sample to all nurses working on 6 units in a large military teaching facility. We developed the "Epidural Knowledge and Attitude Survey" using the nursing literature on epidural analgesia. The survey consisted of a demographics section, true/false (T/F) questions, multiple choice (M/C) questions, an attitude section, and a comment section. These sections addressed the nurses' knowledge, attitudes, and practices in regard to epidural pharmacology, management, and adverse effects, as well as their general satisfaction with the APS of their facility. Data were analyzed statistically using means, standard deviations, percentages, forward step-wise linear regression, the Fisher-Irwin (exact) test, the chi 2 test, and analysis of variance with Bonferroni multiple comparisons. A P value of attitude section illustrated that 73% of nurses had "positive" attitudes toward epidural analgesia. Correct management of patients receiving epidural analgesia was being practiced by 77% of nurses. The satisfaction with the APS at this facility was 32% "very satisfied" and 62% "somewhat satisfied." The demographic characteristics that best predicted a higher score on the knowledge portion of the survey were greater years of practice as a nurse and receipt of pain education in nursing training. Nurses who had received inservice education about

  1. Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia Clonidina y dexmedetomidina por vía peridural para analgesia y sedación pós-operatoria de colecistectomía Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation

    Directory of Open Access Journals (Sweden)

    Antônio Mauro Vieira

    2004-08-01

    local anesthetic effects when epidurally administered. The goal of this study was to evaluate the analgesia and sedation promoted by clonidine or dexmedetomidine associated to epidural ropivacaine, in the postoperative period of subcostal cholecystectomy. METHODS: Forty patients of both gender participated in this randomized double-blind study , aged 18 to 50 years, weighing 50 to 100 kg, physical status ASA I or II, submitted to subcostal cholecystectomy. The subjects were distributed in two groups: Clonidine (CG, receiving clonidine (1 mL = 150 µg associated to 0.75% epidural ropivacaine (20 mL; Dexmedetomidine (DG, receiving dexmedetomidine (2 µg.kg-1 associated to 0.75% epidural ropivacaine (20 mL. Analgesia and sedation were evaluated 2, 6 and 24 hours anesthetic recovery. RESULTS: Both groups present some grade of sedation in the moments 2 and 6 hours , with statistically significant difference between the two moments for the dexmedetomidine group. There has been analgesia in both groups, especially at 2 and 6 hours. There have been statistically significant difference among periods of 2, 6 and 24 hours in the dexmedetomidine group; in the clonidine group, this statistically significant difference was observed between the periods of 2 and 6 hours and between 2 and 24 hours. CONCLUSIONS: Our results allowed to conclude that the association of clonidine or dexmedetomidine to 0.75% ropivacaine induces analgesia and sedation in 2 and 6 hours after anesthetic recovery in patients submitted to subcostal cholecystectomy and that clonidine promotes more prolonged analgesia.

  2. Opioides como coadyuvantes de la analgesia epidural en pediatría Opiates as co-adjuvants of epidural analgesia in pediatrics

    Directory of Open Access Journals (Sweden)

    M. A. Vidal

    2005-09-01

    Full Text Available Hay un elevado número de receptores opioides localizados en la sustancia gelatinosa del asta dorsal medular. La inyección epidural de opioides permite la unión de forma saturable y competitiva con estos receptores, con lo que se consigue analgesia y disminución del riesgo de efectos adversos asociados a la administración parenteral de los mismos. No obstante, es importante tener en cuenta los posibles efectos adversos que pueden aparecer, siendo la depresión respiratoria la complicación más importante. La morfina es el opioide agonista mu más utilizado para el tratamiento del dolor agudo o crónico y constituye el analgésico estándar con el que se comparan los nuevos analgésicos. El fentanilo es un agonista opioide derivado de la fenilpiperidina que posee una alta afinidad por los receptores mu, lo que le confiere una potencia analgésica 50-100 veces superior a la morfina. El tramadol es el más reciente de los opioides sintéticos empleados en España. Tiene baja afinidad por los receptores mu, kappa y delta, no obstante su potencia analgésica respecto a la morfina es 1/10 por vía parenteral y 1/30 por vía espinal. Los opioides por vía epidural se han empleado ampliamente en adultos, pero con una frecuencia mucho menor en pediatría. En este artículo se repasan los distintos estudios que han evaluado sus efectos en pediatría, haciendo referencia a la farmacocinética, consideraciones clínicas y posibles efectos adversos tras la administración de morfina, fentanilo o tramadol por vía epidural.There is a high number of opiate receptors located at the gelatinous substance of the medullar dorsal horn. Epidural injection of opiates allows saturable and competitive binding to these receptors, thus providing analgesia and reducing the risk of side effects associated to their parenteral administration. However, potential side effects must be taken into account, the major complication being respiratory depression. Morphine is the

  3. Analgesia combinada vs analgesia peridural para trabajo de parto

    Directory of Open Access Journals (Sweden)

    Juan Pablo Aristizábal

    2005-06-01

    Full Text Available Introducción: Las ventajas de la analgesia epidural-espinal incluyen una identificación confiable del espacio subaracnoideo, requerimiento de poco fármaco, disminución de toxicidad sistemica y analgesia de instauración rápida. En este estudio se comparan las técnicas peridural y epidural-espinal. Materiales y Métodos: Se incluyeron 200 pacientes en un periodo de 12 meses. Los criterios de inclusión fueron mujeres en trabajo de parto con dilatación mayor o igual a 5 cm sin patologías asociadas. Se evalúo la respuesta analgésica a los 5 y 15 minutos, la respuesta hemodinamica, bloqueo motor, efectos adversos y respuesta fetal. La técnica peridural se realizo con bupivacaina al 0.065% y la técnica epidural-espinal con fentanyl 25mcg intratecales sin anestésico local. Resultados : Cada grupo incluyó 100 pacientes (peridural o analgesia A y epidural-espinal o analgesia B. La percepción de dolor fue similar en ambos grupos a los 5 minutos (p value = 0.291, a los 15 minutos fue menor con analgesia epidural-espinal (p value = 0.008. No hubo cambios hemodinamicos ni bloqueo motor ni diferencia fetal en ambos grupos. Se encontró una incidencia de prurito con la técnica epidural-espinal de 36%. Conclusión: La analgesia epidural-espinal con opioides intratecales produce mayor disminución en la percepción del dolor a los 15 minutos comparado con la peridural, sin presentar cambios hemodinamicos ni bloqueo motor y sin alteración en el recién nacido, con una incidencia de 36% de prurito.Backround: The advantage of epidural-spinal analgesia technique include better subaracnoid space identification, less drug requirements, less sistemic toxicity, and rapid analgesic effect. In this study we compare peridural and peridural-spinal tecnique. Methods: The study included 200 patients during a period of 12 months. The inclusion criteria were women during labour with dilatation of 5cm or more without any associated pathology. The study evaluate

  4. EFFECT OF DIFFE RENT CONCENTRATIONS OF EPIDURAL D E XMEDITOMIDINE FOR POST - OPERATIVE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Varaprasad

    2015-09-01

    Full Text Available BACKGROUND: The aim of our study was to know the ideal epidural dose to achieve analgesia in the postoperative patients using different concentrations of epidural dexmeditomidine. METHODS AND MATERIAL S : Ninety patients of either sex, with age ran ging from 25 years to 60 years were randomly selected and divided into three groups of thirty each. Group A received epidural 0.25% bupivacaine along with 25mcg of dexmeditomidine, Group B received epidural 0.25% bupivacaine along with 50mcg dexmeditomidin e and Group C received epidural 0.25 % bupivacaine along with 75 mcg dexmeditomidine. The duration of analgesia, sedation and cardiovascular stability were studied. RESULTS: Analgesia and sedation was more in Group C than the other two groups. Cardiovascula r stability was good in groups A and B.

  5. Controversy of the use of epidural analgesia in labour

    Directory of Open Access Journals (Sweden)

    Enrique Ramón Arbués

    2008-11-01

    Full Text Available During last years, it was thought that free-pain labour was a big advance for woman. Recently, ideological patrons such as ecofeminism have feed a critical mind in the woman who is going to give birth. In this bibliographic review we don’t approach a reliable and definitive conclusion, due to the bias and lack of scientific rigour of some studies and the doubtful methodological reliability and generalization of others.This way, we conclude the need to make a tolerant effort on the part of everyone, just as researching and assuming on the services portfolio (if needed alternative techniques such as combined spinal-epidural analgesia, sterile water injections, water immersion, acupuncture, hypnosis, etc.

  6. Effects of epidural analgesia using different concentrations of bupivacaine during combined general and epidural anesthesia

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    Unić-Stojanović Dragana

    2012-01-01

    Full Text Available Introduction. Thoracic epidural analgesia, combined with general anesthesia, is an established anesthetic choice for abdominal aortic surgery. However, there are controversies about the level of anesthesia as well as the dose and concentration of the local anesthetic used. The aim of the study was to compare the effects of two different concentrations of epidural bupivacaine on sevoflurane requirements and hemodynamic parameters during aortic surgery under combined epidural/general anesthesia. Methods and Material. Sixty patients scheduled for abdominal aortic surgery were randomly divided into two groups according to the concentration of local anesthetic used for epidural anesthesia: - Group 1- low concentration - where 0.125% bupivacaine was used, and - Group 2 - high concentration - where 0.5% bupivacaine was used at the beginning and then the concentration was reduced to 0.25%. Anesthesia was maintained with sevoflurane, the dose was adjusted to achieve the target entropy of 40-60. The measurements included the inspired sevoflurane concentrations, blood pressure, and heart rate at the beginning and every 5 min during the surgery. Results. Both groups had similar heart rate and blood pressure, but the inspired sevoflurane concentration was significantly higher and more variable in patients where bupivacaine 0.125% was used. Vasopressors were used more often and in higher doses in the 0.5% bupivacaine group, and in the same group the blood loss and fluid requirements were reduced. Conclusion. When 0.5% bupivacaine is used in combined thoracic epidural/ general anesthesia for aortic surgery, the sevoflurane concentrations are lower and less variable. In addition, the blood loss and fluid requirements are reduced.

  7. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

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    Akanksha Lamba

    2016-06-01

    Conclusions: Maternal outcome in labour analgesia is similar with 100 mg I/M tramadol and epidural ropivacaine. There is no significant difference between duration of labour, rate of LSCS, incidence of instrumental delivery and neonatal outcome in the two modes of analgesia. Analgesic efficacy with epidural ropivacaine seems to be better compared to intramuscular tramadol. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1722-1727

  8. COMPARATIVE STUDY OF EPIDURAL FENTANYL AND FENTANYL PLUS MAGNESIUM SULPHATE FOR POSTOPERATIVE ANALGESIA

    OpenAIRE

    Shiva; Sampathi Shiva; Deepraj Singh

    2015-01-01

    AIMS AND OBJECTIVES Magnesium has antinociceptive effects in animal and human models of pain. It is found that the addition of Magnesium sulphate to postoperative Epidural infusion of Fentanyl may decrease the need for Fentanyl. We undertook a study to compare the duration of postoperative analgesia after Epidural Fentanyl and Epidural Fentanyl plus Magnesium sulphate administered postoperatively, along with side effects. MATERIALS AND METHODS 50 patients undergoi...

  9. Analgesia epidural obstétrica: fallos y complicaciones neurológicas de la técnica Obstetric epidural analgesia: failures and neurological complications of the technique

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    M. I. Segado-Jiménez

    2011-10-01

    Full Text Available Objetivos: Estudiar la incidencia de fallos y complicaciones neurológicas de la analgesia epidural en obstetricia, así como hacer un seguimiento y análisis de las mismas. Pacientes y método: Estudio observacional prospectivo de gestantes que recibieron analgesia epidural para el trabajo de parto en un hospital terciario durante 2009 y 2010. Se registraron los datos demográficos maternoinfantiles, del trabajo de parto y el tipo de parto así como las complicaciones que se produjeron tanto durante la realización de la técnica como durante el peri- y postparto. Se siguieron a todas las pacientes hasta su alta hospitalaria identificándose y tratándose las posibles complicaciones hasta su resolución. Resultados: Se incluyeron 438 gestantes. Se dividieron las complicaciones en 2 etapas: peripartum y postpartum. En el periparto se identificaron, de mayor a menor frecuencia, las siguientes complicaciones: analgesia lateralizada (16,4%, punción hemática (8,7%, parestesias (8,2%, técnica dificultosa (5,2%, analgesia ineficaz (2,7%, hipotensión arterial (2,5% y bloqueo subdural (0,2%. En el postparto: lumbalgia (18,5%, retención urinaria (3,4%, cefalea post-punción dural (1,4%, neuropatías periféricas (0,9% e hipoestesia prolongada (0,2%. Todas las complicaciones se resolvieron ad integrum con tratamiento conservador salvo un caso de cefalea que precisó la realización de un parche hemático. Conclusiones: La alta tasa de fallos de la analgesia epidural en obstetricia así como la posibilidad de complicaciones neurológicas pueden resolverse siguiendo unas normas de buena práctica que incluyen la aspiración previa a la inyección, la dosis test y la revisión periódica del catéter. Resulta imprescindible conocer dichas complicaciones para su evaluación y tratamiento precoz.Objectives: To determine the incidence of failures and neurological complications related to the epidural analgesia for labour and to analyze their evolution and

  10. COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST - OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

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    Nagesh

    2015-02-01

    Full Text Available Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post - operative period as epidural analgesia . It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post - operative analgesia in abdominal and lower limb surgery. METHODS: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 a ged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm m ark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post - operative period the following parameters were studied , 1. Onset of analgesia , 2. Duration of analges ia , 3. Vital parameters such as heart beat , blood pressure , respiratory rate , sedation score and visual analogue score were recorded , 4. Side effects like nausea , vomiting , hypotension , respiratory depression , and pruritus allergic reaction were looked for . RESULTS: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine was 7.35 min. When compared to Group B which 15.5 min , which is statically significant (P<0.05. Duration of analgesia in Group A is 17.23 hrs compared to Group B , which is 5.2 hrs , this is statically significant (P<0.05. Visual analogue scale was reduced in Group A compared to Group B CONCLUSIONS: Addition of buprenorphine to bupivacaine by epidural injection for post - operative analgesia improves the on set , The duration and the

  11. Optimal single-dose epidural neostigmine for postoperative analgesia after partial hepatectomy

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    Qiao Sheng Zhong

    2014-01-01

    Full Text Available Objective: Neostigmine can produce analgesia by acting on the spinal cord. This study was to determine the optimal single-dose of epidural neostigmine for postoperative analgesia after partial hepatectomy. Patients and Methods: Twenty-six patients undergoing elective partial hepatectomy under general anesthesia combined with epidural block were studied. The dose of epidural neostigmine was determined using Dixon′s up-and-down method, starting from neostigmine 100 μg with an interval of 25 μg. Thirty minutes after skin incision, a predetermined dose of neostigmine was injected via the epidural catheter. Each patient received 0.125% bupivacaine and fentanyl 2 μg/ml for patient controlled epidural analgesia (PCEA after the operation. Assessment of analgesia quality was performed at 8 h and 24 h after the operation. Results : The ED 50 of epidural neostigmine in combination with PCEA for satisfactory analgesia was 226.78 ± 33.20 μg. Probit analysis showed that the ED 50 and ED 95 of epidural neostigmine were 228.63 μg (95% CI = 197.95-299.77 μg and 300.12 μg (95% CI = 259.44-741.65 μg, respectively. Conclusion: The ED 50 and ED 95 of epidural neostigmine in combination with PCEA for satisfactory analgesia after partial hepatectomy were 228.63 μg (95% CI = 197.95-299.77 μg and 300.12 μg (95% CI = 259.44-741.65 μg.

  12. Opiodes como coadyuvantes de la analgesia epidural en pediatría Opioids as adjuvants of epidural analgesia in the paediatric age

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    M. A. Vidal

    2006-03-01

    Full Text Available Hay un elevado número de receptores opioides localizados en la sustancia gelatinosa del asta dorsal medular. La inyección epidural de opioides permite la unión de forma saturable y competitiva con estos receptores, con lo que se consigue analgesia y disminución del riesgo de efectos adversos asociados a la administración parenteral de los mismos. No obstante, es importante tener en cuenta los posibles efectos adversos que pueden aparecer, siendo la depresión respiratoria la complicación más importante. La morfina es el opioide agonista mu más utilizado para el tratamiento del dolor agudo o crónico y constituye el analgésico estándar con el que se comparan los nuevos analgésicos. El fentanilo es un agonista opioide derivado de la fenilpiperidina que posee una alta afinidad por los receptores mu, lo que le confiere una potencia analgésica 50-100 veces superior a la morfina. El tramadol es el más reciente de los opioides sintéticos empleados en España. Tiene baja afinidad por los receptores mu, Kappa y delta, no obstante su potencia analgésica respecto a la morfina es 1/10 por vía parenteral y 1/30 por vía espinal. Los opioides por vía epidural se han empleado ampliamente en adultos, pero con una frecuencia mucho menor en pediatría. En este artículo se repasan los distintos estudios que han evaluado sus efectos en pediatría, haciendo referencia a la farmacocinética, consideraciones clínicas y posibles efectos adversos tras la administración de morfina, fentanilo o tramadol por vía epidural.A large number of opioid receptors are located in the substantia gelatinosa of the medullar dorsal horn. Epidurally injected opioids bind with these receptors in a competitive and saturable manner causing analgesia and a lower risk of side effects as compared with its parenteral administration. However, its possible side effects, mainly respiratory depression, should be considered. Morphine is the mu agonist opioid most widely used for

  13. Maternal and Cord Serum Cytokine Changes with Continuous and Intermittent Labor Epidural Analgesia: A Randomized Study

    OpenAIRE

    Mantha, Venkat R.; Vallejo, Manuel C.; Vimala Ramesh; Jones, Bobby L; Sivam Ramanathan

    2012-01-01

    Background. Maternal fever during labor epidural analgesia (LEA) may cause increased maternal and cord serum inflammatory cytokines. We report the effects of intermittent and continuous LEA on these cytokines. Methods. Ninety-two women were randomly assigned to continuous (CLEA) or intermittent (ILEA) groups, 46 in each. Maternal temperature was checked and blood drawn at epidural insertion (baseline) and four-hourly until 4 h postpartum (4 PP). Cord blood was drawn after placental delivery. ...

  14. Do antenatal education classes decrease use of epidural analgesia during labour? – a Danish RCT

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Axelsen, Solveig Forberg;

    reduce fear during birth which in turn may decrease use of pain relief. Few randomised trials have examined the effect of attending antenatal education in small groups on use of epidural analgesia and among these conclusions are conflicting. The objective of this study was therefore to examine the effect...... of an antenatal education program in small classes on use of epidural analgesia. Methods: Data from the NEWBORN trial were used. A total of 1766 women from the Copenhagen area, Denmark were randomized to participate in either antenatal education in small groups or standard care. Data were analysed...

  15. Caudal epidural analgesia using lidocaine alone or in combination with ketamine in dromedary camels (Camelus dromedarius

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    Omid Azari

    2014-02-01

    Full Text Available This study was performed to investigate the analgesic effect of lidocaine and a combination of lidocaine and ketamine following epidural administration in dromedary camels. Ten 12–18-month-old camels were randomly divided into two equal groups. In group L, the animals received 2% lidocaine (0.22 mg/kg and in group LK the animals received a mixture of 10% ketamine (1 mg/kg and 2% lidocaine (0.22 mg/kg administered into the first intercoccygeal (Co1–Co2 epidural space while standing. Onset time and duration of caudal analgesia, sedation level and ataxia were recorded after drug administration. Data were analysed by U Mann-Whitney tests and significance was taken as p < 0.05. The results showed that epidural lidocaine and co-administration of lidocaine and ketamine produced complete analgesia in the tail, anus and perineum. Epidural administration of the lidocaine-ketamine mixture resulted in mild to moderate sedation, whilst the animals that received epidural lidocaine alone were alert and nervous during the study. Ataxia was observed in all test subjects and was slightly more severe in camels that received the lidocaine-ketamine mixture. It was concluded that epidural administration of lidocaine plus ketamine resulted in longer caudal analgesia in standing conscious dromedary camels compared with the effect of administering lidocaine alone.

  16. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

    OpenAIRE

    Akanksha Lamba; Priya Sardana; Ramanjeet Kaur

    2016-01-01

    Background: The pain of childbirth is one of the most severe types of pain that a woman experiences in her lifetime. Adequate analgesia during labour has a positive influence on the course of labour. For labor analgesia several non-pharmacologic and pharmacologic methods are adopted. The objective of the study is to compare parenteral tramadol and epidural ropivacaine with regard to maternal and labour outcome. Methods: This prospective, comparative, interventional clinical study was condu...

  17. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    Science.gov (United States)

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated. PMID:14740589

  18. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

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    Sukhen Samanta

    2016-01-01

    Full Text Available Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001 regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.

  19. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA? Should epidural analgesia still be a routine technique in pain units?

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    F. Caba

    2010-05-01

    Full Text Available La analgesia epidural se ha convertido en una técnica rutinaria en el manejo perioperatorio de los pacientes quirúrgicos que se ha extendido fuera de los quirófanos y de las unidades de alta dependencia hacia las salas de hospitalización. La irrupción en este nuevo escenario ha mejorado la analgesia postoperatoria con aceptables márgenes de seguridad, lo que le ha servido para colocarse en un lugar predominante entre las pautas analgésicas de las Unidades de Dolor Agudo (UDA. La analgesia epidural con anestésicos locales y opioides frente a la sistémica con opioides ha presentado históricamente una superior eficacia analgésica, y una disminución de complicaciones derivadas de la atenuación del estrés quirúrgico y de la mejora en la función cardiorrespiratoria. Sin embargo, frente a estas ventajas la analgesia epidural también presenta inconvenientes como la hipotensión arterial o la retención urinaria, junto a las potencialmente graves derivadas del daño neurológico ocasionado por un hematoma epidural, una infección o una lesión directa del tejido nervioso. Si sus ventajas han resultado consistentes y fundamentadas, en este momento no lo parecen tanto. El avance que ha supuesto la cirugía mínimamente invasiva con altas más precoces, junto al desarrollo de estrategias multimodales, está conduciendo a un replanteamiento de la utilización de técnicas como la epidural y a una reevaluación de sus indicaciones. Las últimas evidencias nos inducen a pensar que la epidural probablemente haya tocado techo en el tratamiento del dolor postoperatorio y comenzará a perder terreno frente a otras técnicas igualmente efectivas, con menores complicaciones y efectos secundarios. Este será un proceso lento en el que deberá quedar asegurado que las alternativas analgésicas ofrecen realmente mejores resultados en cuanto a eficacia, seguridad, tolerabilidad y calidad de la recuperación desde la perspectiva del paciente.Epidural

  20. Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.

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    Rong Lin

    Full Text Available Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min (P < 0.0001, and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001 and a higher sedation score (P < 0.0001 within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007 and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001 compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001 was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative

  1. Patient Controlled Epidural Analgesia during Labour: Effect of Addition of Background Infusion on Quality of Analgesia & Maternal Satisfaction

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    Uma Srivastava

    2009-01-01

    Full Text Available Patient controlled epidural analgesia (PCEA is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 ìg.ml-1 of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 ml.hr-1 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8 required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable& prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine

  2. Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial

    Science.gov (United States)

    Sng, Ban Leong; Kwok, Sarah Carol; Mathur, Deepak; Ithnin, Farida; Newton-Dunn, Clare; Assam, Pryseley Nkouibert; Sultana, Rehena; Sia, Alex Tiong Heng

    2016-01-01

    Background and Aims: Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section. Methods: A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction. Results: One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4–8, 8–12 and 12–24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia. Conclusion: There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period. PMID:27053782

  3. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L;

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred...

  4. Effects of epidural lidocaine analgesia on labor and delivery: A randomized, prospective, controlled trial

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    Nafisi Shahram

    2006-12-01

    Full Text Available Abstract Background Whether epidural analgesia for labor prolongs the active-first and second labor stages and increases the risk of vacuum-assisted delivery is a controversial topic. Our study was conducted to answer the question: does lumbar epidural analgesia with lidocaine affect the progress of labor in our obstetric population? Method 395 healthy, nulliparous women, at term, presented in spontaneous labor with a singleton vertex presentation. These patients were randomized to receive analgesia either, epidural with bolus doses of 1% lidocaine or intravenous, with meperidine 25 to 50 mg when their cervix was dilated to 4 centimeters. The duration of the active-first and second stages of labor and the neonatal apgar scores were recorded, in each patient. The total number of vacuum-assisted and cesarean deliveries were also measured. Results 197 women were randomized to the epidural group. 198 women were randomized to the single-dose intravenous meperidine group. There was no statistical difference in rates of vacuum-assisted delivery rate. Cesarean deliveries, as a consequence of fetal bradycardia or dystocia, did not differ significantly between the groups. Differences in the duration of the active-first and the second stages of labor were not statistically significant. The number of newborns with 1-min and 5-min Apgar scores less than 7, did not differ significantly between both analgesia groups. Conclusion Epidural analgesia with 1% lidocaine does not prolong the active-first and second stages of labor and does not increase vacuum-assisted or cesarean delivery rate.

  5. Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

    DEFF Research Database (Denmark)

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D; Guldager, H; Kehlet, H

    1999-01-01

    Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1 or...... continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P < 0.01) but...... significantly lower pain scores during rest (P < 0.05) and mobilization (P < 0.01). More patients undergoing general anaesthesia received antiemetics (13 vs five; P < 0.05), but fewer received supplementary opioids on the ward (eight vs 16; P < 0.05). We conclude that opioid-free epidural-spinal anaesthesia for...

  6. Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination

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    Kalpana S Vora

    2012-01-01

    Conclusion: Epidural administration of a combination of sufentanil and morphine offered the advantage of faster onset of action and longer duration of analgesia as compared to the two drugs administered alone.

  7. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries

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    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available Background and Aims: Opioids as epidural adjunct to local anesthetics (LA have been in use since long and α-2 agonists are being increasingly used for similar purpose. The present study aims at comparing the hemodynamic, sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine. Methods: A total of one hundred patients of both gender aged 21-56 years, American Society of Anaesthesiologist (ASA physical status I and II who underwent lower limb orthopedic surgery were enrolled into the present study. Patients were randomly divided into two groups: Ropivacaine + Dexmedetomidine (RD and Ropivacaine + Fentanyl (RF, comprising 50 patie nts each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 μg/kg of dexmedetomidine in RD group and 1 μg/kg of fentanyl in RF group. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed which included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic. At the end of study, data was compiled systematically and analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P<0.05 is considered significant and P<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory analgesia at T10 (7.12±2.44 vs 9.14±2.94 and establishment of complete motor blockade (18.16±4.52 vs 22.98±4.78 was significantly earlier in the RD group. Postoperative analgesia was prolonged significantly in the RD group (366.62±24.42 and consequently low dose consumption of local anaesthetic LA (76.82±14.28 vs 104.35±18.96 during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on

  8. Combined spinal-epidural analgesia in labour: its effects on delivery outcome

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    Suneet Kaur Sra Charanjit Singh

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55 or Non-CSE (n = 55 group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%. The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

  9. Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia

    DEFF Research Database (Denmark)

    Stjernström, H; Henneberg, S; Eklund, A; Tabow, F; Arturson, G; Wiklund, L

    1985-01-01

    anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per- and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection of...... the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma...... catecholamines increased, while no such changes could be detected using epidural analgesia. The ability to increase mean body temperature by increasing heat production was negatively correlated to age....

  10. [The characteristics of epidural analgesia during the removal of lumbar intervertebral disk hernias].

    Science.gov (United States)

    Arestov, O G; Solenkova, A V; Lubnin, A Iu; Shevelev, I N; Konovalov, N A

    2000-01-01

    Epidural analgesia (EA) was used in 29 patients undergoing surgical removal of lumbar discal hernia. Marcain EA with controlled medicinal sleep and non-assisted breathing allowed to perform the whole operation in 27 patients. EA may be ineffective in combination of sequestrated disk hernia with scarry adhesive process. The technique of the operation demands a single use of the anesthetic drug which is potent enough to make blockade throughout the operation up to the end. PMID:10738758

  11. Efficacy of the methoxyflurane as bridging analgesia during epidural placement in laboring parturient

    Directory of Open Access Journals (Sweden)

    Jamil S Anwari

    2015-01-01

    Full Text Available Background: Establishing an epidural in an agitated laboring woman can be challenging. The ideal pain control technique in such a situation should be effective, fast acting, and short lived. We assessed the efficacy of inhalational methoxyflurane (Penthrox™ analgesia as bridging analgesia for epidural placement. Materials and Methods: Sixty-four laboring women who requested epidural analgesia with pain score of ≥7 enrolled in an observational study, 56 of which completed the study. The parturients were instructed to use the device prior to the onset of uterine contraction pain and to stop at the peak of uterine contraction, repeatedly until epidural has been successfully placed. After each (methoxyflurane inhalation-uterine contraction cycle, pain, Richmond Agitation Sedation Scale (RASS, nausea and vomiting were evaluated. Maternal and fetal hemodynamics and parturient satisfaction were recorded. Results: The mean baseline pain score was 8.2 ± 1.5 which was reduced to 6.2 ± 2.0 after the first inhalation with a mean difference of 2.0 ± 1.1 (95% confidence interval 1.7-2.3, P < 0.0001, and continued to decrease significantly over the study period (P < 0.0001. The RASS scores continuously improved after each cycle (P < 0.0001. Only 1 parturient from the cohort became lightly sedated (RASS = −1. Two parturients vomited, and no significant changes in maternal hemodynamics or fetal heart rate changes were identified during treatment. 67% of the parturients reported very good or excellent satisfaction with treatment. Conclusion: Penthrox™ provides rapid, robust, and satisfactory therapy to control pain and restlessness during epidural placement in laboring parturient.

  12. Primary Failure of Thoracic Epidural Analgesia in Training Centers: The Invisible Elephant?

    Science.gov (United States)

    Tran, De Q H; Van Zundert, Tom C R V; Aliste, Julian; Engsusophon, Phatthanaphol; Finlayson, Roderick J

    2016-01-01

    In teaching centers, primary failure of thoracic epidural analgesia can be due to multiple etiologies. In addition to the difficult anatomy of the thoracic spine, the conventional end point-loss-of-resistance-lacks specificity. Furthermore, insufficient training compounds the problem: learning curves are nonexistent, pedagogical requirements are often inadequate, supervisors may be inexperienced, and exposure during residency is decreasing. Any viable solution needs to be multifaceted. Learning curves should be explored to determine the minimal number of blocks required for proficiency. The problem of decreasing caseload can be tackled with epidural simulators to supplement in vivo learning. From a technical standpoint, fluoroscopy and ultrasonography could be used to navigate the complex anatomy of the thoracic spine. Finally, correct identification of the thoracic epidural space should be confirmed with objective, real-time modalities such as neurostimulation and waveform analysis. PMID:27035462

  13. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    Kalra Sumit

    2010-01-01

    Full Text Available Objectives: A study to compare the efficacy between fentanyl and sufentanil combined with low concentration (0.0625% of bupivacaine for epidural labor analgesia in laboring women. Materials and Methods: Fifty full term parturients received an initial bolus dose of a 10 ml solution containing 0.125% bupivacaine. The patients were randomly divided into two: group F received 0.0625% bupivacaine with 2.5 mcg/ml fentanyl and group S received 0.0625% bupivacaine with 0.25 mcg/ml sufentanil. Verbal analogue pain scores, need of supplementary/rescue boluses dose of bupivacaine consumed, mode of delivery, maternal satisfaction, and neonatal Apgar scores were recorded. No significant difference was observed between both groups. Results: Both the groups provided equivalent labor analgesia and maternal satisfaction. The chances of cesarean delivery were also not increased in any group. No difference in the cephalad extent of sensory analgesia, motor block or neonatal Apgar score were observed. Although mean pain scores throughout the labor and delivery were similar in both groups, more patients in fentanyl group required supplementary boluses though not statistically significant. Conclusion: We conclude that both 0.0625% bupivacaine-fentanyl (2.5 μg/ml and 0.0625% bupivacaine-sufentanil (0.25 μg/ml were equally effective by continuous epidural infusion in providing labor analgesia with hemodynamic stability achieving equivalent maternal satisfaction without serious maternal or fetal side effects. We found that sufentanil was 10 times more potent than fentanyl as an analgesic for continuous epidural labor analgesia.

  14. Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

    Science.gov (United States)

    Baduni, Neha; Sanwal, Manoj Kumar; Vajifdar, Homay; Agarwala, Radhika

    2016-01-01

    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. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind. PMID:27275053

  15. COMPARATIVE STUDY OF EPIDURAL ROPIVACAINE WITH DEXMEDETOMIDINE, ROPIVACAINE WITH CLONIDINE AND ROPIVACAINE ALONE FOR PERIOPERATIVE ANALGESIA IN ABDOMINAL HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Satheedev

    2015-11-01

    Full Text Available Regional anesthesia is widely used for abdominal hysterectomies. It is divided into spinal and epidural anaesthesia. Epidural anesthesia has got the advantage of extending the period of anesthesia to post-operative analgesia. We can use various pharmacological agents as adjuvants, which prolong the duration of action of local anesthetics. They include opiods, alpha 2 agonists like clonidine and dexmedetomidine. In this we studied the efficacy of local anesthetic agent – ropivacaine alone, ropivacaine with clonidine and ropivacaine with dexmedetomidine for epidural block. Present study showed that Epidural Dexmedetomidine and clonidine have synergistic action in combination with epidural ropivacaine resulting in smooth and prolonged postoperative analgesia and sedation. Group RD (Ropivacaine and Dexmedetomidine had significant difference in comparison of postoperative block characteristics, such as time of two segment regression, time to Bromage scale 1, time of regression to S1 dermatome and time of first epidural top up than group RC and R. (Ropivacaine with clonidine and Ropivacaine alone. Thus epidural dexmedetomidine is a better neuraxial adjuvant in combination with epidural ropivacaine in producing prolonged analgesia and better sedation for abdominal hysterectomy

  16. Effects of thoracic epidural analgesia with morphine or bupivacaine on lower oesophageal motility--an experimental study in man.

    Science.gov (United States)

    Thorén, T; Carlsson, E; Sandmark, S; Wattwil, M

    1988-07-01

    Lower oesophageal peristalsis and lower oesophageal sphincter (LOS) pressure during thoracic epidural analgesia (TEA) were studied in 20 healthy volunteers. After oesophageal manometric baseline recordings, 10 volunteers received 4 mg epidural morphine. The other ten received 0.5% bupivacaine epidurally in sufficient amounts to block the sympathetic innervation of the oesophagus. Thereafter oesophageal manometry was repeated. During epidural morphine oesophageal peristalsis, resting LOS pressure and the contraction of LOS after swallowing did not change, but the relaxation of the LOS in response to swallowing decreased significantly (P less than 0.01). Following TEA with bupivacaine, neither distal oesophageal peristalsis nor LOS pressure changed. PMID:3414347

  17. A comparative study of oral tapentadol with thoracic epidural analgesia versus intravenous tramadol and paracetamol combination for postoperative analgesia in off pump CABG

    OpenAIRE

    Shah, Himanshu A; Jaishree S. B.; Mrugank Bhavsar

    2013-01-01

    Background: Accurate management of post operative pain is quite impossible with single drug therapy approach. For this, our aim was to combine use of tapentadol tablet orally along with thoracic epidural in comparison with intravenous combined use of tramadol, paracetamol and diclofenac for postoperative analgesia in case CABG patients. Methods: 60 patients of CABG (Coronary Artery Bypass Surgery) randomly and equally divided into two groups. Group TTE (Tab. Tapentadol -Thoracic Epidural, ...

  18. Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia Clonidina y dexmedetomidina por vía peridural para analgesia y sedación pós-operatoria de colecistectomía Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation

    OpenAIRE

    Antônio Mauro Vieira; Taylor Brandão Schnaider; Antônio Carlos Aguiar Brandão; Flávio Aparecido Pereira; Everaldo Donizeti Costa; Carlos Eduardo Povoa Fonseca

    2004-01-01

    JUSTIFICATIVA E OBJETIVOS: A clonidina e a dexmedetomidina são agonistas alfa2-adrenérgicos que, quando administrados por via peridural, possuem propriedades analgésicas e potencializam os efeitos dos anestésicos locais. A presente pesquisa objetivou avaliar a analgesia e a sedação produzidas pela clonidina ou dexmedetomidina associadas à ropivacaína, por via peridural, no pós-operatório de colecistectomia por via subcostal. MÉTODO: Participaram do estudo aleatório e duplamente encoberto 40 p...

  19. [Effects of epidural analgesia combined with general anesthesia on hemodynamics during neck surgery].

    Science.gov (United States)

    Arakawa, M; Amemiya, N; Nagai, K; Kato, S; Goto, F

    1993-10-01

    The aim of the present study was to investigate the effect of epidural analgesia combined with general anesthesia on hemodynamics. Thirty patients undergoing surgery for the treatment of cancer of the neck were studied. The patients were divided into two groups of those who received epidural analgesia combined with general anesthesia group (Group 1) and those with general anesthesia alone (Group 2). Blood pressure was not different between the groups. But heart rate and rate pressure products in Group 1 were significantly lower than those of Group 2. CVP in Group 1 increased significantly to 10.1 +/- 2.9 mmHg during surgery from 6.8 +/- 1.8 mmHg at the beginning of the surgery. There was no difference in intraoperative blood loss and the amount of fluid infused between the two groups. These results suggest that epidural anesthesia combined with general anesthesia is effective to stabilize hemodynamics during cervical surgery, but we have to be careful about using local anesthetics during long cervical procedures, because it increases CVP which might result from the depression of cardiac function. PMID:8230698

  20. Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

    LENUS (Irish Health Repository)

    Tan, T

    2012-02-01

    BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug\\/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.

  1. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus; Bigler, D; Hjortsø, N C; Kehlet, Henrik

    1988-01-01

    -point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given......The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five...... than 0.01). Mean duration of sensory blockade was significantly longer (P less than 0.005) in the patients with chronic pain than in surgical patients (13.1 +/- 1.2 and 8.5 +/- 0.7 hours, respectively). Thus, surgical injury hastens regression of sensory analgesia during continuous epidural bupivacaine...

  2. A comparative study of oral tapentadol with thoracic epidural analgesia versus intravenous tramadol and paracetamol combination for postoperative analgesia in off pump CABG

    Directory of Open Access Journals (Sweden)

    Himanshu A. Shah

    2013-12-01

    Conclusions: Our study concludes that Tapentadol with Thoracic epidural is very much effective as a multimodal analgesia approach in controlling acute postoperative pain after CABG. Tapentadol is quite a newer drug so its usefulness for other patients and different surgeries is still to be debated. [Int J Basic Clin Pharmacol 2013; 2(6.000: 723-727

  3. La analgesia epidural en el parto. Aspectos prácticos.

    Directory of Open Access Journals (Sweden)

    Miguel Picot Castro

    2012-08-01

    Full Text Available Es mucha la literatura científica relacionada con la analgesia epidural (AE durante el trabajo de parto. La mayor parte dirigida a estudiar consecuencias, efectos secundarios o complicaciones de su uso. El objetivo de esta revisión es ofrecer una visión actualizada de la bibliografía centrándonos en aquellos aspectos prácticos que podrían suponer cambios en las actuaciones diarias de las matronas basados en el conocimiento científico.Objetivo principal: El objetivo de esta revisión es ofrecer una visión actualizada de la evidencia científica, centrándonos en aquellos aspectos prácticos que podrían suponer cambios en las actuaciones diarias de las matronas Metodología: Se ha llevado a cabo la revisión consultando las siguientes bases de datos biomédicas: Cuiden, PubMed y Cochrane.Resultados principales: Se detallan a continuación prácticas habituales llevadas a cabo por las matronas no avaladas por la evidencia científica y se describen las prácticas más recomendables en relación con el uso de la analgesia epidural durante el trabajo de parto.Conclusión principal: El conocimiento por parte de la matrona de la evidencia científica en relación al uso de analgesia epidural durante el trabajo de parto, puede disminuir el número de intervenciones innecesarias así como la aparición de complicaciones tanto maternas como fetales.

  4. Foetal heart rate deceleration with combined spinal-epidural analgesia during labour: a maternal haemodynamic cardiac study.

    Science.gov (United States)

    Valensise, Herbert; Lo Presti, Damiano; Tiralongo, Grazia Maria; Pisani, Ilaria; Gagliardi, Giulia; Vasapollo, Barbara; Frigo, Maria Grazia

    2016-06-01

    To understand the mechanisms those are involved in the appearance of foetal heart rate decelerations (FHR) after the combined epidural analgesia in labour. Observational study done at University Hospital for 86-term singleton pregnant women with spontaneous labour. Serial bedside measurement of the main cardiac maternal parameters with USCOM technique; stroke volume (SV), heart rate (HR), cardiac output (CO) and total vascular resistances (TVR) inputting systolic and diastolic blood pressure before combined epidural analgesia and after 5', 10', 15' and 20 min. FHR was continuously recorded though cardiotocography before and after the procedure. Correlation between the appearance of foetal heart rate decelerations and the modification of maternal haemodynamic parameters. Fourteen out of 86 foetuses showed decelerations after the combined spino epidural procedure. No decelerations occurred in the women with low TVR (1200 dyne/s/cm(-5)). Soon after the epidural procedure, the absence of increase in SV and CO was observed in these women. No variations in systolic and diastolic blood pressure values were found. The level of TVR before combined epidural analgesia in labour may indicate the risk of FHR abnormalities after the procedure. Low TVR (<1000 dyne/s/cm(-5)) showed a reduced risk of FHR abnormalities. FHR decelerations seem to occur in women without the ability to upregulate SV and CO in response to the initial effects of analgesia. PMID:26333691

  5. Is urinary drainage necessary during continuous epidural analgesia after colonic resection?

    DEFF Research Database (Denmark)

    Basse, L; Werner, M; Kehlet, H

    2000-01-01

    . METHODS: This is a prospective, uncontrolled study with well-defined general anesthesia, postoperative analgesia, and nursing care programs in patients with a planned 2-day hospital stay, urinary catheter removal on the first postoperative morning, and epidural catheter removal on the second postoperative...... and, subsequently, for cystitis and left-sided epididymitis. Three patients had uncomplicated urinary infection. No patients had urological complaints at 30 days follow-up (95% confidence limit, 0% to 3.6%). CONCLUSION: The low incidence of urinary retention (9%) and urinary infection (4%) suggests...

  6. Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy

    NARCIS (Netherlands)

    Fant, F.; Tina, E.; Sandblom, D.; Andersson, S. -O.; Magnuson, A.; Hultgren-Hornkvist, E.; Axelsson, K.; Gupta, A.

    2013-01-01

    Background. Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropu

  7. Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

    OpenAIRE

    J.R. Ortiz-Gómez; F.J. Palacio-Abizanda; I. Fornet-Ruiz

    2014-01-01

    La analgesia epidural es hoy día el método de elección para el tratamiento del dolor del trabajo de parto, el expulsivo y el alumbramiento. Sin embargo, esta técnica puede fallar y aliviar de forma inadecuada (o nula) a la parturienta. En el presente artículo se revisan los factores de riesgo, las posibles causas y las alternativas terapéuticas posibles a la analgesia inadecuada, ya sea mediante terapias farmacológicas (neuroaxiales, bloqueos periféricos o administración de analgésicos vía in...

  8. High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia is Associated with Better Outcome in Low-to-Moderate Risk Cardiac Surgery Patients

    DEFF Research Database (Denmark)

    Stenger, Michael; Fabrin, Anja; Schmidt, Henrik; Greisen, Jacob; Erik Mortensen, Poul; Jakobsen, Carl-Johan

    2013-01-01

    The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome.......The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome....

  9. The effects of desflurane and remifentanyl anaesthesia compared to lumbar epidural analgesia combined with desflurane on recovery

    Directory of Open Access Journals (Sweden)

    Celaleddin Soyalp

    2014-12-01

    Full Text Available Objective: Our primary objective in this study is to compare the effects of the applications of desflurane and remifentanyl anaesthesia, along with lumbar epidural analgesia combined with desflurane on postoperative recovery in the cases who undergoing lower abdominal surgery. Methods: This study performed 240 patients who undergoing elective lower abdominal surgery. Patients were divided into two random groups as Group DR (desflurane + remifentanyl n=120 and Group DL (desflurane +Lumbar Epidural Analgesia n=120.The general anaesthesia in Group DR was performed through the use of desflurane and remifentanyl. Group DL was administered a general anaesthesia through a pre-operative epidural catheter insertion and an application of desflurane. Extubation, eye opening, head lift for 5 seconds, and the surgical durations of the patients as well as the postoperative side-effects were recorded. Modified Aldrete Scoring System was used to assess the recovery of the patients from anaesthesia. Results: According to the inter group comparison results between Group DR and Group DL, the duration of extubation, eye opening, head lift for 5 seconds and the average amount of elapsed time until the modified Aldrete Scoring reached 10 were found statistically and significantly shorter in Group DL than Group DR( respectively p=0.002, p<0.001, p<0.001, p<0.001.The duration of the first analgesic need was statistically and significantly longer in Group DL compared to Group DR (p<0.001. The postoperative patient satisfaction in Group DL was statistically and significantly higher than that in Group DR (p=0.010. Conclusion: The Epidural analgesia included in the general anaesthesia in lower abdominal surgery is considered by us to be the beneficial and efficient method of analgesia which leads to an earlier recovery of the patients without affecting the intraoperative hemodynamic stability and which boosts the patient satisfaction by providing a more efficient analgesia

  10. Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain

    OpenAIRE

    Alka Chandra; Banavaliker, Jayant N.; Das, Pradeep K; Sheel Hasti

    2010-01-01

    The present randomized study was conducted in our institute of pulmonary medicine and tuberculosis over a period of 1 year. This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunctive to thoracic epidural analgesia for the treatment of postoperative pain in patients who underwent posterolateral thoracotomy for decortication of lung. Sixty patients in the age group 15-40 years scheduled to undergo elective posterolateral thoracotomy wer...

  11. The Impact of Labour Epidural Analgesia on the Childbirth Expectation and Experience at a Tertiary Care Center in Southern India.

    OpenAIRE

    Bhatt, Hitanshu; Pandya, Sunil; Kolar, Geeta; Nirmalan, Praveen Kumar

    2014-01-01

    Background: Labour epidural analgesia is increasingly used as a means of pain relief for women during labour and delivery. The significant pain during labour and delivery can be terrifying for mothers-to-be and the prospect of relief from pain can help reduce fear of childbirth to an extent. However, it is not necessary that reduced fear of childbirth may lead to an increased satisfaction with the childbirth experience.

  12. Colonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient

    DEFF Research Database (Denmark)

    Møiniche, S; Dahl, J B; Rosenberg, J; Kehlet, H

    1994-01-01

    early oral feeding and mobilization. METHODS. Intraoperative subarachnoid anesthesia was followed by epidural analgesia with bupivacaine and morphine for 72 hours and oral acetaminophen 1 g every 6 hours. RESULTS. The technique resulted in a pain-free postoperative course (rest and mobilization) with......BACKGROUND AND OBJECTIVES. A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids, and...

  13. Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    WANG Li-zhong; CHANG Xiang-yang; LIU Xia; HU Xiao-xia; TANG Bei-lei

    2010-01-01

    Background Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine (Group B), ropivacaine (Group R) or levobupivacaine (Group L) with sufentanil 0.5 μg/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was ≤30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction (P >0.05). The relative median potency was bupivacaine/ropivacaine: 0.828 (0.602-1.091), bupivacaine/levobupivacaine: 0.845 (0.617-1.12), ropivacaine/levobupivacaine: 1.021 (0.774-1.354), respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of ≥0.1% within each group (P<0.05). Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine

  14. Clinical evaluation of postoperative analgesia provided by ketoprofen associated with intravenous or epidural morphine in bitches undergoing ovariosalpingohysterectomy

    Directory of Open Access Journals (Sweden)

    Gabriela Carvalho Aquilino Santos

    2015-04-01

    Full Text Available Multimodal analgesia refers to the practice of combining multiple analgesic drug classes or techniques to target different points along the pain pathway. The objective of this work was to evaluate clinically if ketoprofen associated or not with intravenous or epidural morphine provided adequate postoperative analgesia in bitches undergoing ovariosalpingohysterectomy (OSH. Forty healthy female dogs, weighing 10.7±6.0 kg, sedated with acepromazine (0.05mg kg –1.iv, induced with propofol (5 mg.kg-1. iv and maintained with isoflurane anesthesia, were distributed into four groups of 10 animals each. After stabilization of inhalation anesthesia, the bitches in Miv and CMiv groups received 0.2 mg.kg-1 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received 0.1mg.kg-1 of epidural morphine. Thirty minutes after premedication, 2.0mg.kg-1.im of ketoprofen was administered in groups CMiv and CMep. Heart and respiratory rate, systolic blood pressure, and rectal temperature were measured. The degree of analgesia was assessed by a blind study in the following 6 hours after surgery, using a descriptive scale and a scale composed by physiologic and behavioral parameters. An statistical analysis was performed using the Tukey-Kramer test and nonparametric Kruskal-Wallis test, with statistical significance of 5%. There was no important difference between the four groups regarding postoperative analgesia, heart and respiratory rate, systolic blood pressure and rectal temperature. According to the results it can be concluded that the use of ketoprofen associated with intravenous or epidural morphine provided adequate and safe analgesia in the first six hours of postoperative in bitches undergoing ovariohysterectomy, suggesting that there was no analgesic potentiation when both agents were combined.

  15. RANDOMISED CONTROLLED STUDY COMPARING A 0.75% ROPIVACAINE TO A CONVENTIONAL DOSE OF HYPERBARIC BUPIVACAINE FOR CESARIAN SECTION BY EPIDURAL ANALGESIA

    Directory of Open Access Journals (Sweden)

    Porika

    2015-09-01

    Full Text Available Central neuraxial blocked is one of the safest and efficacious methods of anaesthesia and analgesia. It has the added advantage of prolonged pain relief into the postoperative period. Epidural analgesia has increased steadily in popularity when compared to spinal anaesthes ia due to its neurological consequences and improved post - operative analgesia with epidural Opioids and as a consequence decreased side effects and prolonged the duration of analgesia. Present study is undertaken to compare hemodynamic and analgesic charac teristics using a 0.75% ropivacaine to a conventional dose of 0.5% bupivacaine for cesarean section under epidural anaesthesia. This study was conducted in ASA Grade I 50 singleton parturient to compare hemodynamics, APGAR scores and analgesic characterist ics of ropivacaine and bupivacaine. We have observed that the onset of sensory blockade was slower with ropivacaine and the duration of sensory blockade was also less. Whereas there was no significant change in haemodynamics and APGAR scores with both the drugs.

  16. Transición analgésica tras anestesia basada en remifentanilo en cirugía abdominal mayor: morfina-ketorolaco versus analgesia epidural Analgesic transition after remifentanyl-based anaesthesia in major abdominal surgery: morphine-ketorolac versus epidural analgesia

    Directory of Open Access Journals (Sweden)

    E. Calderón

    2004-02-01

    Full Text Available Objetivos: El objetivo de nuestro estudio ha sido comparar la eficacia analgésica y efectos adversos de dos modalidades analgésicas, epidural con bupivacaína-fentanilo e intravenosa con morfina-ketorolaco en la transición de una anestesia basada en remifentanilo tras cirugía abdominal mayor durante las primeras 6 horas del periodo postoperatorio. Material y métodos: Hemos realizado un estudio clínico en 30 pacientes adultos, programados para cirugía abdominal mayor. Todos los pacientes recibieron una técnica anestésica estándar. Cuarenta minutos antes de finalizar la intervención quirúrgica, a los pacientes del grupo E se le administró 15 ml de bupivacaína 0,25% y 1 µg.kg-1 de fentanilo vía epidural, y a los pacientes del grupo M se les administró por vía intravenosa 0,15 mg.kg-1 de cloruro mórfico y 30 mg de ketorolaco. Hemos valorado durante las primeras 6 horas postextubación, los parámetros hemodinámicos, respiratorios, grado de sedación y recuperación postanestésica, y tiempo en el que eran elegibles para ser dado de alta de la reanimación, la intensidad del dolor postoperatorio mediante escala verbal simple y escala analógica visual, los efectos adversos y las necesidades de analgesia de rescate. Como analgésico de rescate se utilizó morfina a dosis de 0,05 mg.kg-1 en el grupo M y bolo epidural de 5 ml de bupivacaína 0,25% en el grupo E cuando entre determinaciones la intensidad del dolor en la EVS ≥ 2. Resultados: No hemos encontrado diferencias estadísticamente significativas en las características generales, parámetros hemodinámicos, respiratorios, nivel de sedación, grado de recuperación y elección para el alta entre ambos grupos de estudio. Las necesidades de rescate fueron significativamente mayores en el grupo M (40% que en el grupo E (13% (p Objectives: The aim of our study was to compare analgesic effectiveness and side effects of two analgesic regimes: epidural analgesia with bupivacaine

  17. Applicable study of patient-controlled epidural analgesia in peri-interventional uterine arterial embolization for uterine myomata

    International Nuclear Information System (INIS)

    Objective: To study the effectiveness and safety of epidural patient-controlled analgesia (PCEA) for post-operative pain relief and adverse reactions after uterine arterial embolization (UAE). Methods: 100 patients (ASA I-II grade) undergoing transcatheter UAE of uterine myomata were randomly divided into five groups. All patients except group V used PCEA; including group I ( n=20) for epidural infusion with 0.2% ropivacaine plus 0.004% morphine, group II (n=20) with epidural infusion of 0.2% ropivacaine and 0.004% morphine plus 0.005% droperidol, group III (n=20) with epidural infusion of 0.2% ropivacaine and 0.004% morphine plus 0.01% droperidol, group IV (n=20) of epidural infusion of 0.2% ropivacaine plus 0.01% morphine, group V (n=20) served as the control with either traditional oral drugs of micronized nimesulide, or intramuscular injection (plus analgesic of rotundin or pethidine hydrochloride), or both. Results The quality of pain relief in the group I, group II, group III and group IV was obviously superior to that of group V. The PCEA application group recovered faster than that of group V after the procedure (P<0.01). Conclusions: During or after UEA, PCEA could effectively relieve pain by providing less side effects, faster recovery and high safety to the patient. The best analgetic methods of PCEA are coincident with the use of 0.2% ropivacaine plus 0.01% morphine. (authors)

  18. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    proporcionado un rápido e inmediato alivio del dolor. Estudios clínicos con mayor número de casos son necesarios para evaluar diferencia en la incidencia de cesarianas.BACKGROUND AND OBJECTIVES: Pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. Several analgesia techniques can be used during labor. The aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl. METHODS: Forty pregnant women, in labor, with cervical dilation between 4 and 5 cm, were randomly divided in two groups. Group I received continuous epidural anesthesia. Group II received combined anesthesia. The following parameters were evaluated: anthropometric measurements, gestational age, cervical dilation, length of time between the blockade and absence of pain according to the visual analogic scale, ability to walk, length of time between analgesia and complete cervical dilation, duration of the expulsive phase, maternal hemodynamic parameters, and vitality of the newborn. Possible complications, such as respiratory depression, maternal hypotension, pruritus, nausea, and vomiting were also evaluated. The Student t test was used to compare the means and the Chi-square test was used to compare the number of pregnancies and type of labor. RESULTS: There were no statistically significant differences between both groups regarding the length of time between the beginning of analgesia and complete cervical dilation, as well as regarding the duration of the expulsive phase, incidence of cesarean section related to the analgesia, maternal hemodynamic parameters, and vitality of the newborn. CONCLUSIONS: Both techniques are effective and safe for labor analgesia, although the combined technique provided fast and immediate pain relief. Clinical studies with a larger number of patients are necessary to

  19. Predicting postoperative vomiting among orthopedic patients receiving patient-controlled epidural analgesia using SVM and LR.

    Science.gov (United States)

    Wu, Hsin-Yun; Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Chang, Kuang-Yi; Tsou, Mei-Yung; Ting, Chien-Kun

    2016-01-01

    Patient-controlled epidural analgesia (PCEA) has been applied to reduce postoperative pain in orthopedic surgical patients. Unfortunately, PCEA is occasionally accompanied by nausea and vomiting. The logistic regression (LR) model is widely used to predict vomiting, and recently support vector machines (SVM), a supervised machine learning method, has been used for classification and prediction. Unlike our previous work which compared Artificial Neural Networks (ANNs) with LR, this study uses a SVM-based predictive model to identify patients with high risk of vomiting during PCEA and comparing results with those derived from the LR-based model. From January to March 2007, data from 195 patients undergoing PCEA following orthopedic surgery were applied to develop two predictive models. 75% of the data were randomly selected for training, while the remainder was used for testing to validate predictive performance. The area under curve (AUC) was measured using the Receiver Operating Characteristic curve (ROC). The area under ROC curves of LR and SVM models were 0.734 and 0.929, respectively. A computer-based predictive model can be used to identify those who are at high risk for vomiting after PCEA, allowing for patient-specific therapeutic intervention or the use of alternative analgesic methods. PMID:27247165

  20. Effectiveness of epidural versus alternate analgesia for pain relief after radical prostatectomy and correlation with biochemical recurrence in men with prostate cancer

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    Mir MC

    2013-10-01

    differences were statistically significant (P = 0.012.Conclusion: Epidural analgesia increased length of hospital stay and technical problems related to the epidural. Furthermore, men receiving an epidural showed an increased recurrence of PSA. In light of our findings, epidurals are probably not indicated for men undergoing RRP. However, as minimally invasive techniques are becoming more widespread, and epidural analgesia is being used less frequently, large randomized controlled trials to definitively support our hypotheses are unlikely to be undertaken.Keywords: prostate neoplasm, surgery, prostatectomy, analgesia, epidural

  1. Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril Efectos de la analgesia epidural y del bloqueo continuo del plexo lumbar sobre la rehabilitación funcional después de la artroplastia total de cadera Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

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    Leonardo Teixeira Domingues Duarte

    2009-10-01

    ésica eficaz y que permita la movilidad precoz, la participación en las actividades de rehabilitación, y una rápida recuperación funcional. El objetivo de este estudio, fue comparar los efectos de las técnicas de analgesia controlada por el paciente (ACP, por las vías epidural y perineural del plexo lumbar sobre la rehabilitación funcional en pacientes sometidos a la ATC. MÉTODO: Pacientes en estado físico ASA I a III, que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. Para la ATC, se realizó la anestesia epidural lumbar continua con ropivacaína a 0,5% (Epidural o bloqueo continuo del plexo lumbar con ropivacaína a 0,5% (Lumbar. En la sala de recuperación, se inició ACP con infusión de ropivacaína a 0,2% (Lumbar o ropivacaína a 0,2% + fentanil 3 µg.mL-1 (Epidural. La eficacia de la analgesia en las primeras 48 horas después de la ATC (niveles de dolor, consumo de morfina de rescate y de bolos de la bomba de ACP, se comparó entre los grupos. Los diferentes parámetros de la rehabilitación postoperatoria también se estudiaron. RESULTADOS: Cuarenta y un pacientes se sometieron al análisis estadístico. Los niveles de dolor en reposo fueron similares en los dos grupos. A pesar de un control más efectivo del dolor dinámico en el grupo Epidural y de un uso más potente de la morfina, que se aplicó más a menudo y precozmente en el grupo Lumbar, no hubo diferencia entre los grupos en ninguno de los parámetros estudiados de rehabilitación. Las técnicas de analgesia no influyeron en las fallas en el proceso de rehabilitación. CONCLUSIONES: El más alto nivel de efectividad de la analgesia epidural, no se tradujo en una mejoría en el proceso de rehabilitación, ni tampoco redujo el tiempo necesario para alcanzar los resultados estudiados.BAKGROUND AND OBJECTIVES: Pain after total hip arthroplasty (THA is severe and it is aggravated by movements, which requires an effective analgesic technique that allows early mobilization, participation

  2. Influencia de la analgesia epidural sobre la incidencia de taquiarritmias en el postoperatorio de la cirugía pulmonar Influence of epidural analgesia on the incidence of tachyarrhythmia during pulmonary surgery postoperative

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    A. Gutiérrez-Guillén

    2004-02-01

    Full Text Available Objetivos: Valorar la influencia del uso de analgesia epidural torácica (AET intra y postoperatoria sobre la presentación de taquiarritmias en el postoperatorio de las resecciones pulmonares. Material y métodos: Se han analizado, de forma retrospectiva, los cursos postoperatorios de 200 pacientes consecutivos intervenidos de resecciones pulmonares mayores (lobectomías, bilobectomías y neumonectomías en nuestro hospital durante el periodo comprendido entre octubre de 1998 y junio de 2002. En este tiempo se ha introducido progresivamente en nuestro Servicio la AET como parte de la técnica anestésica en cirugía pulmonar. Se ha analizado la influencia del empleo de AET en la presentación de episodios de taquiarritmia supraventricular en las primeras 48 horas de postoperatorio. Resultados: Se empleó AET para el manejo anestésico y control del dolor postoperatorio en el 49,5% de los casos (99/200. No existen diferencias significativas entre los grupos de pacientes con y sin AET en cuanto a edad, sexo, riesgo ASA, duración de la intervención y tipo de resecciones practicadas. Presentaron crisis de taquiarritmia el 9,5% de los pacientes (19/200, tratándose, en todos los casos, de fibrilación auricular paroxística. Entre los pacientes que no recibieron AET la tasa de arritmias fue del 13,86% (14/101, mientras que en aquellos en los que se empleó AET como parte de la técnica anestésica y durante el postoperatorio, dicha tasa fue del 5,05% (5/99, siendo dicha diferencia estadísticamente significativa (p=0,034. Conclusiones: El empleo de AET como parte de la técnica anestésica y para el manejo del dolor postoperatorio en cirugía de resección pulmonar parece ejercer un efecto protector en cuanto al desarrollo de fibrilación auricular en el postoperatorio inmediato. Se discuten las posibles causas de este efecto.Objectives: To assess the impact of intra- and post-operative thoracic epidural analgesia (TEA on the incidence of tachy

  3. Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain

    Directory of Open Access Journals (Sweden)

    Alka Chandra

    2010-01-01

    Full Text Available The present randomized study was conducted in our institute of pulmonary medicine and tuberculosis over a period of 1 year. This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS as an adjunctive to thoracic epidural analgesia for the treatment of postoperative pain in patients who underwent posterolateral thoracotomy for decortication of lung. Sixty patients in the age group 15-40 years scheduled to undergo elective posterolateral thoracotomy were divided into two groups of 30 each. Patients were alternatively assigned to one of the groups. In group I, only thoracic epidural analgesia with local anaesthetics was given at regular intervals; however, an identical apparatus which did not deliver an electric current was applied to the control (i.e. group I patients. While in group II, TENS was started immediately in the recovery period in addition to the epidural analgesia. A 0-10 visual analog scale (VAS was used to assess pain at regular intervals. The haemodynamics were also studied at regular intervals of 2 h for the first 10 h after the surgery. When the VAS score was more than three, intramuscular analgesia with diclofenac sodium was given. The VAS score and the systolic blood pressure were comparable in the immediate postoperative period (P = NS but the VAS score was significantly less in group II at 2, 4, 6, 8 h (P < 0.01, P < 0.05, P < 0.05, P < 0.05, respectively, and at 10 h the P value was not significant. Similarly, the systolic blood pressure was significantly less in group II at 2, 4, 6 h after surgery, that is P < 0.02, P < 0.01, P < 0.01, respectively, but at 8 and 10 h the pressures were comparable in both the groups. Adding TENS to epidural analgesia led to a significant reduction in pain with no sequelae. The haemodynamics were significantly stable in group II compared to group I. TENS is a valuable strategy to alleviate postoperative pain following thoracic surgery with no side

  4. Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia

    OpenAIRE

    Agarwal, Kiran; Agarwal, Navneet; Agrawal, V. K.; Agarwal, Ashok; Sharma, Mahender

    2012-01-01

    Background: Obstetric anesthesia presents a challenge to the anesthesiologist. The effective pain management allows the partu-rient adequate degree of comfort and promotes physical reco-very and a sense of well being. Materials and Methods: This randomized controlled study was designed to assess the analgesic efficacy and side effects of 1.20 mg single-dose epidural morphine (Group 1) versus intermittent 12 hourly epidural morphine (0.5 mg) with bupivacaine (Group2) for postoperative analgesi...

  5. A COMPARATIVE STUDY OF BUPIVACAINE AND FENTANYL V/s BUPIVACAINE AND BUTORPHANOL IN LABOUR ANALGESIA BY EPIDURAL TECHNIQUE

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    Nagarjuna Reddy

    2015-09-01

    Full Text Available BACKGROUND: Pain is a subjective experience with sensory and emotional components that are inextricably linked to each other. P ain during labour is very intense for many mothers. Severe labour pains may adversely affect both mother and fetus. Variety of regional anal gesia techniques are available, Of all these techniques epidural analgesia using local anaesthetics and opiates has gained popularity as a safe and effective technique of pain relief largely replacing other modalities. AIM: The present study was undertaken to compare bupivacaine and fentanyl with a combination of bupivacaine and butorphanol by intermittent bolus epidural technique in relieving pain during labour. DESIGN: Randomized control study . METHODS: A total number of 100 parturients studied were divid ed into two groups randomly. Group - 1: received a combination of Bupivacaine and Fentanyl. The initial bolus dose was 0.1% Bupivacaine 10ml with 2mcg/ml [20mcg] of Fentanyl and top up doses were 0.1% Bupivacaine with Fentanyl 2mcg/ml [10ml]. Group - 2: This G roup received a combination of Bupivacaine and Butorphanol. The initial bolus dose was 0.1% Bupivacaine 10ml with 0.01% of Butorphanol [1mg] and top up doses were with 0.1% Bupivacaine [10ml]. Maternal blood pressure, pulse rate, fetal heart rate were moni tored every 1 - 2 min for first 10 min and then every 5 - 10 min for subsequent 30 min and later every half an hour. Time of onset of analgesia, level of sensory blockade and motor blockade, if any was noted. VISUAL ANALOGUE PAIN SCALE [VAPS] assessed pain a t different time intervals. The sedation was assessed by WILSON GRADING, BROMAGE SCALE assessed the motor blockade. RESULTS: The onsets of analgesia were quicker in group - 1 parturients who received 0.1% bupivacaine with 0.0002% fentanyl. The duration of anal gesia with the 1st dose was significantly more in the group - 2 also the requirement of top up doses was also less in group - 2 and also the quality in group

  6. 硬膜外分娩镇痛的研究进展%Advances in epidural analgesia for labour

    Institute of Scientific and Technical Information of China (English)

    罗宝蓉; 李树人

    2008-01-01

    硬膜外分娩镇痛对分娩的影响一直存在争议.新近资料不仅提供了硬膜外分娩镇痛对产程、剖宫产率、阴道器械助产率、及新生儿影响的进展,而且它与持续性枕后位和产妇发烧的关系也受到关注.改进硬膜外分娩镇痛技术的关键是减小对分娩不利影响并保证产妇满意镇痛的重要手段.研究表明采用低浓度局麻药复合阿片类药硬膜外镇痛,设置大容量PCEA和长锁定时间的输注模式对分娩的影响最小.%Controversy has suspended about the influence of epidural analgesia on labour in past years. Recent literatures provide new findings not only about its influeuee on labour stages, the incidence of instrumental and operative delivery, and neonate safety, but also about its relation with fetal head position at delivery, and maternal pyrexia. To avoid mstoward effects on delivery and ensure sarisfactory analgesia during labor are the key points of success of labor analgesia. Studies show that patient-controlled epidural analgesia with a lower concentration of anesthetic, a higher bolus volume and a longer lockout interval had minimal influence on labour.

  7. Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: "la buena sufridora" Analysis of rejection of epidural analgesia during labor in Andalusian women: "the silent sufferer"

    Directory of Open Access Journals (Sweden)

    L. Biedma Velázquez

    2010-02-01

    Full Text Available Introducción: La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Objetivo: Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Material y métodos: Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Resultados: Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral. Conclusiones: Las características sociales, económicas y culturales que definen el rechazo, es decir, el "tipo" de mujer que rehúsa la epidural, coinciden con el esquema de "mujer tradicional" estudiado por otros autores (que se caracteriza por tener escasos

  8. Immediate and prolonged effects of pre- versus postoperative epidural analgesia with bupivacaine and morphine on pain at rest and during mobilisation after total knee arthroplasty

    DEFF Research Database (Denmark)

    Dahl, J B; Daugaard, J J; Rasmussen, B;

    1994-01-01

    Thirty-two patients scheduled for total knee arthroplasty were randomized to receive an identical epidural blockade initiated 30 min before surgical incision (N = 16), or at closure of the surgical wound (N = 16). Before induction of general anaesthesia the epidural catheter was tested with...... bupivacaine 7.5 mg.ml-1, 2 ml. General anaesthesia was induced with thiopentone, pancuronium or atracurium, and fentanyl 0.1-0.3 mg, and maintained with N2O/O2 and enflurane. The epidural regimen consisted of a bolus of 16 ml of bupivacaine 7.5 mg.ml-1 plus morphine 2 mg, and continuous infusion of......, during or after cessation of the epidural regimen. These results do not suggest timing of analgesia with a conventional, continuous epidural regimen to be of major clinical importance in patients undergoing total knee arthroplasty....

  9. Intra-operative Patient-Controlled Sedation (PCS:Propofol versus Midazolam Supplementation During Epidural Analgesia (Clinical and Hormonal Study

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    Hassan S Al-khayat

    2008-01-01

    Full Text Available This study was done on sixty adult males scheduled to have an epidural analgesia for elective inguinal hernia repair. The study was designed to compare propofol and midazolam with regard to their suitability for the patient-controlled sedation (PCS technique during epidural analgesia. Patients were divided into three equal groups and premedicated with 0.2mg.kg -1 oral midazolam. Group I (G1 served as control. Using PCS technique, the pump was programmed to deliver on demand a bolus dose of 0.5 mg.kg- 1 of propofol in Group II (G2 or 0.1mg.kg -1 midazolam in Group III(G3. Patient′s sedation status was assessed by sedation score, comfort scale and by psychometric testing. The total delivered dose of each tested drug was calculated. Serum concentrations of propfol and midazolam, plasma cortisol and free fatty acids were measured. Propofol and midazolam PCS technique produced excellent and easily controllable sedation. The dose needed to produce steady state sedation was 2.8±1.42 and 0.11±0.6 mg.kg -1 .h- 1 for propofol and midazolam respectively. Propofol was more suitable than midazolam for PCS because of its rapid onset, favorable recovery profile and low side effects. PCS proved to be a stress-free and acceptable technique.

  10. Maternal and Cord Serum Cytokine Changes with Continuous and Intermittent Labor Epidural Analgesia: A Randomized Study

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    Venkat R. Mantha

    2012-01-01

    Full Text Available Background. Maternal fever during labor epidural analgesia (LEA may cause increased maternal and cord serum inflammatory cytokines. We report the effects of intermittent and continuous LEA on these cytokines. Methods. Ninety-two women were randomly assigned to continuous (CLEA or intermittent (ILEA groups, 46 in each. Maternal temperature was checked and blood drawn at epidural insertion (baseline and four-hourly until 4 h postpartum (4 PP. Cord blood was drawn after placental delivery. Interleukin-1β (IL-1β, interleukin-6 (IL-6, interleukin-8 (IL-8, granulocyte macrophage-colony stimulating factor (GM-CSF, and tumor necrosis factor-α (TNF-α were measured and analyzed according to group randomization, and then combined and reanalyzed as febrile (temperature ≥38°C or afebrile groups. Results. Significant intragroup changes from baseline were noted in some groups. Data are pg/mL, median (Q1/Q3. IL-6 rose at all time points in all groups. CLEA: baseline: 18.5 (12.5/31.1, 4 h: 80.0 (46.3/110.8, 8 h: 171.9 (145.3/234.3, and 4 PP: 81 (55.7/137.4. ILEA: baseline: 15.7 (10.2/27.1, 4 h: 68.2 (33.3/95.0, 8 h: 125.0 (86.3/195.0, and 4 PP: 70.2 (54.8/103.6. Febrile group: baseline: 21.6 (13.8/40.9, 4 h: 83.9 (47.5/120.8, 8 h: 186.7 (149.6/349.9, and 4 PP: 105.8 (65.7/158.8. Afebrile group: baseline: 10.9 (2.1/17.4, 4 h: 38.2 (15.0/68.2, 8 h: 93.8 (57.1/135.7, and 4 PP: 52.9 (25.1/78. IL-8 rose at all time points in CLEA: baseline: 2.68 (0.0/4.3, 4 h: 3.7 (0.0/6.5, 8 h: 6.0 (3.3/9.6, 4 PP: 5.6 (0.8/8.0, and afebrile group baseline: 2.5 (0.0/4.7, 4 h: 3.3 (0.0/6.2, 8 h: 5.3 (1.9/9.8, and 4 PP: 4.7 (0.0/7.6. It fell at 4 PP in febrile group: baseline: 4.1 (0.0/6.4, 4 h: 3.8 (0.0/6.5, 8 h: 5.2 (2.5/8.0, and 4 PP: 2.9 (0.0/4.0. GM-CSF increased at 8 h and decreased at 4 PP in ILEA baseline: 2.73 (0.0/7.2, 4 h: 2.73 (0.0/7.9, 8 h: 3.9 (2.7/11.5, and 4 PP: 2.0 (0.0/7.2. It increased at 4 h and 8

  11. DISPOSABLE NON-MECHANICAL ELASTOMERIC BALLOON PUMP FOR CONTINUOUS EPIDURAL INFUSION: AN EFFECTIVE AND RELIABLE MEANS FOR POSTOPERATIVE ANALGESIA

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    Dilip Kumar

    2016-01-01

    Full Text Available Postoperative pain an unpleasant sensory and emotional experience is one of the most challenging and gratifying domains to treat. Aim is here to assess effectiveness of postoperative pain relief, side effects and complications while using non-mechanical disposable elastomeric pump as continuous epidural infusion. PATIENTS AND METHODS The present study has been carried out on thirty patients in postoperative wards. At the end of operation the Elastomeric pump containing 125ml of bupivacaine (0.125% was connected with the epidural catheter Pain was assessed by VAS scoring system ranging from 0 to 10. Haemodynamic parameters, quality of analgesia, degree of motor block, and adverse effect encountered were recorded at two hours interval for 24 hours at the end of two hours of subarachnoid block when operation is over. RESULTS AND OBSERVATIONS None of our patients had shown any clinically significant changes in their cardiorespiratory indices in the postoperative period. All the patients at 0 hr. were having VAS score of 0 and till 22 hours enjoyed good pain relief, i.e. VAS of 3-4. Infusion is not always steady as set by the manufacturer. There is no motor blockade after 16 hours (Bromage-0. Insignificant number of patients experienced nausea or vomiting and backache. CONCLUSIONS Elastomeric balloon pumps is a reliable device to deliver LA agents steadily and safely with 0.125% bupivacaine as continuous epidural.

  12. Algorithm for the anesthetic management of cesarean delivery in patients with unsatisfactory labor epidural analgesia [v1; ref status: indexed, http://f1000r.es/5a3

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    Sonia Vaida

    2015-04-01

    Full Text Available The management of a patient presenting with unsatisfactory labor epidural analgesia poses a severe challenge for the anesthetist wanting to provide safe anesthetic care for a cesarean delivery. Early recognition of unsatisfactory labor analgesia allows for replacement of the epidural catheter. The decision to convert labor epidural analgesia to anesthesia for cesarean delivery is based on the urgency of the cesarean delivery, airway examination, and the existence of a residual sensory and motor block.  We suggest an algorithm which is implemented in our department, based on the urgency of the cesarean delivery.

  13. Bloqueo epidural lumbar continuo para espasmos vesicales incoercibles Continuous lumbar epidural uncontrollable bladder spasms

    OpenAIRE

    C. López Carballo; S. Vázquez del Valle; M. Garrido García; J. Pico Veloso; R. Valle Yáñez; M. J. Bermúdez López; F. J. Pardo-Sobrino López

    2013-01-01

    Presentamos un caso clínico de espasmos vesicales por hiperactividad del detrusor de la vejiga, desencadenados por lavado vesical continuo aplicado en un paciente con hematuria, en el contexto de hipertrofia benigna de próstata. Los espasmos llegaron a ser refractarios a tratamiento sistémico con antimuscarínicos, espasmolíticos y opioides. Se optó por la colocación de un catéter epidural lumbar para infusión continua de anestésicos locales y opioides como terapia analgésica alternativa, que ...

  14. Bloqueo epidural lumbar continuo para espasmos vesicales incoercibles Continuous lumbar epidural uncontrollable bladder spasms

    Directory of Open Access Journals (Sweden)

    C. López Carballo

    2013-04-01

    Full Text Available Presentamos un caso clínico de espasmos vesicales por hiperactividad del detrusor de la vejiga, desencadenados por lavado vesical continuo aplicado en un paciente con hematuria, en el contexto de hipertrofia benigna de próstata. Los espasmos llegaron a ser refractarios a tratamiento sistémico con antimuscarínicos, espasmolíticos y opioides. Se optó por la colocación de un catéter epidural lumbar para infusión continua de anestésicos locales y opioides como terapia analgésica alternativa, que no solo proporcionó un aceptable grado de confort, sino que permitió el mantenimiento del sondaje uretral y el lavado vesical continuo. Realizamos una revisión bibliográfica sobre el uso del bloqueo epidural de la neurotransmisión de las aferencias sensitivas vesicales en dolor de origen disfuncional vesical, y analizamos algunas de la teorías publicadas sobre la fisiopatología y génesis de dolor en estos trastornos vesicales, con la intención de interpretar las peculiaridades y complejidad del dolor en el cuadro del caso presentado.We present a clinical case of bladder spasms due to detrusor overactitivity, triggered by continuous vesicoclysis therapy, which was applied in a patient with benign prostatic hypertrophy-related hematuria. Bladder spasms turned out to be refractory to combined antimuscarinic, spasmolytic and systemic opioid therapies. Implantation of a lumbar epidural catheter was chosen for continuous epidural infusion of local anesthetics and opioid drugs as an alternate analgesic therapy, which provided the patient an optimum comfort, but let urethral indwelling catheterization and the maintenance of continuous vesicoclysis therapy as well. We reviewed scientific literature concerning bladder-afferent neurotransmission blockade at epidural level for dysfunctional bladder pain therapy, and discussed several published theories about pain physiopathology and origin in those cases of dysfunctional bladder disturbance, with the

  15. Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: "la buena sufridora"

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    L. Biedma Velázquez

    2010-02-01

    Full Text Available Introducción: La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Objetivo: Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Material y métodos: Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Resultados: Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral. Conclusiones: Las características sociales, económicas y culturales que definen el rechazo, es decir, el "tipo" de mujer que rehúsa la epidural, coinciden con el esquema de "mujer tradicional" estudiado por otros autores (que se caracteriza por tener escasos

  16. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    : Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism. Furthermore, dynamic pain relief is achieved with improved pulmonary function and a pronounced reduction of postoperative ileus, thereby providing optimal conditions for...

  17. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated meta-analysis.

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    Xibing Ding

    Full Text Available OBJECTIVE: The most recent systematic review and meta-analysis comparing the analgesic efficacy and side effects of paravertebral and epidural blockade for thoracotomy was published in 2006. Nine well-designed randomized trials with controversial results have been published since then. The present report constitutes an updated meta-analysis of this issue. SUMMARY OF BACKGROUND: Thoracotomy is a major surgical procedure and is associated with severe postoperative pain. Epidural analgesia is the gold standard for post-thoracotomy pain management, but has its limitations and contraindications, and paravertebral blockade is increasingly popular. However, it has not been decided whether the analgesic effect of the two methods is comparable, or whether paravertebral blockade leads to a lower incidence of adverse side effects after thoracotomy. METHODS: Two reviewers independently searched the databases PubMed, EMBASE, and the Cochrane Library (last performed on 1 February, 2013 for reports of studies comparing post-thoracotomy epidural analgesia and paravertebral blockade. The same individuals independently extracted data from the appropriate studies. RESULT: Eighteen trials involving 777 patients were included in the current analysis. There was no significant difference in pain scores between paravertebral blockade and epidural analgesia at 4-8, 24, 48 hours, and the rates of pulmonary complications and morphine usage during the first 24 hours were also similar. However, paravertebral blockade was better than epidural analgesia in reducing the incidence of urinary retention (p<0.0001, nausea and vomiting (p = 0.01, hypotension (p<0.00001, and rates of failed block were lower in the paravertebral blockade group (p = 0.01. CONCLUSIONS: This meta-analysis showed that PVB can provide comparable pain relief to traditional EPI, and may have a better side-effect profile for pain relief after thoracic surgery. Further high-powered randomized trials

  18. Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis

    Science.gov (United States)

    Jebaraj, B; Khanna, P; Baidya, DK; Maitra, S

    2016-01-01

    Background: Dexamethasone is a potent anti-inflammatory, analgesic, and antiemetic drug. Individual randomized controlled trials found a possible benefit of epidural dexamethasone. The purpose of this meta-analysis is to estimate the benefit of epidural dexamethasone on postoperative pain and opioid consumption and to formulate a recommendation for evidence-based practice. Materials and Methods: Prospective, randomized controlled trials comparing the analgesic efficacy of epidural local anesthetic and dexamethasone combination, with local anesthetic alone for postoperative pain management after abdominal surgery, were planned to be included in this meta-analysis. PubMed, PubMed Central, Scopus, and Central Register of Clinical Trials of the Cochrane Collaboration (CENTRAL) databases were searched for eligible controlled trials using the following search words: “Epidural”, “dexamethasone”, and “postoperative pain”, until February 20, 2015. Results: Data from five randomized control trials have been included in this meta-analysis. Epidural dexamethasone significantly decreased postoperative morphine consumption (mean difference −7.89 mg; 95% confidence interval [CI]: −11.66 to −3.71) and number of patients required postoperative rescue analgesic boluses (risk ratio: 0.51; 95% CI: 0.41-0.63). Conclusion: The present data shows that the addition of dexamethasone to local anesthetic in epidural is beneficial for postoperative pain management. PMID:27375389

  19. Efecto de la hidratación endovenosa con hidroxietil almidón 6% 130/0.4 (voluven®) versus ringer lactato previa a la analgesia epidural en la incidencia de hipotensión durante el trabajo de parto

    OpenAIRE

    Francés González, Sonia

    2015-01-01

    La fluidoterapia endovenosa en las gestantes durante trabajo de parto es fundamental para la prevención de la hipotensión materna tras la analgesia epidural y así mantener el bienestar materno-fetal. El tipo de fluidoterapia administrada, coloides o cristaloides, puede influir en la incidencia de dicha hipotensión. Presentamos los resultados de un estudio prospectivo observacional de 188 gestantes en trabajo de parto. El objetivo principal del estudio fue comparar la inciden...

  20. Nonanalgesic benefits of combined thoracic epidural analgesia with general anesthesia in high risk elderly off pump coronary artery bypass patients

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    Bhanu Prakash Zawar

    2015-01-01

    Full Text Available Objective: Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG. Thoracic epidural anesthesia (TEA, combined with general anesthesia (GA attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha( TNF ά, interleukin-6 and leucocyte count. Design: A prospective randomised non blind study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty six patients. Material and Methods/intervention: The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group or GA only (control group. Inclusion Criteria (for participants were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction. Serum concentration of Interlukin: - 6, TNF ά, cortisol, Troponin - I, CK-MB, and HsCRP (highly sensitive C reactive protein, was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis. Primary Outcomes: Postoperative complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response. Result: Study group

  1. COMPARISON OF EPIDURAL ANESTHESIA AND POSTOPERATIVE ANALGESIA WITH ROPIVACAINE AND FENTANYL IN OFF - PUMP CORONARY ARTERY BYPASS GRAFTING: A RANDOMIZED, CONTROLLED STUDY

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    Kaushal

    2014-01-01

    Full Text Available BACKGROUND: Our aim was to assess the efficacy of thoracic epidural anesthesia followed by postoperative epidural infusion with ropivacaine and Fentanyl in off - pump coronary bypass grafting. INTRODUCTION : In cardiosurgical patients, high thoracic epidural anesthesia (EA with local anesthetics and opioids can provide effective analgesia and reduce the number of perioperative complications. However, the use of EA in coronary surgery is controversial, and it is still unclear whether EA influences lung fluid balance , cardiopulmonary function and clinical outcome in OPCAB. Thus, the method requires further evaluation and its potential benefits in coronary patients should be weighed against its risks. MATERIALS AND METHODS : A prospective study was performed in 4 0 patients undergoing coronary artery bypass surgery who received high thoracic epidural analgesia. Group 1 received thoracic epidural 0.2% ropivacaine (bolus 10 ml, 10 min before starting surgery while group 2 pts. received Fentanyl 2 mcg/ml (bolus 10 ml , 10 min before starting surgery, then rate of epidural infusion adjusted between 3 - 8 ml/ hr. of the same concentration according to response. The Regimens aimed at a visual analog scale (VAS score < or = 4/10 . Hemodynamic parameters and blood gases were measured from extubation till 24 h after OPCAB. RESULTS : O utcome measures included the incidence of Visual Analogue Score (VAS < or =4/10, infusion rate adjustments and side - effects. Patients receiving ropivacaine were less likely to experience pain < or =4/10 (P' = 0.002; the infusion rate was lower (P' = 0.024; required less rate adjustments (P' = 0.001; a less need for noradrenaline (P' = 0.001 and antiemetic drugs (P' = 0.001. There were no significant differences between the groups for sedation s cores or the incidence of respiratory depression. CONCLUSION : This study suggests that ropivacaine 0.2% may be superior to fentanyl 2 microg/ml. We found a reduced number of

  2. Abscesso do músculo psoas em paciente submetida à analgesia por via peridural: relato de caso Absceso del músculo psoas en paciente sometida a analgesia por vía peridural: relato del caso Psoas muscle abscess after epidural analgesia: case report

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    Durval Campos Kraychete

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O abscesso do músculo psoas é uma complicação rara da analgesia peridural. O manuseio adequado dessa intercorrência é fundamental para uma boa resolução do quadro clínico. O objetivo deste relato foi discutir o diagnóstico e o tratamento do abscesso do músculo psoas. RELATO DO CASO: Paciente do sexo feminino, 65 anos, com dor neuropática nos membros inferiores de difícil controle com medicamentos por via sistêmica. Optou-se pela administração de opióide e anestésico local por via peridural como alternativa analgésica. Vinte dias após o uso contínuo da via peridural, a paciente começou a apresentar dor na região lombar, cefaléia e febre. A tomografia computadorizada da pelve revelou abscesso do músculo psoas, sendo indicada drenagem fechada e antibioticoterapia. CONCLUSÕES: A supervisão minuciosa do paciente é necessária e deve ser contínua quando um cateter peridural for colocado. Essa vigilância deve ser mantida após a sua retirada.JUSTIFICATIVA Y OBJETIVOS: El absceso del músculo psoas es una complicación rara de la analgesia peridural. El manoseo adecuado de esa situación intercurrente es fundamental para una buena resolución del cuadro clínico. El objetivo de este relato fue discutir el diagnóstico y el tratamiento del absceso del músculo psoas. RELATO DEL CASO: Paciente del sexo femenino, 65 años, con dolor neuropático en los miembros inferiores de difícil control con medicamentos por vía sistémica. Se optó por la administración de opioide y anestésico local por vía peridural como alternativa analgésica. Veinte días después del uso continuo de la vía peridural, la paciente empezó a presentar dolor en la región lumbar, cefalea y fiebre. La tomografía computadorizada de la pelvis reveló absceso del músculo psoas, siendo indicado el drenado cerrado y antibioticoterapia. CONCLUSIONES: La supervisión minuciosa del paciente es necesaria y debe ser continua cuando

  3. Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Nygård, Eigil; Sørensen, Lars H; Hviid, Lamia B;

    2004-01-01

    OBJECTIVE: This study was designed to assess the effects of a perioperative dosing regimen of amiodarone administration, high thoracic epidural anesthesia (TEA), or a combination of the 2 regimens on atrial fibrillation (AF) after coronary artery bypass grafting (CABG). DESIGN AND SETTING: The...... E+A 10 of 35 (28.6%), in group A 10 of 36 (27.8%), and in the control group 20 of 48 (41.7%) patients developed AF (odds ratio amiodarone/nonamiodarone 0.47 [0.24-0.90]; P = 0.02). CONCLUSIONS: The perioperative amiodarone regimen used in this study was effective in reducing the incidence of AF...... randomized to 1 of 4 regimens in which group E had perioperative TEA, group E+A had TEA and amiodarone, group A had amiodarone, and group C served as control. The epidural catheter was inserted at T1-3 the day before surgery. TEA groups received TEA for 96 hours. The amiodarone regimen consisted of a single...

  4. Avulsión del plexo braquial traumático no controlado con remifentalino: Papel de la analgesia epidural cervical Traumatic brachial plexus root avulsion unresponsive to remifentanyl role cervical epidural analgesia

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    M. Cortiñas

    2007-04-01

    Full Text Available Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8 de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con éxito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6. El dolor es controlado en fase crónica (escala visual analógica 2 con agentes específicos contra dolor neuropático (gabapentina, amitriptilina, clonacepam y tramadol.We presented you a patient who suffered a left brachial plexus avulsión with hard neuropatic pain in the posttraumatic acute phase (visual analogue scale 8. High-dose remifentanil infusión was uneffective in controlling pain, which was further ameliorated by ropivacaine infused through a cervical (C5-6 epidural catheter. At discharge pain remained controlled (visual analogue scale 2 with specific treatment against neuropathic pain (gabapentin, amytriptiline, clonacepam, and tramadol.

  5. Avulsión del plexo braquial traumático no controlado con remifentalino: Papel de la analgesia epidural cervical Traumatic brachial plexus root avulsion unresponsive to remifentanyl role cervical epidural analgesia

    OpenAIRE

    M. Cortiñas; G. Moreno-Pardo; S. Uña; M. Arcasa; M. R. Calero; Parra, R.; R. Gálvez

    2007-01-01

    Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8) de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con éxito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6). El dolor es controlado en fase crónica (escala visual analógica 2) con age...

  6. Analgesia pós-toracotomia com associação de morfina por via peridural e venosa Analgesia pós-toracotomia con asociación de morfina por vía peridural y venosa Comparison of intravenous and epidural morphine analgesia after thoracotomy

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    Neuber Martins Fonseca

    2002-09-01

    bolus de 25 µg.kg-1, por 30 horas. Análisis de gases arteriales, frecuencias cardíaca y respiratoria, presencia de prurito, náuseas y vómitos y analgesia pós-operatoria fueron evaluados a cada 6 horas, hasta un total de 30 horas del pós-operatorio. La analgesia fue evaluada por escala de graduación numérica (EGN de 0 a 10. RESULTADOS: A EGN presentó reducción en el grupo I apenas en el momento M2 no ocurriendo en los demás intervalos. Nos grupos II y III ocurrieron reducción del dolor a partir de 18 horas en relación a los valores iniciales y en relación al grupo I. Hubo mayor necesidad de analgesia complementar en el grupo I de que en los otros grupos. CONCLUSIONES: Se observó mejor efecto analgésico con morfina venosa o con la asociación de vías venosa y peridural utilizando menos dosis de morfina. Esta diferencia fue expresiva cuando menos cantidades de analgésicos complementares fueron utilizados en estos grupos, ofreciendo un efectivo método de analgesia para el pós-operatorio de cirugía de tórax con menores efectos depresivos respiratorios e emetogénicos.BACKGROUND AND OBJECTIVES: Patients undergoing thoracotomy experience severe postoperative pain. This study aimed at evaluating postoperative analgesia with the association of intravenous and epidural morphine as compared to a single route. METHODS: Participated in this study 20 patients of both genders, physical status ASA I, II or III, scheduled for thoracotomy. Patients were premedicated with intravenous midazolam (3 to 3.5 mg in the OR. Monitoring consisted of continuous ECG, invasive blood pressure, pulse oximetry, capnography, CVP, diuresis and temperature. Continuous epidural anesthesia was induced in T7-T8 with 10 ml of 0.25% bupivacaine followed by fentanyl (5 µg.kg-1, etomidate(0.2 to 0.3 mg.kg-1 and succinylcholine (1 mg.kg-1. Tracheal intubation was performed with a double lumen tube and complemented with pancuronium(0.08 to 0.1 mg.kg-1 and mechanically controlled ventilation

  7. Remifentanil as analgesia for labour pain

    OpenAIRE

    Tveit, Tor Oddbjørn

    2013-01-01

    Aims: To collect updated information about pharmacological labour analgesia in Norway, especially systemic opioids and epidural. Evaluation of efficacy and safety with remifentanil IVPCA (intravenous patient-controlled analgesia) for pain relief during labour. To compare remifentanil IVPCAwith epidural analgesia (EDA) regarding efficacy and safety during labour. Methods: In paper I, two national surveys identified Norwegian labour analgesia methods and changes during the study ...

  8. Protocolo de analgesia epidural obstétrica en el contexto de la gestión innovadora de la asistencia y de los criterios de calidad y seguridad Guidelines for obstetric epidural analgesia within a framework of innovative managementand quallity and safety criteria

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    C. Campuzano

    2007-03-01

    Full Text Available La Analgesia Epidural Obstétrica en nuestro hospital, comienza en el año 2000 a los pocos meses de inaugurar el nuevo Hospital Comarcal de Antequera. Elaboración de un Protocolo y la presencia de un Coordinador entre los distintos colectivos fueron los primeros pasos hasta el año 2002. La Unidad de Gestión Clínica del Bloque Quirúrgico comienza a funcionar en el año 2002 e implica directamente otra dinámica de trabajo, a saber: participación en el Proceso Integrado Embarazo-Parto-Puerperio y su relación con Asistencia Primaria de Salud, Actividad Asistencial Obstétrica marcada por objetivos de productividad, Recursos Humanos y Carga de Trabajo implicada en la analgesia obstétrica, Medios Materiales necesarios, Gestión de los recursos económicos, Mapa de Competencias específicas para los profesionales implicados e Informatización de las técnicas analgésicas dirigida a la obtención de determinados indicadores de actividad con los datos estadísticos pertinentes. Criterios de Calidad y de Seguridad desarrollados en la Unidad de Gestión Clínica serán expuestos en este artículo: Audits Clínicos de cumplimentación del protocolo, eficacia analgésica, satisfacción del usuario, valoración de partos instrumentales, inicio de epidural ambulante, control de la morbilidad a través de otro protocolo de Complicaciones de Loco-Regional de la Unidad, detección de eventos adversos y valoración e investigación de los casos centinelas ocurridos. Indudablemente no basta con efectuar la técnica, la Unidad Clínica y sus Objetivos han creado mecanismos de información sobre lo que hacemos y sobre las rectificaciones y mejoras a implementar. Es el camino a seguir y incluye un periodo de adaptación de los profesionales donde las motivaciones tanto económicas como de satisfacción profesional van marcadas por objetivos. Saber negociar estos objetivos anuales entre los gestores y los profesionales es el reto del futuro

  9. Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

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    J.R. Ortiz-Gómez

    2014-12-01

    Full Text Available La analgesia epidural es hoy día el método de elección para el tratamiento del dolor del trabajo de parto, el expulsivo y el alumbramiento. Sin embargo, esta técnica puede fallar y aliviar de forma inadecuada (o nula a la parturienta. En el presente artículo se revisan los factores de riesgo, las posibles causas y las alternativas terapéuticas posibles a la analgesia inadecuada, ya sea mediante terapias farmacológicas (neuroaxiales, bloqueos periféricos o administración de analgésicos vía intravenosa o inhalatoria o no farmacológicas (técnicas de relajación, psicológicas o mecánicas. En todos los casos posibles se revisan la eficacia y las indicaciones de las terapias alternativas en función de la literatura publicada, especialmente desde el punto de vista de la medicina basada en la evidencia. Se insiste en la necesidad de aplicar una aproximación terapéutica multifactorial a la embarazada, no limitándonos solo a eliminar el dolor del parto.

  10. Analgesia preemptiva com S(+cetamina e bupivacaína peridural em histerectomia abdominal Analgesia preemptiva con S(+cetamina y bupivacaína peridural en histerectomía abdominal Preemptive analgesia with epidural bupivacaine and S(+ketamine in abdominal hysterectomy

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    Ferdinand Edson de Castro

    2005-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O presente estudo investiga a capacidade de o antagonista do receptor NMDA, S(+cetamina, associado à injeção peridural de anestésico local (bupivacaína, previamente administrado à incisão promover analgesia preemptiva em pacientes submetidas a histerectomia total abdominal. MÉTODO: Foram avaliadas 30 pacientes, distribuídas aleatoriamente em dois grupos de igual tamanho e estudadas prospectivamente de forma encoberta. Injeção peridural e inserção de cateter foram realizadas entre os interespaços de L1-L2. No grupo I (G1, n = 15, as pacientes receberam, por via peridural, 17 mL de bupivacaína a 0,25%, sem vasoconstritor, associados a 30 mg de S(+cetamina (3 mL, trinta minutos antes da incisão cirúrgica; após 30 minutos da incisão, receberam 20 mL de solução fisiológica a 0,9%. No grupo 2 (G2, n = 15, receberam 20 mL de solução fisiológica, por via peridural, 30 minutos antes da incisão, sendo feita administração de 17 mL de bupivacaína a 0,25% associados a 30 mg de S(+cetamina (3 mL, trinta minutos depois da incisão. Após a injeção peridural, realizou-se anestesia geral com propofol, pancurônio, O2 e isoflurano. Para analgesia pós-operatória foi usada solução peridural em bolus de fentanil associada à bupivacaína, em intervalo mínimo de quatro horas e suplementação com dipirona, se necessária. Avaliou-se a intensidade da dor através de escala numérica e verbal (ao despertar, 6, 12, 18 e 24 horas após o término da operação, o tempo necessário para solicitar pela primeira vez o analgésico e o consumo total de analgésicos. RESULTADOS: Não houve diferença significativa entre os grupos em relação ao tempo para solicitar analgésicos pela primeira vez, ao consumo de analgésicos e aos escores de dor pelas escalas numérica e verbal. CONCLUSÕES: Não foi possível demonstrar efeito preemptivo com a utilização peridural de S(+cetamina e bupivacaína nas doses

  11. Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis

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    McQuay Henry J

    2006-09-01

    Full Text Available Abstract Background Epidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems. Methods We performed an extensive systematic review to find published cohorts of use of epidural catheters during vascular, cardiac, and thoracic surgery, using electronic searching, hand searching, and reference lists of retrieved articles. Results Twelve studies included 14,105 patients, of whom 5,026 (36% had vascular surgery, 4,971 (35% cardiac surgery, and 4,108 (29% thoracic surgery. There were no cases of epidural haematoma, giving maximum risks following epidural anaesthesia in cardiac, thoracic, and vascular surgery of 1 in 1,700, 1 in 1,400 and 1 in 1,700 respectively. In all these surgery types combined the maximum expected rate would be 1 in 4,700. In all these patients combined there were eight cases of transient neurological injury, a rate of 1 in 1,700 (95% confidence interval 1 in 3,300 to 1 in 850. There were no cases of persistent neurological injury (maximum expected rate 1 in 4,600. Conclusion These estimates for cardiothoracic epidural anaesthesia should be the worst case. Limitations are inadequate denominators for different types of surgery in anticoagulated cardiothoracic or vascular patients more at risk of bleeding.

  12. Patient-controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short-acting opioid remifentanil. Survey in the French part of Belgium (Wallonia and Brussels).

    Science.gov (United States)

    Lavand'homme, P; Roelants, F

    2009-01-01

    Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epidural or combined spinal-epidural technique) is the most effective way to relieve that pain but it is contraindicated or impossible to perform for some parturients. We designed a survey of the current use of analgesic alternatives to epidural analgesia (EA) for labor pain, specifically the use of opioid patient-controlled intravenous analgesia (PCIA), in the French part of Belgium (Wallonia and Brussels). A questionnaire was mailed to the departmental chair of the hospitals with an obstetric unit, both in university and non-university centers (total of 53 centers). The questionnaire evaluated the availability of EA, the alternatives used when EA was contraindicated, the use of opioid-based PCIA for labor analgesia as well as opioid preference and doses, and finally the reasons for not using opioid PCIA. The response rate was 67.5% (36 centers). Among the responding hospitals, EA was available for 68% (range 25-85%) of labors and deliveries. When EA was not available or contraindicated, a parenteral opioid (piritramide, tramadol or pethidine) was proposed in 19% (7/36) of the centers, Entonox in 11% (4/36), a pudendal block by obstetricians in 28% (10/36) and non-pharmacologic alternatives (i.e. hypnosis, sophrology, baths and massages) in 19% (7/36). In 28% (10/36) of the centers however, no analgesic alternative was proposed. Opioid PCIA was employed in 36% (13/36) of the centers and for an additional 11% (4/36) only in case of intrauterine death. Remifentanil was the first choice (76.5% of the PCIA), followed by sufentanil (23.5%). Other opioids (piritramide, morphine, fentanyl) and ketamine were also administered by PCIA. Forty-five percents of the centers reported never using opioid PCIA by either lack of knowledge (7%), fear of maternal or fetal side effects (48%) and unability to provide a correct supervision of the parturient during PCIA use (48%), opposition from

  13. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

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    Sharma Munish

    2010-01-01

    Full Text Available Perioperative Thoracic epidural analgesia (TEA is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB. We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index> 30 kg/m 2 for elective OPCAB were randomized into two groups (n=30 each. Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO 2 /FiO 2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

  14. Protocolo de analgesia epidural obstétrica en el contexto de la gestión innovadora de la asistencia y de los criterios de calidad y seguridad Guidelines for obstetric epidural analgesia within a framework of innovative managementand quallity and safety criteria

    OpenAIRE

    Campuzano, C.

    2007-01-01

    La Analgesia Epidural Obstétrica en nuestro hospital, comienza en el año 2000 a los pocos meses de inaugurar el nuevo Hospital Comarcal de Antequera. Elaboración de un Protocolo y la presencia de un Coordinador entre los distintos colectivos fueron los primeros pasos hasta el año 2002. La Unidad de Gestión Clínica del Bloque Quirúrgico comienza a funcionar en el año 2002 e implica directamente otra dinámica de trabajo, a saber: participación en el Proceso Integrado Embarazo-Parto-Puerperio y ...

  15. A RANDOMIZED COMPARISON OF 0.125% LEVOBUPIVACAINE, 0.125% ROPIVACAINE AND 0.125%BUPIVACAINE COMBINED WITH 2μG/ML FENTANYL FOR EPIDURAL LABOR ANALGESIA

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    Gopal Reddy

    2015-06-01

    Full Text Available The labor pain is one of the most severe pains that a woman could ever be suffered. Today, many medical and psychological methods are used in an effort to reduce labor pain. Epidural analgesia is the best current method used for the purposes of obstetric a nalgesia. OBJECTIVE: To compare analgesic efficacy and intensity of sensory block with continuous infusions of bupivacaine, levobupivacaine and ropivacaine for labor epidural analgesia. Design: Prospective, randomized, double - blind study. PATIENTS: 95 ASA physical status I and II, term, primigravida. Interventions: All patients received epidural labor analgesia. Epidural medication consisted of an initial bolus of 10 mL 0.125% local anesthetic combined with2μg/ml Fentanyl followed by an infusion at 10 ml/h of local anesthetic with2μg/ml Fentanyl . Patients were allocated to three groups, as follows: each group received bolus and infusion of 0.125%local anaesthetic group1 bupivacaine, group 2 levobupivacaine and group 3 ropivacaine respectively. MEASUREMENTS: Maternal vital signs, pain visual analog scale (VAS score, sensory levels, and motor block (Bromage score were recorded at intervals. Duration of first and second stage and mode of delivery were also recorded. CONCLUSION: All three regimens were effectiv e during first stage of labor although pain scores were higher in those receiving levobupivacaine and ropivacaine. Motor block was greater with bupivacaine than with levobupivacaine and ropivacaine.

  16. Administración epidural de lidocaína, morfina y detomidina para la resección quirúrgica de un tumor de pene en un toro joven (Epidural administration of lidocaine, morphine and detomidine for surgical removal of a tumour in a young bull penis

    Directory of Open Access Journals (Sweden)

    Castiñeiras Pérez, Eva:

    2007-04-01

    Full Text Available ResumenCon objeto de mejorar la fertilidad en las explotaciones, algunos ganaderos optan por la presencia de un toro para la monta natural. En toros jóvenes es relativamente común la aparición de fibropapilomas en el pene. Esta patología está causada por un adenovirus quepenetra a través de pequeñas heridas, dando lugar a neoplasias en la porción libre del pene. Por lo general, suelen ser de naturaleza benigna y sólo se recomienda su eliminación quirúrgica cuando dificultan la monta.1 Aunque, en los animales de producciónnunca se ha tenido muy en cuenta la analgesia intra y postoperatoria, estudios recientes muestran que el control del dolor permite una más rápida y mejor recuperación. La anestesia epidural se ha convertidoen una técnica muy utilizada para el control del dolor en diversas especies domésticas. La administración epidural de lidocaína 2% (0,2 mg/kg, morfina 2% (0,3 mg/kg y detomidina 1% (30 µg/kg en un volumen total de 14 ml, proporciona en el ganado vacuno unabuena anestesia y analgesia en ambas fosas paralumbares, abdomen,extremidades posteriores, ubre, ano, periné, vulva y vagina durante más de 100 minutos. El animal permanece de pie con mínimos efectoscardiorrespiratorios.2 La aplicación epidural antes descrita permite la exploración del aparato reproductor del animal y proporcionaanestesia y analgesia para la eliminación del tumor en el pene. Al permanecer de pie, se evitan toda una serie de problemas asociados al decúbito en el bovino (timpanismo, daños musculares y nervioso, etc..

  17. 硬膜外分娩镇痛转行硬膜外剖宫产麻醉失败的危险因素探讨%Study on risk factors for failure to convert labor epidural analgesia to epidural anesthesia for cesarean section

    Institute of Scientific and Technical Information of China (English)

    罗宝蓉; 吴优; 李玲; 雷波; 左娟

    2013-01-01

    Objective: To explore the risk factors for failure to convert labor epidural analgesia to epidural anesthesia for cesarean section. Methods: A total of 186 parturients who received epidural analgesia during cesarean section were selected. Epidural analgesia was performed by continuous infusion with patient - controlled analgesia. Top - ups were provided by anesthesiologists when parturients were not satisfied with pain relief. Parturients who were taken for cesarean section were given 2% lidocaine through the epidural catheter in place. The failure of epidural anesthesia was defined as a need of other methods of anesthesia to complete the operation. Parturients were divided into successful conversion group and failure conversion group. Results: The failure rate of epidural anesthesia was 15. 6%. There was no statistically significant difference in VAS score before analgesia and at 30 minutes after analgesia between the two groups (P > 0. 05) . Compared with successful conversion group, the number of top - ups in failure conversion group increased, and the duration of epidural analgesia were prolonged in failure conversion group (P < 0. 05) . Conclusion: More top - ups and longer duration analgesia are risk factors for failure to convert labor epidural analgesia to epidural anesthesia for cesarean section. Early identifying these risk factors and taking effective methods of anesthesia are important to reduce maternal and infantile complications.%目的:探讨硬膜外分娩镇痛转行硬膜外剖宫产麻醉失败的危险因素.方法:选择实施硬膜外分娩镇痛中途转行剖宫产的产妇186例.硬膜外分娩镇痛采用背景输注加病人自控镇痛,镇痛效果不满意的产妇可求助麻醉医师补救镇痛.转行剖宫产时,直接经硬膜外镇痛导管行硬膜外麻醉,若麻醉效果不能完成剖宫产手术,需辅助局麻或全麻则定义为硬膜外麻醉失败.将产妇分为硬膜外麻醉成功组和失败组.结果:

  18. Bloqueio peridural sacral: avaliação da duração da analgesia com o uso associado de lidocaína, fentanil e clonidina Bloqueo peridural sacral: evaluación de la duración de la analgesia con el uso asociado de lidocaína, fentanil y clonidina Epidural caudal block: evaluation of length of analgesia with the association of lidocaine, fentanyl and clonidine

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Souza Martins

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A associação de diferentes substâncias aos anestésicos locais é feita com o objetivo de melhorar a qualidade do bloqueio e prolongar a duração da analgesia. O objetivo deste trabalho foi comparar a eficácia da associação de clonidina, clonidina e fentanil e do fentanil à lidocaína, no tempo de analgesia pós-operatória. MÉTODO: O estudo envolveu 64 pacientes com idade igual ou superior a 23 anos, estado físico I ou II (ASA, escalados para cirurgia proctológica orificial, submetidos à anestesia peridural sacral. Os pacientes foram distribuídos em 4 grupos de 16: grupo I (lidocaína isolada, grupo II (lidocaína e fentanil, grupo III (lidocaína, fentanil e clonidina e grupo IV (lidocaína e clonidina. Foram comparadas as características dos bloqueios sensitivo e motor. RESULTADOS: Não houve diferença entre a latência, bem como no nível máximo de bloqueio entre os grupos. A ausência de bloqueio motor foi o resultado mais freqüente, encontrado em cerca de 64% dos pacientes. O intervalo de analgesia foi diferente entre os grupos, sendo mais significativo no grupo III. CONCLUSÕES: O uso da clonidina, associada ou não ao fentanil, prolongou o tempo de analgesia pós-operatória na anestesia peridural sacral com lidocaína.JUSTIFICATIVA Y OBJETIVOS: La asociación de diferentes substancias a los anestésicos locales es hecha con el objetivo de mejorar la cualidad del bloqueo y prolongar la duración de la analgesia. El objetivo de este trabajo fue comparar la eficacia de la asociación de clonidina, clonidina y fentanil y de fentanil a la lidocaína, en el tiempo de analgesia pós-operatoria. MÉTODO: El estudio envolvió 64 pacientes con edad igual o superior a 23 años, estado físico I ó II (ASA, escalados para cirugía proctológica orificial, sometidos a anestesia peridural sacral. Los pacientes fueron distribuidos en 4 grupos de 16: grupo I (lidocaína aislada, grupo II (lidocaína y

  19. Adjunct High Frequency Transcutaneous Electric Stimulation (TENS) for Postoperative Pain Management during Weaning from Epidural Analgesia Following Colon Surgery: Results from a Controlled Pilot Study.

    Science.gov (United States)

    Bjerså, Kristofer; Jildenstaal, Pether; Jakobsson, Jan; Egardt, Madelene; Fagevik Olsén, Monika

    2015-12-01

    The potential benefit of nonpharmacological adjunctive therapy is not well-studied following major abdominal surgery. The aim of the present study was to investigate transcutaneous electrical nerve stimulation (TENS) as a complementary nonpharmacological analgesia intervention during weaning from epidural analgesia (EDA) after open lower abdominal surgery. Patients were randomized to TENS and sham TENS during weaning from EDA. The effects on pain at rest, following short walk, and after deep breath were assessed by visual analog scale (VAS) grading. Number of patients assessed was lower than calculated because of change in clinical routine. Pain scores overall were low. A trend of lower pain scores was observed in the active TENS group of patients; a statistical significance between the groups was found for the pain lying prone in bed (p < .05). This controlled pilot study indicates benefits of TENS use in postoperative pain management during weaning from EDA after open colon surgery. Further studies are warranted in order to verify the potential beneficial effects from TENS during weaning from EDA after open, lower abdominal surgery. PMID:26541070

  20. Epidural analgesia during open radical prostatectomy does not improve long-term cancer-related outcome: a retrospective study in patients with advanced prostate cancer.

    Directory of Open Access Journals (Sweden)

    Patrick Y Wuethrich

    Full Text Available BACKGROUND: A beneficial effect of regional anesthesia on cancer related outcome in various solid tumors has been proposed. The data on prostate cancer is conflicting and reports on long-term cancer specific survival are lacking. METHODS: In a retrospective, single-center study, outcomes of 148 consecutive patients with locally advanced prostate cancer pT3/4 who underwent retropubic radical prostatectomy (RRP with general anesthesia combined with intra- and postoperative epidural analgesia (n=67 or with postoperative ketorolac-morphine analgesia (n=81 were reviewed. The median observation time was 14.00 years (range 10.87-17.75 yrs. Biochemical recurrence (BCR-free, local and distant recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier technique. Multivariate Cox proportional-hazards regression models were used to analyze clinicopathologic variables associated with disease progression and death. RESULTS: The survival estimates for BCR-free, local and distant recurrence-free, cancer-specific survival and overall survival did not differ between the two groups (P=0.64, P=0.75, P=0.18, P=0.32 and P=0.07. For both groups, higher preoperative PSA (hazard ratio (HR 1.02, 95% confidence interval (CI 1.01-1.02, P<0.0001, increased specimen Gleason score (HR 1.24, 95% CI 1.06-1.46, P=0.007 and positive nodal status (HR 1.66, 95% CI 1.03-2.67, P=0.04 were associated with higher risk of BCR. Increased specimen Gleason score predicted death from prostate cancer (HR 2.46, 95% CI 1.65-3.68, P<0.0001. CONCLUSIONS: General anaesthesia combined with epidural analgesia did not reduce the risk of cancer progression or improve survival after RRP for prostate cancer in this group of patients at high risk for disease progression with a median observation time of 14.00 yrs.

  1. The effects of adding epinephrine or xylazine to lidocaine solution for lumbosacral epidural analgesia in fat-tailed sheep

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    Maryam Rostami

    2012-04-01

    Full Text Available This blinded, randomised experimental study was designed to compare the analgesic effects of lumbosacral epidural administration of lidocaine-epinephrine or lidocaine-xylazine combinations in fat-tailed sheep. Nine healthy fat-tailed male lambs (mean ± s.d. age, 4.6 ± 0.4 months; weight, 24.6 kg ± 2.5 kg were randomly allocated into four groups of six sheep: lidocaine 2% (LID, lidocaine-epinephrine 5 µg/mL (LIDEP, lidocaine-xylazine 0.05 mg/kg (LIDXY or bupivacaine 0.5% (BUP. The onset and duration of flank, perineum and hindlimb anaesthesia and the onset and duration of hindlimb paralysis were recorded. Epidural administration of LID, LIDEP, LIDXY or BUP produced anaesthesia within 6.6 min, 7.6 min, 3.4 min and 8.4 min, respectively. The mean onset of anaesthesia in the LIDXY group was significantly shorter compared with the BUP group (p = 0.02. The mean duration of anaesthesia was 107.9 min, 190.4 min, 147.6 min and 169.7 min for LID, LIDEP, LIDXY and BUP, respectively. The onset of hindlimb paralysis was faster in the LIDXY group than in the BUP group; however, the duration of hindlimb paralysis was shorter in LIDXY compared with LIDEP. Epidural administration of LIDEP or LIDXY provides a comparable duration of local anaesthesia without any adverse effects in fat-tailed sheep. Epidural LIDXY did not appear to be advantageous over epidural LIDEP.

  2. Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

    Directory of Open Access Journals (Sweden)

    Monica Rossi Rodrigues

    2009-12-01

    con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección de PJC en niños. MÉTODO: Estudio randómico doble ciego, en niños sometidos a la intervención quirúrgica para liberación posteromedial de PJC, ubicadas en cuatro grupos conforme a la técnica anestésica: caudal (ACa; bloqueos isquiático y femoral (IF; bloqueos isquiático y safeno (IS; bloqueo isquiático y anestesia local (IL, asociados a la anestesia general. En las primeras 24 horas, los pacientes recibieron dipirona y paracetamol vía oral y fueron evaluados por un anestesiólogo que no conocía la técnica usada. Conforme a las puntuaciones de la escala CHIPPS (Children's and infants postoperative pain scale, se administraba morfina vía oral (0,19 mg.kg-1 por día. RESULTADOS: Fueron estudiados 118 niños distribuidos en los grupos ACa (30, IF (32, IS (28 IL (28. El tiempo promedio entre el bloqueo y la primera dosis de morfina fue de 6,16 horas en el grupo ACa, 7,05 horas en el IF, 7,58 horas en el IS y 8,18 horas en el IL. El consumo de morfina fue de 0,3 mg.kg-1 por día en los cuatro grupos. No hubo diferencia significativa entre los grupos. CONCLUSIONES: Los bloqueos nerviosos periféricos no promovieron un tiempo más elevado de analgesia, ni tampoco una reducción en el consumo de morfina en las primeras 24 horas, en niños sometidos a la corrección de PJC cuando se les comparó con el bloqueo epidural caudal.BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF is associated with

  3. Anestesia epidural cranial com lidocaína e morfina para campanhas de castração em cães Cranial epidural anesthesia with lidocaine and morphine for sterilization campaign in dogs

    Directory of Open Access Journals (Sweden)

    Renato Batista Tamanho

    2010-02-01

    ós epidural, em comparação ao GSO. Conclui-se que a anestesia epidural lombossacra com morfina e lidocaína na dose e no volume propostos é efetiva para realização de OSH em cadelas, com mínimas alterações cardiovasculares e hemogasométricas, as quais são bem toleradas em animais hígidos. Essa prática é exequível em campanhas de castração em que não há possibilidade de oxigenação dos animais.Male and female sterilization have been established as the main technique to reduce the huge number of mongrel dogs. However, there are several barriers regarding to the choice of the best anesthetic protocol, in terms of efficacy, security and cost reduction. The aim of this study was to evaluate the analgesic, cardiorespiratory and hemogasometric effects of epidural anesthesia with a large volume of lidocaine in combination with morphine in female dogs submitted to ovariosalpingohisterectomy (OSH, with or without oxygen supplementation. Twelve adult female dogs were used, with average weight of 11.5±3.7kg and age of 1 to 4 years. The animals received acepromazine (0.1mg kg-1 and meperidine (5mg kg-1 as premedication, administered by the intramuscular route. Fifteen minutes later, thiopental (10mg kg-1 was administered by intravenous route, followed by endotracheal intubation. The animals were allocated into two groups: GCO (group with oxygen, n=06, where the animals received 100% oxygen supplementation and GSO (group without oxygen supplementation, n=6, mantained with endotracheal intubation, but without oxygen supplementation. After intubation, epidural with morphine (0,1mg kg-1, adjusted to 1mL 3kg-1 in lidocaine 2% without epinepherine was administered. Immediately after epidural administration, the animals were positioned in dorsal recumbency, with the head in the same level of the body. In both groups, surgery was performed without the need of additional analgesia and without signs of pain. Mean arterial pressure (MAP was lower in GSO in all moments compared to

  4. Application of Mind Map in the Prevention of Epidural Analgesia Pump Catheter Slippage%思维导图在防止硬膜外镇痛泵导管滑脱中的应用

    Institute of Scientific and Technical Information of China (English)

    肖继荣; 张秀琴; 何红; 龚腊梅; 余知萍

    2014-01-01

    Objective To evaluate the application effect of mind map in preventing epidural analgesia pump catheter slippage.Methods By convenience sampling,122 patients had postoperative epidural analgesia pump in hospital were selected and divided into control group (60 cases)and observation group (62 cases) according to the admission time.The observation group were treated with mind map in nursing,and the control group were carried with routine nursing.The rates of occurrence statistics in two groups of patients with analgesia pump catheter slippage and the analgesic effect of satisfaction were observed.Results The incidence of epidural analgesia pump catheter slippage in observation group was significantly lower than the control group.The analgesic effect of satisfaction was significantly higher than the control group(all P <0.05).Conclusion The mind map epidural analgesia in patients with nursing can effectively reduce the inci-dence rate of analgesia pump catheter slip,and improve analgesia effect of patient satisfaction.%目的:评价思维导图在防止硬膜外镇痛泵导管滑脱中的应用效果.方法2013年5月和7月,便利抽样法选取华中科技大学同济医学院附属荆州医院术后留置硬膜外镇痛泵的122名患者为研究对象,按住院时间的先后将其分为对照组(60例)和观察组(62例),观察组患者使用思维导图进行护理,对照组患者按常规方法进行护理,分别统计两组患者镇痛泵导管滑脱的发生率和对镇痛效果的满意率.结果观察组患者硬膜外镇痛泵导管滑脱发生率显著低于对照组,镇痛效果的满意率显著高于对照组,差异均有统计学意义(均 P <0.05).结论采用思维导图护理留置硬膜外镇痛泵的患者,可有效降低硬膜外镇痛泵导管滑脱的发生率,提高患者对镇痛效果的满意度.

  5. DISPOSABLE NON-MECHANICAL ELASTOMERIC BALLOON PUMP FOR CONTINUOUS EPIDURAL INFUSION: AN EFFECTIVE AND RELIABLE MEANS FOR POSTOPERATIVE ANALGESIA

    OpenAIRE

    Dilip Kumar; Mrinal Kanti; Subhankar

    2016-01-01

    Postoperative pain an unpleasant sensory and emotional experience is one of the most challenging and gratifying domains to treat. Aim is here to assess effectiveness of postoperative pain relief, side effects and complications while using non-mechanical disposable elastomeric pump as continuous epidural infusion. PATIENTS AND METHODS The present study has been carried out on thirty patients in postoperative wards. At the end of operation the Elastomeric pump containin...

  6. 硬膜外分娩镇痛的临床分析%Clinical Analysis of Epidural Labor Analgesia//Medical Innovation of China,2014,11(07):033-035

    Institute of Scientific and Technical Information of China (English)

    陈淑敏

    2014-01-01

    Objective:To investigate the effect of epidural labor analgesia on delivery. Method:Fifty cases of maternal with labor analgesia were randomly enforcement as analgesia group. Fifty cases non-given analgesia primipara were selected as the control group during the same period. The analgesia effect,stage of labor,postpartum haemorrhage and the status of the newborn were observed. Result:(1)The difference of pain of the pregnant women between two groups were statistically significant(P0.05).(3)Natural childbirth rate of analgesia group was higher than that of the control group,the difference was statisticall significance(P0.05).(4)The neonatal Apgar score had no statistical significance between the two groups(P>0.05). Conclusion:Epidural labor analgesia is safe and effective without prolonged labor,increase postpartum haemorrhage amount and affect the neonatal Apgar score. Epidural labor analgesia play a positive role in improving natural births and reduce cesarean section rate,is worthy being popularized and applied.%目的:探讨硬膜分娩镇痛对分娩的影响。方法:选取50例施行分娩镇痛的产妇作为镇痛组,随机抽取同期、条件相似的未实施分娩镇痛者50例为对照组,观察镇痛效果、产程、产后出血量、分娩方式及新生儿情况。结果:(1)两组孕妇疼痛感觉比较差异有统计学意义(P0.05)。(3)镇痛组自然分娩率高于对照组,两组比较差异有统计学意义(P0.05)。(4)两组新生儿Apgar评分差异无统计学意义(P>0.05)。结论:硬膜外分娩镇痛不延长产程、不增加产后出血量、不影响新生儿评分,是安全有效的。同时硬膜外分娩镇痛对提高自然分娩率,降低剖宫产率起到积极作用,值得推广应用。

  7. Ketamina epidural en cirugía de hemiabdomen inferior Epidural ketamine in low abdominal surgery

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    S. F. González-Pérez

    2006-04-01

    Full Text Available Introducción: La ketamina de uso corriente es una droga utilizada principalmente para la inducción y el mantenimiento de la anestesia, compuesta por una mezcla racémica de enantiómeros R (- y S (+. En la década de los años 80 comienza la administración humana de la ketamina por vía epidural. A partir de entonces se han presentado disímiles investigaciones para justificar su acción analgésica en este espacio con varias hipótesis: 1 supresión específica laminar de las astas dorsales, 2 mediación por el sistema opioide endógeno y sustancia gris periacueductal, y 3 bloqueo de los canales del calcio por antagonismo no competitivo de los receptores N-metil-d-aspartato. Objetivo: Demostrar la eficacia de la ketamina por vía epidural como analgésico postoperatorio en la cirugía de hemiabdomen inferior. Material y Método: Se realizó un ensayo clínico aleatorizado y prospectivo en una muestra de 50 pacientes operados de hernia inguinal electiva. Los pacientes fueron divididos en dos grupos, un grupo tratado con 50 mg de ketamina y otro grupo al que se le administró una dosis de 2 mg de morfina liofilizada. Resultados: la ketamina por vía epidural en una dosis de 50 mg proporciona una analgesia adecuada por un período de al menos de 6 horas. La morfina brinda una analgesia por encima de las 18 horas. Conclusión: La ketamina por vía epidural es menos efectiva que la morfina desde el punto de vista analgésico, pero es una alternativa importante pues permite disminuir la dosis de morfina si se combinan ambos fármacos o se asocia a anestésicos locales.Introduction: Ketamine is a drug used for induction and maintenance of anesthesia, exists as a racemic mixture of R- and S+-enantiomers. Epidural ketamine starts to human administration about 80’ years. After that, various studies have been published about the mechanism of analgesic action of ketamine: lamina-specific suppression of dorsal-horn unit activity (1, opiate agonist at

  8. Análisis de la eficacia y seguridad del bloqueo iliofascial continuo para analgesia postoperatoria de artroplastia total de rodilla Analysis of the efficiency and safety of the ileofascial block for postoperatory pain after total knee arthroplasty

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    J. López González

    2012-10-01

    Full Text Available Objetivo: la importancia del dolor agudo postoperatorio radica en su alta frecuencia, en su inadecuado tratamiento y en las repercusiones que tiene en la evolución y en la recuperación del paciente. El bloqueo iliofascial puede ser una técnica adecuada para analgesia postoperatoria en la artroplastia total de rodilla. El objetivo de este estudio es valorar la eficacia y seguridad del bloqueo iliofascial, en comparación con el bloqueo epidural, a efectos de analgesia postquirúrgica en pacientes sometidos a artroplastia total de rodilla bajo anestesia subaracnoidea. Se valoró además si la realización del bloqueo iliofascial es una técnica analgésica segura, las complicaciones derivadas de la misma, los efectos secundarios y el grado de satisfacción del paciente. Material y métodos: estudio multicéntrico, prospectivo, aleatorio, observacional, controlado, con evaluador ciego, en 54 pacientes, adultos, ASA I-III, de ambos sexos, sometidos a cirugía de artroplastia total de rodilla bajo anestesia intradural. Los pacientes incluidos en el estudio se dividieron en dos grupos, BIF y BE. En el grupo BIF (n = 27 se colocó un catéter iliofascial, mientras que en el otro grupo BE (n = 27 se colocó un catéter epidural lumbar (a nivel L3-L4, en ambos casos para la analgesia postoperatoria continua. Ambos grupos recibieron el mismo protocolo analgésico con paracetamol y metamizol pautados, y rescate con bolos de morfina intravenosa. Se utilizó t-Student para comparar las variables cuantitativas. Se consideró significativo (p Objective: the importance of acute postoperative pain lies in its high frequency, where inadequate treatment and the impact it has on the evolution and the patient's recovery. Iliofascial block may be a suitable technique for postoperative analgesia after total knee arthroplasty. The aim of this study is to assess the efficacy and safety of the blockade iliofascial compared with epidural analgesia in postoperative

  9. Substituição da agulha isolada para eletroneuroestimulação pela agulha metálica de cateter intravenoso, na verificação da punção epidural, em cães Replacement of an insulated electric neurostimulation spinal needle with an intravenous catheter metal needle to confirm correct epidural puncture in dogs

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    E.A. Tudury

    2013-02-01

    Full Text Available Utilizou-se o eletroneuroestimulador como um meio adequado para confirmação do posicionamento da ponta de agulhas isoladas no espaço epidural lombossal, por meio de pequenas estimulações elétricas que provocam contrações dos músculos inervados, empregando-se agulha de cateter intravenoso em vez de agulha isolada para a eletroneuroestimulação. Foram utilizados 40 cães para procedimentos cirúrgicos ortopédicos, abdominais ou retroumbilicais que necessitassem de bloqueio epidural. Durante a introdução gradativa da agulha no canal vertebral lombossacral, estímulos elétricos de 1,5 a 0,5mA foram aplicados. Diante de contrações musculares em membros pélvicos, cauda e/ou ânus, as quais foram consideradas respostas condizentes com o correto posicionamento da agulha no espaço epidural, estimulando raízes da cauda equina, procedeu-se à administração da associação de lidocaína, bupivacaína e tramadol. Constatou-se a adequada anestesia epidural mediante relaxamento do esfíncter anal, ausência dos reflexos patelares e flexor e a analgesia na área cirúrgica abdominal. Conclui-se que o método foi eficaz para a confirmação do correto posicionamento da agulha no espaço epidural durante a realização dessa anestesia regional em cães.The electric neurostimulator was used as an adequate mean for the confirmation of the correct placement of the tip of the insulated needles in the lumbosacral epidural space through small electric stimulations causing muscle contractions by using an intravenous catheter needle instead of an electric neurostimulation insulated needle. Forty dogs were selected based on the need for an epidural block for orthopedic, abdominal or retroumbilical surgical procedures. Electrical stimuli were applied from 1.5 to 0.5mA during a gradual introduction of the needle into the lumbosacral vertebral canal. Responses that were considered as indicative of the correct placement of the needle and stimulation of

  10. 罗哌卡因复合舒芬太尼在产妇分娩镇痛中的应用%Application of ropivacaine with sufentanil for patient-controlled epidural analgesia; a randomized clinical trail

    Institute of Scientific and Technical Information of China (English)

    王平

    2011-01-01

    目的 现察不同浓度的罗哌卡因复合舒芬太尼用于产妇分娩硬膜外自控镇痛的临床效果.方法 150例拟行硬膜外分娩镇痛的初产妇随机分为5组,每组30例,分别予以0.05%(A组)、0.075%(B组)、0.1%(C组)、0.125%(D组)、0.15%(E组)的罗哌卡因+0.5μml舒芬太尼进行硬膜外镇痛.结果 镇痛有效率分别为47%,67%,77%,83%,87%.E组有1例运动阻滞发生.结论 0.1%~0.125%罗哌卡因复合0.5μg/ml舒芬太尼能够为产妇分娩提供安全可靠的镇痛.%Objective This study aimed to compare the analgesic efficacy, motor block and side effects of ropivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods One hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0. 05% , 0. 075% , 0. 1% , 0. 125% or 0. 15% of ropivacaine with sufentanil 0. 5 μg/ml was epidurally administered by patient-controlled analgesia mode. Results A significantly less number of effective analgesia were observed in the concentration of 0. 05% and 0. 075% than those of ≥0. 1% within each group (P <0. 05). Conclusion Using patient-controlled epidural analgesia, ropivacaine of 0. 1% or 0. 125% with sufentanil of 0. 5 μg/ml produce good analgesia and safety for labor analgesia.

  11. Déficit motor asociado a analgesia epidural en paciente con patología neurológica preexistente no conocida

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    T. García Navia

    2013-08-01

    Full Text Available Existen múltiples estudios que afirman que las complicaciones neurológicas asociadas a la práctica de un bloqueo neuroaxial pueden tener una mayor incidencia en los pacientes que presentan enfermedades neurológicas preexistentes como la estenosis espinal. Esta incidencia puede ser especialmente relevante si no se cuenta con un diagnóstico previo de dichas patologías. En el presente trabajo describimos nuestra experiencia con una mujer de 60 años de edad, diagnosticada de isquemia crónica de miembro inferior derecho, que presentó un déficit motor importante tras la colocación de un catéter epidural para el manejo del dolor.

  12. Polytrauma and continue epidural anesthesia. A case presentation. Politrauma y analgesia peridural continua. Presentación de un caso.

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    Aleida Hernández Lara

    2005-05-01

    Full Text Available This is a 62 year-old hypertensive patient who was admitted at the Intensive Care Unit of the ¨Dr. Gustavo Aldereguí­a Lima¨ hospital with multiple trauma in the skull, thorax abdomen and extremities. Left and right pleurothomy was performed by bilateral hemonoumothorax. The patient presented hemodynamic inestability so he needed vasoactive suport and an adequate management of the support of volume. The follow up revealed pain that didn´t alliviate with the habitual treatment, which seemed to worsen with treatment. Peridural anaesthesia was applied and it revealed clinical and ventilatory stability and avoided the deleterious effect of pain. The patient was discharged from the intensive care service without sequelae.

    Se presenta el caso de un paciente de 62 años con historia de hipertensión arterial que ingresa en Unidad de Cuidados Intensivos del Hospital Universitario ¨Dr. Gustavo Aldereguía Lima¨ de Cienfuegos por sufrir múltiples traumatismos : cráneo, tórax, abdomen y miembros. Fue necesario realizar pleurotomias, derecha e izquierda por hemoneumotórax bilateral, presentó inestabilidad hemodinámica que necesitó de apoyo vasoactivo y adecuado manejo del aporte de volumen . Predominó en la evolución el dolor rebelde al tratamiento habitual y que amenazaba con empeorar el pronóstico, por lo que se decide emplear la analgesia peridural, se logró estabilidad ventilatoria y clínica, se evitaron así los efectos deletéreos que provoca el dolor, con resultado final favorable y egreso del servicio sin mayores secuelas.

  13. Estudo comparativo dos bloqueios intercostal e interpleural para analgesia pós-operatória em colecistectomias abertas Estudio comparativo de los bloqueos intercostal e interpleural para analgesia pós-operatoria en colecistectomias abiertas Comparative study of intercostal and interpleural block for post-cholecystectomy analgesia

    OpenAIRE

    Antonio Mauro Vieira; Taylor Brandão Schnaider; Antonio Carlos Aguiar Brandão; João Pires Campos Neto

    2003-01-01

    JUSTIFICATIVA E OBJETIVOS: A analgesia no pós-operatório é desejada pelos pacientes e tem sido praticada pela maioria dos anestesiologistas. Além dos opióides, os anestésicos locais têm sido utilizados nos bloqueios periféricos e centrais para se obter a analgesia pós-operatória. O objetivo deste estudo foi comparar duas técnicas de bloqueio dos nervos intercostais para analgesia pós-operatória em colecistectomias abertas. MÉTODO: Sessenta pacientes foram submetidos a colecistectomias abertas...

  14. Neuropatía periférica tras el parto: Implicaciones de la anestesia epidural Peripheral neuropathy after delivery implications for epidural anaesthesia

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    Velázquez, S.; E. Guasch; B. Martínez; Mª A. López; Gilsanz, F.

    2006-01-01

    La incidencia de lesiones neurológicas de miembros inferiores en la práctica obstétrica es del 0,08% y 0,92%. La incidencia de complicaciones neurológicas asociadas a la técnica epidural ha sido estimada en 2 casos de cada 10.000 epidurales. Durante los últimos años, con la generalización de la analgesia epidural para el trabajo de parto, es posible que algunas de las neuropatías sean atribuidas a esta técnica, olvidando que hay otros mecanismos de lesión en estas situaciones. Presentamos el ...

  15. Epidural Naloxone to Prevent Buprenorphine Induced PONV

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    Ashok Jadon

    2008-01-01

    Full Text Available Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. This combina-tion gives excellent anlgesia but nausea and vomiting remains a major concern. Low dose epidural naloxone prevents PONV induced by spinal opioids like morphine, fentanyl and sufentanil. However, it is not known that epidural naloxone administration prevents PONV induced by epidural buprenorphine. We have reported three cases of major abdominal operation in which lowdose epidural infusion of naloxone releived the symptom of buprenorphine induced severe PONV and improved the quality of analgesia.

  16. Tratamiento epidural del dolor en isquemia vascular periférica: Parte II. Revisión bibliográfica basada en la evidencia del tratamiento epidural en la isquemia vascular periférica Epidural pain treatment in peripheral vascular ischemia: (II

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    M.J. Orduña González

    2009-04-01

    Full Text Available Introducción: La isquemia arterial periférica puede ser el resultado de diversas enfermedades que afectan la vascularización de los miembros, generando dolor, discapacidad y deterioro de la calidad de vida del paciente, y en los casos de isquemia crítica, produciendo una considerable morbimortalidad y dolor crónico. Objetivo: Realizar una revisión histórica y crítica de publicaciones científicas sobre la analgesia epidural como método de control del dolor por isquemia vascular periférica y de sus efectos tróficos vasculares, y compararlos con otras técnicas analgésicas, así como recopilar diversas pautas de analgesia epidural y sus resultados. Material y métodos: Búsqueda en Medline, recopilación de datos y posterior análisis crítico, siguiendo los criterios de la medicina basada en la evidencia, de las publicaciones científicas sobre analgesia epidural y el dolor en el contexto de la isquemia arterial periférica. Resultados: a La analgesia con infusión de fármacos epidurales en isquemia de miembros sólo alcanzó un nivel de evidencia 4 en la presente revisión; b la anestesia epidural lumbar para cirugía de revascularización de miembros inferiores se relaciona con unas menores tasas de trombosis postoperatoria y de reintervenciones de revascularización que la anestesia general (nivel de evidencia 2b; c no hay evidencia científica concluyente que apoye la utilización de analgesia epidural preventiva de los síndromes de dolor crónico postamputación de extremidades con isquemia, y d la aplicación de neuroestimulación epidural medular en la isquemia crítica de origen ateroclusivo de miembros no reconstruibles mediante técnicas quirúrgicas está apoyada por un nivel de evidencia 1. En la enfermedad de Buerger, la enfermedad de Raynaud y trastornos vasoespásticos, la aplicación de la neuroestimulación eléctrica epidural viene avalada por un nivel de evidencia 4. Conclusiones: a La isquemia arterial perif

  17. Estudo comparativo dos bloqueios intercostal e interpleural para analgesia pós-operatória em colecistectomias abertas Estudio comparativo de los bloqueos intercostal e interpleural para analgesia pós-operatoria en colecistectomias abiertas Comparative study of intercostal and interpleural block for post-cholecystectomy analgesia

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    Antonio Mauro Vieira

    2003-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A analgesia no pós-operatório é desejada pelos pacientes e tem sido praticada pela maioria dos anestesiologistas. Além dos opióides, os anestésicos locais têm sido utilizados nos bloqueios periféricos e centrais para se obter a analgesia pós-operatória. O objetivo deste estudo foi comparar duas técnicas de bloqueio dos nervos intercostais para analgesia pós-operatória em colecistectomias abertas. MÉTODO: Sessenta pacientes foram submetidos a colecistectomias abertas com incisão subcostal e receberam bloqueio intercostal (Grupo IC, n=30 ou bloqueio interpleural (Grupo IP, n=30, ambos com 100 mg de bupivacaína a 0,5% com adrenalina, para analgesia pós-operatória. Foram avaliados os tempos de analgesia e as queixas relatadas pelos pacientes. RESULTADOS: A qualidade da analgesia foi considerada boa para ambas as técnicas. A duração média de analgesia foi de 505 minutos no grupo IP e 620 minutos no grupo IC, não havendo diferença estatística entre eles. Náuseas, vômitos e dor abdominal leve foram as queixas pós-operatórias mais freqüentes. Não se constatou qualquer complicação pós-operatória associada exclusivamente aos bloqueios, assim como não foi evidenciado nenhum caso de pneumotórax. CONCLUSÕES: Concluiu-se que as técnicas promoveram analgesia satisfatória após colecistectomia, sendo que o bloqueio interpleural apresentou maior facilidade de execução.JUSTIFICATIVA Y OBJETIVOS: La analgesia en el pós-operatorio es deseada por los pacientes y ha sido practicada por la mayoría de los anestesiologistas. Además de los opioides, los anestésicos locales han sido utilizados en los bloqueos periféricos y centrales para obtenerse la analgesia pós-operatoria. El objetivo de este estudio fue comparar dos técnicas de bloqueo de los nervios intercostales para analgesia pós-operatoria en colecistectomias abiertas. MÉTODO: Sesenta pacientes fueron sometidos a colecistectomias

  18. Application effect comparison of pentazocine for intravenous analgesia and epidural analgesia after caesarean section%喷他佐辛在剖宫产术后静脉镇痛与硬膜外镇痛中的应用效果比较

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    罗新萍; 尹新武; 罗芳; 周生智

    2015-01-01

    Objective To compare the application effect of pentazocine on patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) after caesarean section. Methods 120 patients who needed postoperative analgesia after caesarean section in our hospital from November 2013 to April 2014 were selected and evenly divided into PCIA group and PCEA group in random.In PCEA group,90 mg pentazocine,215 mg ropivacaine,5 mg tropisetron,and normal saline were mixed to 100 ml,while in PCIA group,90 mg pentazocine,2 mg propacetamol,5 mg tropisetron,and normal saline were mixed to 100 ml.Fifteen minutes before the end of surgery,disposable patient-controlled analgesia pump (PCA) was connected in both groups.The mode of LCP referred to 5 ml load dosage,2 ml con-tinuous infusion dosage,and 2 ml self-controlled bolus for 15 set minutes.Scores of analgesia and sedation 6 h,12 h,24 h,36 h,and 48 h after surgery were observed.The adverse reactions like nausea,vomiting,respiratory depression,retention of urine after surgery,postoperative pump dropping,and numbness of lower limb were also observed in order to know pa-tient’s satisfaction. Results There was no significant difference about score of analgesia between the two groups (P>0.05).Within 24-hour application of PCA pump,there was significant difference in Ramsay sedation score between the two groups (P0.05)。在自控镇痛泵使用24 h内,两组Ramsay镇静评分差异有统计学意义(P<0.05)。 PICA组患者对镇痛泵的满意度为95%,高于PCEA组的85%,差异有统计学意义(P<0.05)。结论喷他佐辛用于剖宫产PCEA和PCIA镇痛效果相当,但PCIA还具有携带方便、操作简单等优点,可避免留置硬膜外导管可能发生的并发症,患者的满意度较高,PICA更适合剖宫产手术,值得推广。

  19. Transplacental transfer and neonatal influences of sonophoretically administered sufentanil versus epidural sufentanil in labor peridural analgesia: A randomized prospective double-blind contemplate

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    Riham Hussein Saleh

    2014-10-01

    Conclusion: Sufentanil transplacental transport and fetal exposure appeared greater in epidural than in sonophoretic sufentanil. The former group women were facing more difficulty at starting breast-feeding on postpartum day 1 and were more apt to have stopped breast-feeding 6 weeks postpartum than the latter group women.

  20. A COMPARATIVE STUDY OF POSTOPERATIVE ANALGESIA BY CAUDAL EPIDURAL ROUTE USING BUPIVACAINE WITH TRAMADOL AND BUPIVACAINE WITH FENTANYL IN PAEDIATRIC BELOW UMBILICAL SURGERIES

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    Meera

    2015-05-01

    Full Text Available The aim of this study was to compare the effectiveness of Bupivacaine (0.25% 0.5 ml/kg with Fentanyl 1μg/kg and Bupivacaine (0.25% 0.5 ml/kg with Tramadol 2 mg/kg in caudal block for postoperative analgesia. In the present study, 60 children of ASA I and II, aged between 5-12 years who were scheduled for below umbilical surgical procedures were randomly allotted into 2 groups (30 each to receive either bupivacaine with fentanyl or bupivacaine with tramadol. Caudal block was performed after induction of general anesthesia, no analgesics were given intra-operatively. Postoperative analgesia was evaluated by Numerical Rating Scale and sedation was assessed by five point sedation score. Postoperative analgesia was supplemented with Syrup Paracetamol (10mg/kg when Numerical Rating Scale was 4. Any adverse effect like respiratory depression, urinary retention, nausea and vomiting were recorded in all patients. Caudal tramadol with bupivacaine produced significant increased postoperative analgesia. The duration of analgesia was 861±23 minutes in tramadol with bupivacaine group, as compared to 353.46±31.79 minutes in fentanyl with bupivacaine group. No significant difference found in sedation score in both groups in first hour postoperatively. Two cases in fentanyl with bupivacaine and three cases in tramadol with bupivacaine group developed urinary retention in postoperative period. Four cases in fentanyl with bupivacaine and three cases in tramadol with bupivacaine group developed nausea and vomiting. Our study showed that caudal tramadol with bupivacaine provided longer duration of postoperative analgesia without having significant side effects.

  1. Ocorrência de hematoma peridural após anestesia geral associada à analgesia pós-operatória com cateter peridural em paciente em uso de heparina de baixo peso molecular: relato de caso Ocurrencia de hematoma postanestesia general asociada a analgesia postoperatoria con cateter peridural en paciente que usa heparina de bajo peso molecular: relato de caso Epidural hematoma after general anesthesia associated with postoperative analgesia with epidural catheter in patient using low molecular weight heparin: case report

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    Ranger Cavalcante da Silva

    2006-04-01

    drenaje del hematoma la paciente recuperó gradualmente la fuerza en los miembros inferiores, recibió alta en diez días con cuadro de disfunción de esfínteres. Después de tres meses el cuadro remitió y no hubo secuela neurológica definitiva. CONCLUSIONES: El rápido diagnóstico con intervención quirúrgica precoz es el tratamiento más eficaz para la reducción de la lesión neurológica, en pacientes que desarrollan hematoma peridural postoperatorio. La utilización de heparina de bajo peso molecular, con uso actual de catéter peridural, exige la adhesión estricta a protocolos establecidos, para que se reduzcan los riesgos del desarrollo de hematoma peridural.BACKGROUND AND OBJECTIVES: Presents a patient case with epidural hematoma, in the course of the use of epidural catheter and low molecular weight heparin, her clinical condition and treatment. CASE REPORT: A 75-year old female patient, submitted to the fixation of lumbar spine by anterior route, who, in the postoperative period, developed a clinical condition of progressive paralysis of the lower limbs, with loss of sensitivity and presenting no intense radicular pain. The treatment was the immediate medullar decompression, with drainage and surgical cleaning of a epidural hematoma, which extended from the 5th to the 10th thoracic vertebrae. After the drainage of the hematoma, the patient gradually recovered the strength in the lower limbs, was discharged in ten days with a condition of sphincterian dysfunction. After three months, the condition receded and there was no definitive neurological sequel. CONCLUSIONS: The quick diagnosis with early surgical intervention is the most effective treatment for the reduction of neurological damage, in patients that develop postoperative epidural hematoma. The use of low molecular weight heparin, in the course of the use of epidural catheter, requires the strict compliance with the established protocols so that the risks of epidural hematoma development can be

  2. 硬膜外分娩镇痛联合心理干预对产妇焦虑抑郁情绪的影响%Effect of Psychological Intervention Combined with Epidural Labor Analgesia on the Anxiety and Depression of Parturients

    Institute of Scientific and Technical Information of China (English)

    潘麒; 孙立红

    2011-01-01

    [Objective] To explore the effect of psychological intervention combined with epidural labor analgesia on the anxiety and depression of parturients. [Methods]Totally 160 primiparas without relevant contraindication were divided into two groups with 80 in each. Group P was given psychological intervention (gradual muscle relaxation and abdominal respiration) combined with epidural labor analgesia. Group R was given epidural labor analgesia. The analgesia effect(VAS) , the dosage of patient controlled analgesia(PCA) , self rating anxiety scale(SAS) and self rating depression scale(SDS) were compared between two groups. [Results]The VAS score and the dosage of PCA, SAS and SDS scores of first, second and third labor stages in Group P were lower than those in Group R. [Conclusion]Psychological intervention combined epidural labor analgesia for the labor can markedly improve mental state of parturients, and has certain analgesia effect, and is helpful to increase the quality in perinatal period.%[目的]探讨硬膜外分娩镇痛联合心理干预对产妇焦虑抑郁情绪的影响.[方法]160例无相关禁忌的初产妇,随机分成两组,每组80例.P组为硬膜外分娩镇痛联合心理干预(渐进性肌肉放松法和腹式呼吸法)、R组为硬膜外分娩镇痛.比较两组镇痛效果(VAS)、病人自控镇痛(PCA)用药量、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分.[结果]第一产程潜伏期、活跃期和第二产程、第三产程VAS评分、PCA用药量、SAS和SDS评分均P组低于R组.[结论]硬膜外分娩镇痛联合心理干预用于分娩期,能显著改善产妇的心理状态,镇痛效果确切,有助于提高围生期质量.

  3. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics

    Directory of Open Access Journals (Sweden)

    Torsten Kluba

    2010-04-01

    Full Text Available This prospective study aimed to compare the efficacy of epidural (EDA versus intravenous (PCA application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal post-operative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA.

  4. Fisiología y farmacología clínica de los opioides epidurales e intratecales Physiology and clinical pharmacology of epidural and intrathecal opioids

    Directory of Open Access Journals (Sweden)

    B. Mugabure

    2005-02-01

    Full Text Available La historia de la anestesia intratecal y epidural ha discurrido en paralelo al desarrollo de la anestesia general. La primera reseña publicada sobre el uso de opioides para anestesia intradural la realizó un cirujano rumano, que presentó su experiencia en 1901 en París. Ha pasado casi un siglo hasta conseguir la utilización de opioides por vía epidural. En nuestros días, el uso de opioides intradurales y epidurales constituye una práctica clínica habitual para conseguir analgesia intra y postoperatoria. En los últimos 30 años, el uso de opioides epidurales se ha convertido en rutinario para el tratamiento del dolor del trabajo del parto y del manejo tanto del dolor agudo como crónico. Ha sido ampliamente asumido que cualquier opioide depositado en el espacio epidural o intratecal producirá una analgesia altamente selectiva medular y que esta será superior a la conseguida por otras técnicas analgésicas o vías de administración. Desafortunadamente esto simplemente no es verdad. De hecho, en multitud de ocasiones, los opioides son utilizados vía perimedular a pesar de que la evidencia clínica nos demuestra que no producen un efecto específico medular, o que la analgesia producida no es superior a la conseguida tras su administración intravenosa. Para realizar un uso apropiado de los opioides espinales, debemos comprender adecuadamente la fisiología y la farmacología clínica de estos fármacos y cuál produce analgesia selectiva medular y cuál no. Las diferencias son producto de la biodisponibilidad en los receptores específicos de su biofase medular en la sustancia gris. Esta es menor para los opioides lipofílicos, ya que son aclarados hacia el plasma con mayor rapidez que los hidrofílicos, y consecuentemente producen con mayor antelación efectos adversos supramedulares y su vida media es de menor duración. La morfina es probablemente el opioide con mayor acción selectiva medular tras su administración epidural o

  5. Remifentalino intravenoso mediante infusor elastomerico frente a meperidina intramuscular: Estudio comparativo en analgesia obstetrica Intravenous remifentanil delivered through an elastomeric device versus intramuscular meperidine comparative study for obstetric analgesia

    OpenAIRE

    E. Calderón; Martínez, E.; M. D. Román; A. Pernio; R. García-Hernández; L. M. Torres

    2006-01-01

    Objetivos: Evaluar la eficacia y seguridad de remifentanilo administrado mediante infusor elastomérico con PCA iv en analgesia obstétrica comparado con meperidina intramuscular en parturientas con contraindicación para analgesia epidural. Material y Método: Se seleccionaron aletoriamente 24 parturientas, se asoció infusor elastomérico Baxter® con 250 ml de suero fisiológico con 2,5 mg de remifentanilo y un ritmo de 12 ml·h ¹, lo que supone una infusión media de 0,025 μg·kg-1·min-1 de rem...

  6. Efeito da adição de clonidina subaracnóidea à solução anestésica de sufentanil e bupivacaína hiperbárica ou hipobárica para analgesia de parto Efecto de la adición de clonidina subaracnoidea a la solución anestésica de sufentanil y bupivacaína hiperbárica o hipobárica para la analgesia de parto Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia

    Directory of Open Access Journals (Sweden)

    Thaís Cristina Tebaldi

    2008-12-01

    ,5% (grupo CLON/HIPER; n = 11 o 2,5 mg de bupivacaína isobárica 0,5% (grupo CLON/ISO; n = 11 en asociación con el sufentanil 2,5 µg y la clonidina 30 µg. El dolor evaluado por la Escala Analógica Visual, la frecuencia cardíaca y la presión arterial promedio, fueron estudiados a cada 5 minutos en los primeros 15 minutos y a continuación, a cada 15 minutos hasta el nacimiento. Fue evaluada la prevalencia de efectos colaterales (náusea, vómito, prurito y sedación. El estudio fue terminado en el momento en que se hizo necesaria la complementación analgésica epidural (dolor > 3 cm o al nacimiento. El análisis estadístico fue realizado a través de los tests t de Student, Chi-cuadrado, Fisher y ANOVA de dos vías para medidas repetidas, considerando como significativo p BACKGROUND AND OBJECTIVES: The addition of subarachnoid clonidine (α-agonist prolongs the analgesia produced by the combination of sufentanil and isobaric bupivacaine in combined labor analgesia¹. The objective of this study was to compare the quality of analgesia and the prevalence of side effects after the addition of subarachnoid clonidine to the anesthetic solution in labor analgesia. METHODS: After approval by the Ethics Commission, 22 pregnant women in labor were randomly assigned to the subarachnoid administration of either 2.5 mg of 0.5% hyperbaric bupivacaine (CLON/HYPER Group; n = 11 or 2.5 mg of 0.5% isobaric bupivacaine (CLON/ISO Group; n = 11 associated with 2.5 µg of sufentanil and 30 µg of clonidine. Pain, evaluated by the Visual Analogue Scale, heart rate, and mean arterial pressure were assessed every 5 minutes during the first 15 minutes, and then every 15 minutes afterwards until delivery. The prevalence of side effects (nausea, vomiting, pruritus, and sedation was evaluated. The study was terminated whenever the patient needed supplemental epidural analgesia (pain > 3 or upon delivery of the fetus. The Student t test, Chi-square test, Fisher exact test, and two-way ANOVA for

  7. Análisis de la eficacia y seguridad de la administración de cloruro mórfico epidural para el dolor postoperatorio tras cesárea An analysis of the efficacy and safety of epidural morphic chloride administration for postoperative pain following Caesarian section

    Directory of Open Access Journals (Sweden)

    M. Doniz

    2011-02-01

    Full Text Available Objetivo: el control del dolor postcesárea es un punto importante, pues se ha tratado de implementar una técnica analgésica que ocasione mínimos efectos secundarios pero que provea de una buena calidad y duración de la misma, para tener un rápido alivio del dolor, buena recuperación y disminución de los costes de hospitalización. El objetivo de este estudio fue analizar la eficacia y seguridad de la administración de un único bolo de dos miligramos de cloruro mórfico por catéter epidural como coadyuvante analgésico tras cesárea. Material y métodos: estudio multicéntrico prospectivo aleatorio observacional de casos y controles a lo largo de tres años, en 400 pacientes, ASA I-II, con edades comprendidas entre 18 y 39 años, intervenidas de cesárea bajo anestesia epidural. Las pacientes se distribuyeron en dos grupos, un primer grupo denominado GM formado por 200 pacientes a las que se administró dos miligramos de cloruro mórfico, diluidos hasta 10 cm³ con suero fisiológico, a través del catéter epidural, posteriormente a la finalización de la cesárea y tras recuperación de bloqueo sensitivo y motor. El otro grupo denominado GC constituido por las 200 pacientes restantes y a las que no se administró morfina peridural. Ambos grupos recibieron el mismo protocolo analgésico con paracetamol y metamizol pautados, y rescate con bolos de morfina intravenosa en la Unidad de Recuperación Postoperatoria y Ketorolaco en planta. Se utilizó t-Student para comparar las variables cuantitativas. Se consideró significativo p Objective: pain control after cesarean section is an important point, as it has tried to implement an analgesic technique that causes minimal side effects while still providing a good quality and duration of it, to have a quick pain relief, good recovery and decreased hospitalization costs. The aim of this study was to analyze the effectiveness and safety of a single bolus administration of two milligrams of

  8. Analgesia pós-operatória para cesariana: a adição de clonidina à morfina subaracnóidea melhora a qualidade da analgesia? Analgesia postoperatória para cesárea: ¿la adición de clonidina a la morfina subaracnoidea mejora la calidad de la analgesia? Postoperative analgesia for cesarean section: does the addiction of clonidine to subarachnoid morphine improve the quality of the analgesia?

    Directory of Open Access Journals (Sweden)

    José Francisco Nunes Pereira das Neves

    2006-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O mecanismo de ação analgésica a2-adrenérgico tem sido explorado há mais de 100 anos. A clonidina aumenta de maneira dose-dependente a duração dos bloqueios sensitivo e motor e tem propriedades antinociceptivas. O objetivo desse estudo foi avaliar se a adição de clonidina na dose de 15 e 30 µg à raquianestesia, para cesariana, com bupivacaína hiperbárica a 0,5% (12,5 mg e morfina (100 µg, melhora a qualidade da analgesia pós-operatória. MÉTODO: Foi realizado um estudo prospectivo e aleatório com 60 pacientes divididas em três grupos: BM - bupivacaína hiperbárica a 0,5% (12,5 mg e morfina (100 µg, BM15 - bupivacaína hiperbárica a 0,5% (12,5 mg, morfina (100 µg e clonidina (15 µg e BM30 - bupivacaína hiperbárica a 0,5% (12,5 mg, morfina (100 µg e clonidina (30 µg, administradas separadamente. No peri-operatório, foram anotados o consumo de efedrina e a avaliação do recém-nascido pelo índice de Apgar. No pós-operatório, a dor foi avaliada na 12ª h pela Escala Analógica Visual, o tempo para solicitação de analgésicos e efeitos colaterais pós-operatórios, como prurido, náuseas, vômitos, bradicardia, hipotensão arterial e sedação. Os valores foram considerados significativos quando p JUSTIFICATIVA Y OBJETIVOS: El mecanismo de acción analgésica alfa2-adrenérgico ha venido siendo investigado hace más de cien años. La clonidina aumenta de manera dosis-dependiente la duración de los bloqueos sensitivo y motor y tiene propiedades antinociceptivas. El objetivo de este estudio fue el de evaluar si la adición de clonidina en las dosis de 15 y 30 µg a raquianestesia, para cesárea, con bupivacaína hiperbárica a 0,5% (12,5 mg y morfina (100 µg, mejora la calidad de la analgesia postoperatória. MÉTODO: Se realizó un estudio prospectivo, aleatorio con 60 pacientes y divididos en 3 grupos: BM - bupivacaína hiperbárica a 0,5% (12,5 mg y morfina (100 µg, BM15 - bupivaca

  9. 剖宫产及硬膜外吗啡术后镇痛对产妇泌乳的影响及其护理干预%The Cesarean section and epidural morphine for postoperative analgesia maternal lactation and the influence of nursing intervention

    Institute of Scientific and Technical Information of China (English)

    李彩霞

    2013-01-01

    目的:观察剖宫产、硬膜外吗啡术后镇痛产妇的泌乳状况及血清泌乳素(PRL)变化.方法:足月产妇240例均分为四组:Ⅰ组术毕行硬膜外吗啡镇痛;Ⅱ组术毕行硬膜外吗啡镇痛,24h后追加一次;Ⅲ组未行术后镇痛;阴道自然分娩60例为Ⅳ组.240例产妇产前、产后均进行护理干预、科学宣传,实行母婴同室和纯母乳喂养.结果:产后5min、24h及48h内开始泌乳及72h泌乳分泌不足发生率与剖宫产组相比无差异.结论:由于护理干预,剖宫产及硬膜外吗啡术后镇痛不影响产妇母乳喂养的成功率.%objective:To observe the cesarean section, epidural morphine postoperative analgesia maternity lactation status and serum prolactin (PRL) change. Methods:The 240 cases of maternal term are divided into four groups: Ⅰ group operation BiHang epidural morphine analgesia; Ⅱ group operation BiHang epidural morphine analgesia, 24 h after additional one time. Ⅲ group do not postoperative analgesia;Vaginal natural childbirth sixty cases of Ⅳ group. 240 cases were performed antenatal, postpartum nursing intervention, scientific propaganda, the maternal and child inmates and pure breastfeeding. Results:Postpartum 5 min, 24 h and h and start within lactation and 72 h lactation hyposecretion incidence and cesarean section group compared with indifference. Conclusion:Due to the nursing intervention, and cesarean section and epidural morphine postoperative analgesia does not affect maternal breastfeeding success rate.

  10. Effects of Epidural Analgesia on Prognosis after Intestinal Surgery: A Meta-analysis%硬膜外镇痛对肠道手术预后影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    夏海发; 任许利; 王韶双; 吕黄伟

    2011-01-01

    Objective To systematically evaluate the effect of epidural analgesia on prognosis after intestinal surgery. Methods Such databases as PubMed, EBSCO, Springer, Ovid and CNKI were searched to identify randomized controlled trials (RCTs) about the effects of epidural analgesia on prognosis after intestinal surgery published from 1985 to 2010. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Handbook, and then the meta-analyses were conducted by using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that compared with the patient controlled analgesia (PCA), the patient controlled epidural analgesia (PCEA) significantly reduced the waiting time for having first flatus, first defecation, and the length of hospital stay (MD= -1.07, 95%CI -1.63 to -0.50; MD= -0.63, 95%CI -1.19 to -0.08; MD=-1.36, 95%CI -2.28 to -0.44; respectively), lowered the frequency of vomiting on the first and second day after operation (OR=0.33, 95%CI 0.13 to 0.82; OR=0.3, 95%CI 0.13 to 0.84; respectively), and obviously declined the visual analog scale (VAS) scores of rest pain on the first, second and third day after operation (MD= -26.60, 95%CI -33.06 to -20.15; MD=-25.98, 95%CI -30.98 to -20.97; MD= -15.59, 95%CI -27.29 to -3.88; respectively), and the VAS scores of motion pain on the first, second and third day after operation (MD= -26.00, 95%CI -36.00 to -16.00; MD= -27.89, 95%CI -35.70 to -20.08; MD= -11.79, 95%CI -21.28 to -2.30; respectively). There were no significant differences between the two groups in the incidence of urinary tract infection, urinary retention, anastomotic leak and ileus. Conclusion PCEA significantly reduces the waiting time for having first flatus and first feces, the length of hospital stay, the VAS scores of pain, and the incidence of postoperative vomiting.%目的 系统评价硬膜外镇痛对肠

  11. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia

    DEFF Research Database (Denmark)

    Joshi, G.P.; Bonnet, F.; Shah, R.;

    2008-01-01

    evidence is needed to assess the comparative benefits of alternative techniques, guide clinical practice and identify areas requiring further research. METHODS: In this systematic review of randomized trials we evaluated thoracic epidural, paravertebral, intrathecal, intercostal, and interpleural analgesic...... techniques, compared to each other and to systemic opioid analgesia, in adult thoracotomy. Postoperative pain, analgesic use, and complications were analyzed. RESULTS: Continuous paravertebral block was as effective as thoracic epidural analgesia with local anesthetic (LA) but was associated with a reduced...... incidence of hypotension. Paravertebral block reduced the incidence of pulmonary complications compared with systemic analgesia, whereas thoracic epidural analgesia did not. Thoracic epidural analgesia was superior to intrathecal and intercostal techniques, although these were superior to systemic analgesia...

  12. Pain relief and clinical outcome: from opioids to balanced analgesia

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids...... were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...

  13. Efeito da adição de clonidina subaracnóidea à bupivacaína hiperbárica e sufentanil para analgesia de parto Efecto de la adición de clonidina subaracnoidea en la bupivacaína hiperbara y sufentanil en la analgesia del parto The effect of adding subarachnoid clonidine to hyperbaric bupivacaine and sufentanil during labor analgesia

    Directory of Open Access Journals (Sweden)

    Mônica Maria Siaulys Capel Cardoso

    2006-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A adição de clonidina subaracnóidea (um alfa-agonista, prolonga a ação analgésica da combinação do sufentanil e da bupivacaína isobárica em analgesia combinada para o trabalho de parto. O objetivo desse estudo foi comparar a qualidade e a duração de analgesia e a incidência de efeitos colaterais após a adição de clonidina subaracnóidea à bupivacaína hiperbárica e sufentanil em anestesia combinada raqui-peridural para o trabalho de parto. MÉTODO: Foram estudadas 26 gestantes de termo, estado físico ASA I, em trabalho de parto, que receberam aleatoriamente no espaço subaracnóideo: clonidina, sufentanil e bupivacaína (n = 13, denominado Grupo Clon/Sufenta/Bupi, 2,5 mg de bupivacaína hiperbárica a 0,5% associada a 2,5 µg de sufentanil e 30 µg de clonidina; sufentanil e bupivacaína (n = 13, denominado Grupo Sufenta/Bupi, 2,5 mg de bupivacaína hiperbárica a 0,5% associada a 2,5 µg de sufentanil. O estudo foi duplamente encoberto. A dor e os efeitos colaterais (náusea, vômito, prurido, hipotensão arterial e sedação foram avaliados a cada cinco minutos nos primeiros 15 minutos e, a seguir, a cada 15 minutos até o nascimento. A dor foi avaliada com a escala analógica visual de 0-10 cm (VAS = 0, ausência de dor e 10, dor insuportável, e o estudo foi encerrado no momento em que foi necessária complementação analgésica peridural (dor > 3 cm ou ao nascimento. A análise estatística foi realizada com os testes t de Student e Exato de Fisher, considerando como significativo p JUSTIFICATIVA Y OBJETIVOS: La adición de clonidina subaracnoidea (un alfa -agonista, prolonga la acción analgésica de la combinación del sufentanil y de la bupivacaína isobárica en analgesia combinada para el trabajo de parto. El objetivo de este estudio fue comparar la calidad y la duración de la analgesia y la incidencia de los efectos colaterales después de la adición de clonidina subaracnoidea en la

  14. Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain

    Directory of Open Access Journals (Sweden)

    V. Domingo

    2004-05-01

    Full Text Available Existe un interés creciente por la realización de los bloqueos de nervio periférico (BNP debido a sus potenciales beneficios como los concernientes a las interacciones de los fármacos anticoagulantes y los bloqueos neuroaxiales. Los BNP de la extremidad inferior, y sobre todo, los bloqueos periféricos del nervio ciático son el pariente pobre de las técnicas de anestesia regional y, en general, son poco conocidos y por tanto poco utilizados. En este artículo se realiza una revisión de los bloqueos del plexo lumbosacro, realizando especial énfasis en los bloqueos continuos mediante catéteres para analgesia postoperatoria y para el tratamiento del dolor crónico. La utilización de anestésicos locales de larga duración de acción, asociada a un escaso bloqueo motor, como es el caso de la ropivacaína, nos permite combinar técnicas de punción única para conseguir una adecuada analgesia intraoperatoria, con las técnicas de perfusión continua para analgesia postoperatoria. Es necesario un conocimiento anatómico preciso, así como de los territorios cutáneos de inervación de las ramas del plexo lumbosacro, para la realización de estas técnicas de bloqueo. La introducción de diferentes técnicas de imagen, fundamentalmente la ultrasonografía, para la localización de las estructuras nerviosas, facilita la realización de estos bloqueos y disminuye el riesgo de lesiones de los órganos adyacentes. La realización de los bloqueos continuos de nervio periférico ofrece el beneficio de una analgesia postoperatoria prolongada, con menores efectos adversos, mayor grado de satisfacción del paciente, y una recuperación funcional más rápida después de la cirugía.There is increasing interest in peripheral nerve blocks (PNB because of potential benefits relative to interactions of anticoagulants and central neuraxial techniques. Among all the regional anesthesia procedures, PNB of the lower limb, and specially sciatic nerve block

  15. Analgesia in PACU: indications, monitoring, complications.

    Science.gov (United States)

    Savoia, Gennaro; Gravino, Elvira; Loreto, Maria; Erman, Alfredo

    2005-11-01

    The correct treatment of postoperative pain, in the early period immediately following surgery, is founded on the following four principles: 1-correct diagnosis of the source and magnitude of nociception; 2-understanding of the relationship of ongoing nociception and other components of pain including anxiety, ethnocultural components, meaning, prior experience; 3-treatment by establishment and maintenance of drug level at active sites to achieve and maintain analgesia and anxiolysis as appropriate; 4-continued re-evaluation of the therapy and refinement of the approach. The PACU standard of cure requires a strict accordance between intra and postoperative analgesia. It requires "proactive preoperative plan" that includes: preoperative patient evaluation; discussion with a single patient on different treatment options; patient and family education; pre-emptive measures as indicated; intra-operative multimodal analgesia; a correct triage of analgesia, just after initial evaluation of vital parameters in PACU; re-evaluation of analgesia plan, if analgesia is inadequate; a new titration, intravenous or epidural way, in order to achieve a stable VAS < 3; plan a new analgesia scheme or confirm a preoperative plan; control of adverse events, related to analgesia plan (gastric bleeding and/or bleeding of the surgical wound site, NSAIDs-induced renal damage, respiratory depression, delayed canalisation, nausea, vomiting, excessive sedation, difficulty in bladder emptying, itchiness); a transmission of analgesia plan to ward nurses; a control quality for verify at prefixed times patients satisfaction level, analgesia performed, adverse effects percent, analgesia related, plan variations percent. PMID:16305454

  16. No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Specht, K.; Leonhardt, Jane Schwartz; Revald, Peter; Mandoe, H.; Andresen, E.B.; Brodersen, J.; Kreiner, S.; Kjaersgaard-Andersen, P.

    2011-01-01

    BACKGROUND AND PURPOSE: Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged...

  17. Neuropatía periférica tras el parto: Implicaciones de la anestesia epidural Peripheral neuropathy after delivery implications for epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    S. Velázquez

    2006-05-01

    Full Text Available La incidencia de lesiones neurológicas de miembros inferiores en la práctica obstétrica es del 0,08% y 0,92%. La incidencia de complicaciones neurológicas asociadas a la técnica epidural ha sido estimada en 2 casos de cada 10.000 epidurales. Durante los últimos años, con la generalización de la analgesia epidural para el trabajo de parto, es posible que algunas de las neuropatías sean atribuidas a esta técnica, olvidando que hay otros mecanismos de lesión en estas situaciones. Presentamos el caso de una paciente primigesta de 21 años de edad y 139 cm de altura sin antecedentes de interés, que 24 horas tras una epidural para parto y un expulsivo prolongado resuelto con fórceps, desarrolla un "pie caído", que evolucionó a la resolución funcional completa. El pie caído puede darse como consecuencia de una lesión del nervio peroneo, del ciático, o de una raíz del plexo lumbo-sacro. La clínica unida al uso de pruebas como la resonancia magnética (RNM y el electromiograma (EMG, ayudan en el diagnóstico diferencial de la lesión. Parece necesario el estudio del las neuropatías relacionadas con el parto para descartar su relación con la técnica anestésica empleada. Con frecuencia, estas lesiones se deben a mecanismos ajenos a la analgesia-anestesia epidural, si bien debemos procurar minimizar su incidencia con la realización de punciones a niveles adecuados, evitando la inyección de anestésicos cuando existen parestesias, valorando los factores de riesgo en obstetricia y, una vez producida la lesión, con un seguimiento clínico estrecho.Postpartum neurological damage occurs in the obstetric practice with an incidence between 0.08-0.92%. Neurological damage secondary to epidural technique is about 2:10,000. In last years, epidural anesthesia has become a generalized practice in obstetrics. Because of it, sometimes, the postpartum neurological damage can be attributed to epidural analgesia, forgetting other mechanisms. We

  18. Substituição da agulha isolada para eletroneuroestimulação pela agulha metálica de cateter intravenoso, na verificação da punção epidural, em cães Replacement of an insulated electric neurostimulation spinal needle with an intravenous catheter metal needle to confirm correct epidural puncture in dogs

    OpenAIRE

    E.A. Tudury; T.H.T. Fernandes; M.L. Figueiredo; J.A.A. Gomes; B.M. Araújo; M.A. Bonelli; A.C. Silva

    2013-01-01

    Utilizou-se o eletroneuroestimulador como um meio adequado para confirmação do posicionamento da ponta de agulhas isoladas no espaço epidural lombossal, por meio de pequenas estimulações elétricas que provocam contrações dos músculos inervados, empregando-se agulha de cateter intravenoso em vez de agulha isolada para a eletroneuroestimulação. Foram utilizados 40 cães para procedimentos cirúrgicos ortopédicos, abdominais ou retroumbilicais que necessitassem de bloqueio epidural. Durante a intr...

  19. 硬膜外分娩镇痛辅助心理疗法降低剖宫产率临床观察%Epidural analgesia adjuvant psychological therapy to reduce the rate of cesarean sectionclinical observation

    Institute of Scientific and Technical Information of China (English)

    赵晓艳

    2015-01-01

    目的:研究分析硬膜外分娩镇痛辅助心理疗法对降低剖宫产率的临床影响。方法:选取2013年9月-2014年9月期间我院收治的380例产妇作为研究对象,将所有产妇按照入院顺序均分为对照组和观察组,每组各190例。对照组产妇给予单纯的心理疗法,观察组产妇在对照组的基础上联合硬膜外分娩镇痛,观察两组产妇的产程、分娩方式、产后出血量进行对比分析。结果:对照组中140例(73.7%)进行了剖宫产,15例(7.9%)会阴侧切加产钳助产,5例(2.6%)会阴侧切术自娩,30例(15.8%)顺产,观察组中74例(38.9%)因胎儿头盆不称,宫内窘迫进行剖宫产手术,116例(61.1%%)顺产。观察组产妇的剖宫产率明显要比对照组低,两组对比差异具有统计学意义(P<0.05)。结论:产妇分娩应用硬膜外分娩镇痛辅助心理疗法具有显著的镇痛效果,能够有效降低剖宫产率,缩短产程,值得在临床应用中广泛推广。%Objective To study the clinical effect of epidural analgesia assisted therapy to reduce the rate of cesarean section. Methods From 2013 September-2014 year in September in our hospital 380 cases of pregnant women as the research object 190 cases in each group. The control group were treated with psychological therapy alone, the observation group in the control on the basis of combined epidural of two groups were observed. Results The control group in 20 cases (57.1%) were cesarean section, 3 cases (15%) withperineal forceps, 2 cases (5.7%) episiotomy from childbirth, 12 cases (34.3%) had, in the observation group 4 cases (11.4%) with fetal head disproportion, fetal distress of cesarean section the uterus operation, 31 cases (88.6%) had. with significant difference between the two groups (P<0.05). Conclusion the maternal application is worthy of popularization in clinical application.

  20. A meta-analysis of countious femoral nerve block versus continuous epidural analgesia after total knee arthroplasty%全膝关节置换后持续股神经阻滞与持续硬膜外镇痛的Meta分析

    Institute of Scientific and Technical Information of China (English)

    袁志民; 魏建仝; 温景荣; 杨森; 全东和

    2015-01-01

    背景:疼痛是全膝关节置换后阻碍患者早期恢复的重要原因,持续硬膜外镇痛和持续股神经阻滞均是全膝关节置换后镇痛的有效方法,但哪种方法镇痛效果更好且并发症较少一直存在争议。  目的:比较全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的临床疗效及安全性。  方法:计算机检索Cochrane-Library、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang等数据库,同时检索学位论文、会议论文等,检索时间为各数据库建库至2014-10-01,纳入全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的随机对照试验。采用Cochrane系统评价的方法进行评价,用RevMan 5.0软件进行统计学分析。  结果与结论:共纳入12篇随机对照试验,4篇英文,8篇中文,共680例患者,其中持续股神经阻滞组患者343例,持续硬膜外镇痛组患者337例。Meta分析结果显示,持续股神经阻滞组与持续硬膜外镇痛组在全膝关节置换后6,12,24,48 h的目测类比评分差异均无显著性意义;但与持续硬膜外镇痛组相比,持续股神经阻滞可减少恶心/呕吐(RR=0.36,95%CI:0.21-0.63,P=0.003)、尿潴留(RR=0.08,95%CI:0.04-0.16, P <0.001)和头晕(RR=0.24,95%CI:0.06-0.99,P=0.05)的发生率。提示与硬膜外镇痛相比,全膝关节置换后持续股神经阻滞镇痛同样可以提供良好的镇痛效果,有利于患者早期功能恢复训练,且不良反应少,是一种安全、有效的镇痛方法。%BACKGROUND:Pain is the significant cause for patients with early rehabilitation after total knee arthroplasty. Continuous epidural analgesia and continuous femoral nerve block are effective analgesic methods after total knee arthroplasty, however, which method has better effects and less complications remains controversial. OBJECTIVE:To compare the efficacy and safety of countious femoral nerve block

  1. COMPARISION OF TWO DRUG COMBINATIONS FOR LABOUR ANALGESIA, AND ITS EFFECT ON PATIENT SATISFACTION, DURATION OF LABOUR AND FETAL OUTCOME

    OpenAIRE

    Jaideep; Pallavi

    2014-01-01

    : BACKGROUND: Epidural is now established and accepted method to relief labour pain. This study intended to comparison of two drug combinations in labour analgesia and its effect on duration of labour, maternal satisfaction and fetal outcome. Combined epidural infusion of bupivacaine + fentanyl would result in analgesia superior to that provided by a continuous epidural infusion of a similar concentration of Bupivacaine alone. AIMS AND OBJECTIVE: To compare the efficacy of...

  2. Bloqueio do plexo lombar no compartimento do psoas para analgesia pós-operatória em cirurgias ortopédicas Lumbar plexus blockage on psoas compartment for postoperative analgesia after orthopaedic surgeries

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2008-01-01

    Full Text Available OBJETIVOS: O plexo lombar foi localizado entre os músculos quadrado lombar e psoas maior. O objetivo deste estudo foi avaliar a eficácia da injeção única de bupivacaína 0,25% através do bloqueio do compartimento do psoas na analgesia pós-operatória em pacientes de cirurgias ortopédicas. MÉTODO: Quarenta pacientes receberam bloqueio do plexo lombar no compartimento do psoas através da localização com estimulador de nervos e injeção de bupivacaína a 0,25%. Avaliou-se a analgesia e a intensidade da dor às 4, 8, 12, 16, 20 e 24 horas após o término da cirurgia, assim como opióides de resgate. RESULTADOS: Os nervos ilioinguinal, genitofemoral, cutâneo femoral lateral, femoral e obturatório foram bloqueados em 90% dos pacientes. O bloqueio reduziu o regaste de opióides administrados, sendo que 52,5% dos pacientes não necessitaram de complementação analgésica, com duração de 24 horas. Não foram observados sinais e sintomas clínicos da toxicidade da bupivacaína, nem seqüelas associadas com o bloqueio dos nervos. CONCLUSÕES: Este estudo mostra que a injeção no espaço do compartimento do psoas é fácil de realizar com efetivo bloqueio dos cinco nervos. O bloqueio do plexo lombar no compartimento do psoas pode ser recomendado para o uso na analgesia pós-operatória após cirurgias ortopédicas.OBJECTIVES: The lumbar plexus is located between the quadratus lumborum and the psoas major muscles. The aim of this study was to evaluate the efficacy of a single 0.25% bupivacaine injection through the psoas compartment blockage in postoperative analgesia of patients undergoing orthopedic surgery. METHODS: 40 patients received lumbar plexus blockage at the psoas compartment through nerve stimulator and a 0.25% bupivacaine 40-ml injection. Analgesia and pain severity were evaluated at 4, 8, 12, 16, 20 and 24 hours after surgery, similarly to rescue opioids. RESULTS: The ilioinguinal, genitofemoral, lateral cutaneous of the

  3. Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril Efectos de la analgesia epidural y del bloqueo continuo del plexo lumbar sobre la rehabilitación funcional después de la artroplastia total de cadera Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

    OpenAIRE

    Leonardo Teixeira Domingues Duarte; Paulo Sérgio Siebra Beraldo; Renato Ângelo Saraiva

    2009-01-01

    JUSTIFICATIVA E OBJETIVOS: A dor após artroplastia total do quadril (ATQ) é intensa e agravada pelas mobilizações, o que demanda técnica analgésica eficaz e que permita mobilidade precoce, participação nas atividades de reabilitação e rápida recuperação funcional. O objetivo do estudo foi comparar os efeitos das técnicas de analgesia controlada pelo paciente (ACP) pelas vias peridural e perineural do plexo lombar sobre a reabilitação funcional em pacientes submetidos à ATQ. MÉTODO: Pacientes ...

  4. Anestesia epidural cranial com lidocaína e morfina para campanhas de castração em cães Cranial epidural anesthesia with lidocaine and morphine for sterilization campaign in dogs

    OpenAIRE

    Renato Batista Tamanho; Nilson Oleskovicz; Aury Nunes de Moraes; Fabíola Niederauer Flôres; Ademar Luiz Dallabrida; Doughlas Regalin; Ruiney Carneiro; Acácio Duarte Pacheco; Ademir Cassiano da Rosa

    2010-01-01

    A castração de machos e fêmeas tem sido preconizada como a principal técnica para redução do grande número de cães errantes. No entanto, vários são os entraves com relação à escolha do melhor protocolo anestésico, em relação à eficácia, segurança e redução de custos. Objetivou-se, com este trabalho, avaliar os efeitos cardiorrespiratórios, hemogasométricos e analgésicos da utilização de lidocaína em um volume maior, associada à morfina, pela via epidural em cadelas submetidas à ovariosalpingo...

  5. [Maternal behavior toward her newborn infant. Potential modification by peridural analgesia or childbirth preparation].

    Science.gov (United States)

    Wagner, A; Grenom, A; Pierre, F; Soutoul, J H; Fabre-Nys, C; Krebhiel, D

    1989-01-01

    The effects of sophrology and epidural analgesia on early relationship between the mother and her child were studied on a simple of 190 deliveries. The mothers were observed during and just after delivery. Mothers who had been separated from their child before the end of the observation were excluded from the study. The patients had the choice between epidural analgesia or prenatal care with sophrology. Participation to prenatal courses has statistically a positive effect on the relation between the mother and her child (p less than 0.01). Instead, epidural analgesia and posture have very limited effect on this factor. However, a trend to more interaction is found in multipari and patients who didn't choose epidural analgesia. PMID:2928660

  6. Epidural block

    Science.gov (United States)

    ... Drugs & Supplements Videos & Tools Español You Are Here: Home ... It numbs or causes a loss of feeling in the lower half your body. This lessens the pain of contractions during childbirth. An epidural block may also be used to ...

  7. Analgesia multimodal para el postoperatorio en la enfermedad renal crónica: fentanilo transcutáneo, fentanilo oral transmucosa y metamizol

    Directory of Open Access Journals (Sweden)

    P. Mesa Suárez

    2015-04-01

    Full Text Available La enfermedad renal crónica (ERC es una situación clínica cada vez más prevalente. Esto se debe en gran medida al aumento de la esperanza de vida y al incremento de la incidencia de la diabetes mellitus (DM y la hipertensión arterial (HTA. Estos pacientes requieren un manejo cuidadoso de la analgesia postoperatoria. El fentanilo es un fármaco cuya farmacocinética encaja en el manejo del dolor en la ERC. Sus diferentes presentaciones comerciales permiten elaborar estrategias adecuadas para brindarles una analgesia postoperatoria de gran calidad. Presentamos el esquema de analgesia postoperatoria de un paciente en fallo renal severo sometido a artroplastia de cadera: metamizol (6 gramos/24 horas en perfusión durante 48 horas, fentanilo transcutáneo TTS 25 microgramos/hora durante 48 horas y fentanilo oral transmucosa 200 microgramos en caso de exacerbación del dolor. Este tratamiento analgésico permitió el control satisfactorio del dolor sin que se presentaran vómitos, prurito ni estreñimiento; la calidad del sueño y el descanso nocturno fueron buenos.

  8. [History and Technique of Epidural Anaesthesia].

    Science.gov (United States)

    Waurick, Katrin; Waurick, René

    2015-07-01

    In 1901, the first Epidural anesthesia via a caudal approach was independently described by two FrenchmanJean-Anthanase Sicard and Fernand Cathelin.. The Spanish military surgeon, Fidel Pagés Miravé, completed the lumbar approach successfully in 1921. The two possibilities for identification of the epidural space the "loss of resistance" technique and the technique of the "hanging drop" were developed by Achille Mario Dogliotti, an Italian, and Alberto Gutierrez, an Argentinean physician, at the same time. In 1956 John J. Bonica published the paramedian approach to the epidural space. As early as 1931 Eugene Aburel, a Romanian obstetrician, injected local anaesthetics via a silk catheter to perform lumbar obstetric Epidural analgesia. In 1949 the first successful continuous lumbar Epidural anaesthesia was reported by Manuel Martinez Curbelo, a Cuban. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach. Different off-axis angles pose the challenge in learning the technique. PMID:26230893

  9. Tachyphylaxis associated with repeated epidural injections of lidocaine is not related to changes in distribution or the rate of elimination from the epidural space

    DEFF Research Database (Denmark)

    Mogensen, T; Simonsen, L; Scott, N B; Henriksen, Jens Henrik Sahl; Kehlet, H

    1989-01-01

    The relationship between tachyphylaxis (measured as a decrease in the rate of regression of sensory levels of analgesia) during repeated epidural injections of lidocaine and both the distribution of lidocaine within the epidural space (as measured by spread of simultaneous injection of the tracer...... technetium-99m diethylenetriaminepentaacetate [99mTc-DTPA]) and elimination of lidocaine from the epidural space (as measured by serum concentrations of lidocaine) was investigated in 18 patients undergoing minor surgery during lumbar epidural analgesia. Twelve patients received four injections of 20 mL of 2......% lidocaine at 2-hr intervals. Epidural distribution was assessed by injection of 99mTc-DTPA diluted in saline on the preoperative day and diluted in an equal volume of 2% lidocaine on the morning before surgery and again after the fourth injection of lidocaine 6 hr later. The distribution of 99mTc-DTPA in...

  10. 自控腰硬联合分娩镇痛不同的停泵时机对产程和分娩结局的影响%An analysis on the effects of different time of stopping pumping on stages of labour and delivery outcomes during self-controlled combined spinal-epidural labour analgesia

    Institute of Scientific and Technical Information of China (English)

    熊桂生; 潘丽莉; 王玉珏

    2014-01-01

    Objective To explore the effects of different time of stopping pumping on stages of labour, delivery outcomes and parturients' satisfaction during delivery of primiparas who received self-controlled combined spinal-epidural anaesthesia for labour analgesia. Methods 120 eligible primiparas who were admitted from April 2013 to December 2013 were selected and assigned to group A, B and C according to admission order. Every ten people were assigned to each group once a time. Each group had 40 primiparas and received combined spinal-epidural labour analgesia. Pumping was stopped when cervix was wide open for group A and never restarted; pumping was stopped when cervix was wide open for group B, and restarted immediately after delivery; group C kept receiving labour analgesia all the way through the first, second and third stages. All three groups terminated analgesia at the third stage. The analgesia was terminated after perineorrhaphy and tubes for epidural analgesia were removed. Basic conditions of parturients, VAS scores, durations of the first, second and third stages, amount of bleeding in two hours after delivery, use of oxytocin, rate of caesarean section, rate of delivery by pliers, quality of amniotic fluid, satisfaction rate of parturients and Apgar scores were observed and compared. Results No differences of amount of bleeding in two hours after delivery, Apgar scores, and durations of the third stages were detected between the three groups;ratios of labour pain for parturients in group A and B were higher than those in group C, and the number of parturients who encountered pain during perineorrhaphy or felt uncomfortable was higher than that in group C. The satisfaction rate in group C was higher than that in group A and B, and the differences were statistically significant. No statistically significant differences of indices between group A and B were seen. Conclusion Different time of stopping pumping does not prolong the second stage, does not affect

  11. Anaesthetists' experiences with the early labour epidural recommendation for obese parturients: a qualitative study.

    Science.gov (United States)

    Va, Eley; Lk, Callaway; Aaj, van Zundert; J, Lipman; C, Gallois

    2016-09-01

    Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. This qualitative study explored the experiences of anaesthetists regarding early epidural analgesia in obese parturients, to answer the research question: Are anaesthetists consistent in how they apply early epidural analgesia in obese parturients? Personal in-depth interviews with 42 specialist anaesthetists working in south-east Queensland, Australia, were completed between February and April, 2015. Leximancer™ text analysis software applied a validated algorithm to the data to identify themes and concepts. The major themes were explored by the first author to answer the research question. Three major themes were identified: the demands associated with caring for obese women; concern regarding the anaesthetic technique used in obese women; and the importance of communication with obstetric staff. Disagreement regarding interpretation and application of early epidural analgesia was identified within this group of anaesthetists. These anaesthetists were inconsistent in how they interpreted and applied early epidural analgesia for obese parturients, with some questioning the validity of the practice. The combination of uncertainty, urgency and technical difficulty presented by obese parturients provoked anxiety in these clinicians, particularly the anticipation of unplanned general anaesthesia. Consistent anaesthetic practice could improve the implementation of early epidural analgesia in obese parturients. PMID:27608347

  12. Combined Spinal Epidural versus Epidural Sufentanil and Bupivacaine in Labour (Clinical and Histological comparative Study

    Directory of Open Access Journals (Sweden)

    Nagia M. Abd El Moeti, *Zinab B. Youssef, *Soaad S. Abd El Aal

    2006-12-01

    Full Text Available Introduction:- Regional analgesia provides excellent pain relif in labour. This study was designed to compare combined spinal eqidural (CSE versus epidural block using a narcotic (sufentanil and local anaesthetic bupivacaine regarding their effects on progress of labour, method of delivery, pain relif, side effects and neonatal outcome. Patients and Methods :-Forty pregnant women ASA I and II were enrolled in this study. The women were randomly allocated to receive either CSE or epidural ( 20 patient of each . In CSE group analgesia was initiated with 10ug sufentanil with 2mg bupivacaine. In epidural group 10ml bupivacaine 0.125%.and 10ug sufentanil injected epidurally. In both groups the continuous infusion of 0.83% bupivacaine with 0.33ug/ml sufentanil at 10ml/hr adjusted as required. Maternal haemodynamics, analgesia characteristics VAPS, degree of motor block, were measured. Duration of labour, cervical dilation, maternal satisfaction and mode of delivery were assessed. Foetal outcome was assessed by 1 and 5 min. Apgar score and umbilical venous blood gases. Maternal and neonatal side effects were observed. The experimental study was done on 30 rats divided into 3 groups 10 rats of each. Control group (A injected intrathecally with saline, group (B injected intrathecally with 1.5ug/kg sufentanil (low dose, and group (C injected intrathecally with 7.5ug/kg sufentanil (high dose, the pervious doses were injected every 2hr. for 3 times then the spinal cord was obtained and stained for histological evaluation. Results:- The clinical study showed that no difference between the 2 groups for the degree of motor block or adequacy of analgesia, mode of delivery and Foetal outcome. The onset of analgesia was faster with CSE technique, more patient satisfaction and more pruritis. The histological results revealed that no detectable significant neurotoxic changes with the use of small dose of intrathecal sufentanil but mild changes occurred with high

  13. A COMPARATIVE STUDY OF EPIDURAL BUTORPHANOL AND EPIDURAL FENTANYL FOR THE RELIEF OF POST-OPERATIVE PAIN IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

    Directory of Open Access Journals (Sweden)

    Ashwini

    2014-11-01

    Full Text Available BACKGROUND: Epidural anaesthesia is used extensively for both intra-operative and post-operative analgesia. This prospective randomized study was conducted using opioids epidurally for post-operative analgesia. Fentanyl is a pure opioid agonist. Butorphanol tartarate which is an agonist antagonist opioid is considered safer than pure opioid agonist. Hence, we compared epidural 4mg butorphanol and epidural 100 µg fentanyl for the relief of post-operative pain. AIMS AND OBJECTIVES: To compare the onset, duration, quality of analgesia, hemodynamic effects and side effects between the 2 study drugs. MATERIALS AND METHODS: 60 patients of either sex posted for elective lower abdominal and lower limb surgeries were randomly divided into 2 groups of 30 each. Group A received butorphanol 4mg epidurally. Group B received fentanyl 100 µg epidurally. All surgeries were done under lumbar epidural anaesthesia with catheter in situ. Post-operatively when patients complained of pain, intensity of pain was assessed using visual analogue scale [VAS]. When the VAS score was > 5, Group A received butorphanol 4mg diluted to 10 ml with NS or Group B received 100 µg fentanyl epidurally diluted to 10 ml with NS. Onset, duration, quality of analgesia, hemodynamic effects and incidence of side effects were compared between the two groups and treated accordingly. RESULTS: Demographic profile was comparable in both groups. Mean time of onset of analgesia was rapid (3.22 ±0.9 (S.D min in group B compared to group A (6.38± 1.26 (S.D min. Duration of analgesia was longer in group A (344.00 ±63.39 min compared to group B (227±38.12 min. Quality of analgesia was better with group A compared to group B. There was no significant difference in hemodynamic parameters in both groups. Sedation was the main side effect in group A. Incidence of pruritis, vomiting, hypotension and respiratory depression was more in group B. CONCLUSION: Epidural Butorphanol though has a delayed

  14. Cronobiología en anestesia epidural Obstétrica: Efecto de la noche sobre el índice de complicaciones Cronobiology in obstetric epidural anesthesia: consequences of the sleep deprivation among anestresiologist in the complications rate

    Directory of Open Access Journals (Sweden)

    F. Martínez-Jiménez

    2006-03-01

    Full Text Available Introducción: Los efectos del trabajo continuado y nocturno sobre la atención y la incidencia de complicaciones en desarrollo habitual de las labores del médico han sido previamente estudiados, aunque con resultados poco concluyentes. Objetivo: Comparar la incidencia de complicaciones, durante la punción, en el curso del bloqueo, como consecuencia de una analgesia incompleta y evaluar las diferencias que existen entre el día y la noche definiendo día como el periodo entre 9:00 y 21:59 h y noche: de 22:00 a 8:59 h. Material y métodos: Hemos realizado un estudio de los bloqueos recogidos en nuestra base de datos informatizada de pacientes a quienes se practicó algún bloqueo central para analgesia del parto realizados en un hospital universitario de grado 4, con atención durante las 24 horas, durante un periodo de 2 meses. Resultados: Se ha estudiado un total de 1097 pacientes, homogéneas en su distribución (variables demográficas y obstétricas, entre el día y la noche. El número de pacientes a las que se les practica un bloqueo analgésico para trabajo de parto no muestra diferencias entre el día y la noche. No hemos encontrado diferencias en la incidencia de complicaciones en la punción ni de analgesia incompleta, deficiente o necesidad de re-punción. Conclusiones: Parece que el cansancio o la falta de sueño no influyen en la incidencia de complicaciones en la analgesia para el trabajo de parto en una unidad de atención las 24 horas. Probablemente, los médicos se ven incentivados por la realización de una tarea interesante.Introduction: Sleep deprivation effects in vigilance, performance and complications have been previously studied in general population and in medical tasks too. Results from these studies weren’t definitive. Aim: Our objective is to compare the number of complications during the epidural puncture itself, (haematic, paresthesias, accidental dural puncture and others during the analgesia period (lateral

  15. The effect of 0.5% ropivacaine on epidural blood flow

    DEFF Research Database (Denmark)

    Dahl, J B; Simonsen, L; Mogensen, T;

    1990-01-01

    Twenty patients scheduled for elective abdominal surgery received epidural analgesia with 20 ml 0.5% ropivacaine or 0.5% bupivacaine. Epidural blood flow was measured by an epidural 133Xe clearance technique on the day before surgery (no local anaesthetic) and again 1 h before surgery, 30 min after...... injection of the local anaesthetic during continuous infusion (8 ml/h). Median initial blood flow was 5.0 ml/min and 6.0 ml/min per 100 g tissue in patients receiving ropivacaine and bupivacaine, respectively. After epidural bupivacaine, blood flow increased in 8 of 10 patients to 6.9 ml/min per 100 g...

  16. Accidental catheterization of epidural venous plexus: tomographic analysis

    Directory of Open Access Journals (Sweden)

    Mariano Paiva Souza

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. CASE REPORT: A female patient in her sixties, physical status II (ASA, underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. CONCLUSION: It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter.

  17. A randomised controlled trial using the Epidrum for labour epidurals.

    LENUS (Irish Health Repository)

    Deighan, M

    2015-03-01

    The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9\\/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3\\/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.

  18. Epidural catheterization in cardiac surgery: The 2012 risk assessment

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    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  19. Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Hansen, B L;

    1992-01-01

    In a double-blind, randomized study, epidural infusions of low-dose morphine (0.2 mg/h) combined with low-dose bupivacaine (10 mg/h) were compared with epidural infusions of low-dose morphine (0.2 mg/h) alone for postoperative analgesia at rest and during mobilization and cough in 24 patients after...... mobilization from the supine into the sitting position 12 and 30 h after surgical incision and during cough 8, 12, and 30 h after surgical incision (P less than 0.05). We conclude, that low-dose epidural bupivacaine potentiates postoperative low-dose epidural morphine analgesia during mobilization and cough...

  20. Preventive analgesia

    DEFF Research Database (Denmark)

    Dahl, Jørgen B; Kehlet, Henrik

    2011-01-01

    This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. Recent...... findings: The nature of central sensitization during acute and chronic postsurgical pain share common features, and there may be interactions between acute and persistent postoperative pain. The term ‘pre-emptive analgesia’ should be abandoned and replaced by the term ‘preventive analgesia’. Recent studies...... of preventive analgesia for persistent postoperative pain are promising. However, clinicians must be aware of the demands for improved design of their clinical studies in order to get more conclusive answers regarding the different avenues for intervention. Summary: The concept of preventive...

  1. Tachyphylaxis associated with repeated epidural injections of lidocaine is not related to changes in distribution or the rate of elimination from the epidural space

    Energy Technology Data Exchange (ETDEWEB)

    Mogensen, T.; Simonsen, L.; Scott, N.B.; Henriksen, J.H.; Kehlet, H. (Univ. of Copenhagen (Denmark))

    1989-08-01

    The relationship between tachyphylaxis (measured as a decrease in the rate of regression of sensory levels of analgesia) during repeated epidural injections of lidocaine and both the distribution of lidocaine within the epidural space (as measured by spread of simultaneous injection of the tracer technetium-99m diethylenetriaminepentaacetate (99mTc-DTPA)) and elimination of lidocaine from the epidural space (as measured by serum concentrations of lidocaine) was investigated in 18 patients undergoing minor surgery during lumbar epidural analgesia. Twelve patients received four injections of 20 mL of 2% lidocaine at 2-hr intervals. Epidural distribution was assessed by injection of 99mTc-DTPA diluted in saline on the preoperative day and diluted in an equal volume of 2% lidocaine on the morning before surgery and again after the fourth injection of lidocaine 6 hr later. The distribution of 99mTc-DTPA in the epidural space was unchanged during the three measurements despite significant tachyphylaxis in both sensory analgesia and motor blockade (11 of 12 patients had sensory analgesia 2 hr after the first injection in contrast to only 3 of 12 patients during the third injection). In another six patients 20 mL of 2% lidocaine were injected three times at 2-hr intervals before surgery, with measurements of serum concentrations of lidocaine after the first and last injections. Despite tachyphylaxis (no patient had sensory analgesia 2 hr after the third injection), there was no difference in the rate of disappearance of lidocaine from the epidural space as assessed by plasma lidocaine concentration curves during the first and third injection (0.5 +/- 0.1 and 0.3 +/- 0.04 microgram.mL-1.min-1, respectively).

  2. Tachyphylaxis associated with repeated epidural injections of lidocaine is not related to changes in distribution or the rate of elimination from the epidural space

    International Nuclear Information System (INIS)

    The relationship between tachyphylaxis (measured as a decrease in the rate of regression of sensory levels of analgesia) during repeated epidural injections of lidocaine and both the distribution of lidocaine within the epidural space (as measured by spread of simultaneous injection of the tracer technetium-99m diethylenetriaminepentaacetate [99mTc-DTPA]) and elimination of lidocaine from the epidural space (as measured by serum concentrations of lidocaine) was investigated in 18 patients undergoing minor surgery during lumbar epidural analgesia. Twelve patients received four injections of 20 mL of 2% lidocaine at 2-hr intervals. Epidural distribution was assessed by injection of 99mTc-DTPA diluted in saline on the preoperative day and diluted in an equal volume of 2% lidocaine on the morning before surgery and again after the fourth injection of lidocaine 6 hr later. The distribution of 99mTc-DTPA in the epidural space was unchanged during the three measurements despite significant tachyphylaxis in both sensory analgesia and motor blockade (11 of 12 patients had sensory analgesia 2 hr after the first injection in contrast to only 3 of 12 patients during the third injection). In another six patients 20 mL of 2% lidocaine were injected three times at 2-hr intervals before surgery, with measurements of serum concentrations of lidocaine after the first and last injections. Despite tachyphylaxis (no patient had sensory analgesia 2 hr after the third injection), there was no difference in the rate of disappearance of lidocaine from the epidural space as assessed by plasma lidocaine concentration curves during the first and third injection (0.5 +/- 0.1 and 0.3 +/- 0.04 microgram.mL-1.min-1, respectively)

  3. Epidural lipomatosis

    International Nuclear Information System (INIS)

    Central deposition of fat is a well-known clinical feature of long-term elevated corticosteroid levels. Rarely described is increased extadural fat within the spinal canal causing compression of the spinal cord and neurologic deficits. Together with 12 previously reported cases, the authors present six additional cases of epidural lipomatosis, review presenting signs and symptoms, and demonstrate the myelographic, CT, and MR findings in this condition. Previously undescribed examples of (1) normal myelography with diagnostic postmyelogram CT, (2) MR imaging of this condition, and (3) cases not associated with exogenous steroid use or morbid obesity are presented. The importance of considering this entity in the appropriate clinical setting is stressed. In particular, if clinical suspicion is high, even in the setting of a normal myelogram, CT or MR imaging should be considered

  4. Hematoma epidural secundario a anestesia espinal: Tratamiento conservador Epidural hematoma secondary to spinal anesthesia: Conservative treatment

    Directory of Open Access Journals (Sweden)

    M. Bermejo

    2004-11-01

    Full Text Available Introducción: El hematoma epidural secundario a una anestesia neuroaxial es una complicación poco frecuente, pero de gran trascendencia tanto por sus implicaciones clínicas como por las médico legales; según algunos autores su incidencia puede oscilar entre 1/190.000-1/200.000 para las punciones peridurales y 1/320.000 en el caso de las espinales. El aspecto prioritario en su manejo terapéutico es el del diagnóstico y tratamiento precoz, antes de las 6-12 primeras horas. No obstante, en determinados pacientes como en el caso que presentamos puede no ser precisa la cirugía, resolviéndose el cuadro con tratamiento conservador. Caso clínico: Varón de 73 años, ASA IV, con antecedentes de cirrosis con hipertensión portal, hiperesplenismo, EPOC, obesidad, cardiopatía hipertensiva e insuficiencia tricuspídea. Se programa para alcoholización prostática al haber sido desechada la cirugía. En la analítica preoperatoria destacaba una actividad de protrombina del 80% y 90.000 plaquetas. Se realizaron varios intentos fallidos de punción espinal, finalmente fue precisa una anestesia general con ventilación espontánea mediante mascarilla laríngea, propofol, fentanilo y sevoflurano. A las 36 horas, comienza la clínica en forma de dolor intenso lumbar, sin irradiación y arreflexia cutáneo plantar, confirmándose en la RMN la presencia de un hematoma epidural de L1 a L4. Ante la ausencia de paraparesia flácida, afectación esfinteriana u otros signos sensitivo-motores y tras consulta con la Unidad de Raquis y con el Servicio de Neurología se decide tratamiento conservador y actitud expectante en forma de analgesia y monitorización neurológica estricta, clínica y radiológica. Evolucionando favorablemente en los siguientes días. Discusión: Determinadas condiciones clínicas pueden influir en la aparición de un hematoma tras la realización de un bloqueo regional central: heparinas de bajo peso molecular, punciones dificultosas

  5. Spinal and epidural anesthesia

    Science.gov (United States)

    Intraspinal anesthesia; Subarachnoid anesthesia; Epidural; Peridural anesthesia ... Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). Patients usually recover their senses ...

  6. Effect of non-medicine intervention on the postoperative patient controlled epidural analgesia of lower limbs orthopedics surgery%非药物干预对下肢骨科术后硬膜外镇痛效果的影响

    Institute of Scientific and Technical Information of China (English)

    陈文娟; 姜景卫; 潘红英

    2014-01-01

    目的:观察非药物干预措施对下肢骨科术后硬膜外镇痛效果的影响,评价非药物干预措施在术后镇痛中的临床价值。方法将80例择期下肢骨科手术患者按随机数字表法分为观察组和对照组,每组40例。两组均采用硬膜外麻醉,术后使用自控式镇痛泵。对照组采用常规护理,包括镇痛泵的使用、口腔护理、饮食护理、导管护理、会阴护理、常规宣教及适当体位等。观察组在常规护理的基础上增加以责任护士为主导的一系列非药物干预措施,如加强医护人员疼痛管理教育、患者参与的预期疼痛教育、使用三维立体冰袋、心理干预和音乐干预。观察两组术后48 h内疼痛强度以及不良反应的发生情况及镇痛泵按压总次数。结果观察组在术后4,8,12,24,48 h各时段疼痛强度均低于对照组,差异有统计学意义(P<0.05)。观察组不良反应总发生率为7.5%,低于对照组的25.0%,差异有统计学意义(χ2=4.5006,P<0.05)。观察组的镇痛泵按压次数为(2.2±1.1)次,低于对照组的(3.3±1.2)次,差异有统计学意义(t=4.2737,P<0.05)。结论非药物干预措施能有效降低疼痛程度,减少镇痛泵按压次数及不良反应的发生率。%Objective To study the effect of non-medicine intervention on the postoperative patient controlled epidural analgesia of lower limbs orthopedics surgery , and to assess the clinic value of non-medicine intervention .Methods Totals of 80 cases were selected and randomly divided into observation group and control group with 40 cases each group , they received epidural anesthesia and patient controlled analgesia .Patients in control group received the routine nursing such as analgesia using , diet and mouth care , catheter and perineum nursing, routine education and suitable position and so on .On the basis of that, patients in

  7. Estudio descriptivo de la analgesia obtenida durante el trabajo de parto con PCA de remifentanilo: modelo británico

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    C. Morales Muñoz

    2014-12-01

    Full Text Available Introducción: la analgesia epidural obstétrica continúa siendo el "gold-standard" para controlar el dolor durante el trabajo de parto, pero en determinadas ocasiones la técnica está contraindicada o la analgesia es incompleta. El remifentanilo es un opioide potente de rápida acción y vida media ultracorta, que se adapta perfectamente a la dinámica del parto. La coordinación entre el comienzo de las contracciones y la administración del fármaco mediante un dispositivo PCA hacen que esta técnica pueda ser considerada de elección para el alivio de dolor durante el parto y no solo como alternativa a la epidural. Objetivo: este estudio pretende valorar la eficacia y seguridad en el parto del remifentanilo administrado por vía intravenosa, así como la satisfacción materna de la analgesia recibida. Materiales y métodos: estudio descriptivo prospectivo basado en el análisis de la recogida de datos realizado por los investigadores durante el parto donde se recoge el dolor durante la dilatación y el expulsivo antes y después de la aplicación de la PCA de remifentanilo, así como las complicaciones y la incidencia de efectos secundarios. Paralelamente se realiza una encuesta de satisfacción materna de la técnica recibida y su vivencia personal. Resultados: se han recogido un total de 32 casos durante el periodo de estudio (6 meses. Todas las pacientes han presentado una reducción de dolor manifestado por una disminución del EVA respecto del dolor basal de 5,9 puntos en los primeros minutos, 4,6 puntos en completa y 3,4 en el expulsivo. No se han registrado complicaciones materno-fetales importantes derivadas de la técnica. La satisfacción materna ha sido alta, volviendo incluso a repetir la técnica en un 90 % de los casos. Conclusiones: la PCA de remifentanilo ha demostrado ser efectiva y segura como analgesia obstétrica. Es por ello que la PCA ha teniendo una amplia aceptación entre matronas, ginecólogos y anestesiólogos en

  8. Depth of the thoracic epidural space in children.

    Science.gov (United States)

    Masir, F; Driessen, J J; Thies, K C; Wijnen, M H; van Egmond, J

    2006-01-01

    Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epidural puncture in 61 children. The epidural puncture was performed using the loss of resistance technique with saline 0.9%. The distance from the needle tip to the point where the needle emerged from the skin was measured. The post-operative analgesia parameters were also measured. Skin to epidural distance correlated significantly with the age and weight of the children. The equation for the relation between SED (cm) and age was 2.15 + (0.01 x months) and for SED vs weight was 1.95 + (0.045 x kg). Despite considerable variability among individuals, the observed correlation of SED with both age and weight shows that this parameter may be helpful to guide thoracic epidural puncture in anaesthetized children. PMID:17067139

  9. COMPARISION OF TWO DRUG COMBINATIONS FOR LABOUR ANALGESIA, AND ITS EFFECT ON PATIENT SATISFACTION, DURATION OF LABOUR AND FETAL OUTCOME

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    Jaideep

    2014-09-01

    Full Text Available : BACKGROUND: Epidural is now established and accepted method to relief labour pain. This study intended to comparison of two drug combinations in labour analgesia and its effect on duration of labour, maternal satisfaction and fetal outcome. Combined epidural infusion of bupivacaine + fentanyl would result in analgesia superior to that provided by a continuous epidural infusion of a similar concentration of Bupivacaine alone. AIMS AND OBJECTIVE: To compare the efficacy of two drug combinations for labour analgesia, and its effect on patient satisfaction, duration of labour and fetal outcome. MATERIALS AND METHODS: Study design – comparative randomized controlled study. Sample size: For this study 50 pregnant women were randomly selected and divided into two groups. GROUP I: Control Group (Continuous epidural infusion of Bupivacaine CEI: 25 parturient who were given a bolus of 0.1% Bupivacaine + 20mcg Fentanyl followed by infusion of 0.0625% Bupivacaine epidurally. GROUP II: Study Group (Continuous epidural infusion of Bupivacaine with Fentanyl CEIF: 25 parturients who were given a bolus of 0.1% Bupivacaine + 20mcg Fentanyl followed by infusion of 0.0625% Bupivacaine + 0.0001% Fentanyl epidurally. Duration of labour, Analgesia, maternal satisfaction, fetal outcome was assessed by different scales like bromage scale, visual analogue scale, APGAR score and pin prick method are used. Side effects and complications, if present were recorded.

  10. CLINICAL EVALUATION OF EPIDURAL ADMINISTRATION OF MORPHINE, FENTANYL, METHADONE, LIDOCAINE AND LIDOCAINE WITH EPINEPHRINE IN CATTLE

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    A. Tabatabaei Naeine, A. Rezakhani and J. Fazlinia

    2004-01-01

    Full Text Available The purpose of this study was to determine the analgesic efficacy and clinical effects of morphine, fentanyl, methadone, lidocaine, lidocaine with epinephrine and saline (control when injected epidurally into the caudal epidural space in cattle. Epidural analgesia was achieved in five cattle on five successive occasions at weekly intervals. Analgesia was defined as a lack of response to hemostat pressure and pinprick in the skin of the perineal area and ventral aspect of the tail. The results demonstrated that while epidural lidocaine and lidocaine with epinephrine decreased the response to hemostat and pinprick compared to control, there was no reduction in response after the administration of morphine, methadone or fentanyl. Heart rate, pulse and respiratory rates were not significantly altered by any of the drugs. Neither did the drugs produce any change in the electrocardiogram (ECG of the animals.

  11. Paravertebral And Epidural Blocks For Post Thoracotomy Pain

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    Fatma A. A. Zorob, Amira M. Nassar, And Tarek El-Said

    2001-06-01

    Full Text Available Thoracic anesthesia offers particular challenge. Thoracic patients frequently have a painful wound after surgery. So analgesia after thoracic surgery is of particular significance. In the present study we assessed the efficacy of thoracic paravertebral and epidural blockade on post thoracotomy pain and pulmonary function. Thirty adult ASA I-III patients undergoing elective thoracic surgery were enrolled in this study. they were randomly divided into two groups : paravertebral and epidural group (15 patients each. Both percutaneous paravertebral and epidural catheters were placed preoperatively. Before chest closure each patient received a bolus dose of bupivacaine (0.25 % according to its height. This was followed by postoperative bupivacaine infusion (0.25 % 0.1 ml kg-1h ­1 in both groups. Also patients were encouraged to take supplementary doses of morphine from a patient controlled analgesia (PCA. Subjective pain relief was assessed on a linear visual analogue scale and pulmonary function was measured by spirometry. Stress responses to noxious stimuli was assessed by plasma levels of cortisol and glucose. Respiratory variables were recorded throughout the study period. Also sensory level of analgesia and performance status were assessed in the two groups. Although we found significantly lower visual analogue pain scores at rest and on maximal coughing in the paravertebral compared to the epidural group, no significant difference in patient controlled morphine requirements was noted between the two groups. Pulmonary function (FVC, FEV1 and PEFR was significantly better in the paravertebral group. Meanwhile no significant difference in respiratory variables was recorded between the two groups. Paravertebral block produced significantly diminished stress responses to noxious stimuli as manifested by less increase in plasma cortisol level than in epidural block. Sensory levels of analgesia and performance status was similar in both groups. Side

  12. Efeitos cardiorrespiratórios e analgésicos da cetamina por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur Cardiorespiratory and analgesic effects of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis

    Directory of Open Access Journals (Sweden)

    Adriano Bonfim Carregaro

    2010-07-01

    Full Text Available A cetamina tem demonstrado efeito analgésico em doses subanestésicas, além da manutenção da estabilidade dos parâmetros fisiológicos. O estudo objetivou avaliar os efeitos cardiorrespiratórios e a analgesia pós-operatória da cetamina administrada por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur. Foram utilizadas 25 cadelas, hígidas, distribuídas aleatoriamente em quatro grupos: CEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural, CIV (lidocaína 2% via epidural e 1mg kg-1 de cetamina IV seguido de infusão contínua IV com 100µg kg min-1 da mesma, CIVEP (2mg kg-1 de cetamina associada à lidocaína 2% via epidural e 1mg kg-1 de cetamina IV, seguido de infusão contínua IV com 100µg kg min-1 e CON (anestesia epidural com lidocaína 2%. Avaliaram-se FC, f, PAS, PAM, PAD, T°C, tempo de bloqueio motor e analgesia pós-operatória por meio de escala analógica visual. Houve elevação da FC no CIV e diminuição desse parâmetro no CEP. As pressões arteriais mantiveram-se dentro dos valores fisiológicos e não foram observadas diferenças na f e T°C. O tempo de duração do bloqueio anestésico foi potencializado nos grupos que receberam cetamina epidural, diferindo significativamente em relação ao controle. O tempo para a analgesia resgate não diferiu entre os grupos. Conclui-se que a administração de cetamina pela via epidural, por infusão contínua intravenosa ou pela associação de ambas promoveu estabilidade cardiorrespiratória no período transcirúrgico, porém não foi capaz de prolongar a duração da analgesia pós-operatória em cães submetidos à osteossíntese de fêmur.Ketamine has demonstrated analgesic effects in subanesthetic doses, besides the maintenance of stability of physiological parameters. The study aimed to evaluate the cardiorespiratory effects and the post operative analgesia of ketamine via epidural

  13. Utilidad del citrato fentanilo oral transmucosa (CFOT para procurar ansiolisis preoperatoria y analgesia postoperatoria en cirugía pediátrica Premedication with oral fentanil (CFOT in paedriatic surgery

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    F. J. Pérez-Bustamante

    2008-03-01

    Full Text Available La cirugía en la población infantil representa una fuente de disconfort para el paciente y su entorno familiar que a menudo es infravalorado tanto por éstos como por los profesionales. Aún hay mucho por hacer para disminuir este impacto y proporcionar a los niños unas condiciones emocionales adecuadas para enfrentarse a la cirugía y al postoperatorio. El objetivo de este trabajo era demostrar la utilidad del citrato de fentanilo oral transmucosa (CFOT como medio de ansiolisis preoperatorio y analgesia postoperatoria. Para ello se administró previo a la intervención 10 ug/Kg de CFOT a un grupo de 45 niños sometidos a adenoamigdalectomía y se valoró el comportamiento, la colaboración y la analgesia obtenida en el antequirófano y postoperatorio inmediato. Los resultados obtenidos se compararon con los de un grupo control similar utilizando para ello la T de student y ANOVA, obteniéndose diferencias significativas en cuanto al grado de colaboración, ansiolisis y analgesia a favor del grupo CFOT. Nosotros sostenemos que este método es además seguro, sencillo y goza de una gran aceptación por parte de los padres y profesionales implicados en el proceso asistencial.The surgery in the paedriatic population represents a source of disconfort for the patient and his familiar surroundings that often are infravalued, so much by these as by the professionals. Still there is much to make to diminish this impact and to provide to the children emotional conditions adapted to face the surgery and the postoperative period. The objective of this work was to demonstrate the utility of fentanyl oral (CFOT to provide ansiolityc and postoperative analgesia. 10 ug/Kg of CFOT was administered previous to intervention to a group of 45 children submissive for amigdalectomy and the behavior was valued, the collaboration and the analgesia obtained in the immediate postoperative period. The obtained results was compared with those of a similar placebo group

  14. Is the combination of epidural clonidine–levobupivacaine has same analgesic efficacy and safety as the combination fentanyl–levobupivacaine after radical cystectomy?

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    Essam A. Mahran

    2014-04-01

    Conclusion: We concluded that both clonidine and fentanyl can be used as effective additive to epidural levobubivacaine for postoperative analgesia after radical cystectomy with no significant difference between them in vital signs, analgesic, sedative effects and safety profile on adding each of them in doses not exceeding 20 μg/h to epidural continuous levobupivacaine infusion.

  15. The Advantages of Continuous Epidural Anesthesia in Spinal Deformity Surgery

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    Ezhevskaya А.А.

    2014-09-01

    Full Text Available The aim of the investigation was to assess the efficacy of epidural anesthesia and analgesia during the integrated anesthetic management in spinal deformity surgery. Materials and Methods. The prospective randomized study involved 350 patients aged from 15 to 65 years, divided into two groups: group 1 (n=205 were given combined anesthesia — epidural and endotracheal anesthesia with sevoflurane and continuous epidural analgesia with ropivacaine, fentanyl and epinephrine after surgery; group 2 (n=145 had general anesthesia with sevoflurane and fentanyl, and systemic administration of opioids after surgery. We assessed systemic hemodynamics parameters (a non-invasive method, pain at rest and activities, parameters of hemostasis and fibrinolysis, plasma levels of stress hormones, cytokine levels at seven stages of the study (before, during and three days after surgery. Results. Patients in group 1 with epidural anesthesia had significantly less pain both at rest and motion. The most blood saving effect (up to 60% of blood loss was also found in group 1. Hemodynamic monitoring demonstrated epidural anesthesia not to lead to the life-threatening events of myocardial contractility, cardiac output, systemic vascular resistance and critical increasing of extravascular lung water. The impact of epidural anesthesia on hemostasis encompassed the activation of both coagulation and fibrinolysis. Furthermore, patients in group 1 compared to group 2 had significantly lower plasma levels of glucose, lactate, С-reactive protein, cortisol, and interleukins IL-1β, IL-6, IL-10. Conclusion. Comprehensive anesthetic protection in spinal deformity surgery based on epidural anesthesia provides adequate antinociceptive effects, inhibition of endocrine and metabolic stress response and correction of hemostasis problems.

  16. 硬膜外麻醉与静脉麻醉两种分娩镇痛方式对产妇及新生儿的影响%Intravenous anesthesia epidural anesthesia and two types of labor analgesia effect on maternal and neonatal

    Institute of Scientific and Technical Information of China (English)

    王丽霞

    2015-01-01

    Objective To study the intravenous anesthesia and epidural anesthesia in childbirth analgesia effect,as well as to the influ-ence degree of the maternal and Mr Son. Methods 165 cases of obstetrics and gynecology in our hospital childbirth puerperal were included into this study. All cases were randomly divided into experimental group A,the experimental group B and control group 55 cases. The patients of con-trol group maternal way did not use labor analgesia. The experimental group A maternal give way of epidural analgesia,select fentanyl with pp be-cause drugs. The experimental group B women give intravenous anesthesia analgesic way,select fentanyl drugs. The analgesic effect of three groups of samples,the pregnancy outcome and neonatal situation,comparative analysis and statistics were observed. Results Anesthesia effect of experiment group A and group B were significantly better than the control group( P ﹤ 0. 05). But comparison between experiment group A and group B no statistical difference( P ﹥ 0. 05). In experiment group A and group B,the total labor time and labor time were significantly shorter than the control group,the occurrence of neonatal adverse events were less than the control group( P ﹤ 0. 05). But comparison between experi-ment group A and group B no statistical difference( P ﹥ 0. 05). Experiment group A and group B vaginal births,bleeding volume,compared with the control group no significant difference( P ﹥ 0. 05). Conclusion Using epidural anesthesia in the puerpera childbirth way was similar with that of intravenous anesthesia analgesic effect. The effect on the improvement included the neonatal and maternal itself. Patients with clinical prac-tice can be based on the basic situation of discretion to give appropriate anesthesia.%目的:探讨硬膜外麻醉与静脉麻醉在分娩中的镇痛效果,以及对产妇和新生儿的影响程度比较。方法选取妇产科分娩的165例产妇,随机分为实验 A 组、实验 B

  17. Epidural hematoma after routine epidural steroid injection

    Science.gov (United States)

    Alkhudari, Azzam M.; Malk, Craig S.; Rahman, Abed; Penmetcha, Taruna; Torres, Maria

    2016-01-01

    Background: There are few reported cases of an epidural spinal hematoma following interventional pain procedures. Case Description: We report a case of a spinal epidural hematoma in a patient with no known risk factors (e.g. coagulopathy), who underwent an epidural steroid injection (ESI) in the same anatomic location as two previously successful ESI procedures. Conclusion: Early detection was the key to our case, and avoiding sedation allowed the patient to recognize the onset of a new neurological deficit, and lead to prompt diagnosis as well as surgical decompression of the resultant hematoma.

  18. Bloqueos nerviosos periféricos en la extremidad inferior para la analgesia postoperatoria de la artroplastia total de rodilla

    OpenAIRE

    Gonzalo Pellicer, Inmaculada; Gómez Gómez, Roberto; Martínez Delgado, Fernando

    2014-01-01

    INTRODUCCIÓN: El control del dolor en el postoperatorio inmediato de la artroplastia total de rodilla (ATR) es básico tanto para la precoz recuperación y movilidad de la extremidad como para el confort del paciente, puesto que se trata de una de las intervenciones más dolorosas que se realizan. Según los últimos estudios publicados, el bloqueo del nervio femoral, ya sea con una punción única o dejando un catéter con bloqueo continuo podría ser la técnica de elección para el control del dolor ...

  19. Effects of lumbosacral epidural ketamine and lidocaine inxylazine-sedated cats : article

    OpenAIRE

    R. DeRossi; A.P. Benites; J.Z. Ferreira; J.M.N. Neto; L.C. Hermeto

    2009-01-01

    In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1) ketamine (2.5 mg/kg), (2) lidocaine (4.0 mg/kg), and (3) ketamine (2.5 mg/kg) plus lidocaine (4.0 mg/kg). Epidural injections were administered through the lumbosacral space. Analgesia, motor block...

  20. Bloqueio do plexo lombar no compartimento do psoas para analgesia pós-operatória em cirurgias ortopédicas Lumbar plexus blockage on psoas compartment for postoperative analgesia after orthopaedic surgeries

    OpenAIRE

    Luiz Eduardo Imbelloni

    2008-01-01

    OBJETIVOS: O plexo lombar foi localizado entre os músculos quadrado lombar e psoas maior. O objetivo deste estudo foi avaliar a eficácia da injeção única de bupivacaína 0,25% através do bloqueio do compartimento do psoas na analgesia pós-operatória em pacientes de cirurgias ortopédicas. MÉTODO: Quarenta pacientes receberam bloqueio do plexo lombar no compartimento do psoas através da localização com estimulador de nervos e injeção de bupivacaína a 0,25%. Avaliou-se a analgesia e a intensidade...

  1. Comparação entre raquianestesia, bloqueio combinado raqui-peridural e raquianestesia contínua para cirurgias de quadril em pacientes idosos: estudo retrospectivo Comparación entre raquianestesia, bloqueo combinado raqui-peridural y raquianestesia continua para cirugías de cuadril en pacientes ancianos: estudio retrospectivo Comparison between spinal, combined spinal-epidural and continuous spinal anesthesias for hip surgeries in elderly patients: a retrospective study

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2002-06-01

    pacientes ancianos durante cuatro años, para determinar las posibles ventajas y desventajas de las tres técnicas. MÉTODO: Fueron evaluadas 300 fichas siendo que: 100 pacientes recibieron raquianestesia simple (Grupo 1, 100 recibieron bloqueo combinado raqui-peridural (Grupo 2 y 100 recibieron raquianestesia continua (Grupo 3 en los últimos cuatro años. Todos los bloqueos fueron realizados en decúbito lateral izquierdo. Fueron evaluados: suceso de punción, nivel de analgesia, bloqueo motor de miembros inferiores, calidad de la anestesia, necesidad de complementación, incidencia de fallas, parestesias, cefalea pós-punción, alteraciones cardiovasculares, confusión mental y delirium, transfusión sanguínea y mortalidad. RESULTADOS: No existe diferencia significativa entre los grupos en relación a la edad, peso y sexo. Los pacientes del grupo 2 fueron menores de que los del grupo 1 y 3. Las dosis utilizadas fueron de 15,30 mg de bupivacaína en el grupo 1; 23,68 mg en el grupo 2 y 10,10 mg en el grupo 3. No fue encontrada diferencia significativa (p BACKGROUND AND OBJECTIVES: There are still many questions involving study designs, data analyses and samples size which regard to the demonstration of the benefits of regional anesthesia on patients outcome. Database analysis and data acquisition in general cost less and require less time as compared to large randomized controlled trials. This retrospective study compares continuous spinal anesthesia, combined spinal-epidural and single shot spinal anesthesia for hip surgery in elderly patients during a 4-year period, to determine possible advantages and disadvantages of the three techniques. METHODS: Anesthetic records of 100 patients receiving spinal anesthesia (Group 1, 100 patients receiving combined spinal-epidural block (Group 2 and 100 patients receiving continuous spinal anesthesia (Group 3 over a 4-year period were analyzed. All blockades were performed with patients in the left lateral position. Evaluated

  2. Analgesia preemptiva nas cirurgias da coluna lombossacra: estudo prospectivo e randomizado Analgesia preventiva en las cirugías de la columna lumbosacra: estudio prospectivo y aleatorio Preemptive analgesia in lumbosacral spine surgeries: prospective randomized study

    Directory of Open Access Journals (Sweden)

    Augustin Malzac

    2009-06-01

    Full Text Available OBJETIVO: Analisar a eficácia da analgesia preemptiva pelo método da administração de analgésicos antes e após o início do estímulo doloroso operatório, comparando-as. A melhora do quadro doloroso pós-operatório nas cirurgias da coluna vertebral no segmento lombossacro, por via posterior, não tem sido completamente investigada. MÉTODOS: Sessenta e dois pacientes submetidos à microdiscectomia ou microdescompressão, em um único nível, na coluna lombossacra, foram divididos em três grupos, 20 pacientes no primeiro (A não receberam qualquer substância analgésica (controle. Vinte e dois no segundo (B, os quais foram submetidos à injeção epidural, 20 minutos antes da incisão cirúrgica, contendo 10 mL de marcaína e morfina. No terceiro e no último grupo (C com vinte pacientes, foi injetado, com auxílio de um cateter, no espaço epidural, as mesmas drogas do grupo B, através da incisão antes do fechamento da ferida operatória. Os pacientes foram examinados durante as primeiras 24 horas com auxílio da escala verbal de dor. RESULTADOS: Os três grupos foram comparados quanto à idade, sexo, nível e tempo cirúrgico. Os dados não obedeceram a uma distribuição Gaussiana, o teste não paramétrico de Mann-Whitney foi adotado para análise estatística. Desta maneira, os valores da escala verbal de dor, em todos os intervalos de tempo, foram significativamente baixos (pOBJETIVO: analizar la eficacia y comparar la analgesia preventiva por el método de la administración de analgésicos antes y después del inicio del estímulo doloroso operatorio. La mejoría del cuadro doloroso postoperatorio en las cirugías de la columna vertebral en el segmento lumbosacro, por vía posterior, no ha sido completamente investigada. MÉTODOS: sesenta y dos pacientes sometidos a la microdisección o microdescompresión, en un único nivel, en la columna lumbosacra fueron divididos en tres grupos. Veinte pacientes en el primer grupo (A no

  3. Postoperative analgesia in elderly patients.

    Science.gov (United States)

    Falzone, Elisabeth; Hoffmann, Clément; Keita, Hawa

    2013-02-01

    Elderly people represent the fastest-growing segment of our society and undergo surgery more frequently than other age groups. Effective postoperative analgesia is essential in these patients because inadequate pain control after surgery is associated with adverse outcomes in elderly patients. However, management of postoperative pain in older patients may be complicated by a number of factors, including a higher risk of age- and disease-related changes in physiology and disease-drug and drug-drug interactions. Physiological changes related to aging need to be carefully considered because aging is individualized and progressive. Assessment of pain management needs to include chronological age, biological age with regard to renal, liver and cardiac functions, and the individual profile of pathology and prescribed medications. In addition, ways in which pain should be assessed, particularly in patients with cognitive impairment, must be considered. Cognitively intact older patients can use most commonly used unidimensional pain scales such as the visual analogue scale (VAS), verbal rating scale (VRS), numeric rating scale (NRS) and facial pain scale (FPS). VRS and NRS are the most appropriate pain scales for the elderly. In older patients with mild to moderate cognitive impairment, the VRS is a better tool. For severe cognitively impaired older patients, behavioural scales validated in the postoperative context, such as Doloplus-2 or Algoplus, are appropriate. For postoperative pain treatment, most drugs (e.g. paracetamol, nonsteroidal anti-inflammatory drugs, nefopam, tramadol, codeine, morphine, local anaesthetics), techniques (e.g. intravenous morphine titration, subcutaneous morphine, intravenous or epidural patient-controlled analgesia, intrathecal morphine, peripheral nerve block) and strategies (e.g. anticipated intraoperative analgesia or multimodal analgesia) used for acute pain management can be used in older patients. However, in view of pharmacokinetic

  4. Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica Estudio comparativo entre la anestesia epidural torácica y la anestesia general en mastectomia oncológica Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia peridural torácica é utilizada com freqüência para procedimentos estéticos da mama e há poucos relatos de seu emprego para mastectomias com exploração axilar. O presente estudo comparou a técnica com anestesia geral em operações oncológicas da mama. MÉTODO: Quarenta pacientes foram divididas em dois grupos. No grupo peridural (n = 20 foi realizada peridural torácica com bupivacaína e fentanil associada à sedação com midazolam. O outro grupo (n = 20 recebeu anestesia geral convencional com propofol, atracúrio e fentanil e manutenção com O2 e isoflurano. Registraram-se no intra-operatório duração da operação, necessidade de complementação da anestesia ou da sedação e variáveis hemodinâmicas. No pós-operatório, foram registrados o tempo para alta da sala de recuperação pós-anestésica e hospitalar, a intensidade da dor e o consumo de analgésicos, os efeitos adversos e a satisfação com a técnica anestésica. RESULTADOS: Os grupos foram semelhantes e não houve diferença na duração da operação. Foi necessário complementar a sedação em 100% das pacientes que receberam anestesia peridural e em 15% foi complementada a analgesia com infiltração de anestésico local na axila. Houve maior incidência de hipertensão arterial no grupo da anestesia geral e de hipotensão entre as que receberam peridural. Ocorreu prurido em 55% das pacientes com anestesia peridural. Náusea (30% e vômito (45% foram mais freqüentes entre as que receberam anestesia geral. A analgesia pós-operatória teve melhor qualidade e o consumo de analgésicos foi menor no grupo da anestesia peridural. O período de internação também foi menor. CONCLUSÕES: A técnica peridural tem algumas vantagens com relação à anestesia geral e pode ser considerada uma opção para anestesia em mastectomias oncológicas com esvaziamento axilar.JUSTIFICATIVA Y OBJETIVOS: La anestesia epidural torácica se

  5. Effect of epidural 0.25% bupivacaine on somatosensory evoked potentials to dermatomal stimulation

    DEFF Research Database (Denmark)

    Lund, C; Hansen, O B; Kehlet, H

    1989-01-01

    The effect of lumbar epidural analgesia with similar volumes (about 25 ml) of 0.25% and 0.5% bupivacaine on early (less than 0.5 seconds) somatosensory evoked potentials (SEPs) to electrical stimulation of the S1, L1, and T10 dermatomes was examined in two groups of ten patients. Level of sensory...

  6. Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy

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    Sandeep Kundra

    2014-01-01

    Full Text Available Background: Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use. Materials and Methods: One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml was contoured to be placed in the epidural space whereas, in group II, gelfoam soaked in saline was placed in the epidural space and 5 mg morphine (1mg/ml was instilled over the intact epidural space. Analgesic consumption for 48 hours, time-of first analgesic request, time of ambulation, time of discharge from post anesthesia care unit (PACU and hospital and adverse effects were recorded. The data was analyzed using appropriate statistical tests. Results: Mean analgesic consumption in 48 hours was significantly less in group I (8.47 ± 3.674 mg as compared to group II (24.80 ± 6.009 mg. Supplemental analgesia was requested at 30.03 ± 6.796 hours in Group I, vs 10.25 ± 2.243 in group II (P 0.01. Conclusion: Epidural application of morphine soaked in gelfoam is an effective method for prolonging the postoperative analgesia after spine surgery.

  7. Sedation with Xylazine-Diazepam and Epidural Administration of Lidocaine and Xylazine for Castration and Ovariohysterectomy in Cats

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    Bizhan Ziaei

    2010-06-01

    Full Text Available The aim of this study was to determine whether anesthesia consisting of sedation induced by intramuscular administration of xylazine-diazepam and lumbosacral analgesia induced by epidural administration of lidocaine and xylazine is satisfactory for castration and ovariohysterectomy in cats. Six adult (3 male and 3 female, 2.5 ± 0.5 years of age cats (mean body weight ± SD, 2.2 ± 0.44 kg were used in this study. Cats were sedated with xylazine (1-2 mg kg-1 IM and diazepam (0.2 mg kg-1, IM and 5 minutes later a 2% solution of lidocaine (0.5ml/4.5kg and xylazine (1 mg kg-1 were administered into the lumbosacral epidural space. Open castration technique or ventral midline routine ovariohysterectomy were performed. Time to onset, duration and cranial spread of analgesia were recorded. Heart rate, respiratory rate and rectal temperature were recorded at time 0 (prior to epidural drugs administration as a base line values and at 10, 20, 30, 45 and 60 minutes after the epidural administration. Onset time of analgesia was 4.0 ± 0.63 min (Mean ± SEM and duration of analgesia was 89.5 ± 3.0 min (Mean ± SEM. However, surgical procedures were completed within 25-37 min. There were significant decrease in heart rate and rectal temperature values and significant increase in respiratory rate (P < 0.001. Intramuscular administration of xylazine-diazepam for sedation and epidural administration of lidocaine and xylazine for analgesia provided satisfactory analgesia for castration and ovariohysterectomy in cats. Utilizing epidural anesthetic technique with this combination is most useful for spaying surgery, especially when the surgical procedure can be completed in < 40 minutes.

  8. Identificación de factores predictores de técnica epidural dificultosa en la paciente obstétrica

    Directory of Open Access Journals (Sweden)

    L. M. Charco Roca

    2013-10-01

    Full Text Available Introducción: Los intentos repetidos de punción son factores de riesgo para la aparición de complicaciones neurológicas secundarias a la práctica de la analgesia espinal y aumentan la ansiedad del paciente. El objetivo de este estudio es determinar qué factores son mejores predictores de la colocación dificultosa del catéter epidural en la paciente obstétrica. Material y método: Estudio observacional y prospectivo en 120 gestantes a término que solicitan la analgesia epidural para el trabajo de parto. Se recogen variables demográficas y antecedentes de anestesia espinal previa no exitosa o considerada dificultosa por la paciente. Se identifican variables anatómicas y se clasifica la calidad de los puntos de referencia anatómicos según los criterios publicados por Chien en cuatro grados. Las condiciones de la técnica y la experiencia del anestesiólogo son similares en todos casos. Consideramos punción dificultosa si se necesita más de una punción en la piel o una punción pero más de un cambio de dirección de aguja en el espacio interespinoso. Se recoge el éxito obtenido y las complicaciones de la técnica. Resultados: Fueron calificadas de punción difícil según los criterios del estudio en el 36,67 % de los casos. En la mayoría de los casos la técnica fue efectiva obteniendo una adecuada analgesia. La incidencia de repunción epidural fue de 5 %. En las pacientes clasificadas en el grado 4, la tasa de punción epidural considerada dificultosa supuso un 90 %, necesitando en el 80 % de esos casos 3 o más intentos. En las pacientes con antecedentes personales de técnica neuroaxial dificultosa se encontró dificultad de punción epidural en un 28,57 % de los casos. El hábito corporal no tuvo efecto significativo sobre la tasa de éxito con el primer intento. Discusión: Nuestro estudio representa una buena estimación de la dificultad técnica de un bloqueo neuroaxial. Seria difícil saber si los datos reflejados ser

  9. Efeito da adição de clonidina subaracnóidea à solução anestésica de sufentanil e bupivacaína hiperbárica ou hipobárica para analgesia de parto Efecto de la adición de clonidina subaracnoidea a la solución anestésica de sufentanil y bupivacaína hiperbárica o hipobárica para la analgesia de parto Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia

    OpenAIRE

    Thaís Cristina Tebaldi; Luíz Marcelo Sá Malbouisson; Kondo, Mario M.; Mônica M. S. C. Cardoso

    2008-01-01

    JUSTIFICATIVA E OBJETIVOS: Adição de clonidina subaracnóidea (±-agonista) prolonga a ação analgésica da combinação sufentanil e bupivacaína isobárica em analgesia combinada para o trabalho de parto ¹. O objetivo deste estudo foi comparar a qualidade de analgesia e a prevalência de efeitos colaterais após a adição de clonidina subaracnóidea à solução anestésica em gestantes durante trabalho de parto. MÉTODO: Após aprovação da Comissão de Ética, 22 gestantes em trabalho de parto receberam aleat...

  10. Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine.

    OpenAIRE

    M Jahangiri; Jayatunga, A. P.; Bradley, J. W.; Dark, C. H.

    1994-01-01

    Phantom limb pain may appear in up to 85% of patients after amputation. There is no effective treatment. Perioperative epidural infusion of morphine and bupivacaine, alone or in combination, is effective in preventing phantom limb pain in patients with pre-existing limb pain. Serious side-effects, however, make them difficult to manage on a general ward. Clonidine has been shown to be an effective postoperative analgesia when applied epidurally. To mitigate the potentially serious side-effect...

  11. Efficacy of caudal epidural injection of lidocaine, xylazine and xylazine plus hyaluronidase in reducing discomfort produced by electroejaculation in bulls

    OpenAIRE

    PAGLIOSA, Ronaldo C.; DEROSSI, Rafael; COSTA, Deiler S.; FARIA, Fabio J.C.

    2015-01-01

    To test the hypothesis that epidural administration of lidocaine, xylazine or xylazine plus hyaluronidase provides reduced pain and stress during electroejaculation in bulls, eight 30-month-old Nellore bulls received saline solution (control), 2% lidocaine, 2% xylazine or 2% xylazine plus hyaluronidase injected into the first intercoccygeal (Co1–Co2) epidural space in randomized order. Heart rate, respiratory rate, mean arterial pressure, analgesia, animal behavior and motor blockade were eva...

  12. Epidural anesthesia for laparoscopic cholecystectomy in a patient with sickle cell anemia, beta thalassemia, and Crohn's disease -A case report-

    OpenAIRE

    Baş, Sema Şanal; Özlü, Onur

    2012-01-01

    A 37-year-old woman diagnosed with sickle cell anemia (SCA), beta (+) thalassemia, Crohn's disease, and liver dysfunction was scheduled for laparoscopic cholecystectomy (LC) due to acute cholecystitis with gall bladder. Regional anesthesia was performed. An epidural catheter was inserted into the 9-10 thoracal epidural space and then 15 ml of 0.5% bupivacaine was injected through the catheter. The level of sensorial analgesia tested with pinprick test reached up to T4. Here we describe the fi...

  13. Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

    Directory of Open Access Journals (Sweden)

    Raheleh Aligholipour Maleki

    2011-08-01

    Full Text Available Introduction: Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may re-quire such high dose that they produce respiratory depression, especially in el-derly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. Methods: sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or inter-costal block with %0.25 bupivacaine. The patients were assessed through ICU and hos-pital stay length, ventilation function tests. Pain score among the patients was meas-ured with verbal rating scale, before and after administration of the analgesia. Results: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P < 0.004. Changes in the visual Analogue Scale were associated with marked improvement re-garding pain at rest and pain caused by coughing and deep breathing in group A com-pared group B... ICU and hospital stay markedly reduced in Group A. Conclusion: tho-racic epidural analgesia is superior to intercostals block regarding pain relief of rib frac-tures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

  14. Influencia del empleo de opioides epidurales durante el parto Impact of the use of epidural opiates during labour

    Directory of Open Access Journals (Sweden)

    A. Domínguez Ruiz-Huerta

    2005-09-01

    Full Text Available Objetivos: Analizar la relación entre el empleo de opioides en la analgesia epidural obstétrica y su posible repercusión sobre la evolución y finalización del parto, así como sobre diversas variables obstétrico-fetales. Material y métodos: Estudio retrospectivo y observacional que incluyó a todas las mujeres que dieron a luz en el Complejo Hospitalario de Segovia durante un periodo de 8 meses. La analgesia epidural obstétrica, cuando se administró, consistió en una perfusión de bupivacaína al 0,125% más fentanilo a 2 µg.mL-1 (grupo F, o en una perfusión de bupivacaína al 0,125% (grupo B. Se recogieron los siguientes parámetros: edad, nuliparidad, administración de analgesia epidural (sí/no, tipo de parto, duración de la dilatación, duración del expulsivo, causa de la cesárea, peso fetal, test de Apgar y pH arterial umbilical fetal. Resultados: Se recogieron datos de 576 mujeres. Se administró analgesia epidural en el 47,7% de las parturientas, de las cuales 29,4% recibieron fentanilo en la perfusión continua. La duración de los periodos de dilatación y expulsivo fue más larga en las mujeres con analgesia epidural (p = 0,01 y p = 0,03, respectivamente, con independencia de que recibieran o no opioides epidurales. La analgesia epidural con y sin opioides también se asoció a un mayor riesgo de parto instrumental (28%; p = 0,006, pero no a un incremento de la tasa de cesáreas. Las pacientes que recibieron opioides epidurales presentaron fiebre intraparto en el 12,8% de los casos, frente al 7,1% de las que sólo recibieron bupivacaína en la perfusión. Estas diferencias no se mostraron estadísticamente significativas. Conclusiones: La analgesia epidural durante el parto no modificó el bienestar fetal ni la tasa de partos mediante cesárea, pero sí alteró la dinámica del parto, provocando una prolongación de las fases del mismo, mayor número de partos instrumentados y una alteración en la regulación de la

  15. Analgesia caudal continua guiada por ultrasonido en una paciente de 4 años Caudal anesthesia ultrasound-guided continuos flow in patient 4 years

    Directory of Open Access Journals (Sweden)

    A. Beltrán Franco

    2013-02-01

    Full Text Available La epidural caudal es la técnica más popular en anestesia y analgesia regional pediátrica. El empleo de una guía ecográfica en este procedimiento, aunque aún no es un estándar, podría disminuir los riesgos inherentes a la técnica tradicional y ofrecer algunas ventajas. Nosotros describimos el caso de una niña de 4 años sometida a una resección de un rabdomiosarcoma en muslo izquierdo con metástasis ganglionar inguinal e implantación de catéteres para braquiterapia; a quien se le colocó un catéter caudal para analgesia postoperatoria continua, usando la ultrasonografía (US como método para guiar la colocación de dicho catéter. Después de inducir anestesia general, se realizó un escaneo ecográfico previo de la zona sacra identificando la anatomía, posteriormente después de implementar las medidas antisépticas y asépticas se colocó un catéter caudal guiado por US en tiempo real y con modo Doppler color se confirmó la posición en el espacio epidural caudal al inyectar una dosis en bolo de mezcla anestésica. Se presentó un adecuado control del dolor postoperatorio. El uso de US es una excelente alternativa a las técnicas clásicas fundamentadas en anatomía para la inserción de catéteres epidurales continuos en pediatría y permite ciertas ventajas que las técnicas a ciegas no pueden brindar.Caudal epidural is the most popular regional analgesia and anesthesia technique in pediatrics. The use of ultrasound (US guidance in this procedure, is not yet the standard, but could reduce the risks related with the traditional approach and offer some advantages. We described a case of a 4-years-old patient undergoing a resection of a rabdomyosarcome on the left thigh plus inguinal metastatic nodes and implantation of brachitherapy catheters, in whom a continous caudal epidural catheter was placed under US guidance. After general anesthesia induction, a scout scanning identified the anatomy and afterwards, using strict

  16. Laparoscopic cholecystectomy under epidural anesthesia: A feasibility study

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    Ranendra Hajong

    2014-01-01

    Full Text Available Background: Laparoscopic cholecystectomy (LC is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia. Aims: The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated. Materials and Methods: In all, 20 patients with the American Society of Anesthesiologist′s class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study. Results: The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia. Conclusions: The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.

  17. Effects of lumbosacral epidural ketamine and lidocaine in xylazine-sedated cats.

    Science.gov (United States)

    DeRossi, R; Benites, A P; Ferreira, J Z; Neto, J M N; Hermeto, L C

    2009-06-01

    In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1) ketamine (2.5 mg/kg), (2) lidocaine (4.0 mg/kg), and (3) ketamine (2.5 mg/kg) plus lidocaine (4.0 mg/kg). Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, heart rate, arterial blood pressure, respiratory rate and arterial oxygen saturation were measured. Rectal temperature was compared before and after sedation as well as after epidural administration of the drugs. Epidural administration of the ketamine/lidocaine combination induced prolonged analgesia extending from the coccygeal to the T13-L1 dermatomes, leading to severe ataxia. Cardiovascular effects were significant in all treatments: heart rate decreased, but there was a minimal reduction in arterial pressure. It was concluded that adding a dose of ketamine to epidural lidocaine in cats is feasible and effective. PMID:19831267

  18. Effects of lumbosacral epidural ketamine and lidocaine inxylazine-sedated cats : article

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    R. DeRossi

    2009-05-01

    Full Text Available In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1 ketamine (2.5 mg/kg, (2 lidocaine (4.0 mg/kg, and (3 ketamine (2.5 mg/kg plus lidocaine (4.0 mg/kg. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, heart rate, arterial blood pressure, respiratory rate and arterial oxygen saturation were measured. Rectal temperature was compared before and after sedation as well as after epidural administration of the drugs. Epidural administration of the ketamine/lidocaine combination induced prolonged analgesia extending from the coccygeal to the T13-L1 dermatomes, leading to severe ataxia. Cardiovascular effects were significant in all treatments: heart rate decreased, but there was a minimal reduction in arterial pressure. It was concluded that adding a dose of ketamine to epidural lidocaine in cats is feasible and effective.

  19. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique.

    Science.gov (United States)

    Dillon, John P; Brennan, Louise; Mitchell, David

    2012-04-01

    The optimal form of post-operative analgesia in hip and knee arthroplasty is still debated. Traditionally, patient-controlled analgesia and epidural anaesthesia were used. Potential side-effects such as nausea, confusion, urinary retention, hypotension and immobility have resulted in the emergence of newer techniques that limit opioid use. Peripheral nerve blockade provides excellent analgesia but limits patient ability to ambulate in the immediate post-operative period. Local infiltrative analgesia (LIA) is an emerging technique that has shown to provide superior analgesia, higher patient satisfaction and earlier discharge from hospital when compared to some of the more traditional methods. This review article highlights the advantages of LIA in hip and knee arthroplasty surgery. We describe the technique used, including additional measures that aid early ambulation and discharge from hospital in this cohort of patients. PMID:22696983

  20. [Labor analgesia in the US and Japan].

    Science.gov (United States)

    Morishima, Hisayo O

    2007-09-01

    Obstetric anesthesia has made significant progress over the last 50 years. It is one of the major subspecialties in anesthesia in US. Society for Obstetric Anesthesia and Perinatology (SOAP) was founded in 1968. According to its SCORE project on the practice of obstetric anesthesia, 82.4% of all parturients received some form of anesthesia for cesarean section or labor analgesia. Epidural analgesia was the most common form of labor analgesia (65%), followed by CSEA. This high percentage of anesthesia care for parturients mandates the presence of obstetric anesthesiologists at labor and delivery suites in major hospitals in US. The Japanese Society of Obstetrics and Anesthesia, formerly "Mutsu-bunben Kenkyukai", now called "Bunben to Masui Kenkyukai", was founded in Japan at about the same time as SOAP. Despite its long history, obstetric anesthesia is yet to be a major subspecialty in Japan. It is encouraging, however, that the number of attendants in obstetric anesthesia sessions in JSA seems increasing. SOAP has played an important role in the education and progress of obstetric anesthesia in US. I hope that the joint symposium of SOAP, Bunben to Masui Kenkyukai, and JSA at 39th SOAP annual meeting will facilitate the progress of obstetric anesthesia in Japan. PMID:17877044

  1. Efficacy of low-dose epidural anaesthesia in surgery of the anal canal--a randomised controlled trial.

    Science.gov (United States)

    Kausalya, R; Jacob, R

    1994-04-01

    The aim of the study was to compare in terms of patient comfort, surgical requirements and anaesthetic safety, the difference between epidural and general anaesthesia in patients undergoing surgery of the anal canal. The study was undertaken on 50 adult patients undergoing anal surgery. By random allocation 25 were given a general anaesthetic while 25 were given a low-dose epidural using 0.375% bupivacaine. Advantages and disadvantages of both methods were noted in the study. It was concluded that low-dose epidural is a more effective means of providing analgesia, while maintaining adequate sphincter tone for surgery on the anal canal, than general anaesthesia. PMID:8210019

  2. Cetamina e analgesia preemptiva Cetamina y analgesia preemptiva Ketamine and preemptive analgesia

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    Caio Márcio Barros de Oliveira

    2004-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Desde a descoberta de que a cetamina bloqueia os receptores NMDA nos neurônios do corno dorsal da medula, ela tem sido usada para inibir ou reduzir a sensibilização central provocada por estímulos nociceptivos. Assim, este trabalho visa mostrar aspectos farmacológicos da cetamina racêmica e de seu composto levogiro e seu emprego na analgesia preemptiva. CONTEÚDO: São apresentados conceitos atuais sobre analgesia preemptiva, aspectos farmacológicos da cetamina e seu derivado levogiro, bem como estudos experimentais e clínicos sobre a cetamina e seu uso em analgesia preemptiva. CONCLUSÕES: Ainda não está totalmente comprovada a eficácia da cetamina em inibir ou reduzir a sensibilização central provocada por estímulos nociceptivos. Provavelmente isso se deva ao uso de diferentes métodos de estudo e de análise estatística.JUSTIFICATIVA Y OBJETIVOS: Desde la descubierta de que la cetamina bloquea los receptores NMDA en los neuronios del cuerno dorsal de la médula, ella ha sido usada para inhibir o reducir la sensibilización central provocada por estímulos nociceptivos. Así, este trabajo tiene por finalidad mostrar aspectos farmacológicos de la cetamina racemica y de su compuesto levogiro y su empleo en la analgesia preemptiva. CONTENIDO: Se presentan conceptos actuales sobre analgesia preemptiva, aspectos farmacológicos de la cetamina y su derivado levogiro, bien como estudios experimentales y clínicos sobre la cetamina y su uso en analgesia preemptiva. CONCLUSIONES: Aun no está totalmente comprobada la eficacia de la cetamina en inhibir o reducir la sensibilización central provocada por estímulos nociceptivos. Probablemente eso se deba al uso de diferentes métodos de estudio y de análisis estadística.BACKAGROUND AND OBJECTIVES: Since the finding that ketamine blocks NMDA receptors in the neurons of spinal dorsal horn, it has been used to inhibit or decrease central sensitization triggered

  3. Spontaneous spinal epidural abscess.

    LENUS (Irish Health Repository)

    Ellanti, P

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  4. Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência do fentanil associado ao anestésico local na qualidade do bloqueio e na analgesia pós-operatória Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia del fentanil asociado al anestésico local en la calidad del bloqueo y en la analgesia pos-operatoria Extraconal block for cataract extraction surgery with implantation of intraocular lens: contribution of fentanyl associated to local anesthetics for quality of block and postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Daniel Espada Lahoz

    2003-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia locorregional para cirurgias oftalmológicas oferece vantagens, como: mínimas alterações fisiológicas, anestesia completa, bloqueio dos reflexos oculares, pequena incidência de náuseas e vômitos, menor tempo de recuperação e analgesia pós-operatória. A preocupação constante com a qualidade do bloqueio, assim como da abordagem da analgesia pós-operatória deve ficar sob a responsabilidade do anestesiologista. O objetivo deste estudo foi avaliar se o fentanil contribui na qualidade do bloqueio extraconal e na analgesia pós-operatória de facectomias com implante de lente intra-ocular. MÉTODO: Estudou-se a associação do fentanil e bupivacaína a 0,75% na qualidade do bloqueio ocular e na analgesia pós-operatória em 164 pacientes submetidos a facectomia com implante de lente intra-ocular (técnica extracapsular, de ambos os sexos com homogeneidade de parâmetros antropométricos, olho operado, classificação do estado físico (ASA e índice de risco cardíaco de Goldman. Os pacientes foram distribuídos em dois grupos (82 pacientes em cada grupo por sorteio de forma aleatória, com e sem fentanil. Avaliou-se a qualidade do bloqueio por: aparecimento da dor no per-operatório, manutenção de movimentação das pálpebras ou do globo ocular, persistência do reflexo de Bell, número de bloqueios realizados para a obtenção de condições cirúrgicas e avaliação do bloqueio pelo cirurgião. A analgesia pós-operatória foi avaliada pela necessidade de complementação analgésica pelo paciente. RESULTADOS: Fentanil associado à solução anestésica no bloqueio extraconal aumentou significativamente o bloqueio do músculo reto medial (com fentanil - 17,1%, sem fentanil - 32,9% e diminuiu o consumo de analgésicos no período pós-operatório (uso de analgésicos com fentanil - 20,7%, não uso de analgésicos com fentanil - 41,5%. CONCLUSÕES: Nas condições deste estudo o fentanil

  5. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal Analgesia postoperatoria para procedimientos quirúrgicos ortopédicos de cadera y fémur: comparación entre bloqueo del compartimiento del psoas y bloqueo perivascular inguinal Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks

    OpenAIRE

    Luiz Eduardo Imbelloni; Lúcia Beato; Carolina Beato; José Antônio Cordeiro

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: Este estudo avaliou a eficácia da injeção única de bupivacaína a 0,25% no compartimento do psoas ou perivascular inguinal por meio do estimulador de nervos periféricos para analgesia pós-operatória em pacientes submetidos a intervenções cirúrgicas ortopédicas. MÉTODO: Cem pacientes receberam bloqueio do plexo lombar através do compartimento do psoas e foram comparados com 100 pacientes que receberam bloqueio do plexo lombar via perivascular inguinal, identificados p...

  6. Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Jung, Young Jin [Soonchunhyang University, Gumi Hospital, Gumi (Korea, Republic of); Goo, Dong Erk; Jang, Yun Woo [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2006-04-15

    We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 {mu} m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

  7. Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

    International Nuclear Information System (INIS)

    We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 μ m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

  8. Continuous shoulder analgesia via an indwelling axillary brachial plexus catheter.

    Science.gov (United States)

    Reuben, S S; Steinberg, R B

    2000-09-01

    Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. In the first case report, previous neck surgery made the anatomic landmarks for performing an interscalene block very difficult. An epidural catheter was advanced from the axillary brachial plexus sheath to the interscalene space under fluoroscopic guidance. This technique provided both intraoperative analgesia for shoulder surgery as well as 24-hour postoperative analgesia by an infusion of 0.125% bupivacaine. In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted. PMID:11090734

  9. Low-dose spinal neostigmine further enhances the analgesic effect of spinal bupivacaine combined with epidural dexamethasone, following orthopedic surgery

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    Gabriela Rocha Lauretti

    2014-01-01

    Full Text Available Background: Opioids are considered mainstream for combined spinal-epidural anesthesia, but frequently limited by adverse effects. The aim of this study was to examine whether low-dose spinal neostigmine, epidural dexamethasone or their combination enhances analgesia from spinal bupivacaine without adverse effects. Materials and Methods : A total of 60 patients undergoing orthopedic surgery were randomized to one of four groups and evaluated for 24-h after surgery for analgesia (time to first rescue analgesic and rescue analgesic consumption. Patients received 15 mg bupivacaine plus the test drug intrathecally (saline or 1 microgram (μg neostigmine. The epidural test drug was either saline or 10 mg dexamethasone. The Control group (CG received spinal and epidural saline. The Neostigmine group (NG, spinal neostigmine and epidural saline; the Dexamethasone group (DG, spinal saline and epidural dexamethasone; and the Neostigmine-dexamethasone group (NDG, spinal neostigmine and epidural dexamethasone. Results: The CG (282 ± 163 min and NG (524 ± 142 min were similar in their times to first rescue analgesic and analgesic consumption. The time to first rescue analgesic was longer for the DG (966 ± 397 min compared with CG and NG (P < 0.0002, and the DG had less ketoprofen consumption and lower overall visual analogue scale-pain sores compared with CG and NG (P < 0.0005. Addition of 1 mg-neostigmine (NDG resulted in longer time to rescue analgesic (1205 ± 303 min; P < 0.02 and lower ketoprofen consumption (P < 0.05 compared to DG. Sporadic cases of vesical catheterization and emesis were observed, however adverse effects were similar among groups. Conclusion: Spinal 1 microgram (μg neostigmine further enhanced analgesia from spinal bupivacaine combined with epidural dexamethasone, without increasing the incidence of adverse effects.

  10. A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats.

    Science.gov (United States)

    Lawal, F M; Adetunji, A

    2009-12-01

    A mixture of 2% lignocaine (LIG) and 0.5% bupivacaine (BUP), at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP), was compared to LIG (4 mg/kg) and BUP (1 mg/kg) for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg) and ketamine hydrochloride (10 mg/kg). Onset and duration of analgesia, and time to walking were determined. Associated changes in heart rate (HR), respiratory frequency (fR) and rectal temperature (RT) were recorded. Onset of analgesia with epidurally administered LIG-BUP (4.5 +/- 0.7 min), LIG (3.9 +/- 1.0 min) and BUP (5.0 +/- 1.0 min) was similar. Duration of analgesia with LIG-BUP (49.4 +/- 4.5 min) was significantly (P<0.05) longer than with LIG (40.2 +/- 1.0 min) but shorter than with BUP (79.4 +/- 6.3 min). There were no significant differences in times to standing with LIG-BUP (26.3 +/- 6.4 min), LIG (20.4 +/- 4.7 min) and BUP (22.6 +/- 10.3 min). Minimal changes were observed in HR, fR and RT. In conclusion, duration of analgesia produced by LIG-BUP was shorter compared with BUP but longer compared with LIG. Neither LIG nor LIG-BUP has any advantage over epidural BUP in terms of onset of analgesia, time to standing and physiological responses. Therefore, lumbosacral epidural administration of BUP appears to be the best choice for a long surgical procedure lasting more than 1 hour when compared with either LIG or LIG-BUP. PMID:20458866

  11. A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats

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    F.M. Lawal

    2009-05-01

    Full Text Available A mixture of 2% lignocaine (LIG and 0.5% bupivacaine (BUP, at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP, was compared to LIG (4 mg/kg and BUP (1 mg/kg for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg and ketamine hydrochloride (10 mg/kg. Onset and duration of analgesia, and time to walking were determined. Associated changes in heart rate (HR, respiratory frequency (ƒR and rectal temperature (RT were recorded. Onset of analgesia with epidurally administered LIG-BUP (4.5 ± 0.7 min, LIG (3.9 ± 1.0 min and BUP (5.0 ± 1.0 min was similar. Duration of analgesia with LIG-BUP (49.4 ± 4.5 min was significantly (P < 0.05 longer than with LIG (40.2 ± 1.0 min but shorter than with BUP (79.4 ± 6.3 min. There were no significant differences in times to standing with LIG-BUP (26.3 ± 6.4 min, LIG (20.4 ± 4.7 min and BUP (22.6 ± 10.3 min. Minimal changes were observed in HR, ƒR and RT. In conclusion, duration of analgesia produced by LIG-BUP was shorter compared with BUP but longer compared with LIG. Neither LIG nor LIG-BUP has any advantage over epidural BUP in terms of onset of analgesia, time to standing and physiological responses. Therefore, lumbosacral epidural administration of BUP appears to be the best choice for a long surgical procedure lasting more than 1 hour when compared with either LIG or LIG-BUP.

  12. Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente Comparación de la morfina administrada por vía intravenosa y vía epidural con /sin bupivacaína o ropivacaína en el tratamiento del dolor pos toracotomía con la técnica de analgesia controlada por el paciente Comparison of intravenous morphine, epidural morphine with/without bupivacaine or ropivacaine in postthoracotomy pain management with patient controlled analgesia technique

    Directory of Open Access Journals (Sweden)

    Esra Mercanoğlu

    2013-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo randomizado, duplo-cego e prospectivo foi determinar a eficácia e os efeitos colaterais da administração por via intravenosa ou epidural de morfina, bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia. MÉTODOS: Sessenta pacientes submetidos a procedimentos de toracotomia eletiva foram randomicamente alocados em quatro grupos com o uso da técnica de envelopes lacrados. Os grupos MIV, ME, MEB e MER receberam morfina controlada pelo paciente por via intravenosa, e morfina, morfina-bupivacaína e morfina- ropivacaína epidural, respectivamente. Frequência cardíaca, pressão arterial e saturação de oxigênio perioperatórias e dor pós-operatória em repouso e durante a tosse, efeitos colaterais e necessidade de analgésicos de resgate foram registrados aos 30 e 60 minutos e em duas, quatro, seis, 12, 24, 36, 48 e 72 horas. RESULTADOS: A necessidade de sódio diclofenaco durante o estudo foi menor no grupo ME. A área sob a curva de tempo na VAS foi menor no grupo ME em comparação com o Grupo MIV, mas similar aos Grupos MEB e MER. Os escores de dor em repouso foram maiores nos tempos 12, 24, 36 e 48 horas no Grupo MIV em comparação com o Grupo ME. Os escores de dor em repouso foram maiores aos 30 e 60 minutos nos Grupos ME e MIV em comparação com o Grupo MEB. Os escores de dor durante a tosse aos 30 minutos foram maiores no grupo ME em comparação com o Grupo MEB. Não houve diferença entre os Grupos MIV e MER. CONCLUSÕES: Morfina administrada por via epidural foi mais eficaz do que por via intravenosa. A eficácia foi maior no grupo EM no período pós-operatório tardio e no Grupo MEB no período pós-operatório inicial. Concluímos que morfina administrada por via epidural foi a mais eficaz e preferida.JUSTIFICATIVA Y OBJETIVOS: El objetivo de este estudio aleatorio, doble ciego y prospectivo fue determinar la eficacia y los efectos colaterales de la administraci

  13. Anestesia peridural contínua com ropivacaína a 0,2% associada a anestesia geral para cirurgia do abdômen superior em crianças Anestesia peridural contínua con ropivacaína a 0,2% asociada a anestesia general para cirugía del abdomen superior en niños Continuous epidural anesthesia with 0.2% ropivacaine associated to general anesthesia for upper abdominal surgery in children

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2003-04-01

    el grupo Propofol, sin embargo, la intensidad y duración de la sedación fueron mayores en ese grupo en relación al grupo Sufentanil. Los escores de recuperación fueron similares en los dos grupos. Después de 3 horas en la SRPA, todos los pacientes habían llegado a los criterios de transferencia para las enfermarías. Hipotensión arterial transitoria fue observada en 2 pacientes del grupo Sufentanil. CONCLUSIONES: La combinación de la anestesia peridural torácica continua con ropivacaína a 0,2% (1,5 ml.kg-1 asociada a la infusión de propofol promueve anestesia efectiva y segura para cirugías abdominales altas en niños. El ritmo de infusión de propofol y el tiempo de sedación fueron reducidos con la adición de sufentanil.BACKGROUND AND OBJECTIVES: Several anesthetic techniques have been proposed for different pediatric surgeries to promote postoperative analgesia, among other advantages. This study aimed at evaluating propofol infusion rate and postanesthetic recovery of children submitted to upper abdominal surgeries under epidural anesthesia with 0.2% ropivacaine associated to general anesthesia with propofol or propofol plus sufentanil. METHODS: Participated in this study 26 children physical status ASA I, II and III, aged 0 to 4 years, were scheduled to upper abdominal surgeries under thoracic epidural anesthesia (T7-T8 with 0.2% ropivacaine (1.5 ml.kg-1. They were randomly distributed in two groups: Propofol (propofol infusion and Sufentanil (propofol infusion plus 1 µg.kg-1 sufentanil. Propofol infusion rates were 20 and 10 mg.kg-1.h-1 for the Propofol and Sufentanil groups, respectively, adjusted to maintain blood pressure in approximately 20% of baseline values and withdrawn 10 to 15 minutes before estimated surgery completion. Postanesthetic recovery was evaluated by a modified Aldrete-Kroulik scale and sedation was evaluated by a 5 grade score. RESULTS: Techical difficulties excluded two children of each group. Infusion rate was significantly

  14. AVALIAÇÃO DE SEGURANÇA E ANALGESIA DE PROTOCOLOS ANESTÉSICOS PARA ELETROEJACULAÇÃO EM GATOS DOMÉSTICOS (Felis catus)

    OpenAIRE

    TICIANA FRANCO PEREIRA DA SILVA; CARLOS GABRIEL ALMEIDA DIAS; CAMILA LOUISE ACKERMANN; FRANCISCO TIAGO SILVA PINHEIRO; ANA CRISTINA PAULINO BRAGA; LÚCIA DANIEL MACHADO DA SILVA

    2011-01-01

    The objective of this study was to evaluate the security and analgesia of anesthetics protocols usually used for electroejaculation (EEJ) in domestic cats. Fourteen toms were anesthetized with 4 protocols and submitted to a 3 series of electric stimuli (2-6 mA). The heart rate, respiratory rate, temperature, pain sensibility and eyes blink were analyzed prior and after induction, and during and after electroejaculation. The anesthesia protocol thatused isoflurane was the best for analgesic pa...

  15. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal Analgesia postoperatoria para procedimientos quirúrgicos ortopédicos de cadera y fémur: comparación entre bloqueo del compartimiento del psoas y bloqueo perivascular inguinal Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2006-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Este estudo avaliou a eficácia da injeção única de bupivacaína a 0,25% no compartimento do psoas ou perivascular inguinal por meio do estimulador de nervos periféricos para analgesia pós-operatória em pacientes submetidos a intervenções cirúrgicas ortopédicas. MÉTODO: Cem pacientes receberam bloqueio do plexo lombar através do compartimento do psoas e foram comparados com 100 pacientes que receberam bloqueio do plexo lombar via perivascular inguinal, identificados pelo estimulador de nervos periféricos com a injeção de 40 mL bupivacaína a 0,25% sem epinefrina. A analgesia nos nervos ilioinguinal, genitofemoral, cutâneo femoral lateral, femoral e obturatório foi avaliada 4, 8, 12, 16, 20 e 24 horas após o final da intervenção cirúrgica. A intensidade da dor foi também avaliada no mesmo período. A quantidade de opióides administrada no pós-operatório foi anotada. Em cinco pacientes de cada grupo, estudo radiográfico com contraste não-iônico foi realizado para avaliar a dispersão da solução anestésica. RESULTADOS: Os nervos ilioinguinal, genitofemoral, cutâneo femoral lateral, femoral e obturatório foram bloqueados em 92% dos pacientes no compartimento do psoas versus 62% no bloqueio perivascular inguinal. O bloqueio do plexo lombar reduziu a necessidade de opióides e 42% dos pacientes submetidos ao bloqueio do compartimento do psoas e 36% dos pacientes no bloqueio inguinal não necessitaram de analgésico adicional no pós-operatório. A duração da analgesia foi em torno de 21 horas com bloqueio do compartimento do psoas e 15 horas com bloqueio perivascular inguinal. CONCLUSÕES: O bloqueio do compartimento do psoas e perivascular inguinal é uma excelente técnica para analgesia pós-operatória em intervenções cirúrgicas ortopédicas reduzindo a necessidade de opióides. Este estudo mostrou que a injeção no compartimento do psoas foi mais fácil e mais efetiva no bloqueio

  16. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove; Gahrn-Hansen, B; Siboni, K

    1995-01-01

    central nervous system infection of at least 0.7% at Odense University Hospital. This degree of infection is of the same magnitude as that reported for intravascular devices. We found that the patients with generalized symptoms of infection had been catheterized for a longer time, and were older than......Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of...... patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more...

  17. Primary spinal epidural lymphomas

    Directory of Open Access Journals (Sweden)

    Goutham Cugati

    2011-01-01

    Full Text Available An epidural location for lymphoma is observed in 0.1-6.5% of all the lymphomas. Primary spinal epidural lymphoma (PSEL is a subset of lymphomas, where there are no other recognizable sites of lymphomas at the time of diagnosis. The incidence of this subset of lymphomas is much less. It, however, is increasingly diagnosed, due to the increased use of more sensitive imaging modalities. For the electronic search, Pubmed was used to identify journals that enlisted and enumerated PSEL from 1961 to January 2011. The following combination of terms: "primary," "spinal," "epidural," and "lymphoma" were used. The most significant articles and their bibliographies were analyzed by the authors. The symptoms, pathogenesis, diagnostic workup, histopathology, treatment, and outcome have been analyzed in a systematic manner

  18. Diclofenaco por via muscular ou retal associado com baixas doses de morfina subaracnóidea para analgesia pós-operatória em cesarianas Diclofenaco por vía muscular o rectal asociado con bajas dosis de morfina subaracnóidea para analgesia pós-operatoria en cesáreas Intramuscular versus rectal diclofenac associated with low dose spinal morphine for post-cesarean analgesia

    Directory of Open Access Journals (Sweden)

    Mônica Maria Siaulys Capel Cardoso

    2002-11-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O diclofenaco tem sido utilizado em combinação com opióides por via subaracnóidea no controle da dor pós-operatória; entretanto, a melhor forma de sua administração não é conhecida. Este estudo avaliou a qualidade da analgesia pós-operatória de diferentes esquemas de administração de diclofenaco, em pacientes submetidas à cesariana sob raquianestesia com bupivacaína e morfina. MÉTODO: Após o final da cirurgia, as pacientes foram distribuídas aleatoriamente em três grupos que receberam diclofenaco como se segue: G50VR (n=62, 50 mg por via retal; G50IM (n=62, 50 mg por via muscular e G75IM (n=62, 75 mg por via muscular. A dor foi avaliada com uma escala analógica visual de 0-10 cm (EAV a cada 30 minutos nas primeiras seis horas e meperidina, via venosa, foi administrada como medicação de resgate sempre que a EAV fosse igual ou maior que 3 cm. RESULTADOS: No intervalo entre 30 e 150 minutos após a administração do diclofenaco, a média da intensidade de dor no grupo G50VR (0,9 ± 1,4; 1,4 ± 1,4; 1,3 ± 1,5; 1,3 ± 1,2 e 1,5 ± 3,3 cm foi maior quando comparada com as do G50IM (0,4 ± 0,8; 0,5 ± 0,8; 0,7 ± 1,0; 0,7 ± 1,1 e 0,7 ± 1,1 cm e G75IM (0,4 ± 0,8; 0,7 ± 1,3; 0,7 ± 1,1; 0,8 ± 1,2 e 0,7 ± 1,0 cm. A necessidade de meperidina de resgate (43,5% e o consumo total de meperidina (21,3 ± 28,9 mg foram maiores no G50VR, quando comparados com G50IM (21% e 8,2 ± 18,2 mg e G75IM (19,4% e 6,8 ± 16,7 mg. CONCLUSÕES: Quando combinada com baixas doses de morfina subaracnóidea, a administração do diclofenaco por via muscular promove melhor analgesia pós-operatória que por via retal. Além disso, parece haver um efeito teto para esta droga, já que não se observam vantagens com doses superiores a 50 mg por via muscular.JUSTIFICATIVA Y OBJETIVOS: El diclofenaco ha sido utilizado en combinación con opioides por vía subaracnóidea en el control del dolor pós-operatorio; mientras que, la

  19. Effect of epidural clonidine on characteristics of spinal anaesthesia in patients undergoing gynaecological surgeries: A clinical study

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    Rachna Prasad

    2016-01-01

    Full Text Available Background and Aims: Combined spinal–epidural (CSE anaesthesia is being increasingly used for effective post-operative analgesia. This study was designed to evaluate the effect of epidural clonidine on characteristics of spinal anaesthesia for gynaecological surgeries. Methods: This was a prospective randomised, double-blind, controlled study involving sixty patients belonging to American Society of Anesthesiologists Physical Status I and II who underwent gynaecological surgeries were randomly divided into clonidine (C group and saline (S group of thirty each. All patients received CSE anaesthesia. Ten minutes before subarachnoid block (SAB, Group C received clonidine 150 μg diluted to 5 ml in normal saline (NS and Group S received NS epidurally. Hyperbaric bupivacaine (15 mg was administered intrathecally for both groups after epidural injection. Sensory and motor block characteristics, analgesia, sedation and haemodynamics were observed. Statistical analysis was performed using appropriate tests. Results: Epidural clonidine produced faster onset (37.83 ± 8.58 s in Group C compared to 50.33 ± 8.80 s in Group S, P = 0.001 and prolonged duration of sensory block (241.17±18.65 minutes in group C compared to 150.33±19.16 minutes in group S, P = 0.001. Time for two segment regression of sensory block was193.67 ± 19.82 min in Group C and 109.33 ± 18.56 min Group S (P < 0.001. The duration of analgesia was 299.00 ± 43.38 min in Group C and 152.50 ± 21.04 min in Group S (P < 0.001. Haemodynamics and sedation scores were comparable between two groups. Conclusion: Administration of clonidine epidurally, 10 min before SAB, caused early onset and prolonged duration of motor blockade and analgesia, without any significant post-operative complication.

  20. Epidural Steroid Injections

    Science.gov (United States)

    ... the spinal sac and provides cushioning for the nerves and spinal cord. Steroids (‘cortisone’) placed into the epidural space ... spinal segments and cover both sides of the spinal canal. With a transforaminal ESI, often referred to as a ‘nerve block’, the needle is placed alongside the nerve ...

  1. AVALIAÇÃO DE SEGURANÇA E ANALGESIA DE PROTOCOLOS ANESTÉSICOS PARA ELETROEJACULAÇÃO EM GATOS DOMÉSTICOS (Felis catus

    Directory of Open Access Journals (Sweden)

    TICIANA FRANCO PEREIRA DA SILVA

    2011-09-01

    Full Text Available The objective of this study was to evaluate the security and analgesia of anesthetics protocols usually used for electroejaculation (EEJ in domestic cats. Fourteen toms were anesthetized with 4 protocols and submitted to a 3 series of electric stimuli (2-6 mA. The heart rate, respiratory rate, temperature, pain sensibility and eyes blink were analyzed prior and after induction, and during and after electroejaculation. The anesthesia protocol thatused isoflurane was the best for analgesic parameters, security and speed of recuperation for electroejaculation in domestic cats

  2. Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy

    OpenAIRE

    Sandeep Kundra; Vishnu Gupta; Hanish Bansal; Anju Grewal; Sunil Katyal; Ashwini Kumar Choudhary

    2014-01-01

    Background: Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use. Materials and Methods: One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg...

  3. Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy

    OpenAIRE

    Kundra, Sandeep; Gupta, Vishnu; Bansal, Hanish; Grewal, Anju; Katyal, Sunil; Choudhary, Ashwini Kumar

    2014-01-01

    Background: Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use. Materials and Methods: One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml)...

  4. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

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    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  5. The effect of balanced analgesia on early convalescence after major orthopaedic surgery

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Hansen, B L;

    1994-01-01

    Forty-two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid and...... care, were the most important reasons limiting mobilization and activity. We conclude that effective early (48 h) postoperative pain relief with balanced analgesia does not per se lead to important improvements in convalescence and hospital stay....

  6. Analgesia de parto em paciente com tetralogia de Fallot não corrigida: relato de caso Analgesia de parto en paciente con tetralogía de Fallot no corregida: relato de caso Labour analgesia in parturient with uncorrected tetralogy of Fallot: case report

    Directory of Open Access Journals (Sweden)

    Florentino Fernandes Mendes

    2005-02-01

    obstétrica fue la de parto vía baja, siendo realizada analgesia de parto a través de bloqueo peridural con bupivacaína a 0,125% y fentanil (100 µg y colocación de catéter peridural. Después de 1h30 minutos del inicio de la analgesia, ocurrió el nacimiento. El peso del recién nacido fue 1485 g y el índice de Apgar 6 y 8 en el primero y en el quinto minutos, respectivamente. La paciente permaneció estable y sin alteraciones hemodinámicas y/o electrocardiográficas. CONCLUSIONES: La elección de la técnica anestésica es de fundamental importancia en el manoseo de las pacientes con tetralogía de Fallot no corregidas. Condiciones favorables del cuello y buena dinámica uterina, particularmente en aquellas pacientes sin historia de síncope, se vuelven imprescindibles para una buena indicación de la analgesia de parto.BACKGROUND AND OBJECTIVES: Although tetralogy of Fallot is the most common cyanotic congenital heart disease, national publications correlating this condition with anesthetic practice are scarce. This report aimed at presenting a case of labor epidural analgesia in a patient with uncorrected tetralogy of Fallot diagnosed during gestation. CASE REPORT: Patient 26 years old, 1.54 m, 56 kg, 32 weeks and 5 days of gestational age, who had been diagnosed with tetralogy of Fallot during gestation. Patient was admitted in labour. After obstetric evaluation and decision for natural birth, epidural analgesia was performed with 0.125% bupivacaine associated to 100µg fentanyl through a catheter. Patient gave birth 1 hour and 30 minutes after the procedure. The newborn weighed 1485 grams and had an Apgar score of 6 and 8 at one and five minutes, respectively. Patient remained stable, with no hemodynamic or ECG changes. CONCLUSIONS: Selecting the appropriate anesthetic technique is extremely important when managing patients with uncorrected tetralogy of Fallot. Favorable uterine dynamics and cervical conditions, particularly in patients with no history of

  7. Aspergillus spinal epidural abscess

    International Nuclear Information System (INIS)

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host

  8. Anestesia peridural torácica para cirurgia plástica de mama em paciente portadora de miastenia gravis: relato de caso Anestesia peridural torácica para cirugía plástica de mama en paciente portadora de miastenia gravis: relato de caso Thoracic epidural anesthesia for mammaplasty in myasthenia gravis patient: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2005-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A miastenia gravis é uma doença crônica, auto-imune, caracterizada pela fraqueza da musculatura esquelética em decorrência da diminuição dos receptores de acetilcolina na junção neuromuscular. O objetivo deste relato é mostrar um caso de paciente com miastenia gravis submetida a anestesia peridural torácica para cirurgia plástica de mama. RELATO DO CASO: Paciente com 51 anos, portadora de miastenia gravis foi submetida a anestesia peridural torácica com bupivacaína e fentanil. Não houve sinais de depressão respiratória. A paciente recebeu alta hospitalar após 36 horas. CONCLUSÕES: O presente caso sugere como conduta anestésica para o paciente portador de miastenia gravis a anestesia peridural como técnica única, sem a obrigatoriedade de intubação orotraqueal.JUSTIFICATIVA Y OBJETIVOS: La miastenia gravis es una enfermedad crónica, auto-inmune, caracterizada por la debilidad de la musculatura esquelética resultante de la disminución de los receptores de acetilcolina en la unión neuromuscular. El objetivo de este relato es mostrar el caso de una paciente con miastenia gravis sometida a anestesia peridural torácica para una cirugía plástica de mama. RELATO DEL CASO: Paciente del sexo femenino, 51 años, portadora de miastenia gravis fue sometida a anestesia peridural torácica con bupivacaína y fentanil. No hubo señales de depresión respiratoria. La paciente recibió alta hospitalaria después de 36 horas. CONCLUSIONES: Este actual caso sugiere como conducta anestésica para el paciente portador de miastenia gravis la anestesia peridural como única técnica, sin la obligatoriedad de intubación orotraqueal.BACKGROUND AND OBJECTIVES: Myasthenia gravis is a chronic autoimmune disease characterized by skeletal muscles weakness promoted by decreased acetylcholine receptors in the neuromuscular junction. This report aimed at describing a case of myasthenia gravis patient submitted to thoracic

  9. [Analgesia for childbirth in a patient with factor V Leiden mutation].

    Science.gov (United States)

    Puértolas Ortega, M; Izquierdo Villarroya, B; Oliva Perales, P; Lafuente Ojeda, N; Izquierdo Villarroya, J; Ruiz Pérez, R

    2007-01-01

    Factor V Leiden mutation is the most common congenital thrombophilic disorder, affecting between 5% and 8% of the Caucasian population. Pregnancy creates a state of hypercoagulability and all factors that increase the risk of thrombosis should be considered, as they may be cumulative. In recent years, the diagnosis of new allelic variants of thrombophilic states have increased the incidence of pregnant women receiving anticoagulant therapy, with the anesthetic considerations that implies. We report the case of a 33-year-old woman with heterozygous Leiden factor V mutation who was admitted with spontaneous amniorrhexis in the 38th week of gestation. She was taking low molecular weight heparin therapy. An epidural catheter was inserted to provide analgesia for labor, with all safety precautions to prevent an epidural hematoma. Epidural anesthesia is the technique of choice for obstetric labor in patients with hypercoagulability because of its effects of favoring blood flow and inhibiting clot formation. PMID:17319433

  10. Convalescence and hospital stay after colonic surgery with balanced analgesia, early oral feeding, and enforced mobilisation

    DEFF Research Database (Denmark)

    Møiniche, S; Bülow, Steffen; Hesselfeldt, Peter;

    1995-01-01

    OBJECTIVE: To evaluate the combined effects of pain relief by continuous epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection. DESIGN: Uncontrolled pilot investigation. SETTING: University hospital, Denmark. SUBJECTS: 17...... unselected patients (median age 69 years) undergoing colonic resection. INTERVENTIONS: Patients received combined epidural and general anaesthesia during operations and after operation were given continuous epidural bupivacaine 0.25%, 4 ml hour and morphine 0.2 mg hour, for 96 hours and oral paracetamol 4 g....../daily. No patient had a nasogastric tube, and oral feeding with normal food and protein enriched solutions (1000 Kcal (4180 KJ/day) was instituted 24 hours postoperatively together with intensive mobilisation. RESULTS: Median visual analogue pain scores were zero at rest and minimal during coughing and...

  11. A comparative study of epidural catheter colonization and infection in Intensive Care Unit and wards in a Tertiary Care Public Hospital.

    Science.gov (United States)

    Harde, Minal; Bhadade, Rakesh; Iyer, Hemlata; Jatale, Amol; Tiwatne, Sagar

    2016-02-01

    Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h) postoperative analgesia in postanesthesia care unit and wards. It was a prospective observational study done in a tertiary care teaching public hospital over a period of 2 years and included 400 patients with 200 each belonged to two groups PACU and ward. We also studied epidural tip culture pattern, skin swab culture at the entry point of the catheter, their relation to each other and whether colonization is equivalent to infection. Data were analyzed using statistical software GraphPad. Overall positive tip culture was 6% (24), of them 7% (14) were from PACU and 5% (10) were from ward (P = 0.5285). Positive skin swab culture was 38% (150), of them 20% (80) were from PACU and 18% (70) were from ward (P = 0.3526). The relation between positive tip culture and positive skin swab culture in same patients is extremely significant showing a strong linear relationship (95% confidence interval = 0.1053-0.2289). The most common microorganism isolated was Staphylococcus epidermidis. No patient had signs of local or epidural infection. There is no difference in the incidence of epidural catheter tip culture and skin swab culture of patients from the general ward and PACU. Epidural analgesia can be administered safely for 48 h in general wards without added risk of infection. The presence of positive tip culture is not a predictor of epidural space infection, and colonization is not equivalent to infection; hence, routine culture is not needed. Bacterial migration from the skin along the epidural track is the most common mode of bacterial colonization; hence, strict asepsis is necessary. PMID:27076712

  12. A comparative study of epidural catheter colonization and infection in Intensive Care Unit and wards in a Tertiary Care Public Hospital

    Directory of Open Access Journals (Sweden)

    Minal Harde

    2016-01-01

    Full Text Available Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h postoperative analgesia in postanesthesia care unit and wards. It was a prospective observational study done in a tertiary care teaching public hospital over a period of 2 years and included 400 patients with 200 each belonged to two groups PACU and ward. We also studied epidural tip culture pattern, skin swab culture at the entry point of the catheter, their relation to each other and whether colonization is equivalent to infection. Data were analyzed using statistical software GraphPad. Overall positive tip culture was 6% (24, of them 7% (14 were from PACU and 5% (10 were from ward (P = 0.5285. Positive skin swab culture was 38% (150, of them 20% (80 were from PACU and 18% (70 were from ward (P = 0.3526. The relation between positive tip culture and positive skin swab culture in same patients is extremely significant showing a strong linear relationship (95% confidence interval = 0.1053–0.2289. The most common microorganism isolated was Staphylococcus epidermidis. No patient had signs of local or epidural infection. There is no difference in the incidence of epidural catheter tip culture and skin swab culture of patients from the general ward and PACU. Epidural analgesia can be administered safely for 48 h in general wards without added risk of infection. The presence of positive tip culture is not a predictor of epidural space infection, and colonization is not equivalent to infection; hence, routine culture is not needed. Bacterial migration from the skin along the epidural track is the most common mode of bacterial colonization; hence, strict asepsis is necessary.

  13. [Fentanyl in peridural obstetrical analgesia. Evaluation after 4 years' use].

    Science.gov (United States)

    Lévêque, C; Garen, C; Pathier, D; Mazuir, E; Maneglia, R; Janse-Marec, J; Cousin, M T

    1987-01-01

    7,500 deliveries occurred from the date of opening of the Maternity Hospital Jean-Rostand. 3,500 of these were conducted under epidural anaesthesia. At different stages prospective studies were carried out to recall the effect of adding fentanyl to bupivacaine when the epidural injection was made. A pharmacokinetic study. This shows that the levels in the mother and the fetus begin to coincide more with the number of doses that are given and pass from 0.3 after 50 micrograms have been administered to 0.5 after 100 micrograms have been administered and 0.7 after 150 micrograms have been administered. The fetal levels are far lower than those required to depress respiration. The half life of distribution through the circulation has been worked out at 4 minutes and the half for elimination of the drug at 460 minutes. The maternal levels show great fluctuations and late alterations. Analgesia is earlier, more complete and more prolonged when fentanyl is added. Fentanyl also masks irregularities. Undesirable effects such as tiredness, pruritus, nausea, vomiting and urinary retention occur infrequently and last only for short periods of time. No mother had respiratory depression. The doses of bupivacaine that had to be given were as a whole less when fentanyl was added. In 40% of cases it only required one injection to achieve analgesia throughout the whole labour. The length of labour and the number of caesarean operations carried out did not change.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3584862

  14. Ethanol-induced analgesia

    Energy Technology Data Exchange (ETDEWEB)

    Pohorecky, L.A.; Shah, P.

    1987-09-07

    The effect of ethanol (ET) on nociceptive sensitivity was evaluated using a new tail deflection response (TDR) method. The IP injection of ET (0.5 - 1.5 g/kg) produced raid dose-dependent analgesia. Near maximal effect (97% decrease in TDR) was produced with the 1.5 g/kg dose of ET ten minutes after injection. At ninety minutes post-injection there was still significant analgesia. Depression of ET-induced nociceptive sensitivity was partially reversed by a 1 mg/kg dose of naloxone. On the other hand, morphine (0.5 or 5.0 mg/kg IP) did not modify ET-induced analgesia, while 3.0 minutes of cold water swim (known to produce non-opioid mediated analgesia) potentiated ET-induced analgesic effect. The 0.5 g/kg dose of ET by itself did not depress motor activity in an open field test, but prevented partially the depression in motor activity produced by cold water swim (CWS). Thus, the potentiation by ET of the depression of the TDR produced by CWS cannot be ascribed to the depressant effects of ET on motor activity. 21 references, 4 figures, 1 table.

  15. Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation

    Directory of Open Access Journals (Sweden)

    Shilpi Agarwal

    2015-11-01

    Results: The time of onset of sensory block at T10 and time to reach maximum sensory block (T6 in group-I was significantly longer as compared to group-II. The complete motor blockade (grade-3 was achieved much later and time taken for recovery to grade-0 was significantly shorter in group-I. The time for rescue analgesia in group-I was significantly shorter as compared to group-II. Hypotension was the most common side effect in both the groups. Dry mouth is a known side effect of alpha-2 agonists. Epidural dexmedetomidine produced profound sedation. Conclusions: We conclude from this study that dexmedetomidine is a better adjuvant than clonidine for providing early onset of sensory analgesia, superior sedative properties and prolonged post-operative analgesia. [Int J Res Med Sci 2015; 3(11.000: 3254-3261

  16. EFFECT OF INTRATHECAL CLONIDINE ON DURATION OF SPINAL ANALGESIA

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    Sourabh

    2015-06-01

    Full Text Available BACKGROUND: Clonidine is an α 2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space along with local anaesthetic. AIMS AND OBJECTIVE: This study was designed to evaluate the effect of two different doses of intrathecal clonidine (37.5 μg and 75 μg on the duration of analgesia and side effects produced by hyperbaric bupivacaine 0.5%. MATERIALS AND METHODS : A prospective hospital based, randomized and double blind study. Selected 75 patients who was scheduled for elective below umbilical surgeries were randomly allocated to one of three groups. Group I (n=25, control group received 3ml hyperbaric bupivacaine, Group II (n=25 3ml hyperbar ic bupivacaine + 37.5 μg clonidine and Group III (n=25 3 ml hyperbaric bupivacaine + 75μg clonidine intrathecally. Total volume (4ml remained constant by adding sterile water. Data were analyzed by using SPSS software ver.18. RESULTS: The (mean ±SD dura tion of analgesia was found to be 171.3±6.37 mins in Group I, 217.7±7.01 mins in Group II and 257.1±6.50 mins in Group III (p<0.05. It shows that 37.5  g & 75  g intrathecal clonidine increases the duration of analgesia of 15mg hyperbaric bupivacaine by abo ut 46 mins & 86 mins respectively. The addition of intrathecal clonidine upto 75 μg does not cause any significant major side effect except mild sedation, without an increase in incidence of hypotension, bradycardia and respiratory depression. CONCLUSION: Intrathecal clonidine (37.5  g & 75  g as an adjuvant to hyperbaric bupivacaine 0.5% prolong the duration of analgesia in a dose dependent manner without increase in incidence of significant side effects

  17. Post operatory analgesia in caesarean surgery. Analgesia posoperatoria en la operación cesárea.

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    María Antonia Cabezas Poblet

    2003-12-01

    >Fundamento: El dolor posoperatorio constituye un problema muy difundido y constante en los cuidados del paciente quirúrgico. La lucha por encontrar nuevas terapéuticas para aliviar el dolor ha llevado a la fabricación y uso de gran variedad de analgésicos que son administrados por diferentes vías. Se conocen bien los efectos de los narcóticos en el recién nacido y fue la preocupación al respecto lo que motivó el interés por el uso de esos fármacos por vía epidural e intratecal en la paciente obstétrica. Objetivo: Evaluar la factibilidad del uso de morfina liofilizada por vía peridural en la operación cesárea. Métodos : Estudio de serie de casos desarrollado durante el periodo comprendido entre febrero del 2001 a agosto del 2002 en la unidad quirúrgica del Servicio de Ginecoobstetricia del Hospital Universitario ¨Dr.Gustavo Aldereguía Lima¨ de Cienfuegos, que incluyó 120 pacientes sometidas a cesárea iterativa electiva. Se analizaron variables correspondientes a tensión arterial, frecuencia cardiaca, frecuencia respiratoria durante el preoperatorio, transoperatorio y posoperatorio, comienzo del efecto anestésico y duración de este, además se analizaron las complicaciones perioperatorias, la calidad de la analgesia posoperatoria y su repercusión en el recién nacido, medida mediante el puntaje de Apgar. El procesamiento estadístico se realizó utilizando el paquete estadístico Epi Info 6. Resultados : El comienzo del efecto anestésico y el tiempo de duración de la anestesia no se modificaron con el uso de la morfina liofilizada. Los parámetros vitales se mantuvieron con valores normales en la mayoría de las pacientes durante el preoperatorio, transoperatorio y posoperatorio. Las complicaciones que se presentaron fueron: prurito, retención urinaria, náuseas y vómitos. La calidad de la analgesia resultó satisfactoria en la mayoría de las pacientes. Los valores de Apgar fueron normales en todos

  18. The study of patient controlled analgesia undergoing interventional therapy for gynecology and obstetrics ailment

    International Nuclear Information System (INIS)

    Uterine artery embolism is widely used for interventional therapy of gynecology and obstetrics ailment, but immediate incidence of pain occurs in 90% to 100% after uterine artery embolism and postoperative incidence of pain takes place from 80% to 90%. Patient controlled epidural analgesia (PCEA) could be adopted to treat pain with obviously outweighed effects over the traditional drug regimen or patient intravenous analgesia during the period of interventional therapy of uterine artery embolization. PCEA possesses good effect of analgesia and less adverse reaction and furthermore could eliminate or lessen the sufferings of patient and thus improve rehabilitation quality. Adding droperidol (0.005%) into the preparation of PCEA could decrease adverse effect incidence of nausea and vomiting; so it deserves recommendation for extending application in clinical interventional therapy. (authors)

  19. Epidural Naloxone to Prevent Buprenorphine Induced PONV

    OpenAIRE

    Ashok Jadon; S S Parida; Swastika Chakroborty; Amrita Panda

    2008-01-01

    Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. This combina-tion gives excellent anlgesia but nausea and vomiting remains a major concern. Low dose epidural naloxone prevents PONV induced by spinal opioids like morphine, fentanyl and sufentanil. However, it is not known that epidural naloxone administration prevents PONV induced by epidural buprenorphine. We have reported three cases of major abdominal operation in which lowdose epidural infus...

  20. Considerações sobre analgesia controlada pelo paciente em hospital universitário Consideraciones sobre analgesia controlada por el paciente en hospital universitario Patient controlled analgesia in a university hospital

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    Guilherme Antônio Moreira de Barros

    2003-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O rápido progresso obtido nas técnicas cirúrgicas e anestésicas nos últimos anos proporcionou extraordinário aumento das indicações de procedimentos invasivos. Por outro lado, com o envelhecimento da população, o período de recuperação pós-operatória passou a ser motivo de maior preocupação da equipe de saúde. Para tanto, novas técnicas de analgesia foram criadas e desenvolvidas e, dentre elas, destaca-se a Analgesia Controlada pelo Paciente (ACP. Em nosso país, o Serviço de Dor Aguda (SEDA da Disciplina de Terapia Antálgica e Cuidados Paliativos, do Departamento de Anestesiologia da Faculdade de Medicina de Botucatu - UNESP, utiliza há muitos anos esta técnica de analgesia. Com a finalidade de atestar a qualidade do serviço prestado, a pesquisa objetiva verificar a eficácia e segurança do método, assim como identificar e caracterizar a população atendida. MÉTODO: De modo retrospectivo, foram avaliados 679 pacientes tratados pelo SEDA, exclusivamente com o método de ACP, durante três anos. Os pacientes foram incluídos na análise aleatoriamente, sem restrições quanto à idade, ao sexo, ao tipo de cirurgia e considerando-se unicamente a possibilidade de indicação da ACP. Foram estudados os seguintes atributos: sexo, idade, tipo de cirurgia, intensidade da dor, dias de acompanhamento, analgésicos utilizados, vias de administração, ocorrência de efeitos colaterais e complicações da técnica. RESULTADOS: 3,96% dos pacientes submetidos a cirurgias e 1,64% dos internados no período observado foram acompanhados com técnica ACP. A cirurgia torácica foi a mais freqüentemente atendida, com 25% dos pacientes. A morfina foi o medicamento mais utilizado (54,2%, sendo a via peridural a preferencial (49,5%. A escala numérica verbal média foi de 0,8 (0-10. Os efeitos colaterais ocorreram em 22,4% dos doentes tratados. CONCLUSÕES: Os resultados foram considerados excelentes quanto

  1. High thoracic epidural anesthesia in cardiac surgery: risk factors for arterial hypotension.

    Science.gov (United States)

    Casalino, Stefano; Mangia, Fabio; Stelian, Edmond; Novelli, Eugenio; Diena, Marco; Tesler, Ugo F

    2006-01-01

    There is an interest in the use of high thoracic epidural anesthesia in cardiac surgery, because experimental and clinical studies have suggested that central neuroaxial blockade attenuates the response to surgical stress and improves myocardial metabolism and perioperative analgesia-thus enabling earlier extubation and a smoother postoperative course. Matters of major concern in the adoption of high thoracic epidural anesthesia in cardiac surgery are neurologic injury secondary to neuroaxial hematoma and hypotension secondary to sympatholysis. The risk associated with possible neuraxial hematoma caused by high thoracic epidural anesthesia has been thoroughly investigated and largely discounted, but scant attention has been devoted to the onset of hypotensive episodes in the same setting. We analyzed the hypotensive episodes that occurred in a series of 144 patients who underwent on-pump cardiac surgery procedures. Among the patient variables that we tested in a multivariate logistic-regression model, only female sex was found to be significantly correlated with hypotension. In order to decrease the incidence and severity of hypotensive episodes resulting from anesthetic blockade, anesthesiologists need to monitor, with special care, women patients who are under high thoracic epidural anesthesia. Further studies are needed in order to determine why women undergoing open heart surgery under high thoracic epidural anesthesia are at a relatively greater risk of hypotension. PMID:16878616

  2. Minilaparotomy under acupuncture analgesia.

    OpenAIRE

    Dias, P L; Subramanium, S

    1984-01-01

    Minilaparotomy was performed using acupuncture analgesia on 78 female patients seeking voluntary sterilization to determine whether this could be used as a substitute for standard analgesic sedation. In 48 women (62%) no intravenous drug medication was required, and sterilization was successfully performed using only the local anaesthetic and acupuncture electrostimulation. These patients could be discharged within one hour of operation. For a developing country with a shortage of trained ana...

  3. Continuous epidural infusion of morphine versus single epidural injection of extended-release morphine for postoperative pain control after arthroplasty: a retrospective analysis

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    Stephanie Vanterpool

    2010-06-01

    Full Text Available Stephanie Vanterpool, Randall Coombs, Karamarie FechoDepartment of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USABackground: This study retrospectively compared the continuous epidural infusion of morphine with a single epidural injection of extended-release morphine for postoperative pain control after arthroplasty.Methods: Medical records were reviewed for subjects who had total knee or hip arthroplasty (THA under spinal anesthesia and received either a continuous epidural infusion of morphine (Group EPID; n = 101 or an extended-release epidural morphine (Group EREM; n = 109 for postoperative pain. Data were collected for three postoperative days (POD on: pain scores; supplemental opioids; medications for respiratory depression, nausea, and pruritus, and distance ambulated during physical therapy.Results: Pain scores were similar until subjects were transitioned to another analgesic approach on POD 2; after that time, pain scores increased in Group EPID, although they decreased in Group EREM. Supplemental opioids were used more on POD1 in Group EREM than in Group EPID, although time to first opioid and total daily morphine equivalents were similar. Naloxone and antiemetics, not antipruritics, were used more in Group EREM. Distance ambulated after THA was greater in Group EREM than in Group EPID.Conclusions: These results suggest that EREM is associated with better postoperative ambulation and analgesia during the transition to oral or intravenous analgesics, although a higher incidence of side-effects was evident.Keywords: continuous epidural morphine infusion, extended-release epidural morphine, lower extremity arthroplasty, ambulation, postoperative pain, side-effects

  4. Epidural injections for back pain

    Science.gov (United States)

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... pillow under your stomach. If this position causes pain, you either sit up or lie on your ...

  5. Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study

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    Jasleen Kaur

    2014-01-01

    Full Text Available Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B. Materials and Methods: A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB and bupivacaine + fentanyl (BF. B (0.5% 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 μg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Conclusions: Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory

  6. Epidural, paraspinal, and subcutaneous lipomatosis

    Energy Technology Data Exchange (ETDEWEB)

    Sener, R. Nuri [Department of Radiology, Ege University Hospital, Bornova, Izmir (Turkey)

    2003-09-01

    A unique case of idiopathic diffuse lipomatosis is reported. The patient was an 11-year-old boy with diffuse lipomatosis in the epidural space, paraspinal muscles, and thoracolumbar subcutaneous regions. Epidural lipomatosis involved the entire thoracolumbar spine and was associated with filar thickening and lipoma. In addition, paraspinal muscles, especially the erector spinae group, had diffuse fatty infiltration. The ultimate clinical effect of this fatty tissue was urinary dysfunction, radicular pain and hypoesthesia in both legs and difficulty walking. (orig.)

  7. Effect of thoracic epidural etidocaine 1.5% on somatosensory evoked potentials, cortisol and glucose during cholecystectomy

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Kehlet, H

    1992-01-01

    patients. Spread of analgesia (pin-prick) was T3 (T1-T3) to L2 (T11-L3) 35 min after injection of etidocaine, and T3 (T2-T4) to T12 (T8-L4) 3 h after surgical incision (median (range)). Before operation, epidural etidocaine had no significant effects on peak-to-peak amplitude of SEPs to electrical...

  8. THORACIC EPIDURAL ANESTHESIA FOR MODIFIED RADICAL MASTECTOMY-IN TYPE2 DIABETES MELLITUS PATIENT

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    Vishwanath R

    2014-12-01

    Full Text Available Modified radical mastectomy (MRM, the standard oncologic surgical procedure of the carcinoma of breast is routinely performed under general anesthesia. Carcinoma breast patients are considered to be at high risk for anesthesia due to high possibility of perioperative complications and mortality when associated with long standing type 2 Diabetes Mellitus (DM with other co morbidities. Cardiac complications due to macro vascular and micro vascular involvement can pose a real threat. Here we present a case report of successful perioperative management of modified radical mastectomy only with thoracic epidural anesthesia (TEA in a case of carcinoma breast with long standing type 2 DM and hypertension. A 71year old female, a known case of DM since 7years with co morbidity; hypertension having a carcinoma breast was scheduled for modified radical mastectomy. Continuous epidural anesthesia was administered at T4-5 level. Local anesthetic supplementation titrated as per the demands of surgery and good postoperative analgesia maintained for 48 hours. Long standing DM with hypertension can lead to perioperative morbidity and mortality due to cardiac complications. However, Thoracic epidural anesthesia (TEA reduces cardiac and sympathetic activity and thereby improves perioperative function of vital organs and reduces postoperative morbidity and mortality. The procedure can lead to prompt recovery with additional benefit of prolonged post-operative analgesia. TEA proved to be an excellent anesthetic technique for MRM in patient with long standing DM.

  9. Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature

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    Radi Shahien

    2011-02-01

    Full Text Available Radi Shahien, Abdalla BowirratDepartment of Neurology, Ziv Medical Center, Zfat, IsraelAbstract: We report a complication related to epidural analgesia for delivery in a 24-year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy.Keywords: facial nerve paralysis, partial brachial plexopathy, epidural blood patch

  10. Analgesia adjuvante e alternativa

    OpenAIRE

    Vale Nilton Bezerra do

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA) podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal no...

  11. Analgesia pós-operatória Postoperative analgesia

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    Betina Sílvia Beozzo Bassanezi

    2006-04-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A dor sempre foi uma das maiores preocupações do homem, entretanto, apesar dos progressos da ciência, ainda existem várias barreiras ao seu adequado tratamento, incluindo a falta de conhecimento por parte da equipe médica, sobre o mecanismo das diversas drogas e técnicas empregadas. O objetivo deste trabalho é abordar as principais drogas e técnicas empregadas no controle da dor pós-operatória, visando estimular o interesse sobre o assunto bem como aumentar a eficácia do tratamento dado aos pacientes. CONTEÚDO: Está ressaltada neste artigo, a importância da adequada analgesia pós-operatória, considerando as principais drogas e técnicas utilizadas no controle da dor, seus mecanismos de ação, posologias, vias de administração e efeitos colaterais, bem como a importância da integração de toda a equipe envolvida nos cuidados do paciente para o sucesso do tratamento. O tratamento inadequado da dor no pós-operatório não se justifica, pois há um arsenal considerável de drogas e técnicas analgésicas. O que se faz necessário, portanto, é que toda equipe, anestesistas, cirurgiões, e enfermeiros tenham conhecimento e estejam integrados na utilização deste arsenal.BACKGROUND AND OBJECTIVES: Pain has been one of the men's biggest worries. Despite of scientific progress there still exist many barriers in an adequate treatment of pain including the lack of knowledge of many drugs and pain management techniques. The objective of this study is to discuss the main drugs and analgesics process in an effort to stimulate our colleague interest about the subject and thus increasing treatment efficiency of our patients. CONTENTS: It is emphasized in this study the importance of an adequate postoperative analgesia discussing the main drugs and techniques used in pain management, their mechanism of action, dose, administration route and side effects of each drug. It is also pointed out the great importance

  12. Eficacia de la aplicación de ozono epidural y paravertebral a una concentración de 30 μg/ml para el manejo de dolor crónico en pacientes con síndrome de cirugía fallida de espalda Effectiveness of the implementation of epidural and paravertebral ozone at a concentration of 30 μg/ml for the management of chronic pain in patients with failed back surgery

    Directory of Open Access Journals (Sweden)

    B. D. Hernández Guinea

    2012-02-01

    Full Text Available Objetivo: determinar la eficacia de la infiltración de ozono epidural y paravertebral a una concentración de 30 μg/ml para el control del dolor crónico en pacientes con síndrome de cirugía fallida de espalda lumbar. Método: se realizó un ensayo clínico cuasi experimental, prospectivo, estudiando 30 pacientes con dolor crónico secundario a síndrome cirugía fallida de espalda, realizando un total de 4 infiltraciones con ozono; en la primera se infiltró 20 ml de ozono a una concentración de 30 μg/ml por vía epidural caudal y 10 ml de ozono a la misma concentración a nivel paravertebral lumbar en L3, L4 y L5 en forma bilateral, con un total de 60 ml paravertebral. Realizándose las siguientes infiltraciones cada semana únicamente en la región paravertebral. Se evaluó la calidad analgésica mediante la escala visual análoga y la funcionalidad por el índice de discapacidad de Oswestry, previo al procedimiento inicial, a la semana, 4 semanas y 2 meses. Resultados: de los 30 pacientes estudiados el 70% fueron mujeres (21 y 30% hombres (9. No se encontró mejoría en el alivio del dolor de acuerdo a la evaluación de la escala visual análoga, con un promedio inicial de 7,2 y un final de 7,4. Tampoco se encontró mejoría en la capacidad funcional evaluada mediante el índice de discapacidad de Oswestry, inicial de 63,47 y final de 64,37, ambos sin significancia estadística. Se presentaron como complicaciones: dolor a la aplicación 40% (12, aumento de discapacidad 13,33% (4 y cefalea 3% (1. Conclusión: el uso de ozono epidural y paravertebral a una concentración de 30 μg/ml, no es eficaz para el alivio del dolor crónico secundario a síndrome de cirugía fallida de espalda.Objective: to determine the efficacy of epidural and paravertebral infiltration of ozone at a concentration of 30 μg/ml for chronic pain control in patients with failled back surgery syndrome. Method: a quasi-experimental clinical trial, prospective study

  13. Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego Ropivacaína, articaína o la combinación de ropivacaína y articaína en la anestesia epidural para cesárea: estudio aleatorio, prospectivo y doble ciego Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study

    Directory of Open Access Journals (Sweden)

    Derya Arslan Yurtlu

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Iniciar a anestesia peridural com anestésicos locais de longa duração consome uma quantidade significativa de tempo, o que pode ser problemático em centros de anestesia obstétrica muito movimentados. Aventamos a hipótese de que uma combinação de articaína e ropivacaína proporcionaria início mais rápido e mesmo uma recuperação precoce das características do bloqueio sensório-motor. MÉTODOS: Sessenta parturientes a termo agendadas para cesariana eletiva foram randomicamente alocadas em três grupos para receber 20 mL de articaína a 2% (Grupo A, 10 mL de articaína a 2% + 10 mL de ropivacaína a 0,75% (Grupo AR ou 20 mL de ropivacaína a 0,75% (Grupo R via cateter peridural. O tempo de início do bloqueio sensorial até T10-T6 e o nível máximo de bloqueio, o tempo para a regressão de dois segmentos do nível máximo de bloqueio sensorial e o tempo de início e duração do bloqueio motor foram todos registrados. A necessidade de analgésicos adicionais, intra- e pós-operatoriamente, também foi registrada. RESULTADOS: Os dados demográficos foram semelhantes. Os tempos de início do bloqueio sensorial até os níveis T10 e T6 foram significativamente menores nos grupos A e AR, em comparação com o Grupo R (p JUSTIFICATIVA Y OBJETIVOS: Iniciar la anestesia epidural con anestésicos locales de larga duración consume una cantidad significativa de tiempo, siendo un problema en los centros de anestesia obstétrica que tienen mucho movimiento. Barajamos la hipótesis de que una combinación de articaína y ropivacaína proporcionaría un inicio más rápido e incluso una rápida recuperación de las características del bloqueo sensitivo motor. MÉTODOS: Sesenta parturientes a término que tenían cita para la cesárea electiva se ubicaron aleatoriamente en tres grupos para recibir 20 mL de articaína al 2% (Grupo A, 10 mL de articaína al 2% + 10 mL de ropivacaína al 0,75% (Grupo AR o 20 mL de ropivaca

  14. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study

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    Fen Wang

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group; in 24 patients, epidural analgesia was done (PCEA group. The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.

  15. Administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia pós-operatória em colecistectomias videolaparoscópicas Administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia postoperatoria en colecistectomías videolaparoscópicas Intraperitoneal administration of 50% enantiomeric excess (S75-R25 bupivacaine in postoperative analgesia of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    João Batista Santos Garcia

    2007-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O efeito analgésico de infusões intraperitoneais de anestésicos locais após colecistectomia videolaparoscópica é controverso e os resultados descritos vão de alívio considerável à pequena redução da dor. O objetivo deste estudo foi avaliar a eficácia da administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para o alívio da dor no pós-operatório de colecistectomia videolaparoscópica. MÉTODO: Estudo aleatório, placebo-controlado e duplamente encoberto com 40 pacientes submetidos à colecistectomia videolaparoscópica divididos em dois grupos: GI (n = 20 que recebeu 80 mL de solução de bupivacaína S75-R25 a 0,125% intraperitoneal no fim da operação; GII (n = 20 que recebeu 80 mL de solução fisiológica a 0,9%. Ambos os grupos receberam 40 mg de tenoxicam e 30 mg.kg-1 de dipirona, por via venosa, pouco antes do fim da operação. A analgesia no pós-operatório (PO foi feita com tramadol. Foram avaliados os escores de dor em repouso, ao sentar e à manobra de Valsalva, segundo a escala numérica ao despertar e 2, 4, 8, 12 e 24 horas no PO; a presença de dor no ombro; o tempo para a primeira solicitação do analgésico; e o seu consumo cumulativo. RESULTADOS: Houve diferença estatística significativa entre os escores de dor às 12 horas no PO com o paciente em repouso (GI JUSTIFICATIVA Y OBJETIVOS: El efecto analgésico de infusiones intraperitoneales de anestésicos locales después colecistectomía videolaparoscópica es controvertido y los resultados descritos van desde el alivio considerable a la pequeña reducción del dolor. El objetivo de este estudio fue evaluar la eficacia de la administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para el alivio del dolor en el postoperatorio de colecistectomía videolaparoscópica. MÉTODO: Estudio aleatorio, placebo-controlado y doblemente encubierto con

  16. EFFICACY OF DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE FOR CAUDAL ANALGESIA IN PAEDIATRIC PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Vijay

    2014-07-01

    Full Text Available CONTEXT: Various adjuvants such as opioids or α2 agonists are being used to improve the quality and duration of caudal analgesia with local anesthetics. Dexmedetomidine a α2 agonist is used frequently in adult patients to enhance the local anesthetic effect. However there is little literature regarding its effectiveness in pediatric caudal analgesia. The objective of this study was to assess the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in increasing the duration of caudal analgesia. AIM: The aim of this study was to investigate the effect of adding Dexmedetomidine to caudal Bupivacaine and observe the effect on the duration of analgesia in the post-operative period. SETTINGS AND DESIGN: One year hospital based Double Blind Randomized Controlled Trial. METHODS AND MATERIAL: Sixty children, aged 1-6 years, undergoing lower abdominal surgeries were included in this prospective randomized double-blind study. The patients were randomly divided into two groups: Group I received Bupivacaine (0.25% 1ml/kg plus 1 ml of normal saline in the caudal epidural space. Group II was administered Bupivacaine (0.25% 1ml/ with Dexmedetomidine 2 mcg/ ml diluted to 1 ml of normal saline in the caudal epidural space. All anesthetic and surgical techniques were standardized. Heart rate, blood pressure, oxygen saturation, respiratory rate were monitored continuously. Surgery was started 10-15 minutes after the injection and confirming adequacy of caudal block. Duration of analgesia was assessed using FLACC scale (Face, Legs, Activity, Cry, Consolability scale. The time from administration of caudal anesthesia to the first time the FLACC score equal or greater than 4 was considered as the duration of caudal analgesia. Paracetamol suppository was used as rescue analgesia with a loading dose of 40mg/kg. STATISTICAL ANALYSIS: Mann-Whitney test and Student ‘t’test was used to compare the data obtained in the two groups. RESULTS: The

  17. Epidural extramedullary haemopoiesis in thalassaemia

    International Nuclear Information System (INIS)

    lntrathoracic extramedullary haematopoiesis is a rare condition. Involvement of the spinal epidural space with haematopoietic tissue is rather unusual. A 31-year-old-man with a known diagnosis of β-thalassaemia was referred with focal back pain. Magnetic resonance imaging revealed diffuse bone-marrow changes, thoracic paraspinal masses and lobulated epidural masses, suggesting extramedullary haemopoiesis. The patient was treated with radiotherapy and blood transfusions. Follow-up MRI was performed for evaluation efficacy of the treatment. Copyright (2002) Blackwell Science Pty Ltd

  18. A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats

    OpenAIRE

    F.M. Lawal; Adetunji, A.

    2009-01-01

    A mixture of 2% lignocaine (LIG) and 0.5% bupivacaine (BUP), at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP), was compared to LIG (4 mg/kg) and BUP (1 mg/kg) for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg) and ketamine hydrochloride (10 mg/kg). Onset and duration of analgesia, and time to walking were determined. Assoc...

  19. A case of trigeminal hypersensitivity after administration of intrathecal sufentanil and bupivacaine for labor analgesia

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    Adriano Bechara de Souza Hobaika

    2014-01-01

    Full Text Available Rostral spread of intrathecal drugs and sensitization of supraspinal sites may provoke several adverse effects. This case describes a patient with right hemifacial paresthesia, trismus and dysphasia on the trigeminal nerve distribution after intrathecal sufentanil administration. Primigravida, 34 years, 39 weeks of pregnancy, with hypothyroidism and pregnancy induced hypertension. Allergic to latex. In the use of puran T4, 50 μg /day. When the patient presented cervical dilatation of 4 cm, she requested analgesia. She was placed in the sitting position and a spinal puncture was performed with a 27G needle pencil point in L4/L5 (1.5 mg of bupivacaine plus 7.5 μg of sufentanil. Next, was performed an epidural puncture in the same space. It was injected bupivacaine 0.065%, 10 ml, to facilitate the passage of the catheter. After 5 min lying down in the lateral upright position, she complained of perioral and right hemifacial paresthesia, mainly maxillary and periorbital, as well as trismus and difficulty to speak. The symptoms lasted for 30 min and resolved spontaneously. After 1 h, patient requested supplementary analgesia (12 ml of bupivacaine 0.125% and a healthy baby girl was born. Temporary mental alterations have been described with the use of fentanyl and sufentanil in combined epidural-spinal analgesia, such as aphasia, difficulty of swallowing, mental confusion and even unconsciousness. In this patient, facial areas with paresthesia indicated by patient appear in clear association with the ophthalmic and maxillary branches of the trigeminal nerve and the occurrence of trismus and dysphagia are in association with the mandibular motor branch. The exact mechanism of rostral spread is not known, but it is speculated that after spinal drug administration, a subsequent epidural dose may reduce the intratecal space and propel the drug into the supraspinal sites.

  20. Sufentanil subaracnóideo associado à bupivacaína hiperbárica para analgesia de parto: É possível reduzir a dose do opióide? Sufentanil subaracnóideo asociado a la bupivacaína hiperbárica para analgesia de parto: Es posible reducir la dosis del opioide? Spinal sufentanil associated to hyperbaric bupivacaine: Is it possible to decrease opioid dose?

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    Eduardo Tsuyoshi Yamaguchi

    2004-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A adição de bupivacaína isobárica a doses menores de sufentanil por via subaracnóidea promove analgesia de qualidade satisfatória, com menor incidência de efeitos colaterais. O objetivo do estudo foi avaliar a qualidade da analgesia e a incidência de efeitos colaterais de doses reduzidas de sufentanil subaracnóideo associados à bupivacaína hiperbárica em analgesia de parto. MÉTODO: Foram estudadas prospectivamente 69 gestantes de termo em trabalho de parto. As gestantes foram aleatoriamente divididas em três grupos que receberam, no espaço subaracnóideo, a combinação de 2,5 mg de bupivacaína hiperbárica e 1 ml de solução fisiológica (Grupo Controle; 2,5 mg de bupivacaína hiperbárica e 2,5 µg de sufentanil (Grupo S2,5 ou 2,5 mg de bupivacaína hiperbárica e 5 µg de sufentanil (Grupo S5. A dor, de acordo com a escala analógico visual (EAV de dor e a incidência de efeitos colaterais foram avaliadas a cada 5 minutos nos primeiros quinze minutos e a seguir a cada 15 minutos até o nascimento. O estudo terminava com o nascimento, ou quando a paciente solicitava medicação analgésica de resgate (EAV > 3 cm. RESULTADOS: Os grupos S2,5 e S5 apresentaram maior duração de analgesia (67,2 ± 38,6 e 78,9 ± 38,7 minutos, respectivamente e maior porcentagem de pacientes com analgesia efetiva (100% e 95,6%, respectivamente que o grupo Controle, no qual a duração média de analgesia foi de 35,9 ± 21,6 minutos (p JUSTIFICATIVA Y OBJETIVOS: La adición de bupivacaína isobárica a dosis menores de sufentanil por vía subaracnóidea promueve analgesia de cualidad satisfactoria, con menor incidencia de efectos colaterales. El objetivo del estudio fue evaluar la calidad de la analgesia y la incidencia de efectos colaterales de dosis reducidas de sufentanil subaracnóideo asociados a bupivacaína hiperbárica en analgesia de parto. MÉTODO: Fueron estudiadas prospectivamente 69 embarazadas de término en

  1. Analgesia for labour pain – analysis of the trends and associations in the Grampian region of Scotland between 1986 and 2001

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    Wang Tao

    2006-04-01

    Full Text Available Abstract Background Although intrapartum analgesia has been in use since Victorian times, there have been few attempts to study its usage from routinely collected data. This population based epidemiological study aimed to analyse retrospective data on the distribution of different types of labour analgesia used by women in the Grampian region of Scotland between 1986 and 2001 in order to examine time trends and associations. Methods Data records on all deliveries occurring in the years 1986 to 2001 were extracted from the Aberdeen Maternity and Neonatal Databank. The rates of the use of epidural, opioid and Entonox or no analgesia for pain relief in labour in each year were calculated. Maternal, pregnancy, labour and delivery characteristics were compared among the users of three different analgesics by univariate and multivariate analyses. Results A total of 81,418 deliveries were analysed. Of these, 12,659 (15.5% women had epidural, 33,819 (41.5% had used opioids and 26,974(33.1% received either Entonox or no analgesia at all. The women who received epidural analgesia were younger, shorter and heavier and had larger babies (OR = 1.05, 95% CI 1.01, 1.08. Three quarters of them were primigravidae and had longer periods of gestation. They were also more likely to have suffered pregnancy related complications (OR = 2.11, 95% CI 1.8, 2.4. Labour was more likely to have been induced (OR = 2.8, 95% CI 2.6, 2.9 and to have lasted longer in this group of women. Women in this group were 5 times more likely to have an instrumental delivery (95% CI 4.9, 5.1 and 7 times more likely to have a Caesarean section (95% CI 5.7, 9.3. Conclusion Non epidural analgesia was found to be the most popular choice for pain relief in labour in the Grampian region between 1986 and 2001, although an increase in the uptake of epidural services is starting to occur. The type of labour analgesia used is associated with the epidemiological characteristics of the women

  2. Duración y calidad de la analgesia postoperatoria después del bloqueo del plexo braquial para cirugía del hombro: ropivacaína 0,5% frente a ropivacaína 0,5% con clonidina

    OpenAIRE

    Esteves, S; Sa, P.; Figueiredo, D.; Souto, A

    2002-01-01

    Resumen OBJETIVOS: Algunos estudios han demostrado que la duración de los bloqueos nerviosos realizados con anestésicos locales puede ser prolongada con clonidina. En este estudio evaluamos la duración y la calidad de la analgesia proporcionada por el bloqueo del plexo braquial por vía interescalénica para cirugía del hombro, comparando la ropivacaína 0,5% con la ropivacaína 0,5% asociada a clonidina. PACIENTES Y MÉTODOS: Treinta pacientes fueron distribuidos en ...

  3. COMPARISON BETWEEN THE ANALGESIC CHARACTERS AND HEMODYNAMIC CHANGES OF 2% LIGNOCAINE ALONE AND 2% LIGNOCAINE WITH CLONIDINE IN EPIDURAL BLOCKADE

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    Sony Sharma

    2015-01-01

    Full Text Available INTRODUCTION: Pain is as old as mankind and so is the quest for its control. It is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. 1 Pain relief is a growing concern to anaesthesiologist, since no single analgesia is free from side effect, so it is a challenge to provide pain relief without much side effect like sedation, respiratory depression or problem like nausea & vomiting. Regional anaesthesia techniques generously offer adequate pain control for early mobilization and compliance with physiotherapy, they also provide additional benefits of decreased surgical stress response 2 improved myocardial stability, 3,4 rapid recovery of bowel function 5,6 and reduced risk of thromboembolic events like deep vein thrombosis and pulmonary embolism. 7 As a result it is also associated with reduction in postoperative morbidity and mortality. 8 Epidural anaesthesia has become increasingly popular in recent years for surgeries of lower abdomen, pelvis and lower limbs as it offer excellent operating conditions and is relatively safe for patients. It offers benefits in the form of greater hemodynamic stability and provision of postoperative analgesia via an epidural catheter. Clonidine is a partial α - 2 adrenergic agonist which, when administered by epidural route, has analgesic properties and potentiates the effect of local anesthetics . 9 Clonidine has analgesic effect at spinal level mediated by alpha - 2 adrenergic receptor situated in the postsynaptic dorsal horn of spinalcord. 10 It works by blocking the conductance of C & A fibres, increases the potassium ion in isolated neurons in - vitro and intensifies conductance block of local anaesthetics. 11 The aim of our study was to compare the quality and duration of analgesia, to assess the hemodynamic effects and to assess the incidence of side effects (sedation, post - operative nausea and vomiting when 2% lignocaine was used alone and

  4. Comparação entre bloqueios peridural e paravertebral torácicos contínuos para analgesia pós-operatória em pacientes submetidos a toracotomias: revisão sistemática

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    Alberto de Pontes Jardim Júnior

    2013-10-01

    Full Text Available INTRODUÇÃO E OBJETIVOS: Toracotomia é um procedimento associado à dor pós-operatória de forte intensidade. O bloqueio peridural (BPD é considerado o padrão-ouro para o seu controle. O bloqueio paravertebral (BPV é uma opção para o controle da dor pós-operatória. O objetivo deste estudo foi fazer metanálises focadas nas comparações entre as analgesias com bloqueio peridural torácico ou paravertebral contínuos quanto à eficácia relativa no controle da dor pós-toracotomia e à incidência de efeitos adversos. MÉTODOS: O estudo seguiu o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA. Foram analisados desfechos, primário (dor pós-operatória em repouso, e secundários (retenção urinária, náuseas e vômitos e hipotensão arterial. A diferença média ponderada foi estimada para as variáveis contínuas e as razões de chances para as variáveis categóricas. RESULTADOS: Foram incluídos oito estudos prospectivos controlados de alocação aleatória. As metanálises não demonstraram diferenças estatisticamente significantes entre as duas técnicas quanto ao desfecho da dor pós-operatória em repouso nos momentos 4h, 8h, 12h, 16h, 20h, 24h, 36h e 48h. A incidência de retenção urinária foi maior no grupo submetido ao BPD (RC = 7,19; IC95 = 1,87-27,7. A ocorrência de hipotensão foi maior no grupo submetido ao BPD (RC = 10,28; IC95 = 2,95-35,77. Não houve diferença estatisticamente significante entre os dois grupos em relação ao desfecho náuseas/vômitos (RC=3,00; IC95=0,49-18,45. CONCLUSÃO: Não se observaram diferenças estatisticamente significantes quanto ao alívio da dor pós-toracotomia quando comparados os tratamentos BPD e BPV. O tratamento BPV mostrou menor incidência de efeitos colaterais com redução na frequência de retenção urinária e hipotensão.

  5. Convalescence and hospital stay after colonic surgery with balanced analgesia, early oral feeding, and enforced mobilisation

    DEFF Research Database (Denmark)

    Møiniche, S; Bülow, Steffen; Hesselfeldt, Peter;

    1995-01-01

    OBJECTIVE: To evaluate the combined effects of pain relief by continuous epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection. DESIGN: Uncontrolled pilot investigation. SETTING: University hospital, Denmark. SUBJECTS: 17...... mobilisation, which allowed early mobilisation for up to 11 hours on the third postoperative day. Gastrointestinal function with defaecation had returned to normal in 12 patients within the first two postoperative days. Median hospital stay was five days with minimal increase in fatigue and without...... postoperative weight loss. CONCLUSION: These results suggest that a combined approach of optimal pain relief with balanced analgesia, enforced early mobilisation, and oral feeding, may reduce the length of convalescence and hospital stay after colonic operations....

  6. Ropivacaína em bloqueio peridural torácico para cirurgia plástica Ropivacaína en bloqueo peridural torácico para cirugía plástica Thoracic epidural anesthesia with ropivacaine for plastic surgery

    Directory of Open Access Journals (Sweden)

    José Roberto Nociti

    2002-04-01

    resultados del bloqueo peridural torácico con ropivacaína a 0,5% asociado a sedación con infusión continua de propofol en cirugía plástica. MÉTODO: Participaron del estudio sesenta pacientes del sexo femenino con edades entre 18 y 62 años, estado físico ASA I ó II, sometidas a cirugías plásticas combinadas envolviendo mama, abdomen, glúteos, lipoaspiración. Después de punción peridural en T9-T10 óT10-T11, recibieron 40 ml de solución de ropivacaína a 0,5% y sufentanil 15 µg. Dosis subsecuentes de anestésico local fueron administradas a través de catéter cuando necesarias. La sedación fue obtenida con infusión venosa continua de propofol 40 a 50 µg.kg-1.min-1. Fueron evaluadas las características de instalación y regresión del bloqueo, la evolución de los parámetros hemodinámicos y respiratorios, la incidencia de eventos adversos. RESULTADOS: El nivel superior de bloqueo sensorial fue T2 en 52 pacientes (86,6%, C4 en 4 (6,6% e T3 en 4 (6,6%. La media para el tiempo de latencia fue 9,1 ± 8,2 minutos. Se obtuvo bloqueo motor grado 2 en 61,7% de las pacientes y grado 1 en 38,3%. La media para el tiempo de regresión completa del bloqueo motor fue 377,9 ± 68,5 minutos. La media para el tiempo de la primera queja espontanea de dolor fue 965,1 ± 371,3 minutos. Los valores medios de PAS, PAD, PAM y FC decrecieron significativamente en relación al control a partir de los 15 min después de la inyección de anestésico local, caracterizando anestesia hipotensiva. Trece pacientes (21,7% que presentaron PAS BACKGROUND AND OBJECTIVES: Thoracic epidural blockade is a method of hypotensive anesthesia able to reduce bleeding during surgery. This non-comparative study aimed at evaluating the results of thoracic epidural blockade with 0.5% ropivacaine associated to propofol continuous infusion sedation in plastic surgery. METHODS: Participated in this study 60 female patients aged 18 to 62 years, physical status ASA I or II, scheduled for combined plastic

  7. Combined spinal epidural and epidural volume extension: Interaction of patient position and hyperbaric bupivacaine

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    Asha Tyagi

    2011-01-01

    Conclusions : If epidural volume extension is being applied with intention of rapid extension of sensory block when hyperbaric bupivacaine has been injected intrathecally, the combined spinal epidural block should be performed in lateral position rather than in the sitting position.

  8. Remifentalino intravenoso mediante infusor elastomerico frente a meperidina intramuscular: Estudio comparativo en analgesia obstetrica Intravenous remifentanil delivered through an elastomeric device versus intramuscular meperidine comparative study for obstetric analgesia

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    E. Calderón

    2006-10-01

    Full Text Available Objetivos: Evaluar la eficacia y seguridad de remifentanilo administrado mediante infusor elastomérico con PCA iv en analgesia obstétrica comparado con meperidina intramuscular en parturientas con contraindicación para analgesia epidural. Material y Método: Se seleccionaron aletoriamente 24 parturientas, se asoció infusor elastomérico Baxter® con 250 ml de suero fisiológico con 2,5 mg de remifentanilo y un ritmo de 12 ml·h ¹, lo que supone una infusión media de 0,025 μg·kg-1·min-1 de remifentanilo, permitiendo la administración de bolos de 5 ml con un tiempo de cierre de 30 minutos (Grupo R o 1 mg·kg¹ de meperidina y 2,5 mg de haloperidol (Grupo M vía intramuscular cada 4 h. Valoramos la intensidad del dolor cada 30 min mediante una escala analógica visual (EVA, tiempo de infusión, bolos administrados, el nivel de sedación mediante escala del estado de alerta y sedación evaluada por el observador (OAA/S, efectos adversos y el test de Apgar del recién nacido al minuto y a los 5 min. Resultados: No hubo diferencias en los datos antropométricos de ambos grupos. La duración media de la infusión en el grupo R fue de 280 ± 55 min y las necesidades de bolos de rescate de 1,2 ± 1,5. La dosis media de meperidina intramuscular en el grupo M fue de 120 ± 25 mg. La intensidad del dolor durante el parto fue significativamente menor en el grupo R durante todo el periodo de dilatación y expulsivo (pObjectives: To evaluate the effectiveness and security of remifentanil administered by means of elastomeric infusor with PCA IV compared obstetrical analgesia with intramuscular meperidine in obstetric patients with contraindication for epidural analgesia, Material and Method: 24 patients were randomized, an elastomeric infusor Baxter® with a capacity of 250 ml was filled with 2.5 mg of remifentanil and a 12 mililiter·h-1, was satarted, (average infusion of 0.025·kg-1·min-1 of remifentanil, and boluses of 5 ml with a time of closing

  9. Intensidade da dor e adequação de analgesia Intensidad del dolor y adecuación de la analgesia Pain intensity of pain and adequacy of analgesia

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    Ana Maria Calil

    2005-10-01

    Full Text Available Trata-se de um estudo inédito em nosso meio, no qual, avaliou-se a intensidade da dor e a adequação da analgesia no setor de emergência. Foram avaliadas 100 vítimas de acidentes de transporte atendidas em um hospital de referência para trauma. A dor foi presente em 90,0% dos casos; 56,0% referiram dor intensa na primeira avaliação e, após três horas de observação, 26,0% permaneceram com dor intensa e 38,0% com dor moderada. Uma significativa parte da população do estudo permaneceu sem analgesia durante o período de observação. Números expressivos de inadequação analgésica foram encontrados demonstrando a reduzida importância conferida a analgesia no trauma em nosso meio.Se trata de un estudio inédito en nuestro medio, en el cual se evaluó la intensidad del dolor y el adecuado procedimiento de analgesia en un sector de emergencia. Se evaluó a 100 víctimas de accidentes de tránsito atendidas en un hospital de referencia para trauma. El dolor fue constatado en el 90,0% de los casos. El 56,0% relató dolor intenso en la primera evaluación. Después de 3 horas de observación, el 26,0% permaneció con dolor intenso y el 38,0% con dolor moderado. Una significativa parte de la población estudiada permaneció sin analgesia durante el período de observación. Se encontró números expresivos de analgesia inadecuada, lo que demuestra la reducida importancia que se da a la analgesia en el trauma en nuestro medio.An unprecedented study in Brazil analyzed pain intensity and adequacy of analgesia at an emergency center. One hundred accident victims attended at a trauma reference hospital were evaluated. Pain was present in 90% of cases; 56.0% complained of severe pain on first evaluation and, three hours later, 26.0% remained in severe pain and 38.0% in moderate pain. A significant portion of the study population did not receive analgesia during the observation period. Considerable numbers of inadequate analgesia were found

  10. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial

    OpenAIRE

    Bergström, M; Kieler, H; Waldenström, U

    2009-01-01

    Objective To examine the effects of antenatal education focussing on natural childbirth preparation with psychoprophylactic training versus standard antenatal education on the use of epidural analgesia, experience of childbirth and parental stress in first-time mothers and fathers. Design Randomised controlled multicentre trial. Setting Fifteen antenatal clinics in Sweden between January 2006 and May 2007. Sample A total of 1087 nulliparous women and 1064 of their partners. Methods Natural gr...

  11. Sedação e analgesia em terapia intensiva Sedación y analgesia en terapia intensiva Sedation and analgesia in intensive care

    Directory of Open Access Journals (Sweden)

    Fábio Ely Martins Benseñor

    2003-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A ansiedade e a dor podem causar maior desconforto e risco aumentado de complicações no pós-operatório de pacientes cirúrgicos, prolongando inclusive seu tempo de internação. O objetivo deste estudo foi revisar os conceitos de sedação e analgesia em terapia intensiva, atualizando os conhecimentos e permitindo a revisão das informações disponíveis na literatura, assim como os consensos já publicados. CONTEÚDO: Apresentamos separadamente a sedação e analgesia, revisando cada grupo de fármacos disponível na prática clínica, suas características principais bem como seus efeitos colaterais mais importantes. Acrescentamos alguns protocolos utilizados em nossa UTI para analgesia e sedação, assim como as conclusões do último consenso do Colégio Americano de Medicina Intensiva e da Sociedade Americana de Terapia Intensiva. CONCLUSÕES: Apesar do grande arsenal terapêutico disponível na prática clínica, nota-se um grande desconhecimento das principais características dos fármacos utilizados para sedação e analgesia em terapia intensiva. Os consensos realizados tentam difundir as qualidades e efeitos colaterais dos fármacos mais utilizados, normatizando seu uso, tornando a analgesia e sedação realizadas nas UTI, procedimentos que beneficiem e recuperem mais rapidamente os pacientes.JUSTIFICATIVA Y OBJETIVOS: La ansiedad y el dolor pueden causar grande falta de comodidad y riesgo aumentado de complicaciones en el pos-operatorio de pacientes quirúrgicos, prolongando también su tiempo de internación. El objetivo de este estudio fue revisar los conceptos de sedación y analgesia en terapia intensiva, actualizando los conocimientos y permitiendo la revisión de las informaciones disponibles en la literatura, como también los consensos ya publicados. CONTENIDO: Presentamos separadamente la sedación y analgesia, revisando cada grupo de fármacos disponibles en la práctica clínica, sus

  12. Contrast study of the epidural space

    Energy Technology Data Exchange (ETDEWEB)

    Sipukhin, Ya.M.; Murzin, V.E.; Artyushenko, V.S. (Vladivostokskij Meditsinskij Inst. (USSR))

    The results of contrast epidurography of 69 patients with various diseases of the vertebral column and spinal marrow are presented. Two methods were used: sacral and transdural. Cardiotrast, urotrast, urografin and verografin were used as contrast substances; during epidural administration the amount did not exceed 4 ml. X-ray signs of changes of the epidural space, such as obstruction, stenosis, deformity, make it possible to diagnose disk hernia, tumors and epiduritis. Complications associated with examination were not observed.

  13. Contrast study of the epidural space

    International Nuclear Information System (INIS)

    The results of contrast epidurography of 69 patients with various diseases of the vertebral column and spinal marrow are presented. Two methods were used: sacral and transdural. Cardiotrast, urotrast, urografin and verografin were used as contrast substances; during epidural administration the amount did not exceed 4 ml. X-ray signs of changes of the epidural space, such as obstruction, stenosis, deformity, make it possible to diagnose disk hernia, tumors and epiduritis. Complications associated with examination were not observed

  14. Tratamiento epidural del dolor en la isquemia vascular periférica (I Treatment of epidural pain in peripheral vascular ischemia (I

    Directory of Open Access Journals (Sweden)

    M.J. Orduña González

    2009-03-01

    Full Text Available La isquemia arterial periférica puede ser el resultado de diversas enfermedades que afectan la vascularización de los miembros, generando dolor, discapacidad y deterioro de la calidad de vida del paciente, y en los casos de isquemia crítica produciendo una considerable morbimortalidad y dolor crónico. El objetivo ha sido realizar una revisión histórica de publicaciones científicas acerca de los distintos tipos de isquemia periférica, del dolor derivado, de su tratamiento analgésico por vía epidural y de las peculiaridades que hay que tener en cuenta en dicha patología. Se ha realizado una búsqueda en MEDLINE y se han recopilado los principales datos respecto a la evolución y las principales líneas de investigación científicas publicadas en las áreas de la analgesia epidural y el dolor en el contexto de la isquemia arterial periférica. Desde su introducción terapéutica en la isquemia periférica, la analgesia con perfusión de fármacos epidurales ha constituido un método eficaz analgésico, que en el caso de los anestésicos locales, además, aporta efectos hemorreológicos positivos a través de un bloqueo simpático. La neuroestimulación eléctrica epidural (NEE medular es una modalidad analgésica crónica con indicaciones específicas dentro de la isquemia periférica, con potencial efecto trófico y capacidad de preservación de miembros, incluso en isquemia crítica aterooclusiva. El efecto, tanto analgésico como trófico de las distintas modalidades analgésicas epidurales, varía según sus características técnicas y según los distintos tipos de isquemia periférica. Se deben tener en cuenta las limitaciones y riesgos del tratamiento analgésico epidural en la isquemia de miembros. Se necesitan estudios científicos que evalúen la eficiencia y la efectividad de la NEE en la isquemia periférica de naturaleza no aterooclusiva, así como la investigación de parámetros clínicos vasculares que puedan actuar como

  15. MR imaging of spinal epidural sepsis

    International Nuclear Information System (INIS)

    Spinal epidural abscess is uncommonly found in adults and children. Early diagnosis and treatment improves prognosis and prevents serious neurologic sequelae. Four patients with spinal epidural infections were recently evaluated with MR and CT of the spine. In all cases, MR and CT localized the site of infection accurately and showed adjacent bony osteomyelitis. MR proved superior in characterizing infection (abscess vs. inflammatory edema) and demonstrating epidural involvement and spinal cord compression. In all cases, MR obviated the need for myelography. Early recognition by MR of spinal epidural sepsis led to expeditious treatment and better clinical outcome

  16. MR findings of the spinal epidural lesions

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun; Lee, Ho Kyu; Shin, Ji Hoon; Choi, Choong Gon; Suh, Dae Chul; Shin, Myung Jin; Rhim, Seung Chul [Ulsan Univ. College of Midicine, Seoul (Korea, Republic of); Park, Sung Tae [Dongguk Univ. College of Midicine, Kyungju (Korea, Republic of)

    2001-04-01

    The spinal canal takes the form of a series of cylinders designated by their relationship to the meninges and is divided by the dura mater into the epidural or extradural space and intradural space. The epidural space is composed of spinal ligaments, connective and areolar tissue, the epidural venous plexus, lymphatic channels and supporting elements, and various pathologic entities are found there. MR imaging can accurately depict the extent and characteristics of lesions, and in some cases specific diagnosis is possible. In this pictorial essay, we illustrate a variety of spinal epidural lesions and their MR findings.

  17. Eficacia de la aplicación de ozono epidural y paravertebral a una concentración de 30 μg/ml para el manejo de dolor crónico en pacientes con síndrome de cirugía fallida de espalda

    Directory of Open Access Journals (Sweden)

    B. D. Hernández Guinea

    2012-02-01

    Full Text Available Objetivo: determinar la eficacia de la infiltración de ozono epidural y paravertebral a una concentración de 30 μg/ml para el control del dolor crónico en pacientes con síndrome de cirugía fallida de espalda lumbar. Método: se realizó un ensayo clínico cuasi experimental, prospectivo, estudiando 30 pacientes con dolor crónico secundario a síndrome cirugía fallida de espalda, realizando un total de 4 infiltraciones con ozono; en la primera se infiltró 20 ml de ozono a una concentración de 30 μg/ml por vía epidural caudal y 10 ml de ozono a la misma concentración a nivel paravertebral lumbar en L3, L4 y L5 en forma bilateral, con un total de 60 ml paravertebral. Realizándose las siguientes infiltraciones cada semana únicamente en la región paravertebral. Se evaluó la calidad analgésica mediante la escala visual análoga y la funcionalidad por el índice de discapacidad de Oswestry, previo al procedimiento inicial, a la semana, 4 semanas y 2 meses. Resultados: de los 30 pacientes estudiados el 70% fueron mujeres (21 y 30% hombres (9. No se encontró mejoría en el alivio del dolor de acuerdo a la evaluación de la escala visual análoga, con un promedio inicial de 7,2 y un final de 7,4. Tampoco se encontró mejoría en la capacidad funcional evaluada mediante el índice de discapacidad de Oswestry, inicial de 63,47 y final de 64,37, ambos sin significancia estadística. Se presentaron como complicaciones: dolor a la aplicación 40% (12, aumento de discapacidad 13,33% (4 y cefalea 3% (1. Conclusión: el uso de ozono epidural y paravertebral a una concentración de 30 μg/ml, no es eficaz para el alivio del dolor crónico secundario a síndrome de cirugía fallida de espalda.

  18. Unusual cervical spine epidural abscess.

    Science.gov (United States)

    Liou, Jr-Han; Su, Yu-Jang

    2015-10-01

    A 48-year-old man presented to the emergency department with complain of severe neck pain and anterior chest pain. Intermittent fever in the recent 2 days was also noted. There is a track maker over his left side of neck. The laboratory examination showed leukocytosis and high C-reactive protein level. Urine drug screen was positive for opiate. Empirical antibiotic administration was given. Blood culture grew gram-positive cocci in chain, and there was no vegetation found by heart echocardiogram. However, progressive weakness of four limbs was noted, and patient even cannot stand up and walk. The patient also complained of numbness sensation over bilateral hands and legs, and lower abdomen. Acute urine retention occurred. We arranged magnetic resonance imaging survey, which showed evidence of inflammatory process involving the retropharyngeal spaces and epidural spaces from the skull base to the bony level of T5. Epidural inflammatory process resulted in compression of the spinal cord and bilateral neural foramen narrowing. Neurosurgeon was consulted. Operation with laminectomy and posterior fusion with bone graft and internal fixation was done. Culture of epidural abscess and 2 sets of blood culture all yielded methicillin-sensitive Staphylococcus aureus. For epidural abscess, the most common involved spine is lumbar followed by thoracic and cervical spine. Diagnosis and treatment in the drug abusers are still challenging because they lack typical presentation, drug compliance, and adequate follow-up and because it is hard to stop drug abuser habit. Significant improvement of neurological deficit can be expected in most spinal abscess in drug abusers after treatment. PMID:26298050

  19. Vascular lesions of the lumbar epidural space: magnetic resonance imaging features of epidural cavernous hemangioma and epidural hematoma

    Directory of Open Access Journals (Sweden)

    Basile Júnior Roberto

    1999-01-01

    Full Text Available The authors report the magnetic resonance imaging diagnostic features in two cases with respectively lumbar epidural hematoma and cavernous hemangioma of the lumbar epidural space. Enhanced MRI T1-weighted scans show a hyperintense signal rim surrounding the vascular lesion. Non-enhanced T2-weighted scans showed hyperintense signal.

  20. Immediate postoperative pain level from lumbar arthrodesis following epidural infiltration of morphine sulfate

    Directory of Open Access Journals (Sweden)

    Carlos Alexandre Botelho do Amaral

    2015-02-01

    Full Text Available OBJECTIVE: To evaluate the pain level in patients treated with epidural infusion of morphine sulfate in a single dose, after a surgical procedure to perform lumber arthrodesis.METHODS: Forty patients underwent posterolateral lumbar arthrodesis or intersomatic lumbar arthrodesis via a posterior route at one, two or three levels. They were prospectively randomized into two groups of 20. In the first group (study group, 2 mg of morphine sulfate diluted in 10 mL of physiological serum was infiltrated into the epidural space, through the laminectomy area. The second group (controls did not receive analgesia. The patients were asked about their pain levels before and after the operation, using a visual analog scale (VAS.RESULTS: It was found that the patients presented a significant diminution of pain as shown by the VAS. From before to after the operation, it decreased by an average of 4.7 points (p = 0.0001, which corresponded to 53.2% (p = 0.0001.CONCLUSION: Application of 2 mg of morphine sulfate in a single epidural dose was shown to be a good technique for pain therapy following lumbar spinal surgery.

  1. Epidural ropivacaine hydrochloride during labour: protein binding, placental transfer and neonatal outcome.

    LENUS (Irish Health Repository)

    Porter, J M

    2012-02-03

    This study was undertaken: (i) to quantify the effects of labour and epidural analgesia on plasma alpha1-acid glycoprotein concentration, (ii) to examine the effects of changes in plasma alpha1-acid glycoprotein concentration on plasma protein binding and placental transfer of ropivacaine, and (iii) to examine the association between umbilical venous ropivacaine concentration and neurobehavioural function in the neonate. Multiparous patients undergoing induction of labour received a continuous epidural infusion of 0.1% ropivacaine following an epidural bolus. A significant association was demonstrated between maternal plasma alpha1-acid glycoprotein concentration and 1\\/free fraction of ropivacaine 60 min after starting ropivacaine administration (r(2) = 0.77) but not at delivery. No significant correlation was demonstrable between maternal unbound ropivacaine concentration and either neonatal (cord) ropivacaine concentration or UV\\/MV (a measure of placental transfer). Thirty minutes after delivery, 9\\/10 neonates had neurological and adaptive capacity scores < 35, whereas only three infants had scores < 35 at 2 h. All scores exceeded 35 16 h after delivery. No association between mean (SD) umbilical venous ropivacaine concentration [0.09 (0.08) mg x l(-1)] and neurological and adaptive capacity scores was demonstrated.

  2. Comparison of Postoperative Analgesic Effects of Thoracic Epidural Morphine and Fentanyl

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    Gönül Sağıroğlu

    2011-11-01

    Full Text Available Objective: In our study, we aimed to compare epidural morphine and fentanyl analgesia and the side effects in post-thoracotomy pain management. Material and Methods: Forty patients, planned for elective thoracotomy were included. Bupivacain- morphine was administered through an epidural catheter to the patients in Group-M while bupivacain-fentanyl was given in Group-F. Pain assessment was carried out with the Visual Analogue Scale (VAS and VAS-I and VAS-II were assessed in 0, 4, 16 and 24th hour in the postoperative unit. Adverse effects were recorded after the 24th hour. Statistical analyses were performed by using Two-sample independent-t test, Mann Whitney-U test, Wilcoxon-signed ranks test and Pearson chi-squared tests. Results: Although, the VAS-I and VAS-II scores were lower in Group-M than Group-F, the difference was not significant statistically (p>0.05. When other hours were compared with initial states, beginning from the 4th hour, in both groups there was a statistically significant drop in VAS-I and VAS-II scores at all times (p<0.001. Comparing the complications between the groups, in Group-M nausea-vomiting (p<0.015 and bradycardia (p<0.012 were found significantly more frequently than in Group-F. Conclusion: We concluded that, in pain management after thoracic surgery, either morphine or fentanyl may be chosen in thoracal epidural analgesia but, especially in the early postoperative hours, close follow-up is necessary due to the risk of bradycardia development.

  3. Epidural Abscess Caused by Streptobacillus moniliformis

    OpenAIRE

    Addidle, Michael; Pynn, Joanne; Grimwade, Kate; Giola, Massimo

    2012-01-01

    We present an interesting case of a patient who developed an epidural abscess caused by Streptobacillus moniliformis. This is the first report in the medical literature of a spinal epidural abscess associated with this organism. Diagnosis of S. moniliformis infection requires a high degree of suspicion, and a delay may be inevitable when a relevant clinical history is lacking.

  4. Skin to posterior lumbar epidural space distance

    International Nuclear Information System (INIS)

    To measure the clinically relevant skin to posterior lumbar epidural space distance in adult surgical patients and to correlate this distance with the patient physical factors to construct a model for the prediction of this distance using the correlation. The study was carried out in 100 patients divided into three groups, who were scheduled for different surgical procedures. Group-I consisted of female patients scheduled for lower segment caesarian section (L.S.C.S); group-II adult non-pregnant females undergoing elective surgery and group-III adult males undergoing different surgical procedures. Epidural anaesthesia was given, using loss of resistance (LOR) technique, and skin to posterior epidural space was measured. The mean skin to posterior lumbar epidural space distance was found to be 3.8 +- 0.5 cm in group-I, 3.76 +- 0.7 cm in group- II and 4.0 +- 0.5 cm in group-III. Skin to posterior epidural space distance correlates best with weight of the patient. Posterior lumbar skin to epidural space distance has been found to be less than what is normal in rest of the world. These results may be used as a guideline for performing successful epidural blocks in Pakistani population. A reliable model using patient physical factors to predict skin to posterior epidural space distance could not be constructed. (author)

  5. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

    Science.gov (United States)

    Temkit, M’hamed; Ewais, MennatAllah M.; Luckritz, Todd C.; Stearns, Joshua D.; Craner, Ryan C.; Gaitan, Brantley D.; Ramakrishna, Harish; Thunberg, Christopher A.; Weis, Ricardo A.; Myers, Kelly M.; Merritt, Marianne V.; Rosenfeld, David M.

    2016-01-01

    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). Methods Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. Results Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0–58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system. Conclusions Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management.

  6. Postoperative analgesia in children when using clonidine or fentanyl with ropivacaine given caudally

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    Usha Shukla

    2011-01-01

    Full Text Available Background: The aim of the study was to compare the efficacy of clonidine and fentanyl as an additive to ropivacaine given via single shot caudal epidural in pediatric patients for postoperative pain relief. Materials and Methods: In the present double blind study, 90 children of ASA-I-II aged 3-8 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either ropivacaine 0.25% 1 ml/kg+clonidine 2 μg/kg (group I or ropivacaine 0.25% 1 μl/kg+fentanyl 1 μg/kg (group II. Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamics, and side effects/complications. Results: Both the groups were similar with respect to patient and various block characteristics. The analgesic properties and hemodynamics were also comparable in both groups (P > 0.05. Side effects such as respiratory depression, vomiting bradycardia were significantly less in group I than group II (P < 0.05 ensuing more patient comfort. Conclusions: The analgesic properties of clonidine and fentanyl as additives to ropivacaine in single shot caudal epidural in children are comparable but clonidine offers a more favorable side effect profile. The use of clonidine as additive to ropivacaine in caudal epidural is superior choice to fentanyl because of lack of unwanted side effects and increased patient comfort.

  7. Hospitalization for partial nephrectomy was not associated with intrathecal opioid analgesia: Retrospective analysis

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    Toby N Weingarten

    2014-01-01

    Full Text Available Background: The aim of this retrospective study is to test the hypothesis that the use of spinal analgesia shortens the length of hospital stay after partial nephrectomy. Materials and Methods: We reviewed all patients undergoing partial nephrectomy for malignancy through flank incision between January 1, 2008, and June 30, 2011. We excluded patients who underwent tumor thrombectomy, used sustained-release opioids, or had general anesthesia supplemented by epidural analgesia. Patients were grouped into "spinal" (intrathecal opioid injection for postoperative analgesia versus "general anesthetic" group, and "early" discharge group (within 3 postoperative days versus "late" group. Association between demographics, patient physical status, anesthetic techniques, and surgical complexity and hospital stay were analyzed using multivariable logistic regression analysis. Results: Of 380 patients, 158 (41.6% were discharged "early" and 151 (39.7% were "spinal" cases. Both spinal and early discharge groups had better postoperative pain control and used less postoperative systemic opioids. Spinal analgesia was associated with early hospital discharge, odds ratio 1.52, (95% confidence interval 1.00-2.30, P = 0.05, but in adjusted analysis was no longer associated with early discharge, 1.16 (0.73-1.86, P = 0.52. Early discharge was associated with calendar year, with more recent years being associated with early discharge. Conclusion: Spinal analgesia combined with general anesthesia was associated with improved postoperative pain control during the 1 st postoperative day, but not with shorter hospital stay following partial nephrectomy. Therefore, unaccounted practice changes that occurred during more recent times affected hospital stay.

  8. Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

    Institute of Scientific and Technical Information of China (English)

    Mohammed Hegazy; Ayman A. Ghoneim

    2013-01-01

    Objective: Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Add-ing tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients. Methods: A prospective randomized controlled trial was conducted over 40 paediatric cancer pa-tients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol. Results: The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis. Conclusion: Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

  9. Spinal epidural empyema in two dogs

    International Nuclear Information System (INIS)

    Extensive, diffuse, epidural spinal cord compression was visualized myelographically in two dogs presented for rapid development of nonambulatory tetraparesis and paraplegia, respectively. Purulent fluid containing bacterial organisms was aspirated percutaneously under fluoroscopic guidance from the epidural space of each dog. One dog responded poorly to aggressive medical therapy, which included installation of an epidural lavage and drainage system. Both dogs were euthanized due to the severe nature of their disorder and the poor prognosis. Spinal epidural empyema (i.e., abscess) is a rare condition in humans and has not been reported previously in the veterinary literature. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with painful myelopathies, especially when accompanied by fever

  10. Sedação e analgesia em crianças: uma abordagem prática para as situações mais freqüentes Analgesia and sedation in children: practical approach for the most frequent situations

    Directory of Open Access Journals (Sweden)

    Santiago Mencía Bartolomé

    2007-05-01

    Full Text Available OBJETIVOS: Revisar as indicações, doses e formas de administração dos sedativos, analgésicos e relaxantes musculares mais utilizados na criança, bem como os métodos de monitorização da sedação. FONTES DOS DADOS: Levantamento bibliográfico utilizando a base de dados MEDLINE e revisão da experiência em nossas unidades de cuidados intensivos pediátricos. SÍNTESE DOS DADOS: A administração contínua de drogas analgésicas e sedativas impede o aparecimento das fases de subsedação e requer menor assistência do que na administração intermitente. O midazolan é a droga mais utilizada para sedação contínua da criança gravemente enferma. Os derivados opiáceos e os antiinflamatórios não-hormonais são os analgésicos mais utilizados na criança gravemente enferma. Os opióides associados aos benzodiazepínicos em infusão contínua são os fármacos de eleição em crianças em ventilação mecânica, especialmente a morfina e o fentanil. O uso de protocolos e a monitorização com a utilização de escores clínicos e métodos objetivos como o BIS permitem ajustar mais corretamente a medicação, evitando a supersedação, a subsedação e a síndrome de abstinência. As intervenções não-farmacológicas, como a musicoterapia, o controle de ruídos, a adequada utilização da luz, a massagem e a comunicação com o paciente, são medidas complementares que auxiliam na adaptação da criança ao ambiente hospitalar adverso. CONCLUSÕES: A sedação deve ser adaptada a cada criança em cada momento. O emprego de protocolos que facilitem uma correta seleção de fármacos, uma administração adequada e uma monitorização cuidadosa melhoram a qualidade da sedoanalgesia e reduzem seus efeitos adversos.OBJECTIVES: To review the most frequent recommendations, doses and routes of administration of sedatives, analgesics, and muscle relaxants in children, as well as the methods for monitoring the level of sedation. SOURCES: Review

  11. Levobupivacaína versus bupivacaína em anestesia peridural para cesarianas: estudo comparativo Levobupivacaína versus bupivacaína en anestesia peridural para cesáreas: estudio comparativo Levobupivacaine versus bupivacaine in epidural anesthesia for cesarean section: comparative study

    Directory of Open Access Journals (Sweden)

    Felipe Bergamaschi

    2005-12-01

    uso de bupivacaína racémica con levobupivacaína en anestesia peridural de pacientes sometidas a cesárea electiva. MÉTODO: Ensayo clínico eventual, doblemente encubierto, con gestantes estado físico ASA I y II. Las pacientes fueron distribuidas para recibir 20 mL de bupivacaína a 0,5% racémica ó 20 mL de levobupivacaína a 0,5%, ambas con 10 µg de sufentanil y vasoconstrictor. RESULTADOS: Participaron del estudio 47 pacientes, 24 en el grupo de la levobupivacaína y 23 en el grupo de la bupivacaína. Los grupos eran comparables entre sí en lo que se refiere a las características materno-fetales. Transcurridos 15 minutos después del término de la punción peridural, 62,5% de las pacientes del grupo de la levobupivacaína tenían Bromage 2 ó 3 contra 72,7% en el grupo de la bupivacaína (p = 0,83. Transcurridos veinte minutos, 66,7% de las pacientes del grupo de la levobupivacaína tenían Bromage 2 ó 3 contra 86,3% del grupo de la bupivacaína (p = 0,21. La complicación más frecuente fue la hipotensión arterial, encontrada en 16 (66,7% pacientes del grupo de la levobupivacaína y en 10 (43,5% pacientes del grupo de la bupivacaína (p = 0,11. CONCLUSIONES: La levobupivacaína y la bupivacaína fueron igualmente efectivas en el bloqueo peridural de pacientes sometidas a cesárea.BACKGROUND AND OBJECTIVES: Local anesthetic bupivacaine is found in two different enantiomers: levobupivacaine - S (- and dextrobupivacaine - R (+. Based on studies showing that S(- enantiomers are less cardiotoxic, their use has been increasing in clinical practice. This study aimed at comparing racemic bupivacaine and levobupivacaine in epidural anesthesia for elective cesarean section. METHODS: Randomized, double blind clinical trial enrolling physical status ASA I and II parturients. Patients were assigned to receive either 20 mL of 0.5% racemic bupivacaine or 20 mL of 0.5% levobupivacaine, both with 10 µg sufentanil and epinephrine 1:200,000. RESULTS: Participated in this

  12. Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5% Bloqueo del plexo lumbar por la vía posterior para analgesia postoperatoria en artroplastia total de la cadera: estudio comparativo entre Bupivacaína a 0,5% con Epinefrina y Ropivacaína a 0,5% Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

    OpenAIRE

    Leonardo Teixeira Domingues Duarte; Franklin Cespedes Paes; Maria do Carmo Barreto de C. Fernandes; Renato Ângelo Saraiva

    2009-01-01

    JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pela via posterior promove analgesia pós-operatória efetiva na artroplastia total do quadril. Ropivacaína e bupivacaína não apresentaram qualquer diferença na eficácia analgésica em diferentes bloqueios de nervos periféricos. O objetivo deste estudo foi comparar a eficácia da analgesia pós-operatória resultante da administração em dose única da bupivacaína a 0,5% ou da ropivacaína a 0,5% no bloqueio do plexo lombar pela via posterior na ar...

  13. Sedation with Xylazine-Diazepam and Epidural Administration of Lidocaine and Xylazine for Castration and Ovariohysterectomy in Cats

    OpenAIRE

    Bizhan Ziaei; Zahra Shafiei; Mohammad Shadkhast; Amin Bigham-Sadegh

    2010-01-01

    The aim of this study was to determine whether anesthesia consisting of sedation induced by intramuscular administration of xylazine-diazepam and lumbosacral analgesia induced by epidural administration of lidocaine and xylazine is satisfactory for castration and ovariohysterectomy in cats. Six adult (3 male and 3 female, 2.5 ± 0.5 years of age) cats (mean body weight ± SD, 2.2 ± 0.44 kg) were used in this study. Cats were sedated with xylazine (1-2 mg kg-1 IM) and diazepam (0.2 mg kg-1, IM) ...

  14. Quebra de cateter no espaço peridural Rotura de catéter en el espacio epidural Breakage of a catheter in the epidural space

    Directory of Open Access Journals (Sweden)

    Cristian Sbardelotto

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A quebra do cateter peridural durante sua remoção é rara, porém descrita. O conhecimento das possíveis complicações e o manuseio adequado são responsabilidades do anestesiologista. O objetivo deste relato foi apresentar caso de quebra de cateter peridural em analgesia de parto. RELATO DO CASO: Paciente do sexo feminino, 33 anos, GII, PI, deu entrada na maternidade em trabalho de parto. Após duas horas de evolução, a paciente solicitou analgesia. Ao exame, encontrava-se em fase ativa do trabalho de parto, com dilatação cervical de 5 cm, dinâmica uterina regular, bolsa rota, com dor classificada pela Escala Visual Analógica - VAS 10. Iniciada a analgesia de parto pela técnica combinada com dupla punção. Durante a evolução foi feita uma complementação analgésica pelo cateter. Na retirada houve pequena dificuldade e conseqüente rompimento do mesmo. Optou-se pela realização de uma tomografia axial computadorizada e radiografia da região lombar que não mostrou evidência do fragmento do cateter. Visto que a paciente evoluiu assintomática clinicamente, sem sinais de irritação radicular, dor ou infecção, procedeu-se às devidas orientações e alta hospitalar. CONCLUSÕES: Cateteres peridurais em região lombar são, em ocasiões raras, difíceis de remover. Fatores que podem aumentar as chances de formação de nós e risco de quebra do cateter foram relacionados. Neste caso, um dos principais fatores envolvidos foi a introdução excessiva do cateter peridural lombar. Felizmente, as complicações neurológicas são ainda mais raras, e seguindo as diretrizes de uma tração lenta e suave na ausência de parestesias, na maioria das vezes, o cateter é removido com sucesso.JUSTIFICATIVA Y OBJETIVOS: La rotura del catéter epidural durante su retirada es rara, pero ya se ha descrito. El conocimiento de las posibles complicaciones y el manejo adecuado es de total responsabilidad del anestesi

  15. Impact of Epidural Failures on the Results of a Prospective, Randomized Trial.

    Science.gov (United States)

    Desai, Amita; Alemayehu, Hanna; Weesner, Kathryn A; St Peter, Shawn D

    2016-04-01

    Introduction We conducted a prospective randomized trial to evaluate the merits of two established postoperative pain management strategies: thoracic epidural (EPI) versus patient-controlled analgesia (PCA) with intravenous narcotics after minimally invasive repair of pectus excavatum. Pain scores favored the EPI group for the first two postoperative days only. Critics of the trial suggest that if the epidural failure rate was not so high, results may have favored the EPI group. Therefore, we performed a subset analysis of the EPI group to evaluate the impact of these failures. Methods Patients for whom epidural catheter could not be placed or whose catheters were removed early owing to dysfunction were compared with those with well-functioning catheters. Those with well-functioning catheters were also compared with the PCA group. A two-tailed independent Student t-test and a two-tailed Fisher exact test were used where appropriate. Results Of 55 patients in the EPI group, 12 patients (21.8%) had failed placement or required early removal. Comparing those with failed placements with the rest of the group, there was no difference in daily visual analogue scale pain scores or measures of hospital course. Likewise, comparing those with well-functioning catheters only to those in the PCA group, the results of the trial are replicated in terms of pain scores, hospital course, and length of stay. Conclusion In patients with failed epidural therapy, there is no significant difference in postoperative hospital course. Comparing those with well-functioning catheters to those in the PCA group, trial results are replicated-that is, no significant difference in length of stay, time to regular diet, or time to transition to oral medications. Therefore, failure rate in the EPI group did not influence the results of the trial. PMID:25643246

  16. Tratamiento epidural del dolor en isquemia vascular periférica: Parte II. Revisión bibliográfica basada en la evidencia del tratamiento epidural en la isquemia vascular periférica Epidural pain treatment in peripheral vascular ischemia: (II)

    OpenAIRE

    M.J. Orduña González; C. López Carballo; E. Camblor Suárez; M. López Rouco

    2009-01-01

    Introducción: La isquemia arterial periférica puede ser el resultado de diversas enfermedades que afectan la vascularización de los miembros, generando dolor, discapacidad y deterioro de la calidad de vida del paciente, y en los casos de isquemia crítica, produciendo una considerable morbimortalidad y dolor crónico. Objetivo: Realizar una revisión histórica y crítica de publicaciones científicas sobre la analgesia epidural como método de control del dolor por isquemia vascular periférica y de...

  17. Patient-controlled analgesia: an appropriate method of pain control in children.

    Science.gov (United States)

    McDonald, A J; Cooper, M G

    2001-01-01

    Patient-controlled analgesia (PCA) is an analgesic technique originally used in adults but now with an established role in paediatric practice. It is well tolerated in children as young as 5 years and has uses in postoperative pain as well as burns, oncology and palliative care. The use of background infusions is more frequent in children and improves efficacy; however, it may increase the occurrence of adverse effects such as nausea and respiratory depression. Monitoring involves measurement of respiratory rate, level of sedation and oxygen saturation. Efficacy is assessed by self-reporting, visual analogue scales, faces pain scales and usage patterns. This is optimally performed both at rest and on movement. The selection of opioid used in PCA is perhaps less critical than the appropriate selection of parameters such as bolus dose, lockout and background infusion rate. Moreover, opioid choice may be based on adverse effect profile rather than efficacy. The concept of PCA continues to be developed in children, with patient-controlled epidural analgesia, subcutaneous PCA and intranasal PCA being recent extensions of the method. There may also be a role for patient-controlled sedation. PCA, when used with adequate monitoring, is a well tolerated technique with high patient and staff acceptance. It can now be regarded as a standard for the delivery of postoperative analgesia in children aged >5 years. PMID:11354699

  18. Epidural Co-Administration of Dexmedetomidine and Levobupivacaine Improves the Gastrointestinal Motility Function after Colonic Resection in Comparison to Co-Administration of Morphine and Levobupivacaine

    Science.gov (United States)

    Zeng, Xian-Zhang; Lu, Zhi-Fang; Lv, Xiang-Qi; Guo, Yue-Ping; Cui, Xiao-Guang

    2016-01-01

    Gastrointestinal motility may be impaired after intestinal surgery. Epidural morphine is effective in controlling postoperative pain, but can further reduce gastrointestinal motility. Here, we aimed to investigate the effects of epidural dexmedetomidine on gastrointestinal motility in patients undergoing colonic resection. Seventy-four patients undergoing colonic resection were enrolled in this clinical trial and allocated randomly to treatment with dexmedetomidine (D group) or morphine (M group). The D group received a loading dose epidural administration of 3 ml dexmedetomidine (0.5 μg kg-1) and then a continuous epidural administration of 80 μg dexmedetomidine in 150 ml levobupivacaine (0.125%) at 3 ml h-1 for two days. The M group received a loading dose epidural administration of 3 ml morphine (0.03 mg kg-1) and then a continuous epidural administration of 4.5 mg morphine in 150 ml levobupivacaine at 3 ml h-1 for two days. Verbal rating score (VRS), postoperative analgesic requirements, side effects related to analgesia, the time to postoperative first flatus (FFL) and first feces (FFE) were recorded. VRS and postoperative analgesic requirements were not significantly different between treatment groups. In contrast, the time to FFL and time to FFE were significant longer in M group in comparison to D group (P < 0.05). Moreover, patients in M group had a significantly higher incidence of nausea, vomiting, and pruritus (P < 0.05). No patients showed neurologic deficits in either group. In comparison to morphine, epidural dexmedetomidine is safe and beneficial for the recovery of gastrointestinal motility after colonic resection when used as an adjunct with levobupivacaine for postoperative pain control. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-14004644 PMID:26751791

  19. Meningitis tras anestesia y analgesia espinal

    Directory of Open Access Journals (Sweden)

    M. Robles Romero

    2013-08-01

    Full Text Available El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como agente implicado el estreptococo salivarius. Como meningitis asépticas se clasifican aquellas en las que el cultivo de líquido cefalorraquídeo es negativo, con un periodo de latencia de síntomas inferior a seis horas, que pueden cursar con eosinofilia en el líquido cefalorraquídeo y unos niveles cercanos a la normalidad en la glucorraquia. Suelen tener buena respuesta y evolución con tratamiento antibiótico con vancomicina y cefalosporinas de tercera generación. Como profilaxis incidir en las medidas de asepsia, sobre todo en el uso de mascarilla facial para realizar la técnica, como práctica para disminuir la incidencia de gérmenes cuyo origen está en la cavidad oral y orofaringe. Asimismo podrían reducir la incidencia de meningitis las medidas de asepsia tales como el lavado de manos, uso de guantes y asepsia de la piel. La diferenciación entre meningitis séptica y aséptica se hará con mayor seguridad cuando se estandaricen las técnicas para detectar genoma bacteriano en el líquido cefalorraquídeo; actualmente se etiquetan como meningitis asépticas aquellas en las que el cultivo de líquido cefalorraquídeo es negativo y cuya tinción de Gram es negativa. Pese a que el pronóstico y evolución en rasgos generales de las meningitis tras anestesia y analgesia espinal es bueno, en comparación con las meningitis adquiridas en la comunidad, por la escasa virulencia de las bacterias implicadas (Estreptococo salivarius

  20. Dorsal spinal epidural cavernous hemangioma

    Directory of Open Access Journals (Sweden)

    Darshana Sanghvi

    2010-01-01

    Full Text Available A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas.

  1. Sedation and Analgesia in Interventional Radiology

    OpenAIRE

    Tuite, Catherine; Rosenberg, Eric J.

    2005-01-01

    Complex medical procedures requiring the administration of sedation and analgesia are frequently performed in sites outside the operating room. In particular, interventional radiologists must understand basic principles of sedation and analgesia to direct nurses or nurse practitioners to provide adequate conscious sedation. The purpose of this article is to review basic principles of sedation, pharmacologic agents used for sedation and analgesia, practice guidelines, monitoring, and managemen...

  2. Rapid progression of spinal epidural lipomatosis

    OpenAIRE

    Choi, Kyung-Chul; Kang, Byung-Uk; Lee, Choon Dae; Lee, Sang-Ho

    2011-01-01

    Spinal epidural lipomatosis (SEL) is a rare but well-recognized condition. In general, the onset of its symptoms is insidious and the disease progresses slowly. We report two cases of rapid progression of SEL with no history of steroid intake in non-obese individuals after epidural steroid injection. These SEL patients developed neurologic symptoms after less than 5 months; these symptoms were confirmed to be due to SEL by serial MR images. After the debulking of the epidural fat, their sympt...

  3. Espondilodiscitis y absceso epidural candidiásico Candida spondylodiscitis and epidural abscess

    Directory of Open Access Journals (Sweden)

    Gisela Di Stilio

    2006-08-01

    Full Text Available La espondilodiscitis candidiásica asociada a absceso epidural es una enfermedad de aparición excepcional. Se presenta el caso de un paciente con linfoma de Hodgkin en tratamiento quimioterápico que desarrolló candidiasis sistémica complicada con espondilodiscitis y absceso epidural por dicho germen.Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epidural abscess.

  4. Postoperative urinary retention: evaluation of patients using opioids analgesic Retención urinaria post-operatoria: evaluación de pacientes en tratamiento analgésico con opioides Retenção urinária pós-operatória: avaliação de pacientes em uso de analgesia com opióides

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Barretto de Carvalho Fernandes

    2007-04-01

    ás frecuente en hombres, así como en aquellos pacientes sometidos a analgesia epidural continua. Se sugiere una orientación y vigilancia adecuadas por el equipo de enfermería, haciendo énfasis en el cateterismo vesical intermitente aséptico, durante el transcurso de la retención urinaria, para prevenir complicaciones del tracto urinario.Os objetivos deste estudo foram determinar a incidência de retenção urinária pós-operatória em pacientes que estavam em uso de analgesia com opióides e descrever o método utilizado para esvaziamento vesical. Trata-se de uma série prospectiva e consecutiva de 1.316 pacientes cirúrgicos de 9/1999 a 4/2003. Dos 1.316 pacientes, 594 não usaram cateterismo de demora no pré-operatório. Desses, 128 pacientes apresentaram retenção urinária, com incidência de 22% (128/594. Houve associação estatisticamente significativa entre a ocorrência de retenção urinária e uso da analgesia peridural contínua (p=0,009. Cerca de 69% dos pacientes apresentaram micção espontânea após a realização de apenas um cateterismo. A incidência de retenção urinária encontrada é semelhante à literatura, sendo mais freqüente em homens e naqueles submetidos à analgesia peridural contínua. Sugere-se orientação e vigilância adequada pela equipe de enfermagem, com ênfase no cateterismo vesical intermitente asséptico, na ocorrência de retenção urinária para prevenção de complicações do trato urinário.

  5. Sucrose ingestion causes opioid analgesia

    Directory of Open Access Journals (Sweden)

    Segato F.N.

    1997-01-01

    Full Text Available The intake of saccharin solutions for relatively long periods of time causes analgesia in rats, as measured in the hot-plate test, an experimental procedure involving supraspinal components. In order to investigate the effects of sweet substance intake on pain modulation using a different model, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l for 1 day or 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The indexes (mean ± SEM, N = 12 for the groups receiving tap water for 1 day or 14 days, and sucrose solution for 1 day or 14 days were 0.09 ± 0.04, 0.10 ± 0.05, 0.15 ± 0.08 and 0.49 ± 0.07, respectively. One-way ANOVA indicated a significant difference (F(3,47 = 9.521, P<0.001 and the Tukey multiple comparison test (P<0.05 showed that the analgesia index of the 14-day sucrose-treated animals differed from all other groups. Naloxone-treated rats (N = 7 receiving sucrose exhibited an analgesia index of 0.20 ± 0.10 while rats receiving only sucrose (N = 7 had an index of 0.68 ± 0.11 (t = 0.254, 10 degrees of freedom, P<0.03. This result indicates that the analgesic effect of sucrose depends on the time during which the solution is consumed and extends the analgesic effects of sweet substance intake, such as saccharin, to a model other than the hot-plate test, with similar results. Endogenous opioids may be involved in the central regulation of the sweet substance-produced analgesia.

  6. Effect of different anesthesia and analgesia methods on theT lymphocyte subsets, cytokines and stress hormone level in patients with breast cancer surgery

    Institute of Scientific and Technical Information of China (English)

    Yan Ma; Xi-Qiang He; Geng Wang

    2015-01-01

    Objective: To explore the effect of different anesthesia and analgesia methods on the T lymphocyte subsets, cytokines and the levels of the stress hormone in patients with breast cancer surgery.Methods: 86 cases of breast cancer were divided into two groups by random digits table, control group of 43 cases with total intravenous anesthesia, and the observation group of 43 cases with total intravenous anesthesia combined with epidural anesthesia and postoperative underwent analgesia. The T lymphocyte subsets, cytokines and the levels of the stress hormone were detected before and after operation and compared. Results:CD3+, CD4+ and CD4+/CD8+ of the two groups at T1 or T2 were significantly lower than those at T0, and those in the observation group were significantly lower than the control group, and the difference between the two groups has statistical significance. IL-6, CRP and TNF-α levels of the two groups at T1, T2 or T3 were significantly higher than those at T0, and those in the observation group were significantly lower than the control group, and the difference between the two groups has statistical significance. Each index of two groups at T4 were restored to T0, and the differences were no statistically significant. The cortisol levels of two groups at T1 or T2 were significantly increased compared with T0, and the increase in the observation group was less than that of the control group, the difference between the two groups has statistical significance. The cortisol levels of two groups at T4 were restored to T0, and the differences were no statistically significant.Conclusion:Epidural analgesia after the intravenous anesthesia combined with epidural anesthesia for breast cancer cure patients has lighter immunosuppression and stress reaction, has less influence on inflammatory factors, is an ideal anesthesia and analgesia.

  7. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection.

    Science.gov (United States)

    Lee, Yujin; Kim, Joon-Sung; Kim, Ji Yeon

    2015-06-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  8. Infektioner i forbindelse med epidural kateterisation

    DEFF Research Database (Denmark)

    Holt, H M; Gahrn-Hansen, B; Andersen, S S; Andersen, O; Siboni, K

    1996-01-01

    Seventy-eight patients with culture-positive epidural catheters were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had en epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of...... central nervous system infection of at least 0.7% at Odense University Hospital. The patients with generalized symptoms of infection had been catheterized for a longer time, and were older than patients with only local symptoms of infection. The microorganisms isolated from the epidural catheters were...... coagulase- negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and other bacteria (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and propose...

  9. Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5% Bloqueo del plexo lumbar por la vía posterior para analgesia postoperatoria en artroplastia total de la cadera: estudio comparativo entre Bupivacaína a 0,5% con Epinefrina y Ropivacaína a 0,5% Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pela via posterior promove analgesia pós-operatória efetiva na artroplastia total do quadril. Ropivacaína e bupivacaína não apresentaram qualquer diferença na eficácia analgésica em diferentes bloqueios de nervos periféricos. O objetivo deste estudo foi comparar a eficácia da analgesia pós-operatória resultante da administração em dose única da bupivacaína a 0,5% ou da ropivacaína a 0,5% no bloqueio do plexo lombar pela via posterior na artroplastia total do quadril. MÉTODO: Trinta e sete pacientes foram alocados aleatoriamente em dois grupos, segundo o anestésico local utilizado no bloqueio: Grupo B - bupivacaína a 0,5% com epinefrina 1:200.000 ou Grupo R - ropivacaína a 0,5%. Durante o período pós-operatório, os escores de dor e o consumo de morfina na analgesia controlada pelo paciente foram comparados entre os grupos. O sangramento durante a operação e a incidência de efeitos adversos e de complicações também foram comparados. RESULTADOS: Apesar dos escores de dor terem sido menores no Grupo R 8, 12 e 24 horas após o bloqueio, essas diferenças não foram clinicamente significativas. Regressão linear múltipla não identificou o anestésico local como variável independente. Não houve diferença no consumo de morfina, no sangramento intraoperatório e na incidência de complicações e efeitos adversos entre os dois grupos. CONCLUSÕES: A bupivacaína a 0,5% e a ropivacaína a 0,5% produziram alívio eficaz e prolongado da dor pós-operatória após artroplastia total do quadril, sem diferença clínica, quando doses equivalentes foram administradas no bloqueio do plexo lombar pela via posterior.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar por la vía posterior, genera una analgesia postoperatoria efectiva en la artroplastia total de la cadera. La ropivacaína y la bupivacaína no arrojaron ninguna diferencia en la eficacia analgésica en

  10. Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

    OpenAIRE

    Lee, Sang-Beom; Park, Hyung-Ki; Chang, Jae-Chil; Jin, So-Young

    2011-01-01

    Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthes...

  11. Epidural glucocorticoid use for vertebrogenic pain

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    M.V. Churyukanov

    2014-06-01

    Full Text Available The literature review deals with the use of glucocorticoids (GC for nonspecific vertebrogenic pain and radiculopathy. The pathophysiology of radiculopathy and the role of mechanical and chemical components in the development of pain syndrome are discussed. The data of clinical trials analyzing the efficiency of epidural GC use, as well as possible indications for this therapy and its adverse reactions are under consideration. The available concepts of the analgesic effect of epidural CG are discussed.

  12. Dexmedetomidina epidural em gatas submetidas à ovariosalpingohisterectomia sob anestesia total intravenosa com propofol e pré-medicadas com cetamina S(+ e midazolam Epidural dexmedetomidine in cats submitted to ovariosalpingohisterectomy under intravenous total anesthesia with propofol and pre medicated with ketamine (S and midazolam

    Directory of Open Access Journals (Sweden)

    Otávia Dorigon

    2009-06-01

    Full Text Available O objetivo deste estudo foi avaliar os efeitos da administração epidural de dexmedetomidina em gatas submetidas à ovariosalpingohisterectomia (OSH, sob infusão contínua de propofol. Para tanto, foram utilizadas 12 gatas adultas, hígidas, com peso médio de 3,3±0,4kg, e entre um e quatro anos de idade. Como medicação pré-anestésica, os animais receberam cetamina S(+ (5mg kg-1 e midazolam(0,5mg kg-1, pela via intramuscular, e propofol como agente indutor (4mg kg-1, pela via intravenosa. Em seguida, os animais foram intubados para receber oxigênio a 100% , por meio de sistema sem reinalação de gases, e a infusão contínua de propofol (0,3mg kg-1 min-1 foi iniciada. Os animais foram alocados em dois grupos, nos quais foram administrados dexmedetomidina (2µg kg-1 por via epidural (GDEX, n=06 e, no grupo controle (GSAL, n=06, solução salina 0,9% pela mesma via. O volume total da solução para administração epidural foi completado com solução salina e ajustado para 0,26ml kg-1 em ambos os grupos. No GSAL, houve necessidade de administração de fentanil imediatamente após o início da cirurgia (T10 em 33,33% dos pacientes. Durante a infusão contínua de propofol, o reflexo palpebral medial esteve presente em 66,6% dos animais do GSAL e em 16,6% dos animais do GDEX. O globo ocular permaneceu centralizado em todos os animais do GSAL e rotacionado em 83,4% dos animais do GDEX. Foi observada redução da freqüência cardíaca após a indução anestésica em ambos os grupos. A pressão arterial média foi menor no T0 e no T5, no GDEX, e maior no T10, no GSAL, em relação ao basal. A freqüência respiratória foi menor no GDEX nos tempos T20 e T30 em relação a GSAL. A SaO2 e a PaO2 foram maiores de T5 até T40 para ambos os grupos em comparação ao basal. Para a PaCO2, foram observados valores maiores de T5 até T40 para o GDEX e maiores no T5, T10 e T20, no GSAL, em relação aos valores basais. Na recuperação anest

  13. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

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    Nilton Bezerra do Vale

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal nos sistemas de neurotransmissão e neuromodulação central relacionados com analgesia, relaxamento e humor: peptidérgico, monaminérgico, gabaérgico, colinérgico e canabinóide. A analgesia adjuvante complementar é habitualmente utilizada nos tratamentos fisiátricos, ortopédicos, reumatológicos, obstétricos e com acupuntura. A analgesia alternativa complementar pode potencializar os métodos analgésicos convencionais, a exposição à luz do sol matutino, luz e cores sob luz artificial, o tempo (T - anestésicos gerais mais potentes à noite, opióides de manhã e anestésicos locais à tarde, dieta, bom humor e riso, espiritualidade, religião, meditação, musicoterapia, hipnose e efeito placebo. CONCLUSÕES: Se a dor aguda é um mecanismo de defesa, a dor crônica é um estado patológico desagradável relacionado com a depressão endógena e a uma baixa qualidade de vida. É importante estabelecer relações interdisciplinares entre a Medicina adjuvante e alternativa nas terapias analgésicas e antiinflamatórias clássicas.JUSTIFICACIÓN Y OBJETIVOS: Aunque el dolor agudo y el crónico sean habitualmente controlados con intervenciones farmacológicas, 14 métodos complementarios de analgesia adyuvante y alternativa (AAA pueden reducir el uso y el abuso en la prescripción de analgésicos y disminuir los efectos colaterales que eventualmente comprometen el estado fisiológico del paciente. CONTENIDO: Todos los mecanismos anti

  14. Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report

    Directory of Open Access Journals (Sweden)

    Luo LL

    2015-05-01

    Full Text Available LinLi Luo,* Juan Ni,* Lan Wu, Dong Luo Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China  *These authors contributed equally to this work and should be considered co-first authors Abstract: Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1–L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg for sedation and analgesia. Satisfactory anesthesia was provided to the patient and spontaneous ventilation was maintained during the surgery. The mother and the baby were discharged 5 days after surgery, no complications were reported for either of them. Our work demonstrated that an ultrasound-guided epidural anesthesia combined with low-dose ketamine can be used to successfully maintain spontaneous ventilation and provide effective analgesia during surgery and reduce the risk of postoperative anesthesia-related pulmonary infection. Keywords: anesthesia, regional, cesarean delivery, ketamine, ultrasound-guided

  15. An evaluation of obstetrical analgesia.

    Science.gov (United States)

    FIST, H S

    1954-02-01

    Relief of pain and safety of mother and child are fundamentals in obstetrical analgesia. Elimination of those drugs which are ineffective or dangerous is the best guide to proper medication. Morphine, codeine, or similar opium derivatives should be avoided as they depress fetal respiration. Barbiturates have the same fault, despite their popularity. Demerol in small dosage is safe and effective. Scopolamine yields excellent results with safety. Magnesium sulfate potentiates and reinforces the action of scopolamine and involves no danger. This combination of drugs may be used by any competent general practitioner in the home or hospital. PMID:13126811

  16. Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

    International Nuclear Information System (INIS)

    Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202–211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202–211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

  17. Uso de morfina, xilazina e meloxicam para o controle da dor pós-operatória em cadelas submetidas à ovariossalpingo-histerectomia Morphine, xylazine and meloxicam in pain management after ovariosalpingohysterectomy of bitches

    Directory of Open Access Journals (Sweden)

    D.A. Pereira

    2009-04-01

    Full Text Available Foram realizados estudos empregando-se analgésicos por via epidural e subcutânea em cadelas de diferentes raças e idades, submetidas à castração mediante celiotomia. Vinte animais foram tranquilizados e anestesiados com tiletamina-zolazepam, e aleatoriamente distribuídos em quatro grupos (n=5, de acordo com o fármaco e a via de administração. Os do grupo morfina (GM foram submetidos à anestesia epidural no espaço lombossacro, com morfina (0,1mg/kg associada ao cloreto de sódio a 0,9%. Aos do grupo xilazina (GX, foram administrados xilazina (0,2mg/kg e cloreto de sódio a 0,9%. Os do grupo meloxicam (GME receberam 0,2mg/kg do anti-inflamatório meloxicam associado ao cloreto de sódio a 0,9%, injetado pela via subcutânea. Os do grupo-controle (CG receberam apenas cloreto de sódio a 0,9%. O volume final para as injeções epidurais foi padronizado para 0,3mL/kg. A mensuração inicial da concentração de cortisol plasmático, do ritmo cardíaco, da frequência respiratória e os parâmetros comportamentais foram registrados imediatamente antes do procedimento cirúrgico (M1. Registros adicionais foram apresentados às 2, 6, 12 e 24 horas após o procedimento cirúrgico (M2, M3, M4 e M5, respectivamente. As variáveis comportamentais foram avaliadas por meio de sinais clínicos e seus respectivos escores. Em GX foram observadas depressão respiratória, bradicardia e concentração de cortisol mais alta do que o registrado no GM. A analgesia obtida pelo meloxicam foi considerada ineficiente. É possível concluir que a morfina, via epidural, promoveu menor incidência de efeitos colaterais e melhor analgesia e bem-estar animal.The use of analgesics by epidural and subcutaneous way in bitches submitted to surgical sterilization by laparotomy was evaluated. Twenty females dogs of different ages and breeds were sedated and anesthetized with a combination of tiletamine-zolazepam and randomly distributed into four experimental groups of

  18. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

    OpenAIRE

    Nilton Bezerra do Vale

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA) podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal no...

  19. Extracranial epidural emphysema: pathway, aetiology, diagnosis and management

    OpenAIRE

    Cloran, F; Bui-Mansfield, L T

    2011-01-01

    Extracranial epidural emphysema is an uncommon phenomenon that refers to the presence of gas within the epidural space. As an isolated finding, it is typically benign, but it can be a secondary sign of more ominous disease processes, such as pneumothorax, pneumoperitoneum and epidural abscess. Although the phenomenon has been cited in case reports, a comprehensive review of this topic is lacking in the radiology literature. The authors' aim is to report our experience with extracranial epidur...

  20. Effects of epidural lidocaine anesthesia on bulls during electroejaculation.

    OpenAIRE

    Falk, A J; Waldner, C L; Cotter, B S; Gudmundson, J.; Barth, A D

    2001-01-01

    Two experiments were conducted to determine whether caudal epidural lidocaine anesthesia reduces a stress response to electroejaculation. In the 1st experiment, changes in cortisol and progesterone concentrations in serial blood samples were used to assess the stress response to restraint (control), transrectal massage, caudal epidural injection of saline, electroejaculation after caudal epidural injection of lidocaine, and electroejaculation without epidural lidocaine. In the 2nd experiment,...

  1. A COMPARATIVE EVALUATION OF DEXMEDETOMIDINE AND CLONIDINE AS ADJUVANTS TO LEVOBUPIVACAINE IN EPIDURAL ANAESTHESIA FOR LOWER LIMB ORTHOPAEDIC SURGERIES

    Directory of Open Access Journals (Sweden)

    Karthik

    2015-02-01

    Full Text Available BACKGROUND: There are always efforts to find a better and safer local anaesthetic along with adjuvants in epidural anaesthesia. Bupivacaine is a long acting , effective local anaesthetic that is commonly administered in anaesthesia practice. Despite its undoubted efficacy, bupivacaine is associated with cardiotoxicity and neurotoxicity. Central nervous system (CNS and cardiovascular adverse reactions reported after inadvertent intravascular or intravenous regional anesthesia have been linked to R (+ isomer of bupivacaine. So Levobupivacaine, the pure S ( - – enantiomer of racemic bupivacaine, was developed as an alternative to bupivacaine. Levobupivacaine is increasingly used in the clinical practice because of its safer pharmacological profile and faster protein binding rate AIM: This study was conducted to evaluate the onset and duration of analgesia, extent and duration of sensory and motor block, sedation and side effects of Dexmedetomidine and Clonidine when used as adjuvants to Levobupivacaine in epidural anaesthesia for lower limb orthopaedic surgeries. MATERIALS AND METHODS: A prospective randomized study was carried out in the department of Anaesthesia at Rajarajeswari Medical College and Hospital which included 50 adult patients between the ages of 21 and 60 years (o f ASA I/II grade who underwent lower limb orthopaedic surgeries. The patients were randomly allocated into two groups; levobupivacaine + dexmedetomidine (LD and levobupivacaine + clonidine (LC, comprising of 25 patients each. Group LD was administered 18 ml of 0.5% epidural levobupivacaine and 1.5 μg/kg of dexmedetomidine, while group LC received admixture of 18 ml of 0.5% levobupivacaine and 2 μg/kg of Clonidine . Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. STATISTICAL ANALYSIS: The data obtained was subjected to statistical analysis using analysis of variance, student t test, chi - square test

  2. Thoracic epidural analgesia to control malignant pain until viability in a pregnant patient

    OpenAIRE

    Mehta, Jaideep

    2016-01-01

    Jaideep H Mehta,1 Mary Elizabeth Gibson,2 David Amaro-Driedger,3 Mahammad N Hussain1 1Department of Anesthesiology, UT Health, McGovern Medical School, Houston, TX, 2Orlando Health, Orlando, FL, 3UT Health, McGovern Medical School, Houston, TX, USA Abstract: Management of nonobstetric pain in the pregnant patient presents unique challenges related to transplacental fetal exposure to opioids and the subsequent risk of neonatal withdrawal syndrome. We present the case of a pregnant patient suff...

  3. Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia

    DEFF Research Database (Denmark)

    Stjernström, H; Henneberg, S; Eklund, A;

    1985-01-01

    Heat loss during anaesthesia and surgery is a common problem. In patients with restricted cardio-pulmonary reserves this may endanger the postoperative outcome. In order to compare thermal balance we studied 25 men undergoing transurethral resection of the prostate (TURP), using either general...... the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma...

  4. Analgesia quirúrgica acupuntural:estudio de la efectividad de dos técnicas

    OpenAIRE

    Pagola Bérger, Victor Valentín

    2008-01-01

    Se presenta el estudio de la efectividad de la aplicación de la acupuntura a la realización de operaciones de cirugía mayor durante 14 años en Villa Clara. Se exponen los resultados de 2582 operados con Analgesia Quirúrgica Acupuntural clásica y 236 intervenciones previa Implantación de Catgut. Para la evaluación de la efectividad de la primera, realizada entre 1992 y 2006, se definieron como resultados esperados: la analgesia transoperatoria, calificada de Bien en el 94% de los operados y la...

  5. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate...... the analgesic efficacy of LIA for early postoperative pain treatment. In addition, the analgesic efficacy of wound catheters and implications for length of hospital stay (LOS) were evaluated. Twenty-seven randomized controlled trials in 756 patients operated on with THA and 888 patients operated on...... reported to have similar or improved analgesic efficacy. In TKA, most trials reported reduced pain and reduced opioid requirements with LIA compared with a control group treated with placebo/no injection. Compared with femoral nerve block, epidural or intrathecal morphine LIA provided similar or improved...

  6. Depth of the thoracic epidural space in children.

    NARCIS (Netherlands)

    Masir, F.; Driessen, J.J.; Thies, K.C.; Wijnen, M.H.W.A.; Egmond, J. van

    2006-01-01

    Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epid

  7. Acute spontaneous spinal epidural haematoma in a child

    International Nuclear Information System (INIS)

    Spontaneous spinal epidural haematomas rarely occur. Patients tend to be in their sixties or seventies. Acute spontaneous spinal epidural haematomas in children without a predisposition for bleeding disorders, trauma, vascular malformations or anticoagulant therapy have seldom been described. We present a case of a 4-year-old girl with a spontaneous cervical epidural haematoma diagnosed with MR. (orig.)

  8. Efficacy of Intramuscular Nalbuphine versus Diphenhydramine for the Prevention of Epidural Morphine-induced Pruritus after Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Chia-Chih Liao

    2011-04-01

    Full Text Available Background: Pruritus is the most common side effect of epidural morphine analgesia.Diphenhydramine is a widely used agent for the treatment of urticarial pruritus.Nalbuphine is a mixed opioid agonist–antagonist and has been reportedto be effective in treating opioid-induced pruritus. We compared the effectivenessof intramuscular diphenhydramine and nalbuphine for the preventionof epidural morphine-induced pruritus after cesarean section.Methods: One hundred and fifty, American Society of Anesthesiologists physical statusI or II, women undergoing cesarean section with epidural anesthesia wererandomly assigned to three groups. Group S, group D, and group N receivedintramuscular normal saline (1 ml; n = 50, diphenhydramine (30 mg/1 ml; n= 50, and nalbuphine (10 mg/1 ml; n = 50, respectively, after delivery of thebaby. The occurrence and the severity of pruritus were assessed at 1, 4, 12,and 24 hours after surgery.Results: The overall incidence of pruritus during the 24 hr follow-up period was 72%,68%, and 44% for group S, group D, and group N, respectively. Pruritusoccurred less frequently in group N than group D (p = 0.027. At 4 and 12hrs postoperatively, the pruritus severity was significantly different (p =0.003 and p = 0.002 and was significantly less in group N than group D inthe intergroup comparison (p = 0.013 and p = 0.012.Conclusion: Nalbuphine proved better than diphenhydramine for prevention of epiduralmorphine-induced pruritus in patients who underwent cesarean section.Prophylactic intramuscular nalbuphine (10 mg is effective in decreasing theincidence and severity of pruritus and does not affect analgesia.

  9. Paediatric analgesia in an Emergency Department.

    LENUS (Irish Health Repository)

    Hawkes, C

    2012-02-03

    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  10. Lumbosacral epidural lipomatosis: MRI grading

    Energy Technology Data Exchange (ETDEWEB)

    Borre, Daniel G. [Department of MRI, RM-Hastings, Clinica Monte Grande, Monte Grande, Buenos Aires (Argentina); Department of MRI, Oncologic Center of Excellence, Gonnet, Buenos Aires (Argentina); Sociedad Argentina de Radiologia, Arenales 1985 P.B., Ciudad Autonoma de Buenos Aires C1124AAC (Argentina); Borre, Guillermo E. [Department of MRI, RM-Hastings, Clinica Monte Grande, Monte Grande, Buenos Aires (Argentina); Department of MRI, Oncologic Center of Excellence, Gonnet, Buenos Aires (Argentina); Aude, Flavio [Department of MRI, Oncologic Center of Excellence, Gonnet, Buenos Aires (Argentina); Palmieri, Gladys N. [Department of MRI, RM-Hastings, Clinica Monte Grande, Monte Grande, Buenos Aires (Argentina)

    2003-07-01

    Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study of 2528 patients (1095 men and 1433 women; age range 18-84 years, mean age 47.3 years) we performed a retrospective analysis of MRI exams. We obtained four linear measurements at the axial plane parallel and tangent to the superior end plate of S1 vertebral body: antero-posterior diameter of dural sac (A-Pd DuS), A-Pd of EF, located ventrally and dorsally to the DuS, and A-Pd of the spinal canal (Spi C). We calculated (a) DuS/EF index and (b) EF/Spi C index. We developed the following MRI grading of LEL: normal, grade 0: DuS/EF index {>=}1.5, EF/Spi C index {<=}40%; LEL grade I: DuS/EF index 1.49-1, EF/Spi C index 41-50% (mild EF overgrowth); LEL grade II: DuS/EF index 0.99-0.34, EF/Spi C index 51-74% (moderate EF overgrowth); LEL grade III: DuS/EF index {<=}0.33, EF/Spi C index {>=}75% (severe EF overgrowth). The MRI exams were evaluated independently by three readers. Intra- and interobserver reliabilities were obtained by calculating Kappa statistics. The MRI grading showed the following distribution: grade 0, 2003 patients (79.2%); LEL grade I, 308 patients (12.2%); LEL grade II, 165 patients (6.5%); and LEL grade III, 52 patients (2.1%). The kappa coefficients for intra- and interobserver agreement in a four-grade classification system were substantial to excellent: intraobserver, kappa range 0.79 [95% confidence interval (CI), 0.65-0.93] to 0.82 (95% CI, 0.70-0.95); interobserver, kappa range 0.76 (95% CI, 0.62-0.91) to 0.85 (95% CI, 0.73-0.97). In LEL grade I, there were no symptomatic cases due to fat hypertrophy. LEL grade II was symptomatic in only 24 cases (14.5%). In LEL grade III, all cases were symptomatic. A subgroup of 22 patients (42.3%) showed other substantial spinal pathologies (e

  11. Radiologic findings of intraspinal epidural arachnoid cyst

    International Nuclear Information System (INIS)

    To evaluate the radiologic findings of intraspinal epidural arachnoid cyst. Six patients with surgically proven intraspinal epidural arachnoid cyst were included in this study. Four were free of specific past history, but two had a history of trauma. All underwent examination by plain radiogr4aphy, CT-myelography and MRI, and the following aspects were retrospectively analysed:vertebral pressure erosion, interpedicular distance, enlargement of neural foramina, as seen on plain radiograph, contrast-filling and lateral bulging of lesions through neural foramina on CT-myelograph, and signal intensity, size and shape of margin and epidural fat pattern, as seen on MRI. Three of four congenital intraspinal epidural arachnoid cysts were single in the thoracolumbar region, while in the other case, there were multiple cysts in the mid-and lower thoracic regions. Cysts were equivaleut in size to between four and six vertebral bodies. Plain radiographic findings of pedicular pressure erosion, widened interpedicular distance, and bilateral neural foraminal enlargement of several contiguous vertebrae were observed in all four cases. One showed posterior vertebral scalloping. On CT-myelograph, a contrast-filled cystic lesion occupying the posterior epidural space, with lateral bulging through neural foramina and anterior displacement of the contrast-filled thecal sac, was seen. On MRI, longitudinally elongated, well-demarcated cysts were seen to be present in the posterior epidural space;their signal intensity was the same as in CSF. An epidural fat cap pattern enveloping the upper and lower ends of the cysts was apparent in all cases. In two cases, traumatic intraspinal epidural arachnoid cysts were situated in the thoracolumbar and lumbosacral region, respectively, near a previously injured region and were smaller (equivalent to the height of three vertebral bodies). CT-myelograph and MRI showed that their effect on the thecal sac was compressive only. When pressure erosion of

  12. Radiologic findings of intraspinal epidural arachnoid cyst

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Jeong Kwon; Eun, Choong Ki; Jeon, Young Seup; Lee, Jong Yuk; Lee, Young Joon; Shim, Jae Hong [Inje Univ. College of Medicine, Pusan (Korea, Republic of); Choi, Soon Seup [Donga Univ. College of Medicine, Pusan (Korea, Republic of)

    1998-10-01

    To evaluate the radiologic findings of intraspinal epidural arachnoid cyst. Six patients with surgically proven intraspinal epidural arachnoid cyst were included in this study. Four were free of specific past history, but two had a history of trauma. All underwent examination by plain radiogr4aphy, CT-myelography and MRI, and the following aspects were retrospectively analysed:vertebral pressure erosion, interpedicular distance, enlargement of neural foramina, as seen on plain radiograph, contrast-filling and lateral bulging of lesions through neural foramina on CT-myelograph, and signal intensity, size and shape of margin and epidural fat pattern, as seen on MRI. Three of four congenital intraspinal epidural arachnoid cysts were single in the thoracolumbar region, while in the other case, there were multiple cysts in the mid-and lower thoracic regions. Cysts were equivaleut in size to between four and six vertebral bodies. Plain radiographic findings of pedicular pressure erosion, widened interpedicular distance, and bilateral neural foraminal enlargement of several contiguous vertebrae were observed in all four cases. One showed posterior vertebral scalloping. On CT-myelograph, a contrast-filled cystic lesion occupying the posterior epidural space, with lateral bulging through neural foramina and anterior displacement of the contrast-filled thecal sac, was seen. On MRI, longitudinally elongated, well-demarcated cysts were seen to be present in the posterior epidural space;their signal intensity was the same as in CSF. An epidural fat cap pattern enveloping the upper and lower ends of the cysts was apparent in all cases. In two cases, traumatic intraspinal epidural arachnoid cysts were situated in the thoracolumbar and lumbosacral region, respectively, near a previously injured region and were smaller (equivalent to the height of three vertebral bodies). CT-myelograph and MRI showed that their effect on the thecal sac was compressive only. When pressure erosion of

  13. Epidural levobupivacaine alone or combined with different morphine doses in bitches under continuous propofol infusion

    Directory of Open Access Journals (Sweden)

    V.B. Albuquerque

    2015-08-01

    Full Text Available The aim of this study was to assess the cardiopulmonary, analgesic, adverse effects, serum concentration of cortisol and plasma levels of levobupivacaine and morphine in bitches undergoing propofol anesthesia and epidural analgesia with levobupivacaine alone or combined with morphine. This was a randomized 'blinded' prospective clinical study using 32 adult bitches weighing 9.8±4.1kg that were admitted for elective ovariohysterectomy. Twenty minutes after administration of acepromazine and midazolam, anesthesia was induced with propofol (4mg kg-1 and maintained by a continuous rate infusion (CRI. Each animal was randomly assigned to one of four epidural groups: GL = levobupivacaine alone (0.33mg kg-1; GLM0.1 = levobupivacaine and morphine (0.1mg kg-1; GLM0.15 = levobupivacaine and morphine (0.15mg kg-1; and GLM0.2 = levobupivacaine and morphine (0.2mg kg-1. Variables obtained during anesthesia were heart rate, respiratory rate, systolic, mean and diastolic arterial blood pressures, oxyhemoglobin saturation, inspired oxygen fraction, end-tidal carbon dioxide tension, blood gases, serum cortisol, and plasma levels of levobupivacaine and morphine. The onset and duration times of the blockade were recorded. Arterial pressures were significantly increased in all groups at the times of ovarian pedicle clamping. There was a decrease in pH, together with an increase in both PaO2and PaCO2 over time. Serum cortisol levels were increased in TESu compared to TB, T30 and TR. Limb spasticity, muscle tremors, opisthotonos and diarrhea were observed in some animals during propofol infusion and ceased with the end of CRI. Reactions happened at different moments and lasted for different periods of time in each individual. Epidural with levobupivacaine alone or combined with morphine allowed for ovariohysterectomy to be performed under low propofol infusion rates, with minimal changes in cardiovascular variables and in serum cortisol levels. Adverse effects were

  14. Lumbar Epidural Varix Mimicking Disc Herniation.

    Science.gov (United States)

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  15. Traumatic cervical epidural hematoma in an infant

    Directory of Open Access Journals (Sweden)

    Vithal Rangarajan

    2013-01-01

    Full Text Available An 8-month-old male infant had presented with a history of a fall from the crib a fortnight ago. He had developed progressive weakness of both lower limbs. On examination, the infant had spastic paraplegia. Magnetic resonance (MR imaging of the cervical spine showed an epidural hematoma extending from the fourth cervical (C4 to the first dorsal (D1 vertebral level with cord compression. The patient had no bleeding disorder on investigation. He underwent cervical laminoplasty at C6 and C7 levels. The epidural hematoma was evacuated. The cervical cord started pulsating immediately. Postoperatively, the patient′s paraplegia improved dramatically in 48 hours. According to the author′s literature search, only seven cases of post-traumatic epidural hematoma have been reported in pediatric patients, and our patient is the youngest. The present case report discusses the etiopathology, presentation, and management of this rare case.

  16. Delayed epidural hematoma after mild head injury

    Directory of Open Access Journals (Sweden)

    Radulović Danilo

    2005-01-01

    Full Text Available Background. Traumatic delayed epidural hematoma (DEH can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a “massive” epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.

  17. Lumbar Epidural Varix Mimicking Disc Herniation

    Science.gov (United States)

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  18. Retrograde Epidural Catheter Relieves Intractable Sacral Pain.

    Science.gov (United States)

    Gupta, Ruchir; Shodhan, Shivam; Hosny, Amr

    2016-01-01

    Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT) drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a "band of anesthesia" which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique. PMID:27162431

  19. Spontaneous epidural hematoma due to cervico-thoracic angiolipoma.

    Science.gov (United States)

    Eap, C; Bannwarth, M; Jazeron, J-F; Kleber, J-C; Theret, É; Duntze, J; Litre, C-F

    2015-12-01

    Epidural angiolipomas are uncommon benign tumors of the spine. Their clinical presentation is usually a progressive spinal cord compression. We report the case of a 22-year-old patient who presented with an acute paraparesis and a spontaneous epidural hematoma, which revealed a epidural angiolipoma which extended from C7 to T3. The patient underwent a C7-T3 laminectomy, in emergency, with evacuation of the hematoma and extradural complete resection of a fibrous epidural tumor bleeding. The postoperative course was favorable with regression of neurological symptoms. Epidural angiolipomas can be revealed by spontaneous intratumoral hemorrhage without traumatism. The standard treatment is total removal by surgery. PMID:26597606

  20. Administración epidural de lidocaína, morfina y detomidina para la resección quirúrgica de un tumor de pene en un toro joven (Epidural administration of lidocaine, morphine and detomidine for surgical removal of a tumour in a young bull penis)

    OpenAIRE

    Castiñeiras Pérez, Eva; Segade Seoane, Marcos; Villanueva Santamarina, Blanca Lidia; González Cantalapiedra, Antonio

    2007-01-01

    ResumenCon objeto de mejorar la fertilidad en las explotaciones, algunos ganaderos optan por la presencia de un toro para la monta natural. En toros jóvenes es relativamente común la aparición de fibropapilomas en el pene. Esta patología está causada por un adenovirus quepenetra a través de pequeñas heridas, dando lugar a neoplasias en la porción libre del pene. Por lo general, suelen ser de naturaleza benigna y sólo se recomienda su eliminación quirúrgica cuando dificultan la monta.1 Aunque,...

  1. Intranasal sufentanil/ketamine analgesia in children

    DEFF Research Database (Denmark)

    Nielsen, Bettina Nygaard; Friis, Susanne M; Rømsing, Janne;

    2014-01-01

    The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking....

  2. Analgesia and Sedation After Pediatric Cardiac Surgery

    OpenAIRE

    2010-01-01

    Abstract In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery, has become recognised as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast track and ultra fast track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric in...

  3. Partial reinforcement, extinction, and placebo analgesia

    OpenAIRE

    Yeung, Siu Tsin Au; Colagiuri, Ben; Lovibond, Peter F.; Colloca, Luana

    2014-01-01

    Numerous studies indicate that placebo analgesia can be established via conditioning procedures. However, these studies have exclusively involved conditioning under continuous reinforcement. Thus, it is currently unknown whether placebo analgesia can be established under partial reinforcement and how durable any such effect would be. We tested this possibility using electro-cutaneous pain in healthy volunteers. Sixty undergraduates received placebo treatment (activation of a sham electrode) u...

  4. MRI features of spinal epidural angiolipomas

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Su; Hu, Chun Hong; Wang, Xi Ming; Dai, Hui [Dept. of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu (China); Hu, Xiao Yun; Fang, Xiang Ming [Dept. of Radiology, Wuxi People' s Hospital Affiliated to Nanjing Medical University, Jiangsu (China); Cui, Lei [Dept. of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu (China)

    2013-10-15

    To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.

  5. Spontaneous extracranial decompression of epidural hematoma

    International Nuclear Information System (INIS)

    Epidural hematoma (EDH) is a common sequela of head trauma in children. An increasing number are managed nonsurgically, with close clinical and imaging observation. We report the case of a traumatic EDH that spontaneously decompressed into the subgaleal space, demonstrated on serial CT scans that showed resolution of the EDH and concurrent enlargement of the subgaleal hematoma. (orig.)

  6. Propuesta de una vía de abordaje y técnica para el tratamiento de los síndromes de atrapamiento nervioso lumbar postcirugía (SANLPC, como alternativa a las técnicas de adhesiolisis o epidurolisis Proposal for a new approach and technique for the treatment of post-surgery lumbar nerve entrapment syndromes, as an alternative to adhesiolysis or epidu-ral lysis techniques

    Directory of Open Access Journals (Sweden)

    R. González-Durán

    2006-08-01

    Full Text Available Objetivo: Describir una vía supracicatricial de abordaje y la técnica para la realización de epidurolisis, adhesiolisis y/o bloqueos repetidos radiculares, en síndromes dolorosos por atrapamiento nervioso cicatricial posterior a cirugías de columna lumbar, como alternativa a la epidurolisis caudal descrita en la literatura. Considerando que puede presentar menos complicaciones y puede presentar mejores resultados. Material y método: Ocho pacientes que presentan dolor posterior a cirugías de columna lumbar, con cuadros clínicos de lumbalgia, lumbociatalgia o ciática, con clínica y estudios de imagen (RNM, TAC, mieloTAC sugerentes de fibrosis epidural, estudios de EMG y PESS que indicaban daño en raíces lumbares igual o más que en raíces sacras. Los pacientes no presentaban patología asociada o contraindicaciones para la realización de la técnica. En todos los casos se utilizo: antibioterapia previa, sedación y monitorización del paciente. Se coloca al paciente en decúbito prono, con apoyo abdominal para reducir la lordosis fisiológica posicional y se localiza el espacio interespinoso inmediatamente superior a la cicatriz, para abordar el espacio epidural. Se localiza el espacio epidural con una aguja RX Coudé Curva 8,75 cm 15 g de Epimed® con el bisel orientado caudalmente, confirmando con escopia de alta resolución, mediante la inyección de 0,5 mL de contraste. Se introduce el catéter Tun-L-Kath Epimed® de 19 g y 84,5 cm y se orienta caudalmente hacia el nivel y el lugar con mayor sintomatología con control radiológico directo, hasta la parada en la progresión del catéter y se inyecta contraste para verificar el obstáculo, con la difusión retrógrada del mismo, producida por la fibrosis cicatricial. Se intenta progresar comprobando que al hacerlo hay reproducción de las sensaciones del dolor del paciente. Se extrae la aguja y se vigila la inmovilidad de la punta del catéter con control radiológico. Se tuneli

  7. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1) com ropivacaína e a analgesia subaracnóidea com morfina Analgesia pós-operatoria en cirugía ortopédica: estudio comparativo entre el bloqueo del plexo lombar por vía perivascular inguinal (3 en 1) con ropivacaína y la analgesia subaracnóidea con morfina Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1) and spinal anesthesia with morphine

    OpenAIRE

    Neuber Martins Fonseca; Roberto Araújo Ruzi; Fernando Xavier Ferreira; Fabrício Martins Arruda

    2003-01-01

    JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pelo acesso perivascular inguinal, chamado de bloqueio 3 em 1, tem sido utilizado para analgesia pós-operatória. O objetivo deste estudo foi comparar a analgesia pós-operatória do bloqueio 3 em 1 a da morfina subaracnóidea em pacientes submetidos a cirurgias ortopédicas em membro inferior (MI). MÉTODO: Foram estudados 40 pacientes escalados para cirurgia ortopédica de MI, de ambos os sexos, estado físico ASA I e II, com idades entre 15 e 7...

  8. Pain analgesia among adolescent self-injurers.

    Science.gov (United States)

    Glenn, Jeffrey J; Michel, Bethany D; Franklin, Joseph C; Hooley, Jill M; Nock, Matthew K

    2014-12-30

    Although non-suicidal self-injury (NSSI) involves self-inflicted physical harm, many self-injurers report feeling little or no pain during the act. Here we test: (1) whether the pain analgesia effects observed among adult self-injurers are also present among adolescents, and (2) three potential explanatory models proposing that habituation, dissociation, and/or self-criticism help explain the association between NSSI and pain analgesia among adolescents. Participants were 79 adolescents (12-19 years) recruited from the community who took part in a laboratory-based pain study. Results revealed that adolescent self-injurers have a higher pain threshold and greater pain endurance than non-injurers. Statistical mediation models revealed that the habituation and dissociation models were not supported; however, a self-critical style does mediate the association between NSSI and pain analgesia. The present findings extend earlier work by highlighting that a self-critical style may help to explain why self-injurers exhibit pain analgesia. Specifically, the tendency to experience self-critical thoughts in response to stressful events may represent a third variable that increases the likelihood of both NSSI and pain analgesia. Prospective experimental studies are needed to replicate and tease apart the direction of these associations, and may provide valuable leads in the development of effective treatments for this dangerous behavior problem. PMID:25172611

  9. Postoperative opioid analgesia: time for a reconsideration?

    DEFF Research Database (Denmark)

    Kehlet, H; Rung, G W; Callesen, T

    1996-01-01

    ;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly...

  10. Recurrent acute low back pain secondary to lumbar epidural calcification

    International Nuclear Information System (INIS)

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  11. Paraplegia complicating percutaneous vertebroplasty for osteoporotic vertebral fracture: case report Remoção cirúrgica de polimetilmetacrilato epidural como complicação de vertebroplastia percutânea para tratamento de fratura com compressão de vértebra dorsal osteoporótica: relato de caso

    Directory of Open Access Journals (Sweden)

    Nilo M. Lopes

    2004-09-01

    Full Text Available We report a case of spinal cord and root compression during percutaneous transpedicular polymethylmethacrylate vertebroplasty (PTPV for a compression fracture due to osteoporosis. Sudden onset of excruciating pain in the distribution of the right sixth intercostal nerve with hyperemia along its path, prompted the interruption of the procedure. Under narcotic sedation the patient was taken to the ICU and 10mg of dexamethasone was administered intravenously. Few hours later she developed paraplegia with preservation of light touch and a CT scan and MRI showed epidural extravasation of polymethylmethacrylate with spinal cord and root compression. Surgical decompression was followed by neurological recovery. The cement could be removed after been thinned out by high speed drill, with microsurgical technique, through a wide three level laminectomy of D5 to D7. Extravasation of cement is commonly encountered in PTPV and most of the time it is asymptomatic. Root compression may require surgical intervention if nonresponsive to steroid treatment. Cord compression is less often seen and requires emergency surgery. The cement does not adhere to the duramater and it can be removed easily.Relatamos um caso de compressão medular e radicular durante vertebroplastia percutanea transpedicular com polimetilmetacrilato (VPTP para tratamento de fratura com compressão por osteoporose. O início súbito de dor lancinante na distribuição do 6º nervo intercostal direito, com hiperemia ao longo de seu trajeto, determinou a interrupção do procedimento. Sob sedação com narcóticos, a paciente foi levada ao CTI, sendo administrados 10mg de dexametazona por via endovenosa. Após algumas horas, ela desenvolveu paraplegia com preservação do tato, e a TC e a RM mostraram extravazamento epidural de polimetilmetacrilato com compressão medular e radicular. Descompressão cirúrgica resultou em recuperação neurológica. O cimento foi removido após ter sua espessura

  12. Epidural spinal electrical stimulation in severe angina pectoris.

    OpenAIRE

    Mannheimer, C; Augustinsson, L E; Carlsson, C A; Manhem, K; Wilhelmsson, C

    1988-01-01

    The short term effects of epidural spinal electrical stimulation were studied in 10 patients with angina pectoris of New York Heart Association functional class III or IV. The antianginal pharmacological treatment given at entry to the study was regarded as optimal and was not changed during the study. The effects of epidural spinal electrical stimulation were measured by repeated bicycle ergometer tests. Treatment with epidural spinal electrical stimulation increased the patients' working ca...

  13. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    International Nuclear Information System (INIS)

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  14. Lab in a needle for epidural space identification

    Science.gov (United States)

    Carotenuto, B.; Micco, A.; Ricciardi, A.; Amorizzo, E.; Mercieri, M.; Cutolo, A.; Cusano, A.

    2016-05-01

    This work relies on the development of a sensorized medical needle with an all-optical guidance (Lab in a Needle) system for epidural space identification. The device is based on the judicious integration of a Fiber Bragg grating sensor inside the lumen of an epidural needle to discriminate between different types of tissue and thus providing continuous and real time measurements of the pressure experienced by the needle tip during its advancement. Experiments carried out on an epidural training phantom demonstrate the validity of our approach for the correct and effective identification of the epidural space.

  15. Potentiation of morphine analgesia by caffeine.

    Science.gov (United States)

    Misra, A L; Pontani, R B; Vadlamani, N L

    1985-04-01

    Significant potentiation of morphine (5 mg kg-1 s.c. or 1 mg kg-1 i.v.) analgesia (tail-withdrawal reflex at 55 degrees C) was observed in caffeine-treated (100 mg kg-1 i.p.) rats as compared to the control group and lower doses of caffeine (2mg kg-1 i.p.) did not show this effect. Potentiated analgesia was reversed by naloxone. Pharmacokinetic or dispositional factors appear to be involved in part in this potentiation. PMID:4005485

  16. Potentiation of morphine analgesia by caffeine.

    OpenAIRE

    Misra, A. L.; Pontani, R. B.; Vadlamani, N. L.

    1985-01-01

    Significant potentiation of morphine (5 mg kg-1 s.c. or 1 mg kg-1 i.v.) analgesia (tail-withdrawal reflex at 55 degrees C) was observed in caffeine-treated (100 mg kg-1 i.p.) rats as compared to the control group and lower doses of caffeine (2mg kg-1 i.p.) did not show this effect. Potentiated analgesia was reversed by naloxone. Pharmacokinetic or dispositional factors appear to be involved in part in this potentiation.

  17. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    : feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. Mandibular block analgesia causes lingual nerve injury more frequently than......Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed...

  18. Salmonella Typhi Vertebral Osteomyelitis and Epidural Abscess

    Science.gov (United States)

    Chua, Ying Ying; Chen, John L. T.

    2016-01-01

    Salmonella vertebral osteomyelitis is an uncommon complication of Salmonella infection. We report a case of a 57-year-old transgender male who presented with lower back pain for a period of one month following a fall. Physical examination only revealed tenderness over the lower back with no neurological deficits. MRI of the thoracic and lumbar spine revealed a spondylodiscitis at T10-T11 and T12-L1 and right posterior epidural collection at the T9-T10 level. He underwent decompression laminectomy with segmental instrumentation and fusion of T8 to L3 vertebrae. Intraoperatively, he was found to have acute-on-chronic osteomyelitis in T10 and T11, epidural abscess, and discitis in T12-L1. Tissue and wound culture grew Salmonella Typhi and with antibiotics susceptibility guidance he was treated with intravenous ceftriaxone for a period of six weeks. He recovered well with no neurological deficits. PMID:27034871

  19. Analgesia continua de miembro superior por bloqueo de plexo braquial en dolor crónico oncológico Continuous analgesia of the upper limb with brachial plexus blockade in chronic cancer pain

    OpenAIRE

    M. Narváez; K. Glasinovic; A. Condori; A. Ballon; M. Torres

    2005-01-01

    Objetivo: Evaluar la utilizdad del bloqueo del plexo braquial en el tratamiento del dolor intenso oncológico. Método: Evaluamos en 6 pacientes con metástasis óseas del miembro superior la efectividad de un bloqueo continuo del plexo braquial. Resultados: Todos los pacientes del estudio tuvieron una evolución favorable y un incremento en la analgesia con el tratamiento sin que se produjeran efectos adversos. Conclusiones: La analgesia continua del plexo braquial es un método efectivo para el c...

  20. Acupuntura e analgesia: aplicações clínicas e principais acupontos Acupuncture and analgesia: clinical applications and main acupoints

    Directory of Open Access Journals (Sweden)

    Marilda Onghero Taffarel

    2009-12-01

    Full Text Available A dor é uma resposta protetora do organismo a estímulos nocivos, que resulta em efeitos indesejáveis quando não controlada. A analgesia pode ser promovida mediante a utilização de vários tipos de fármacos. No entanto, estes podem causar efeitos adversos de acordo com a espécie e condição física do paciente. A acupuntura tem se mostrado eficaz como coanalgésico pela capacidade de diminuir a quantidade de fármacos utilizados para o controle da dor e raramente ser contraindicada. Objetivou-se com este trabalho fazer uma breve revisão sobre as aplicações clínicas e os efeitos fisiológicos da acupuntura nos mecanismos da dor, bem como demonstrar os principais pontos de acupuntura utilizados para analgesia em animais. A pesquisa foi realizada em bases de dados eletrônicas por palavra-chave, durante o período de março a dezembro de 2008.Pain is a protective response of the body to harmful stimulus, which results in undesirable effects if not controlled. Analgesia can be achieved with the use of different types of drugs. However, these drugs can cause adverse effects according to species and patient physical condition. Acupuncture has been proved to be an effective analgesic adjuvant, by the capacity to decrease the amount of drug used for pain control, rarely contra-indicated. The aim of this paper was to review the physiological effects of acupuncture on pain mechanisms, and demonstrate the main acupoints used for animal analgesia. The search was done in electronic search database using key words, in 2008.

  1. Analgesia para a sutura artroscópica do manguito rotador: estudo comparativo entre o bloqueio interescalênico do plexo braquial e o bloqueio da bursa subacromial contínuo Management of pain after the rotator cuff arthroscopic suture: comparative study among the interescalenic blockade and the continuous intrabursal infusion

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2007-10-01

    Full Text Available OBJETIVO: Comparar o nível de dor pós-operatória de pacientes submetidos à sutura artroscópica da lesão do manguito rotador (MR que receberam protocolos diferentes de analgesia pós-operatória. Demonstrar a relação entre dor e o sexo do paciente, a dimensão da lesão suturada e a utilização da capsulotomia interna. Verificar a prevalência dos efeitos colaterais. MÉTODO: Foram analisados três grupos de pacientes operados entre 1º de junho de 2004 e 31 de maio de 2007. O grupo I foi composto pelos pacientes que receberam bloqueio interescalênico com ropivacaína a 0,75%. No grupo II, o mesmo bloqueio foi acrescido de 150µg de clonidina. No grupo III foi administrado um bolus de 30ml de ropivacaína a 0,75% para infiltração dos portais artroscópicos e diretamente no espaço subacromial, seguido de infusão contínua de ropivacaína a 0,2% em bomba de infusão. Os pacientes foram submetidos à medição da escala analógica visual (EAV com 24 horas após o procedimento. As variáveis estudadas foram: EAV, sexo, tamanho da lesão, necessidade de capsulotomia interna e prevalência dos efeitos colaterais. O estudo avaliou 196 pacientes, dos quais foram excluídos 51, totalizando n = 145 pacientes. O total de pacientes no grupo I foi de 65; no grupo II, de 19; e no grupo III, de 61. RESULTADOS: O índice da EAV médio encontrado no grupo I foi de 3,88 ± 1,737 (3; no grupo II, de 3,8 ± 1,6 (3; e no grupo III, de 1,95 ± 1,6 (2. Houve diferença significativa ao comparar os grupos I e III (p OBJECTIVE: To compare the level of postoperative pain in patients submitted to arthroscopic suture of a rotator cuff lesion who had different analgesia protocols. To demonstrate the relationship between pain and the gender of the patient, the dimension of the lesion sutured, and the use of internal capsulotomy. To check the prevalence of side effects. METHODS: Three groups of patients operated on between June 01, 2004 and May 31, 2007 were

  2. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  3. Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement

    Institute of Scientific and Technical Information of China (English)

    Zhang Wei; Hu Yan; Tao Yan; Liu Xuebing; Wang Geng

    2014-01-01

    Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2% ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale (VAS) pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation (P >0.05).At these time-points,mean quadriceps strengths in the adductor group were 3.0 (2.75-3.0),3.0 (3.0-4.0),and 4.0 (3.0-4.0),respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 (2.0-3.0),2.0 (2.0-3.0),and 3.0 (2.0-4.0),respectively (P <0.05).There were no significant differences between the groups in doses of complementary analgesics or side effects (P >0.05).X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2% ropivacaine could be used effectively for analgesia after total knee replacement

  4. Comparison between lignocaine hydrochloride and ropivacaine hydrochloride as lumbosacral epidural anaesthetic agents in goats undergoing laparoscopy assisted embryo transfer

    Directory of Open Access Journals (Sweden)

    Anubhav Khajuria

    2014-10-01

    Full Text Available Goats (n=12 undergoing laparoscopy assisted embryo transfer were randomly allotted to two groups (I and II and injected lignocaine hydrochloride (4mg/kg or ropivacaine hydrochloride (1mg/kg at the lumbosacral epidural space. The animals were held with raised hind quarters for first three minutes following injection. Immediately after induction of regional anaesthesia, they were restrained in dorsal recumbency in Trendelenburg position in a cradle. Laparoscopy was performed after creating pneumoperitoneum using filtered room air. The mean (± S.E induction time in animals of group I was significantly shorter (5.33 ± 0.61 min than those belonging to group II (12.66 ±1.99 min. Complete analgesia developed throughout the hind quarters and abdomen for 30 min and 60 min in group I and II animal’s respectively. Unlike animals of group I, group II goats continued to show moderate analgesia for 180 minutes. The motor activity returned after a lapse of 130.00 ± 12.64 min and 405.00 ± 46.31 min respectively. Occasional vocalization and struggling was noticed in two goats one from each group irrespective of the surgical manipulations during laparoscopy. The rectal temperature and respiration rates showed only non-significant increase, but the heart rate values were significantly higher (P < 0.5 up to 150 min in animals of both the groups when compared to their baseline values. From this study, it was concluded that both anaesthetic agents produced satisfactory regional anaesthesia in goats undergoing laparoscopy. However, considering the very long delay in regaining the hind limb motor activity, the use of ropivacaine may not be recommended for this purpose. Supplementation of sedative/tranquilizer with lumbosacral epidural anaesthesia needs evaluation.

  5. Anesthetic management of nonintubated video-assisted thoracoscopic surgery using epidural anesthesia and dexmedetomidine in three patients with severe respiratory dysfunction.

    Science.gov (United States)

    Iwata, Yoshika; Hamai, Yusuke; Koyama, Tomohiro

    2016-04-01

    Nonintubated video-assisted thoracoscopic surgery (VATS) has been reported to be safe and feasible for patients with various thoracic diseases, including those who have respiratory dysfunction. In nonintubated VATS, it is important to maintain spontaneous respiration and to obtain a satisfactory operating field through adequate collapse of the lung by surgical pneumothorax. Therefore, we need to minimize the patient's physical and psychological discomfort by using regional anesthesia and sedation. If analgesia and sedation are inadequate, conversion to intubated general anesthesia may be required. Dexmedetomidine (DEX) is a highly selective α2-adrenoceptor agonist that provides anxiolysis and cooperative sedation without respiratory depression. It seems to be a suitable sedative for nonintubated VATS, especially in high-risk patients for intubated general anesthesia, but there have been no report about its use combined with epidural anesthesia in nonintubated VATS for adult patients. Here, we report three patients with severe respiratory dysfunction who underwent nonintubated VATS for pneumothorax using epidural anesthesia and DEX. In all three patients, DEX infusion was started after placement of an epidural catheter and was titrated to achieve mild sedation, while maintaining communicability and cooperation. This seems to be a promising strategy for nonintubated VATS in patients with respiratory dysfunction, as well as patients with normal respiratory function. PMID:26758074

  6. MAGNESIUM SULPHATE VS CLONIDINE AS AN ADJUVANT TO 0.5% BUPIVACAINE IN EPIDURAL ANAESTHESIA FOR PATIENTS UNDERGOING LOWER LIMB SURGERIES: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Anand Masih

    2015-09-01

    Full Text Available Epidural anesthesia is a safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. To address the problems of limited duration of action and to improve the quality of analgesia intra - operatively and postoperatively, various adjuvants have been added to bupivacaine. The present study is designed to evaluate the effect of magnesium sulphate vs clonidine as an adjunct to 0.5% Bupivacaine in epidural anesthesia for patients undergoing lower limb surgeries in terms of onset, duration and degree of sensory and motor block, sedation and pain. 90 patients of age group 18 - 60 years of ASA grade I & II of either sex undergoing lower limb surgeries were included in this prospective study who were randomly allocated into three groups . Group A received bupivacaine 0.5%(19ml +normal saline 0.9% (1.0ml, Group B received bupivacaine 0.5%(19ml+magnesium sulphate 50mg dissolved in 0.9% normal saline (1.0ml and Group C received bupivacaine 0.5%(19ml +clonidine 150μgm(1.0ml. Assessments of sensory block were performed at 5, 10, 15, 20, 25, 30 min and then every 10 min until the return of normal sensation. . Assessment of motor block were performed immediately after the assessment of sensory block until the return of normal motor function. The onset and end of all degrees of motor blocks were assessed bilaterally according to the Modified Bromage scale. Duration of analgesia, patient’s satisfaction, duration of motor block and adverse effects were assessed and recorded. We concluded that co - administration of epidural magnesium sulphate 50 MG with bupivacaine 0.5% produces predictable rapid onset of surgical anesthesia without any side - effects, and addi tion of clonidine 150μgmto epidural bupivacaine 0.5% produces prolonged duration of anesthesia with sedation. The results of our study suggest that magnesium may be a useful alternative as an adjuvant to epidural bupivacaine as clonidine .

  7. Acoustic puncture assist device versus loss of resistance technique for epidural space identification

    Science.gov (United States)

    Mittal, Amit Kumar; Goel, Nitesh; Chowdhury, Itee; Shah, Shagun Bhatia; Singh, Brijesh Pratap; Jakhar, Pradeep

    2016-01-01

    Background and Aims: The conventional techniques of epidural space (EDS) identification based on loss of resistance (LOR) have a higher chance of complications, patchy analgesia and epidural failure, which can be minimised by objective confirmation of space before catheter placement. Acoustic puncture assist device (APAD) technique objectively confirms EDS, thus enhancing success, with lesser complications. This study was planned with the objective to evaluate the APAD technique and compare it to LOR technique for EDS identification and its correlation with ultrasound guided EDS depth. Methods: In this prospective study, the lumbar vertebral spaces were scanned by the ultrasound for measuring depth of the EDS and later correlated with procedural depth measured by either of the technique (APAD or LOR). The data were subjected to descriptive statistics; the concordance correlation coefficient and Bland-Altman analysis with 95% confidence limits. Results: Acoustic dip in pitch and descent in pressure tracing on EDS localisation was observed among the patients of APAD group. Analysis of concordance correlation between the ultrasonography (USG) depth and APAD or LOR depth was significant (r ≥ 0.97 in both groups). Bland-Altman analysis revealed a mean difference of 0.171cm in group APAD and 0.154 cm in group LOR. The 95% limits of agreement for the difference between the two measurements were − 0.569 and 0.226 cm in APAD and − 0.530 to 0.222 cm in LOR group. Conclusion: We found APAD to be a precise tool for objective localisation of the EDS, co-relating well with the pre-procedural USG depth of EDS. PMID:27212720

  8. Acoustic puncture assist device versus loss of resistance technique for epidural space identification

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    Amit Kumar Mittal

    2016-01-01

    Full Text Available Background and Aims: The conventional techniques of epidural space (EDS identification based on loss of resistance (LOR have a higher chance of complications, patchy analgesia and epidural failure, which can be minimised by objective confirmation of space before catheter placement. Acoustic puncture assist device (APAD technique objectively confirms EDS, thus enhancing success, with lesser complications. This study was planned with the objective to evaluate the APAD technique and compare it to LOR technique for EDS identification and its correlation with ultrasound guided EDS depth. Methods: In this prospective study, the lumbar vertebral spaces were scanned by the ultrasound for measuring depth of the EDS and later correlated with procedural depth measured by either of the technique (APAD or LOR. The data were subjected to descriptive statistics; the concordance correlation coefficient and Bland-Altman analysis with 95% confidence limits. Results: Acoustic dip in pitch and descent in pressure tracing on EDS localisation was observed among the patients of APAD group. Analysis of concordance correlation between the ultrasonography (USG depth and APAD or LOR depth was significant (r ≥ 0.97 in both groups. Bland-Altman analysis revealed a mean difference of 0.171cm in group APAD and 0.154 cm in group LOR. The 95% limits of agreement for the difference between the two measurements were − 0.569 and 0.226 cm in APAD and − 0.530 to 0.222 cm in LOR group. Conclusion: We found APAD to be a precise tool for objective localisation of the EDS, co-relating well with the pre-procedural USG depth of EDS.

  9. Prolonged Epidural Infusion Improves Functional Outcomes Following Knee Arthroscopy in Patients with Arthrofibrosis after Total Knee Arthroplasty: A Retrospective Evaluation.

    Science.gov (United States)

    Saltzman, Bryan M; Dave, Ankur; Young, Adam; Ahuja, Mukesh; Amin, Sandeep D; Bush-Joseph, Charles A

    2016-01-01

    A total of 20 consecutive patients with knee stiffness post total knee arthroplasty (TKA) underwent arthroscopic lysis of adhesions and manipulation plus indwelling epidural were evaluated retrospectively. Epidural catheters were placed preoperatively for an intended 6 weeks of postoperative analgesia to facilitate intensive physical therapy. The mean loss of knee extension immediately before incision was 13.5 ± 9.1 degrees (range, 0-35 degrees) and flexion was 77.65 ± 19.2 degrees (range, 45-125 degrees). At the 6-week and final (mean, 0.47 years) follow-up, the loss of extension was 1.5 ± 5.1 degrees (range, -10 to +7 degrees) and 5.4 ± 4.7 degrees (range, 0-15 degrees), respectively, and flexion was 99.7 ± 12.3 degrees (range, 75-120 degrees) and 98.5 ± 16.1 degrees (range, 75-130 degrees), respectively. Of the 20 patients, 2 missed their 6-week clinic visit. Improvements in motion immediately preoperative to 6-week and final follow-up were each significant (p definition for clinical motion success and 70% maintained success at final follow-up. Visual analog scale improved significantly from 5.4 to 2.0 (p success postoperatively as measured by range of motion improvement. PMID:25300008

  10. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    during the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myocloniaduring the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has...

  11. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    during the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose...

  12. Idiopathic Lumbar Epidural Lipomatosis Mimicking Disc Herniation: A Case Report.

    Science.gov (United States)

    Duran, Efe; Ilik, Kemal; Acar, Turker; Yıldız, Melda

    2016-05-01

    Spinal epidural lipomatosis is a rare condition which is described as the accumulation of fat in the extradural territory and often causes dural impingement. Spinal epidural lipomatosis has been implicated in causing a variety of neurologic impairments ranging from back pain, radiculopathy, claudication, myelopathy or even cauda equina syndrome. We report a 46-year-old female with obesity and a history of chronic back pain and radiculopathy who developed idiopathic Spinal epidural lipomatosis diagnosed by magnetic resonance imaging. The purpose of this report is to present a case of spinal epidural lipomatosis presenting with symptomatic cord compression and also remind this rare condition as a the differential diagnosis of epidural lesions in patients with risk factors. PMID:27309484

  13. Efeitos fetais e maternos do propofol, etomidato, tiopental e anestesia epidural, em cesariana eletivas de cadelas

    OpenAIRE

    Lavor Mário Sérgio Lima de; Pompermayer Luiz Gonzaga; Nishiyama Shirley Miti; Duarte Tatiana Schmitz; Filgueiras Richard da Rocha; Odenthal Maria Esther

    2004-01-01

    O objetivo deste trabalho foi comparar os efeitos entre os fármacos indutores de anestesia como propofol, etomidato e tiopental, e a anestesia epidural com lidocaína seguida de indução, em cadelas submetidas à cesariana, e seus neonatos. Para tanto, foram utilizadas 20 cadelas e 129 filhotes distribuídos em quatro grupos. No grupo 1 (5 cadelas e 39 neonatos), a indução anestésica foi feita com propofol; no grupo 2 (5 cadelas e 25 neonatos), com etomidato; no grupo 3 (5 cadelas e 26 neonatos) ...

  14. The effect of epidural morphine sponge in postoperative pain control after Microdiscectomy

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    Reza movasaghi

    2012-01-01

    Full Text Available Opiates such as morphine are one of the most effective classes of medication prescribed to treat both acute and chronic pain.They act to suppress pain through mu-receptor activation on primary afferent nerve fibers, dorsal horn neurons and supraspinal pain center neorons. When morphine is administered epidurally, it diffuses to the cord substance, producing analgesia [1],The aim of this study was to check the efficacy of this method for controling postoperative lumbar pain after microdiscectomy. In a randomized clinical trial, numbers of 100 patients were included into two equal groups due to low back radicular pain and underwent microdiscectomy. In study group, an absorbable gelatin sponge (Gelfoam is contoured to the epidural space, placed in methylprednisolone acetate (40-80 mg, and then injected with 2 mg/ml morphine and control group received an absorbable gelatin, placed in methylprednisolone acetate (40-80 mg and were injected with normal saline (5mL as a placebo. The main outcome to be compared between trial and placebo groups were: Patient comfort rate in recovery room and ward, amount of analgesics used, postoperative ambulation time, post operative hospitalization days. The restlessness and agitation during recovery in study group was lower than control group. Mean systolic blood pressure increment was lower in morphine group. Only 6% of patients in study group compared to 98% in placebo group had either moderate or severe pain six hours after operation. Mean morphine dose used for study group was 10.75 mg compared to 21.4 mg among control group patients (P < 0.0001. Mean ambulation time was 2 days among study group patients compared to 2.6 days in control group. Mean hospitalization length was 4.7 and 7 days in study and control group respectively. By means of the technique assigned to the patient (an epidural morphine sponge during Lumbar microdiscectomy the results were: Better controlled postoperative pain, early ambulation of

  15. Continuous epidural block versus continuous popliteal nerve block for postoperative pain relief after major podiatric surgery in children: a prospective, comparative randomized study.

    Science.gov (United States)

    Dadure, Christophe; Bringuier, Sophie; Nicolas, Florence; Bromilow, Luke; Raux, Olivier; Rochette, Alain; Capdevila, Xavier

    2006-03-01

    Foot and ankle surgery in children is very painful postoperatively. Adverse effects from opioids and continuous epidural block (CEB) limit their use in children. Continuous popliteal nerve blocks (CPNB) have not been studied for this indication in children. In this prospective, randomized study we evaluated the effectiveness and adverse events of CPNB or CEB in children after podiatric surgery. Fifty-two children scheduled for foot surgery were separated into four groups by age and analgesia technique. After general anesthesia, 0.5 to 1 mL/kg of an equal-volume mixture of 0.25% bupivacaine and 1% lidocaine with 1:200000 epinephrine was injected via epidural or popliteal catheters. In the postoperative period, 0.1 mL x kg(-1) x h(-1) (group CPNB) or 0.2 mL x kg(-1) x h(-1) (group CEB) of 0.2% ropivacaine was administered for 48 h. Niflumic acid was routinely used. Adverse events were noted in each treatment group. Postoperative pain during motion was evaluated at 1, 6, 12, 18, 24, 36, and 48 h. Requirement for rescue analgesia (first-line propacetamol 30 mg/kg 4 times daily or second-line 0.2 mg/kg IV nalbuphine), and motor blockade were recorded. Parental satisfaction was noted at 48 h. Twenty-seven patients were included in the CEB groups and 25 in CPNB groups. There were 32 children 1 to 6 yr of age (CPNB = 15; CEB = 17) and 20 children 7 to 12 yr of age (CPNB = 10; CEB = 10). The demographic data were comparable among groups. Postoperative analgesia was excellent for the two continuous block techniques and in the two age groups. Motor block intensity was equal between techniques. Adverse events (postoperative nausea or vomiting, urinary retention, and premature discontinuation of local anesthetic infusion in the 1- to 6-yr-old group) were significantly more frequent in the CEB group (P < 0.05). Eighty-six percent of the parents in the CEB groups and 100% in the CPNB groups were satisfied. We conclude that although both CEB and CPNB resulted in excellent

  16. Relação entre a gravidade do trauma e padrões de analgesia utilizados em acidentados de transporte Relación entre la gravedad del trauma y los estándares de analgesia utilizados en accidentados de tránsito Relationship between trauma severity and analgesia standarts used in traffic accident victims

    Directory of Open Access Journals (Sweden)

    Ana Maria Calil

    2009-06-01

    Full Text Available Trata-se de um estudo inédito realizado no país, que identificou relações entre o padrão analgésico e a gravidade do trauma. Para tal, analisou-se uma população de 200 acidentados de transporte admitidos para tratamento na unidade de emergência de um hospital referência para o atendimento ao trauma no Município de São Paulo. A gravidade das lesões e do trauma foi caracterizada por índices de gravidade anatômicos. A partir da análise da terapia analgésica encontrada, construíram-se padrões de analgesia, tendo como base a escala analgésica da Organização Mundial de Saúde. Os resultados permitiram identificar associação estatística entre a gravidade do trauma e padrões distintos de analgesia. Espera-se que a divulgação desses achados possa servir de base para a criação de protocolos de analgesia em trauma e melhoria da qualidade da assistência, além de servir de estímulo para o desenvolvimento de estudos em uma área com tantas lacunas de conhecimento em nosso meio.Se trata de un estudio inédito, realizado en el país, que identificó relaciones entre el estándar analgésico y la gravedad del trauma. Para esto, se analizó una población de 200 accidentados en el tránsito, admitidos para tratamiento en una Unidad de emergencia de un hospital de referencia para la atención de traumas, en el Municipio de San Pablo. La gravedad de las lesiones y del trauma fue caracterizada por índices de gravedad anatómicos. Del análisis de la terapia analgésica encontrada se construyeron estándares de analgesia, teniendo como base la escala analgésica de la Organización Mundial de Salud. Los resultados permitieron identificar una asociación estadística entre la gravedad del trauma y los distintos estándares de analgesia. Se espera que la divulgación de lo encontrado pueda servir de base para crear protocolos de analgesia en traumas, mejorar la calidad de la asistencia y servir de estímulo para el desarrollo de

  17. Sedação e analgesia em neonatologia Sedación y analgesia en neonatología Sedation and analgesia in neonatology

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    Yerkes Pereira e Silva

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A importância do estudo da dor em Neonatologia se deve ao fato de que a sensação de dor e estresse significa sofrimento e desconforto para os recém-nascidos e, apesar desse conhecimento, pouco tem sido feito para minimizá-los. Nessa revisão foram discutidas: a prevenção da dor, as medidas não-farmacológicas e farmacológicas para o seu tratamento e a sedação em recém-nascidos. CONTEÚDO: Várias são as medidas não-farmacológicas que podem ser tomadas com intuito de prevenir a dor nas Unidades de Terapia Intensiva Neonatal e também para tornar o ambiente mais humanizado e menos estressante para os pacientes e seus familiares. O tratamento da dor no recém-nascido consiste em medidas não-farmacológicas (sucção não-nutritiva, glicose e farmacológicas (analgésicos não-opióides, opióides e anestésicos locais. A sedação em recém-nascidos é produzida por fármacos que agem diminuindo a atividade, a ansiedade e a agitação do paciente, podendo levar à amnésia de eventos dolorosos ou não-dolorosos. A sedação pode ser feita pela administração de hidrato de cloral, barbitúricos, propofol e benzodiazepínicos. CONCLUSÕES: A prevenção da dor e a indicação de analgesia devem ser individualizadas e sempre consideradas em todos os recém-nascidos portadores de doenças potencialmente dolorosas e/ou submetidos a procedimentos invasivos, cirúrgicos ou não.JUSTIFICATIVA Y OBJETIVOS: La importancia del estudio del dolor en neonatología se debe al hecho de que la sensación de dolor y de estrés significa sufrimiento e incomodidad para los recién nacidos y, a pesar de ese conocimiento poco se ha hecho para reducirlo. Dentro de esa revisión se discutieron: la prevención del dolor, las medidas no farmacológicas ye farmacológicas para su tratamiento y la sedación en recién nacidos. CONTENIDO: Varias son las medidas no-farmacológicas que pueden ser tomadas con el objetivo de prevenir el

  18. Nefopam analgesia and its role in multimodal analgesia: A review of preclinical and clinical studies.

    Science.gov (United States)

    Girard, Philippe; Chauvin, Marcel; Verleye, Marc

    2016-01-01

    Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug used to prevent postoperative pain, primarily in the context of multimodal analgesia. This paper reviews preclinical and clinical studies in which nefopam has been combined with opioids, non-steroidal anti-inflammatory compounds, and paracetamol. This report focuses on the literature during the last decade and discusses the translational efforts between animal and clinical studies in the context of multimodal or balanced analgesia. In preclinical rodent models of acute and inflammatory pain, nefopam combinations including opioids revealed a synergistic interaction or enhanced morphine analgesia in six out of seven studies. Nefopam combinations including non-steroidal anti-inflammatory drugs (NSAIDs) (aspirin, ketoprofen or nimesulide) or paracetamol likewise showed enhanced analgesic effects for the associated compound in all instances. Clinical studies have been performed in various types of surgeries involving different pain intensities. Nefopam combinations including opioids resulted in a reduction in morphine consumption in 8 out of 10 studies of severe or moderate pain. Nefopam combinations including NSAIDs (ketoprofen or tenoxicam) or paracetamol also demonstrated a synergic interaction or an enhancement of the analgesic effect of the associated compound. In conclusion, this review of nefopam combinations including various analgesic drugs (opioids, NSAIDs and paracetamol) reveals that enhanced analgesia was demonstrated in most preclinical and clinical studies, suggesting a role for nefopam in multimodal analgesia based on its distinct characteristics as an analgesic. Further clinical studies are needed to evaluate the analgesic effects of nefopam combinations including NSAIDs or paracetamol. PMID:26475417

  19. Anestesia para correção intra-útero de mielomeningocele: relato de caso Anestesia para corrección intra-útero de mielomeningocele: relato de caso Anesthesia for intrauterine myelomeningocele correction: case report

    Directory of Open Access Journals (Sweden)

    Angélica de Fátima de Assunção Braga

    2005-06-01

    mantenida arriba de 100 mmHg, con efedrina en bolus (5 mg, coloides y cristalóides. El líquido amniótico perdido fue sustituido por solución fisiológica entibiada. Después de la corrección del defecto fetal, se procedió al encerramiento uterino y de la membrana amniótica en dos planos, con hilo de vicryl y cola de fibrina. Se siguió la disminución gradativa de la concentración del isoflurano, y para el mantenimiento del relajamiento uterino se utilizó sulfato de magnesio (4 g/20minutos, seguido de infusión continuada (2 g/hora. Al final de la cirugía se inyectó morfina (2 mg por el catéter peridural para la analgesia postoperatoria. CONCLUSIONES: La anestesia para cirugía fetal envuelve dos seres, madre y feto, y el manoseo anestésico requiere: seguridad materno-fetal, anestesia e inmovilidad fetal, relajamiento uterino, prevención del trabajo de alumbramiento prematuro y analgesia postoperatoria.BACKGROUND AND OBJECTIVES: Fetal surgery is the treatment of choices for prenatal malformations that are not adequately corrected after birth and aims at treating or preventing the progression of the abnormalities. This report describes a case of anesthesia for intrauterine correction of a myelomeningocele. CASE REPORT: Pregnant patient, 19 years old, 23 weeks of gestational age, without previous anesthetic history, physical status ASA I, submitted to intrauterine fetal surgery under general anesthesia associated to continuous epidural continuous anesthesia. The patient was premedicated with rectal indomethacin (50 mg, intravenous metoclopramide (10 mg and cimetidine (50 mg, in addition to intravenous midazolam (2 mg. The patient received 0.25% bupivacaine with epinephrine (25 mg associated to fentanyl (100 µg epidurally, followed by cephalic catheter insertion for postoperative analgesia. The uterus was left-displace with a Crawford's wedge. Rapid sequence anesthesia was induced with fentanyl, propofol and rocuronium, and was maintained with 2.5% - 3

  20. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  1. Wound catheter techniques for postoperative analgesia

    OpenAIRE

    VINTAR, NELI

    2009-01-01

    Wound catheter technique is a technique of postoperative analgesia in which the surgeon places a catheter to infuse local anesthetic into wounds at the end of the procedure. It can be used in abdominal colorectal surgery or after holecystectomies, was studied after caesarean delivery. It was effective after some orthopaedic procedures such as shoulder and knee surgery, at the donor site in the iliac crest. It can be used in plastic surgery after breast surgery. It is technically efficie...

  2. Continuous subcutaneous pethidine for routine postoperative analgesia.

    OpenAIRE

    Davenport, H T; Al-Khudairi, D.; Cox, P. N.; Wright, B. M.

    1985-01-01

    We consider that the present state of postoperative analgesia is unsatisfactory because drugs are given intermittently and usually only at the patients' request and with nurses' acquiescence. A procedure for routine continuous pethidine infusion, suitable for administration and control by the nursing staff is described. The results of a trial on patients after major surgery are summarised. We believe the procedure to be more efficient and effective than those presently in use.

  3. Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome Migración epidural posterior de fragmento de disco lumbar secuestrado que causa síndrome de cauda equina Migração epidural posterior de fragmento de disco lombar sequestrado que causa síndrome da cauda equina

    Directory of Open Access Journals (Sweden)

    Abolfazl Rahimizadeh

    2013-01-01

    Full Text Available Posterior epidural migration (PEM of a sequestered free lumbar disc fragment is rare. The rarity is due to presence of several anatomical restraints which restrict a free fragment to move to the posterior compartment. This unusual presentation of disc herniation appeared in the literature either as a single case report or in small series from two to six cases. Herein two new demonstrative cases will be presented with a brief review of the literature.La migración epidural (PEM posterior Epidural Migration de fragmento de disco lumbar libre secuestrado es rara. La rareza se debe a la existencia de varias restricciones anatómicas impidiendo que el fragmento libre se mueva hacia el compartimento posterior. Esa presentación no común de hernia de disco apareció en la literatura como un relato de caso único o en pequeñas series de dos a seis casos. En este artículo, se presentan dos casos nuevos demostrativos, conjuntamente con una revisión breve de la literatura.A migração epidural posterior (PEM posterior epidural migration de fragmento de disco lombar livre sequestrado é rara. A raridade deve-se à presença de várias restrições anatômicas que impedem que o fragmento livre se mova para o compartimento posterior. Essa apresentação incomum de hérnia de disco apareceu na literatura como relato de caso único ou em pequenas séries de dois a seis casos. Neste artigo, são apresentados dois novos casos demonstrativos, com uma breve revisão da literatura.

  4. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  5. Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

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    Ozlem Bilir

    2014-01-01

    Full Text Available Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

  6. General versus epidural anesthesia for lumbar microdiscectomy.

    Science.gov (United States)

    Ulutas, Murat; Secer, Mehmet; Taskapilioglu, Ozgur; Karadas, Soner; Akyilmaz, Ahmet Aykut; Baydilek, Yunus; Kocamer, Betul; Ozboz, Ayse; Boyaci, Suat

    2015-08-01

    This study was a retrospective analysis of 850 lumbar microdiscectomy (LMD) under epidural anesthesia (EA; n=573) or general anesthesia (GA; n=277) performed by the same surgeon and paid by invoice to the Social Security Institution of the Turkish Republic between April 2003 and May 2013. Although GA is the most frequently used method of anesthesia during LMD, the choice of regional anesthetia (epidural, spinal or a combination of these) differs between surgeons and anesthetists. Studies have reported that EA in surgery for lumbar disc herniation may be more reliable than GA, as it enables the surgeon to communicate with the patient during surgery, but few studies have compared the costs of these two anesthetic methods in LMD. We found that EA patient costs were significantly lower than GA patient costs (p0.05). The anesthetic method used during LMD affected the complication rate, cost and efficiency of operating room use. We suggest that EA is an anesthetic method that can contribute to health care cost savings and enable LMD to be completed with less nerve root manipulation and more comfort, efficacy, reliability and cost efficiency without affecting the success rate of the surgical procedure. PMID:26067543

  7. Plasma and cerebrospinal fluid alfentanil, butorphanol, and morphine concentrations following caudal epidural administration in horses Concentrações plasmáticas e no líquido cérebro-espinhal de alfentanil, butorfanol e morfina após administração epidural caudal em eqüinos

    Directory of Open Access Journals (Sweden)

    Cláudio Corrêa Natalini

    2006-10-01

    Full Text Available This study was conducted with the objective of determining the plasma and cerebrospinal fluid (CSF concentrations after epidurally administered alfentanil, butorphanol, and morphine in horses. Five clinically healthy adult horses were studied. Morphine 0.1mg kg-1, alfentanil 0.02mg kg-1, and butorphanol 0.08mg kg-1 in equal volumes (20ml were epidurally injected. A 10-ml sample of CSF and blood were drawn at sampling times before the epidural administration and at 5, 10, 20, 30, 40, 50, 60 and 120 minutes, and hourly for 24 hours Enzyme-linked immonosorbent assay (ELISA was used as the screening test to detect the injected opioids. ANOVA and Bonferroni’s test were used with a P values Este estudo foi realizado com o objetivo de se detectar as concentrações plasmáticas e no líquido cérebro-espinhal de alfentanil, butorfanol e morfina administrados por via epidural caudal em cavalos. Foram utilizados cinco eqüinos adultos, clinicamente hígidos. Doses de morfina (0,1mg kg-1, alfentanil (0,02mg kg-1, e butorfanol (0,08mg kg-1, diluídos em volume idêntico de 20ml em solução salina 0,9%, foram administrados por via epidural. Uma amostra de 10ml de sangüe venoso e de líqüido cérebro-espinhal foram colhidas anteriormente à administração epidural e 5, 10, 20, 30, 40, 50, 60 e 120 minutos e a cada hora por 24 horas. O teste enzyme-linked immunosorbent assay (ELISA foi utilizado como método analítico para detecção dos opióides. Os resultados foram avaliados com teste ANOVA e Bonferroni com valor de P<0,05. O teste de ELISA mostrou-se eficiente para detecção plasmática e no LCE de alfentanil, butorfanol, e morfina administrados por via epidural. A administração epidural de alfentanil em eqüinos produz níveis no líquido cérebro-espinhal mais rapidamente que no plasma. Opióides de maior hidrossolubilidade tais como morfina e butorfanol produzem níveis plasmáticos mais rapidamente do que no líquido cérebro-espinhal quando

  8. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

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    Florian Chouchou

    Full Text Available The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers. Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1 placebo analgesia improved with REM sleep deprivation; 2 pain relief expectations did not differ between REM sleep deprivation and control groups; and 3 REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

  9. Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

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    Nathaniel H. Greene

    2015-01-01

    Full Text Available Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter. Methods. This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD on computed tomography (CT to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging. Results. There was a strong association between CT measurement and loss of resistance depth (P35 changed this relationship (P=0.007. The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individual ICCs>0.9. Conclusions. Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.

  10. Post operatory analgesia in caesarean surgery.

    OpenAIRE

    Bárbara Lucía Cabezas Poblet; Guyen Cuellar Chang; Rolando T. Espín González; María Antonia Cabezas Poblet

    2003-01-01

    Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient...

  11. Patient-controlled oral analgesia versus nurse-controlled parenteral analgesia after caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Bonnal, A; Dehon, A; Nagot, N; Macioce, V; Nogue, E; Morau, E

    2016-05-01

    We assessed the effectiveness of early patient-controlled oral analgesia compared with parenteral analgesia in a randomised controlled non-inferiority trial of women undergoing elective caesarean section under regional anaesthesia. Seventy-seven women received multimodal paracetamol, ketoprofen and morphine analgesia. The woman having patient-controlled oral analgesia were administered four pillboxes on the postnatal ward containing tablets and instructions for self-medication, the first at 7 h after the spinal injection and then three more at 12-hourly intervals. Pain at rest and on movement was evaluated using an 11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The pre-defined non-inferiority limit for the difference in mean pain scores (patient-controlled oral analgesia minus parenteral) was one. The one-sided 95% CI of the difference in mean pain scores was significantly lower than one at all time-points at rest and on movement, demonstrating non-inferiority of patient-controlled oral analgesia. More women used morphine in the patient-controlled oral analgesia group (22 (58%)) than in the parenteral group (9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the patient-controlled oral analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1 [1-2]); p = 0.006) in the parenteral group. Minor drug errors or omissions were identified in five (13%) women receiving patient-controlled oral analgesia. Pruritus was more frequent in the patient-controlled oral analgesia group (14 (37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other adverse events and maternal satisfaction. After elective caesarean section, early patient-controlled oral analgesia is non-inferior to standard parenteral analgesia for pain management, and can be one of the steps of an enhanced recovery process. PMID:26931110

  12. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol

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    J. A. Delgado

    2005-05-01

    Full Text Available Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia. Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1 y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12: se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13: se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1 como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.. Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anot

  13. Mielopatia induzida por medicação anticoagulante: relato de um caso com hematoma epidural espinhal

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    Lineu Cesar Werneck

    1982-12-01

    Full Text Available Relato do caso de uma paciente de 51 anos de idade, recebendo anticoagulante por tromboflebite e embolias pulmonares, com tempo de atividade de protrombina dentro do limite terapêutico, que desenvolveu súbita paraplegia. A investigação revelou bloqueio medular e a cirurgia comprovou ser um hematoma epidural espinhal, que foi evacuado. A paciente permaneceu com os mesmos déficits clínicos no post-operatório. São feitos comentários a respeito da etiologia dos hematomas espinhais epidurals, sua patogenia, etiologia e chamada a atenção para o pronto diagnóstico e tratamento cirúrgico.

  14. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer;

    2004-01-01

    BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase when...... hypotension is present, which may have implications for the choice of treatment of hypotension. However, no long-term information or measurements of plasma volumes with or without hypotension after epidural anesthesia are available. METHODS: In 12 healthy volunteers, the authors assessed plasma (125I...... volunteers receiving hydroxyethyl starch. RESULTS: Plasma volume did not change per se after thoracic epidural anesthesia despite a decrease in blood pressure. Plasma volume increased with fluid administration but remained unchanged with vasopressors despite that both treatments had similar hemodynamic...

  15. Imaging diagnosis--Spinal epidural hemangiosarcoma in a dog.

    Science.gov (United States)

    de la Fuente, Cristian; Pumarola, Martí; Añor, Sònia

    2014-01-01

    An 8-year-old, male Boxer was examined for an acute onset of ambulatory paraparesis. Neurologic examination was consistent with a T3-L3 myelopathy. Myelography revealed an extradural spinal cord compression in the region of the T10-T13 vertebrae. On magnetic resonance (MR) imaging, a well-defined epidural mass lesion was detected. The mass was mildly hyperintense on T1-weighted, hyperintense on T2-weighted and STIR images compared to normal spinal cord and enhanced strongly and homogenously. Postmortem examination confirmed a primary epidural hemangiosarcoma. Findings indicated that the MRI characteristics of spinal epidural hemangiosarcoma may mimic other lesions including meningioma and epidural hemorrhages/hematomas of non-neoplastic etiology. PMID:23815770

  16. Delayed Allergic Reaction to Secondary Administrated Epidural Hyaluronidase

    OpenAIRE

    Park, A Reum; Kim, Woong Mo; Heo, Bong Ha

    2015-01-01

    We are reporting a rare case of a delayed hypersensitivity reaction caused by hyaluronidase allergy following a lumbar transforaminal epidural block. Using an intradermal skin test, we have provided evidence that the systemic allergic reaction resulted from hypersensitivity to hyaluronidase. To our knowledge, this is a rare case of a delayed hypersensitivity reaction to epidural hyaluronidase, comprised of an initial exposure to hyaluronidase with no subsequent allergic response in prior bloc...

  17. Sciatica caused by a dilated epidural vein: MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P.; Petre, C.; Wilms, G. [Dept. of Radiology, Catholic University of Leuven (Belgium); Plets, C. [Dept. of Neurosurgery, Catholic University of Leuven (Belgium)

    1999-02-01

    We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now. (orig.) (orig.) With 1 fig., 4 refs.

  18. Transverse myelitis following general and thoracic epidural anaesthesia

    OpenAIRE

    Drnovsek Globokar, Mojca; Paver Erzen, Vesna; Novak Jankovic, Vesna

    2010-01-01

    Acute bacterial transverse myelitis, secondary to an epidural catheter, developed in a 49-year-old man who underwent surgery for carcinoma of the left lung. Left pneumonectomy was performed under combined general and epidural (Th6-7) anesthesia. The operative procedure, anaesthesia and early postoperative course were uneventful. On the fifth postoperative day, the patient developed neurological deficits consistent with high-level paraplegia. Elevated inflammatory parameters along with the res...

  19. Cervical epidural abscess caused by brucellosis.

    Science.gov (United States)

    Lampropoulos, Christos; Kamposos, Panagiotis; Papaioannou, Ioanna; Niarou, Vasiliki

    2012-01-01

    A 70-year-old Greek lady presented with fever, arthralgias of knees, cervical and lumbar pain during the last month. On clinical examination the patient was found to have tenderness of the cervical and the lumbar spine with great motion restriction. The blood tests revealed high erythrocyte sedimentation rate and C-reactive protein, abnormal liver function tests and a positive rheumatoid factor. Serological test for Brucella was positive while cervical MRI revealed epidural abscess and spondylodiscitis. Conservative treatment with streptomycin (it was substituted by rifampicin after the third week) and doxycyclin for 4 months significantly improved her symptoms. The frequency as well as the diagnosis and management of this manifestation are discussed. PMID:23188848

  20. Intrathecal Neostigmine Use For Postoperative Analgesia

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    Tarkan Öztürk

    2003-03-01

    Full Text Available This study aims at evaluating postoperative analgesic efficacy and safety of intrathecal neostigmine doses in patients under hemispinal anesthesia. After Ethics Committee approval, 48 patients sheduled for elective arthroscopic surgery.patients were randomly divided into four groups. Hemispinal block technique was performed at the lateral decubitis position. Group I received 1.4 ml hyperbaric bupivacaine plus 12.5 µg neostigmine, Group II received 1.4 ml hyperbaric bupivacaine plus 25 µg neostigmine, Group III received 1.4 ml hyperbaric bupivacaine plus 50 µg neostigmine, Group IV (control received 1.4 ml hyperbaric bupivacaine plus 0.1 ml saline. Tramadol was used for analgesia during postoperative period. Hemodynamic and respiratorial changes, time to first rescue analgesics, postoperative tramadol consumption, and advers effects were assessed. Neostigmine at these doses was found to have no effect on hemodynamic or respiratory parameters. The time first rescue analgesics were 273±47 minutes in GI, 595±47 minutes in GII, 869±49 minutes in GIII, 190±4 minutes in GIV. Postoperative tramadol consumtion in neostigmin groups was defined low in meaningful degree when compared to the control group. None of the patients in GIV had postoperative nausea-vomiting. Postoperative nausea-vomiting incidences were 8.3% (1 patient in GI, 33.3% In this study it was concluded that intrathecal neostigmine produce a dose-dependent analgesia and dose-dependent incidence of adverse effects with doses studied. Neostigmine 12.5 µg dosage was enough for providing comfortable postoperative analgesia with low adverse effect.

  1. Spinal analgesia for advanced cancer patients: an update.

    Science.gov (United States)

    Mercadante, Sebastiano; Porzio, Giampiero; Gebbia, Vittorio

    2012-05-01

    In the nineties, spinal analgesia has been described as an useful means to control pain in advanced cancer patients. The aim of this review was to update this information with a systematic analysis of studies performed in the last 10 years. 27 papers pertinent with the topic selected for review were collected according to selection criteria. Few studies added further information on spinal analgesia in last decade. Despite a lack of a clinical evidence, spinal analgesia with a combination of opioids, principally morphine, and local anesthetics may allow to achieve analgesia in patients who had been intensively treated unsuccessfully with different trials of opioids. Some adjuvant drugs such as clonidine, ketamine, betamethasone, meperidine, and ziconotide may be promising agents, but several problems have to be solved before they can be used in the daily practice. In complex pain situations, spinal analgesia should not be negated to cancer patients, and oncologists should address this group of patients to other specialists. PMID:21684173

  2. Patterns of epidural progression following postoperative spine stereotactic body radiotherapy: implications for clinical target volume delineation.

    Science.gov (United States)

    Chan, Michael W; Thibault, Isabelle; Atenafu, Eshetu G; Yu, Eugene; John Cho, B C; Letourneau, Daniel; Lee, Young; Yee, Albert; Fehlings, Michael G; Sahgal, Arjun

    2016-04-01

    OBJECT The authors performed a pattern-of-failure analysis, with a focus on epidural disease progression, in patients treated with postoperative spine stereotactic body radiotherapy (SBRT). METHODS Of the 70 patients with 75 spinal metastases (cases) treated with postoperative spine SBRT, there were 26 cases of local disease recurrence and 25 cases with a component of epidural disease progression. Twenty-four of the 25 cases had preoperative epidural disease with subsequent epidural disease progression, and this cohort was the focus of this epidural-specific pattern-of-failure investigation. Preoperative, postoperative, and follow-up MRI scans were reviewed, and epidural disease was characterized based on location according to a system in which the vertebral anatomy is divided into 6 sectors, with the anterior compartment comprising Sectors 1, 2, and 6, and the posterior compartment comprising Sectors 3, 4, and 5. RESULTS Patterns of epidural progression are reported specifically for the 24 cases with preoperative epidural disease and subsequent epidural progression. Epidural disease progression within the posterior compartment was observed to be significantly lower in those with preoperative epidural disease confined to the anterior compartment than in those with preoperative epidural disease involving both anterior and posterior compartments (56% vs 93%, respectively; p = 0.047). In a high proportion of patients with epidural disease progression, treatment failure was found in the anterior compartment, including both those with preoperative epidural disease confined to the anterior compartment and those with preoperative epidural disease involving both anterior and posterior compartments (100% vs. 73%, respectively). When epidural disease was confined to the anterior compartment on the preoperative and postoperative MRIs, no epidural disease progression was observed in Sector 4, which is the most posterior sector. Postoperative epidural disease characteristics

  3. Severe Scapular Pain Following Unintentional Cervical Epidural Air Injection.

    Science.gov (United States)

    Henthorn, Randall W; Murray, Kerra

    2016-03-01

    This a unique case of severe scapular pain following unintentional epidural space air injection during epidural steroid injection.A 70-year-old woman presented for a fluoroscopically guided C7-T1 interlaminar epidural steroid injection. Three injection attempts were made using the loss of resistance with air technique. On the first attempt the epidural space was entered, but contrast injection showed that the needle was intravenous. On the second attempt an equivocal loss of resistance with air was perceived and 5 mL of air was lost from the syringe. The needle was withdrawn and redirected, and upon the third needle passage the contrast injection showed appropriate epidural space filling up to the C4-5 level. Injection of betamethasone mixed in lidocaine was initially uneventful.However, 20 minutes post-injection the patient experienced sudden sharp and continuous pain along the medial edge of the scapula. After failing to respond to multiple intravascular analgesics, the patient was transferred to the emergency room. Her pain subsided completely following an intravenous diazepam injection. Cervical spine computerized tomography showed obvious air in the posterior epidural space from C4-5 to C6-7 as well as outside the spinal canal from (C4-T2). Having recovered fully, she was discharged the following morning. In reviewing the procedure, the equivocal loss of resistance on the second passage was actually a true loss of resistance to epidural space and air was unintentionally injected. Surprisingly, severe scapular pain resulted in a delayed manner after the steroid solution was injected. The authors theorize that unintentional prefilling of the epidural space with air prior to the injection of the subsequent steroid mixture added sufficient pressure to the epidural space to cause right-sided C4 nerve root stretching/entrapment and ensuing radicular pain to the right scapular border. The subsequent intravenous diazepam provided cervical muscle relaxation and

  4. Efeitos fetais e maternos do propofol, etomidato, tiopental e anestesia epidural, em cesariana eletivas de cadelas

    Directory of Open Access Journals (Sweden)

    Lavor Mário Sérgio Lima de

    2004-01-01

    Full Text Available O objetivo deste trabalho foi comparar os efeitos entre os fármacos indutores de anestesia como propofol, etomidato e tiopental, e a anestesia epidural com lidocaína seguida de indução, em cadelas submetidas à cesariana, e seus neonatos. Para tanto, foram utilizadas 20 cadelas e 129 filhotes distribuídos em quatro grupos. No grupo 1 (5 cadelas e 39 neonatos, a indução anestésica foi feita com propofol; no grupo 2 (5 cadelas e 25 neonatos, com etomidato; no grupo 3 (5 cadelas e 26 neonatos com tiopental e no grupo 4, (5 cadelas e 39 neonatos utilizou-se anestesia epidural e indução com halotano através de máscara. Em todos os casos, a medicação pré-anestésica foi feita com midazolam na dose de 0,22mg kg-1 via IM, e a manutenção anestésica com halotano em circuito semifechado e concentração inicial de 3V%. As variáveis avaliadas nas cadelas foram: temperatura retal, freqüência cardíaca, freqüência respiratória, saturação da oxi-hemoglobina (SpO2, pressão arterial média. Para a avaliação dos recém-nascidos, foram mensurados: freqüência cardíaca, esforço respiratório, movimentos musculares, coloração das mucosas e irritabilidade reflexa interpretados através do escore de Apgar modificado, bem como a SpO2 do neonato. Os resultados mostraram que todos os protocolos foram adequados para as mães com mínimos efeitos sistêmicos. Para o neonato, a utilização de anestesia epidural na mãe, seguida de indução e manutenção com halotano foi superior aos protocolos que usaram agentes injetáveis na indução anestésica.

  5. EFFICACY OF TRANSFORAMINAL EPIDURAL STEROID INJECTION IN LUMBOSACRAL RADICULOPATHY

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    Saheel

    2016-02-01

    Full Text Available BACKGROUND Lumbosacral radiculopathy is a common medical and socioeconomic problem with a lifetime prevalence estimated to be around 40%-60%. In 1930, Evans reported that sciatica could be treated by epidural injection. The use of epidural corticosteroid injection for the treatment of axial and radicular back pain was first reported in 1953. Lumbar Transforminal Epidural Steroid Injections (TFESIs are performed to provide symptomatic relief in patients with radicular pain. A transforaminal epidural steroid injection (TFESI using a small volume of local anaesthetic will anaesthetize the spinal nerve and also partially anaesthetize the dura, the posterior longitudinal ligament, the intervertebral disc and facet joint. For these reasons, fluoroscopy-guided TFESI has become the preferred approach to epidural space. AIMS AND OBJECTIVES To study the role of transforaminal epidural steroid injection in management of radiculopathy. SETTINGS AND DESIGN This prospective study was conducted in the Department of Orthopaedics, SKIMS Medical College and Hospital, Bemina, Srinagar, J and K, India, for a 2-year period from November 2012 to October 2014; 110 cases, both male and female in the age group of 20-60 years having back pain with radiculopathy of varied types and duration without neurodeficit were enrolled in the study. MATERIALS AND METHODS After selecting a patient for giving transforaminal block, we used a local anaesthetic (2% Xylocaine. Contrast media, e.g. Iohexol was used to demarcate the correct positioning of the needle. A spinal needle (20-25 gauge and 5mL syringe were used to deliver the drug. CONCLUSION Transforaminal epidural steroid injections with long acting anaesthetic is an excellent form of conservative treatment in management of low back ache with radicular pain. It is relatively safe, simple, economical and shortens the time of recovery from severe pain, avoids risks and complications of surgery and also avoids long periods of bed

  6. Asymptomatic pneumomediastinum resulting from air in the epidural space -a case report-

    OpenAIRE

    Lim, Hyun Kyoung; Cha, Young Deog; Song, Jang Ho; Park, Ji Woong; Lee, Mi Hyeon

    2013-01-01

    There are no reports regarding pneumomediastinum caused by thoracic epidural block complications. We believe that it is possible to experience an occurrence of pneumomediastinum caused by air in the epidural space after performing a thoracic epidural block using the loss of resistance (LOR) technique with air. We report a witnessed case where pneumomediastinum appeared after a thoracic epidural block. Pneumorrrhachis, paravertebral muscle emphysema, and pneumomediastinum were diagnosed by Pos...

  7. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

    International Nuclear Information System (INIS)

    Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.)

  8. Manejo de la analgesia postoperatoria en las primeras 24 horas en un Hospital de segundo nivel: Estudio observacional Postoperative analgesia treatment during the first 24 hours in a second level hospital.

    Directory of Open Access Journals (Sweden)

    D. L. Fernández

    2006-01-01

    y GC (%: morfina: 28, 11.7 ± 12.6 mg/día, 100%; meperidina: 58, 333.4 ± 108.7 mg/día, 35.2%; tramadol: 13, 218.9 ± 80.2 mg/día, 59.3%. Consumo de analgésicos antiinflamatorios no esteroideos (Nº pacientes, X ± DE: diclofenaco ( 39, 223.1 ± 52.5 mg/día; metamizol (74, 6.86 ± 1.8 mg/día ambos superiores a las dosis recomendadas. Conclusiones: Como conclusión pensamos que los resultados expuestos demuestran la ineficacia de la medicación analgésica empleada en el postoperatorio, debida a fallos en la prescripción y en el cumplimiento de la misma. La formación continuada, la implicación de los anestesiólogos y del personal de enfermería y el compromiso institucional son elementos fundamentales para corregir los errores observados en el tratamiento del dolor postoperatorio.Objective: We carried out this study in our second level hospital to evaluate the fulfillment and effectiveness of postoperative analgesics administered without appropriate guidelines during the first 24 h after surgical procedures where the intensity of pain is considered moderate-severe. Method: We included 119 patients above 18 years of age, who underwent orthopedic surgery: total knee or hip replacement, vertebral arthrodesis, shoulder surgery and laparotomies. Postoperative analgesics (base and rescue were prescribed according to criterion of the responsible anesthesiologist through lack of appropriate protocols. The use of morphine, epidural analgesia and PCA (patient controlled analgesia devices were restricted to recovery room and critical care unit. In hospitalized patients the prescribed opiates were meperidine and tramadol by intramuscular and intravenouse route, respectively. The opiates were always associated to nonsteroidal antiinflammatory drugs (NSAIDs as metamizol or diclofenac and analgesics as paracetamol. Intensity of pain was measured by VAS 0-100 mm and verbal scale (VS 1-4, 24 h after surgery (24 and we registered the maxim intensity of pain (Max perceived

  9. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol Postoperative analgesia for the management of chieloplasty in the breast-fed baby. Comparative study: bilateral intraoral blockade of the infraorbitary nerve with bupivacaine 0.25% plus adrenaline versus intravenous analgesia with tramadol

    Directory of Open Access Journals (Sweden)

    J. A. Delgado

    2005-05-01

    Full Text Available Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia. Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1 y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12: se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13: se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1 como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.. Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anot

  10. Efficacy of caudal epidural injection of lidocaine, xylazine and xylazine plus hyaluronidase in reducing discomfort produced by electroejaculation in bulls.

    Science.gov (United States)

    Pagliosa, Ronaldo C; Derossi, Rafael; Costa, Deiler S; Faria, Fabio J C

    2015-11-01

    To test the hypothesis that epidural administration of lidocaine, xylazine or xylazine plus hyaluronidase provides reduced pain and stress during electroejaculation in bulls, eight 30-month-old Nellore bulls received saline solution (control), 2% lidocaine, 2% xylazine or 2% xylazine plus hyaluronidase injected into the first intercoccygeal (Co1-Co2) epidural space in randomized order. Heart rate, respiratory rate, mean arterial pressure, analgesia, animal behavior and motor blockade were evaluated before treatment and at predetermined intervals during and after treatment. Pain and stress were scored subjectively, and semen quality was evaluated. The onset of anesthetic action was significantly faster with lidocaine (3.0 ± 1.2 min) than with xylazine or xylazine plus hyaluronidase (8.9 ± 1.5 and 5.5 ± 2.6 min, P=0.021 and P=0.012, respectively), and the onset of anesthesia with xylazine plus hyaluronidase was significantly faster than that with xylazine alone (P=0.032). Treatment with xylazine or xylazine plus hyaluronidase resulted in less discomfort than treatment with lidocaine, as indicated by animal behavior. Changes in heart rate, respiratory rate and arterial pressure were within acceptable limits. Penile protrusion and semen emission occurred in all animals during all four treatments. Our results suggest that xylazine plus hyaluronidase reduced discomfort during electroejaculation more effectively than xylazine or lidocaine alone. Further experiments are necessary to determine whether electroejaculation with xylazine plus hyaluronidase is feasible for obtaining semen from Nellore bulls unaccustomed to being handled or restrained. PMID:26097016

  11. Posterior epidural fibrotic mass associated with Baastrup’s disease

    Science.gov (United States)

    Jang, Eui-Chan; Lee, Han-Jun; Kim, Jae Yoon; Yang, Jae Jun

    2010-01-01

    A few reports have demonstrated rare cases of Baastrup’s disease that involve epidural cysts that cause dural compression. However, there have been no reports of a midline epidural fibrotic mass being associated with Baastrup’s disease. A 60-year-old man presented with neurogenic claudication that had lasted for 5 years. Radiography showed anterolisthesis at the L4–L5 level, magnetic resonance imaging demonstrated severe stenosis due to a posterior noncystic mass, and the linear fluid signal tracked into the posterior epidural space at the L4–L5 level. A cleft in the ligamentum flavum was identified by probe at surgery, and this enabled the probe to be inserted into the epidural space without excising ligamentum flavum. Histological analysis showed that the fibrotic mass consisted of a collagen matrix that had a cystic component and exhibited a peripheral inflammatory reaction. This report shows that it is possible for an extended epidural cystic mass that occurs in Baastrup’s disease to change over time through peripheral inflammation into a cyst-containing fibrotic mass. PMID:20063020

  12. Spontaneous thoracic epidural hematoma: a case report and literature review.

    Science.gov (United States)

    Babayev, Rasim; Ekşi, Murat Şakir

    2016-01-01

    Spinal epidural hematoma is a rare neurosurgical emergency in respect of motor and sensory loss. Identifiable reasons for spontaneous hemorrhage are vascular malformations and hemophilias. We presented a case of spontaneous epidural hematoma in an 18-year-old female patient who had motor and sensory deficits that had been present for 1 day. On MRI, there was spinal epidural hematoma posterior to the T2-T3 spinal cord. The hematoma was evacuated with T2 hemilaminectomy and T3 laminectomy. Patient recovered immediately after the surgery. Literature review depicted 112 pediatric cases (including the presented one) of spinal epidural hematoma. The female/male ratio is 1.1:2. Average age at presentation is 7.09 years. Clinical presentations include loss of strength, sensory disturbance, bowel and bladder disturbances, neck pain, back pain, leg pain, abdominal pain, meningismus, respiratory difficulty, irritability, gait instability, and torticollis. Most common spinal level was cervicothoracic spine. Time interval from symptom onset to clinical diagnosis varied from immediate to 18 months. Spinal epidural hematoma happened spontaneously in 71.8 % of the cases, and hemophilia was the leading disorder (58 %) in the cases with a definable disorder. Partial or complete recovery is possible after surgical interventions and factor supplementations. PMID:26033378

  13. Anestesia peridural torácica para cirurgia plástica de mama em paciente portadora de miastenia gravis: relato de caso Anestesia peridural torácica para cirugía plástica de mama en paciente portadora de miastenia gravis: relato de caso Thoracic epidural anesthesia for mammaplasty in myasthenia gravis patient: case report

    OpenAIRE

    Fabiano Timbó Barbosa; Marta Cristiane Bezerra Correia; Rafael Martins da Cunha; Ismar Lima Cavalcanti

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: A miastenia gravis é uma doença crônica, auto-imune, caracterizada pela fraqueza da musculatura esquelética em decorrência da diminuição dos receptores de acetilcolina na junção neuromuscular. O objetivo deste relato é mostrar um caso de paciente com miastenia gravis submetida a anestesia peridural torácica para cirurgia plástica de mama. RELATO DO CASO: Paciente com 51 anos, portadora de miastenia gravis foi submetida a anestesia peridural torácica com bupivacaína ...

  14. Meningitis tras anestesia y analgesia espinal

    OpenAIRE

    M. Robles Romero; M.A. Rojas Caracuel; C. del Prado Álvarez

    2013-01-01

    El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como...

  15. Epidural block and neostigmine cause anastomosis leak

    Directory of Open Access Journals (Sweden)

    Ataro G

    2016-05-01

    Full Text Available Getu Ataro Department of Anesthesia, Jimma University, Jimma, EthiopiaI read the article by Phillips entitled, “Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions”, published in the journal of Open Access Surgery with enthusiasm and found it crucial for perioperative management of patients with gastrointestinal (GI surgery, particularly anastomosis. I appreciate the author’s exhaustive search of literature and discussion with some limitation on review basics like methodology, which may affect the reliability of the review findings. The effects of risk factors for anastomosis leak, such as malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique, were well discussed.1 However, from anesthesia perspective, there are some other well-studied risk factors that can affect healing of anastomosis wound and cause anastomosis leak. Among others, the effect of neostigmine and epidural block has been reported in many studies since half a century ago. View the original paper by Phillips

  16. Computational modeling of epidural cortical stimulation

    Science.gov (United States)

    Wongsarnpigoon, Amorn; Grill, Warren M.

    2008-12-01

    Epidural cortical stimulation (ECS) is a developing therapy to treat neurological disorders. However, it is not clear how the cortical anatomy or the polarity and position of the electrode affects current flow and neural activation in the cortex. We developed a 3D computational model simulating ECS over the precentral gyrus. With the electrode placed directly above the gyrus, about half of the stimulus current flowed through the crown of the gyrus while current density was low along the banks deep in the sulci. Beneath the electrode, neurons oriented perpendicular to the cortical surface were depolarized by anodic stimulation, and neurons oriented parallel to the boundary were depolarized by cathodic stimulation. Activation was localized to the crown of the gyrus, and neurons on the banks deep in the sulci were not polarized. During regulated voltage stimulation, the magnitude of the activating function was inversely proportional to the thickness of the CSF and dura. During regulated current stimulation, the activating function was not sensitive to the thickness of the dura but was slightly more sensitive than during regulated voltage stimulation to the thickness of the CSF. Varying the width of the gyrus and the position of the electrode altered the distribution of the activating function due to changes in the orientation of the neurons beneath the electrode. Bipolar stimulation, although often used in clinical practice, reduced spatial selectivity as well as selectivity for neuron orientation.

  17. Review of spinal epidural cavernous hemangioma

    International Nuclear Information System (INIS)

    The characteristics of spinal epidural cavernous hemangioma without primary origin in the vertebral bone were evaluated in 54 patients including our new case. The 36 male and 18 female patients were aged 5 to 78 years (mean 47 years). Most lesions were in the thoracic spine (80%) and on the dorsal side of the spinal cord (93%). The clinical course was mostly slowly progressive, with myelopathy in 33% at onset and 83% at admission. The lesion appeared isointense to the spinal cord on T1-weighted imaging, and isointense or slightly hypointense to the cerebrospinal fluid on T2-weighted imaging. Lesion without hemorrhage showed prominent homogeneous enhancement after administration of gadolinium-diethylenetriaminepenta-acetic acid because of the sinusoidal channel structure. Heterogeneous enhancement was caused by hematoma and/or post-hemorrhagic degeneration. The differential diagnosis of this disease includes metastatic tumor, Ewing's sarcoma, chordoma, eosinophilic granuloma, sarcoidosis, lipoma, hypertrophy of the posterior longitudinal ligament or the ligamentum flavum, meningioma, and neurinoma. The relationships between clinical course and surgery or outcome suggest that early diagnosis and total removal of the lesion before massive lesional bleeding occurs are necessary for a good outcome. (author)

  18. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

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    Harsimran Singh

    2013-01-01

    Full Text Available Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.

  19. MRI spectrum of findings in lumbosacral epidural lipomatosis

    International Nuclear Information System (INIS)

    Lumbosacral epidural lipomatosis (LEL) has been defined as a disease produced by excessive fat deposition within the spinal canal. In the pre MRI-era, this entity has been commonly overlooked. While a mild (or moderate) epidural fat hypertrophy is basically asymptomatic, severe LEL represents the symptomatic end-stage of this disease, conducing in many cases to surgical fat debulking. Since LEL may be concurrent with other substantial spinal abnormalities (e.g. disk herniation) MRI exams may increase our awareness of this condition to avoid its underestimation. MRI enables a reliable LEL characterization and may show its eventual reversibility in obese or corticosteroid receiving patients. This pictorial essay illustrates the usefulness of MRI to demonstrate the ongoing process of epidural fat accumulation in mild, moderate and severe LEL. The different morphologic patterns of the thecal sac produced by advanced LEL are analyzed. LEL and concurrent spinal disorders with superimposed neurological symptoms and signs are illustrated. (author)

  20. Lumbar epidural varices: An unusual cause of lumbar claudication

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    Meenakshisundaram Subbiah

    2016-01-01

    Full Text Available Lumbar epidural varices can also present with radiculopathy similar to acute intervertebral disc prolapse (IVDP. However as the magnetic resonance imaging (MRI in these patients are usually normal without significant compressive lesions of the nerve roots, the diagnosis is commonly missed or delayed leading to persistent symptoms. We present a rare case of acute severe unilateral claudication with a normal MRI unresponsive to conservative management who was treated surgically. The nerve root on the symptomatic side was found to be compressed by large anterior epidural varices secondary to an abnormal cranial attachment of ligamentum flavum. Decompression of the root and coagulation of the varices resulted in complete pain relief. To conclude, lumbar epidural varices should be considered in the differential diagnosis of acute onset radiculopathy and claudication in the absence of significant MRI findings.

  1. Postoperative Spinal Epidural Haematoma Causing Cauda Equina Syndrome: Case Report

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    Emre Delen

    2013-08-01

    Full Text Available Cauda equina syndrome is a neurological disorder defined by urinary and/or anal sphincter dysfunction, bilateral sciatica and bilateral motor and sensory deficits. Regarding the etiology, lumbar disc disease, spinal stenosis, tumors, haematomas, fractures, infectious diseases and ankylosing spondylitis are pathologies causing this syndrome. Spinal epidural haematomas are common amongst complications after spinal surgery. However the majority of these cases are asymptomatic, thus having little clinical importance. Symptomatic postoperative spinal epidural haematomas is a serious complication, and in order to prevent permanent neurologic deficit it requires urgent surgical intervention. This article aims to present the case of a patient with a spinal epidural haematoma after spinal stenosis surgery, causing cauda equina syndrome.

  2. Primary epidural lymphoma without vertebral involvement in a HIV-positive patient

    International Nuclear Information System (INIS)

    Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin's lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs

  3. Continuous epidural block of the cervical vertebrae for cervicogenic headache

    Institute of Scientific and Technical Information of China (English)

    HE Ming-wei; NI Jia-xiang; GUO Yu-na; WANG Qi; YANG Li-qiang; LIU Jing-jie

    2009-01-01

    Background Cervicogenic headache (CEH) is caused by a structural abnormality in the cervical spine. Available treatments for CEH include medical therapy, local botulinum toxin injection, cervical epidural corticosteroid injection, and surgery. The objective of this study was to investigate the safety and efficacy of a continuous epidural block of the cervical vertebra.Methods Medical records were retrospectively analyzed for 37 patients diagnosed with CEH treated by a continuous epidural block of the cervical vertebra with lidocaine, dexamethasone, and saline (5 ml/min) for 3-4 weeks and triamcinolone acetonide 5 mg once weekly for 3-4 weeks. Pain was measured via the visual analogue scale (VAS) in combination with quality of life assessment. Outcome measures were patient-reported days with mild or moderate pain, occurrence of severe pain, and the daily oral dosages of non-steroidal anti-inflammatory drug use (NSAID).Results In the 3 months immediately preceding placement of the epidural catheter, the mean number of days with mild or moderate pain was 22.0±4.3. The mean occurrence of severe pain was (3.20±0.75) times and the mean oral dosage of NSAID was (1267±325) mg. During the first 6 months after epidural administration of lidocaine and corticosteroids, the mean number of days with mild or moderate pain, the mean occurrence of severe pain, and the mean daily oral dosages of NSAIDs were significantly decreased compared to 3-month period immediately preceding treatment (P <0.01). By 12 months post-treatment, no significant difference in these three outcome measures was noted.Conclusions Continuous epidural block of the cervical vertebra for patients with CEH is effective for at least six months. Further research is needed to elucidate mechanisms of action and to prolong this effect.

  4. Abscesso epidural em paciente portador de piomiosite tropical: relato de caso e revisão da literatura Absceso epidural en paciente portador de piomiositis tropical: relato de caso y revisión de la literatura Epidural abscess in patient with tropical pyomyositis: a case report and literature review

    OpenAIRE

    Rodrigo Rezende; Igor Machado Cardoso; Saulo Gomes de Oliveira; José Lucas Batista Junior; Chárbel Jacob Junior

    2012-01-01

    A piomiosite é uma infecção muscular profunda subaguda que pode originar abscessos intramusculares únicos ou múltiplos. Está associada a infecções sistêmicas, diabetes mellitus, terapia imunossupressora, AIDS e mieloma múltiplo. Descrevemos um caso de piomiosite tropical com acometimento da coluna vertebral que evoluiu para abscesso epidural, em paciente com história pregressa de espondilite anquilosante em tratamento com medicações imunossupressoras e apresentou trauma direto na coxa direita...

  5. Sickle cell disease with orbital infarction and epidural hematoma

    International Nuclear Information System (INIS)

    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  6. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    Energy Technology Data Exchange (ETDEWEB)

    Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)

    2001-07-01

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  7. Posterior epidural fibrotic mass associated with Baastrup’s disease

    OpenAIRE

    Jang, Eui-Chan; Song, Kwang-Sup; Lee, Han-Jun; Kim, Jae Yoon; Yang, Jae Jun

    2010-01-01

    A few reports have demonstrated rare cases of Baastrup’s disease that involve epidural cysts that cause dural compression. However, there have been no reports of a midline epidural fibrotic mass being associated with Baastrup’s disease. A 60-year-old man presented with neurogenic claudication that had lasted for 5 years. Radiography showed anterolisthesis at the L4–L5 level, magnetic resonance imaging demonstrated severe stenosis due to a posterior noncystic mass, and the linear fluid signal ...

  8. Sickle cell disease with orbital infarction and epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Naran, A.D.; Fontana, L. [Dept. of Diagnostic Radiology, New York Methodist Hospital, Brooklyn, NY (United States)

    2001-04-01

    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  9. Accidently Discovered Postpartum Pituitary Apoplexy after Epidural Anesthesia

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    Rafik Sedra

    2014-11-01

    Full Text Available Anesthetic consideration of obstetric patients with pituitary disorders is an important topic to deal with. Few cases were reported with accidently discovered pituitary tumor complications especially in the postpartum period. A 26 years old primigravida lady with 39 weeks gestational period was reported to have severe headache and sudden loss of conscious after normal vaginal delivery with lumbar epidural anesthesia. Accidently discovered pituitary adenoma was proved after neurology, endocrine and ophthalmology consultations. Hence, undiagnosed pituitary adenomas should be taken in to consideration with unexplained postpartum generalized weakness and loss of conscious especially after exclusion of epidural anesthesia complications.

  10. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

    Directory of Open Access Journals (Sweden)

    Shubhra Goel

    2011-01-01

    Full Text Available This is a rare case of persistent Horner′s syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI/magnetic resonance angiography (MRA of head, neck, and chest were unremarkable. Medline search using terms Horner′s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner′s syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner′s syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner′s syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  11. Acupuntura e analgesia: aplicações clínicas e principais acupontos Acupuncture and analgesia: clinical applications and main acupoints

    OpenAIRE

    Marilda Onghero Taffarel; Patricia Maria Coletto Freitas

    2009-01-01

    A dor é uma resposta protetora do organismo a estímulos nocivos, que resulta em efeitos indesejáveis quando não controlada. A analgesia pode ser promovida mediante a utilização de vários tipos de fármacos. No entanto, estes podem causar efeitos adversos de acordo com a espécie e condição física do paciente. A acupuntura tem se mostrado eficaz como coanalgésico pela capacidade de diminuir a quantidade de fármacos utilizados para o controle da dor e raramente ser contraindicada. Objetivou-se co...

  12. Sedação e analgesia em terapia intensiva Sedación y analgesia en terapia intensiva Sedation and analgesia in intensive care

    OpenAIRE

    Fábio Ely Martins Benseñor; Domingos Dias Cicarelli

    2003-01-01

    JUSTIFICATIVA E OBJETIVOS: A ansiedade e a dor podem causar maior desconforto e risco aumentado de complicações no pós-operatório de pacientes cirúrgicos, prolongando inclusive seu tempo de internação. O objetivo deste estudo foi revisar os conceitos de sedação e analgesia em terapia intensiva, atualizando os conhecimentos e permitindo a revisão das informações disponíveis na literatura, assim como os consensos já publicados. CONTEÚDO: Apresentamos separadamente a sedação e analgesia, revisan...

  13. Bupivacaína levógira a 0,5% pura versus mistura enantiomérica de bupivacaína (S75-R25 a 0,5% em anestesia peridural para cirurgia de varizes Bupivacaína levógira a 0,5% pura versus mezcla enantiomerica bupivacaína (S75-R25 a 0,5% en anestesia peridural para cirugía de várices Plain 0.5% levogyrous bupivacaine versus 0.5% bupivacaine enantiomeric mixture (S75-R25 in epidural anesthesia for varicose vein surgery

    Directory of Open Access Journals (Sweden)

    José Delfino

    2001-12-01

    inferiores. La casuística, entretanto, no es aún suficiente para permitir conclusiones definitivas.BACKGROUND AND OBJECTIVES: The cardiotoxic effect of racemic bupivacaine (50:50 is still the major safety-related variable for regional blocks requiring higher concentrations and volumes. Recent animal studies suggested that the manipulation of racemic bupivacaine enantiomers could contribute for a better therapeutic efficacy by decreasing its potential toxicity. This study aimed at evaluating the efficacy of 0.5% bupivacaine enantiomeric mixture (S75-R25 as compared to plain S(-100% bupivacaine in lumbar epidural anesthesia for varicose vein surgery. METHODS: Participated in this randomized double-blind study 30 female patients aged 15 to 65 years, physical status ASA I or II scheduled for elective lower limb varicose vein surgery, who were allocated into two groups: S75-R25 Group - 20 ml (100 mg of 0.5% (S75-R25 bupivacaine; and Levogyrous Group - 20 ml (100 mg of 0.5% plain S(-100 bupivacaine without adjuvants. Characteristics of sensory and motor block as well as the incidence of side effects were investigated. RESULTS: Significant demographic differences and a longer surgical time were found in the S75-R25 Group. Faster spread and lower analgesic effects of the isomeric mixture were statistically significant. Motor block was significantly deeper in the S75-R25 Group. Side effects were negligible for both groups. CONCLUSIONS: Fewer side effects, good patients acceptance and the lack of post-operative transient neurological symptoms point towards the safety of both solutions in lumbar epidural anesthesia for elective varicose vein surgery. The sample, however, is still small for final conclusions.

  14. Sedação e analgesia em colonoscopia eletiva: propofol-fentanil versus propofol-alfentanil

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    Hacer Şebnem Türk

    2013-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: Sedação e analgesia são recomendadas em colonoscopia para propiciar conforto, pois são procedimentos invasivos e podem ser dolorosos. Este estudo teve como objetivo comparar as combinações de propofol-alfentanil e propofol-fentanil para sedação e analgesia em pacientes submetidos à colonoscopia eletiva. MÉTODOS: Estudo prospectivo e randomizado. Participaram do estudo 80 pacientes, ASA I-II, entre 18 e 65 anos. A indução de sedação e a analgesia foram feitas com propofol (1 mg.kg-1 e fentanil (1 µg.kg-1 no grupo propofol-fentanil (PF e com propofol (1 mg.kg-1 e alfentanil (10 µg.kg-1 no grupo propofol-alfentanil (PA. Para manutenção, doses adicionais de propofol foram administradas em bolus de 0,5 mg.kg-1 para obter escores de 3-4 na Escala de Sedação de Ramsey (ESR. Registrados os dados demográficos, a frequência cardíaca, a pressão arterial média (PAM, a saturação de oxigênio da hemoglobina (SpO2, os valores da ESR, o tempo de colonoscopia, a dose total de propofol, as complicações, o tempo de recuperação e o tempo para alta, bem como os escores de satisfação do colonoscopista e do paciente. RESULTADOS: A PAM aos 15 minutos no Grupo PA foi significativamente maior do que no Grupo PF (p = 0,037. A frequência cardíaca média do grupo PA foi maior no início do que nas mensurações subsequentes (p = 0,012, p = 0,002. A média da dose total de propofol do Grupo PA foi significativamente maior do que a do Grupo PF (p = 0,028. O tempo médio de recuperação do grupo PA foi significativamente maior do que o do grupo PF (p = 0,032. CONCLUSÃO: Fentanil proporciona melhores condições de operação e reduz a necessidade de doses adicionais de propofol. Essas vantagens diminuem o tempo de recuperação. Portanto, propofol-fentanil é superior ao propofol-alfentanil para sedação e analgesia em co