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Sample records for analgesia epidural para

  1. Analgesia epidural para parto en la gestante obesa Epidural analgesia for labour in obese patients

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    E. Guasch

    2006-10-01

    Full Text Available La obesidad es un problema global de salud en continuo aumento en el mundo desarrollado. Dado que la incidencia de la obesidad es mayor en mujeres que en hombres, los anestesiólogos con especial dedicación a la obstetricia, tendrán mayor oportunidad de enfrentarse a este tipo de pacientes. Nuestro objetivo es determinar la dificultad en la realización de la técnica epidural para analgesia de parto y analizar la incidencia de complicaciones ocurridas durante la punción en las gestantes obesas, así como evaluar la eficacia de la analgesia epidural en este grupo de pacientes en un estudio observacional retrospectivo de todos los bloqueos epidurales para analgesia de parto realizados en un hospital universitario de nivel 4 durante un periodo de cuatro años. Se ha estudiado un total de 13616 pacientes, clasificándolas según el índice de masa corporal en Kg./m² (IMC. En las pacientes no obesas (IMCObesity is an increasing global health problem in Developer countries. As its incidence is grater in women than men, obstetric anesthesiologists wil be envolved in the care of the obese patient more often. Our aim is to study punction dificulties in obese parturients requiring epidural analgesia for labor, and to compare punction complications between obese and non obese parturients as analgesic efficacy between obese and non obese patients in a retrospective observational study among all the epidural analgesic blocks performed in a universitary hospital in a four years period. We studied 13616 patients, who were classified according to body mass index in Kg/m² (BMI. In the non obese group patients (BMI<30; first attempt epidural success was achieved in 76,5%. Mild obese patients (BMI 30-32, severe obese (BMI 33-39 and morbid obese (BMI≥40, the percents were 69, 3%, 63,2% y 47,4% respectively. The comparison among obese and non obese patients was significati-vely different (p<0,001. Punction complications did not show differences among groups

  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. 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

  5. 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...

  6. 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

  7. 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.

  8. Epidural labour analgesia using Bupivacaine and Clonidine

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    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...

  9. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    -structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth. Findings...... 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 College of Midwives. Published...

  10. Epidural anaesthesia and analgesia for liver resection.

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    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  11. Effect of postoperative epidural analgesia on surgical outcome

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    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 controv...

  12. [Epidural analgesia in combination with general anesthesia].

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    Gottschalk, Antje; Poepping, Daniel M

    2015-07-01

    Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

  13. 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

  14. 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.

  15. 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.

  16. Bloqueio combinado raquiperidural versus bloqueio peridural contínuo para analgesia de parto em primigestas: resultados maternos e perinatais Combined spinal-epidural block versus continuous epidural block in labor analgesia for primiparous women: newborns and women outcomes

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    Márcio Antonio de Souza

    2009-10-01

    Full Text Available OBJETIVOS: comparar a evolução materna e perinatal após a utilização da analgesia peridural contínua versus analgesia combinada raqui-peridural em parturientes primigestas. MÉTODOS: foi realizado ensaio clínico aleatorizado com 128 gestantes primigestas em trabalho de parto, divididas em dois grupos: analgesia peridural (APC com 65 mulheres e grupo analgesia combinada raqui-peridural (ACRP com 63, admitidas no pré-parto de duas maternidades na cidade de Jundiaí - SP. Foram estudadas as variáveis: tempo de latência de instalação da analgesia, intensidade da dor e tempo total decorrido até a dilatação completa, índice de Apgar no primeiro e quinto minutos, tempo de resolução do parto, grau de bloqueio motor, efeitos adversos como náuseas, vômitos, prurido, hipotensão arterial, e grau de satisfação materna. Foram critérios de inclusão: primigestas, estado físico ASA 1 e 2, feto único, apresentação cefálica, de termo, dilatação cervical de 3 a 6 cm e solicitação de analgesia pelo obstetra. Foram excluídas mulheres com morbidades, ruptura de membranas, anormalidades fetais e uso de opioides até quatro horas antes. Para a análise estatística utilizou-se o teste de Mann-Whitney para as variáveis contínuas não paramétricas e os testes exato de Fisher e χ2 de Pearson, para variáveis categóricas. RESULTADOS: não houve diferença entre os grupos para velocidade de dilatação cervical, tempo para resolução do parto, parâmetros hemodinâmicos maternos, vitalidade do recém-nascido, complementações analgésicas durante o trabalho de parto e modo de parto. Houve maior rapidez de instalação da analgesia no grupo da ACRP e menor bloqueio motor no grupo de APC. Não foram observadas diferenças em relação aos efeitos adversos como náuseas, vômitos, prurido e hipotensão, sendo hipotensão mais frequente no grupo APC (16,9 versus 6,3% e náusea no grupo ACRP (6,3 versus 3,1%. CONCLUSÕES: as duas t

  17. COMPARISON OF PATIENT CONTROLLED EPIDURAL ANALGESIA WITH CONTINUOUS EPIDURAL INFUSION FOR LABOUR ANALGESIA

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    Sumaiah Tahseen

    2016-07-01

    Full Text Available We conducted a study to compare the efficacy and safety of Patient Controlled Epidural Analgesia (PCEA with that of Continuous Infusion of Epidural Analgesia (CIEA for maintenance of labour analgesia and evaluated the quality of analgesia and obstetric and safety outcomes. METHODS The study was a hospital-based prospective, randomised control trial on 80 parturients who had a normal antenatal period. Each parturient received 500-1000 mL lactated ringer solution Intravenously (IV prior to initiating epidural blockade. Epidural catheter placement was performed in a standard manner and all patients received an initial dose of 8-10 mL bupivacaine 0.25%. Parturients self-administered 0.125% bupivacaine with fentanyl 2.5 µg/mL using PCA pumps programmed as follows: 4 mL bolus with a 20 mins Lockout Interval (LI. Group B received CIEA of 8 mL 0.125% bupivacaine with fentanyl 2.5/mL. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, analgesic supplements, bupivacaine and fentanyl consumption. RESULTS Data from 80 patients showed no differences among groups in pain relief. Maternal satisfaction was greater in PCEA group. Anaesthetic interventions by way of supplemental doses of Bupivacaine and Fentanyl in the PCEA group were minimal (4 and 2 vs 25 and 12 P <0.001 compared to CEI group. PCEA group received less local anaesthetic (5.2 vs 9.4 p <0.001 and few patients in PCEA group had motor weakness compared to CEI group (6 vs 17 p <0.05. Both methods were safe for mother and newborn. CONCLUSION Patients who received PCEA required less anaesthetic interventions, required lower doses of local anaesthetic, fentanyl and have less motor weakness than those who received CEI.

  18. 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

  19. 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 .

  20. 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...

  1. CLINICAL EFFECTS OF ROPIVACAINE MESYLATE IN EPIDURAL ANESTHESIA AND ANALGESIA

    Institute of Scientific and Technical Information of China (English)

    Jian-qing Xu; Bo Zhu; Tie-hu Ye

    2005-01-01

    @@ SINCE the report that ropivacaine hydrochloride, a new amide local anesthetic, is of lower cardiac toxicity both in animals and humans,1 several studies have shown it to be a clinically effective local anesthetic widely used for both epidural anesthesia2-4 and analgesia5-7. Ropivacaine mesylate made in China is structurally from ropivacaine hydrochloride by substituting a mesylate group for hydrochloride group.8 This study was designed to clinically provide a double-blind comparison of ropivacaine mesylate with ropivacaine hydrochloride in epidural anesthesia and analgesia.

  2. 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.

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

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    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

  4. 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

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    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.

  5. Analgesia epidural com clonidina ou romifidina em cães submetidos à cirurgia coxofemoral Epidural analgesia with clonidine or romifidine in dogs submitted to coxofemoral surgery

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    J.T. Brondani

    2004-04-01

    Full Text Available Avaliaram-se as alterações cardiorrespiratórias e a analgesia da administração epidural de clonidina ou romifidina em cães submetidos à cirurgia coxofemural. Foram utilizados 14 cães distribuídos em dois grupos: o grupo Cloni recebeu 150µg de clonidina e o grupo Romi, 20µg/kg de romifidina. A indução anestésica foi realizada com propofol e a anestesia cirúrgica mantida com halotano e O2 em respiração espontânea. A punção do espaço epidural foi feita logo após a indução. Antes da indução e a cada 10 minutos foram avaliadas as freqüências cardíaca e respiratória, a pressão arterial sistólica, a saturação de oxigênio da hemoglobina e a concentração de halotano. Após indução e ao término do procedimento cirúrgico coletou-se sangue arterial para avaliação gasométrica de pH, PaCO2, PaO2, SaO2, BE e HCO3-. Foi realizada avaliação pós-operatória do grau de analgesia (intensa, pouco intensa e inadequada nas primeiras duas horas após término da cirurgia. Os animais do grupo Romi apresentaram bradicardia, bradiarritmias e hipertensão. A freqüência cardíaca e a pressão arterial sistólica no grupo Cloni mantiveram-se dentro da faixa de variação fisiológica para a espécie. A analgesia trans-operatória foi considerada intensa nos dois grupos. A administração epidural de clonidina ou romifidina produziu intensa analgesia transcirúrgica sem depressão respiratória e pouco intensa analgesia pós-operatória por duas horasCardiovascular alterations and analgesia in 14 dogs submitted to epidural administration of clonidine or romifidine to enable coxofemoral surgery were evaluated. Dogs were separated in two groups: Cloni group received 150µg of clonidine and Romi group, 20µg/kg of romifidine. Anesthetic induction was performed using propofol (8mg/kg and maintenance using halothane and O2 in spontaneous breathing. The puncture of epidural space was performed just after anesthetic induction. Heart

  6. 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 ...

  7. 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....

  8. 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.

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

    DEFF Research Database (Denmark)

    Andersen, Karen V; Bak, Marie; Christensen, Birgitte V;

    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...

  10. 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.

  11. 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

  12. 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...

  13. 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 postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before...... 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...

  14. 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

  15. 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-...

  16. A Study of Fetomaternal Outcome of Epidural Analgesia During Labour

    Directory of Open Access Journals (Sweden)

    Shital H Halvadia

    2013-04-01

    Full Text Available Background: Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. This produces pain relief with minimal side effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. Objectives: This study was conducted to assess the fetomaternal outcome of epidural analgesia in labour. Methods: This study was descriptive case series study which was conducted in department of obstetrics and gynecology, GMERS medical college, Gandhinagar, Gujarat from January 2012 to December 2012. Pregnant women who received epidural analgesia during labour were involved in the study. The inclusion criteria were primi gravida patients who had gestational age of greater than 37 weeks (confirmed by ultrasound without any risk factors, in true labour (cervical dilatation >3 cm with regular uterine contraction and with vertex presentation. Results: Total number of patients was 80 with the mean age of 21.9±1.7 years. Mode of delivery was spontaneous vaginal in 46 patients (57.5%, forceps delivery in 4 patients (5%, ventouse in 14 patients (17.5% and caesarean section in 16 patients (20%. At one minute majority of the babies (n 63, 78.75% had Apgar score of more than 7, only 5 babies (6.25% had Apgar score less than 4, and 12 babies (15% had Apgar score between 4-7. At 5 minutes majority of the babies (n 74, 92.5% had Apgar score of more than 7, only one baby (1.25% had Apgar score less than 4, and 5 babies (6.25% had Apgar score between 4-7. Conclusion: Epidural anaesthesia provided excellent pain relief in majority of the patients. It can also be associated with increase duration of second stage of labour but not associated with fetal compromise in a properly managed patient. [Natl J Med Res 2013; 3(2.000: 184-186

  17. 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.

  18. 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

  19. 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

    and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 µg/ml, 4 ml/h. Postoperative pain......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......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  20. 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.

  1. [Labor epidural analgesia for a woman with a pityriasis versicolor in the lumbar region].

    Science.gov (United States)

    Dubar, G; Omarjee, M; Viguié, C; Barbarot, S; Mignon, A

    2011-01-01

    Epidural analgesia is usually contraindicated in case of infection at the site of needle insertion. Tinea versicolor is a benign superficial cutaneous fungal infection caused by the proliferation of a skin commensal yeast of low pathogenicity. We report the case of a pregnant woman with a tinea versicolor in the lumbar region, who benefited from a labor epidural analgesia, realised with reinforced antiseptic measures. No neurological or infectious complication occurred.

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

    Directory of Open Access Journals (Sweden)

    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

  3. Does epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?

    NARCIS (Netherlands)

    Broekema, AA; Kuizenga, K; Hennis, PJ

    1996-01-01

    assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n=20, ES group) or 10 mi normal saline (n=20, control group) via a thoracic epidural

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    DEFF Research Database (Denmark)

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D;

    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 ....01) but significantly lower pain scores during rest (P anaesthesia received antiemetics (13 vs five; P epidural-spinal anaesthesia...

  7. Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor

    Directory of Open Access Journals (Sweden)

    Veena Chatrath

    2015-01-01

    Full Text Available Background: Neuraxial labor analgesia using new local anesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Combined spinal-epidural analgesia (CSEA has become the preferred method for labor analgesia as it combines benefits of both spinal analgesia and flexibility of the epidural catheter. Adding opioids to local anesthetic drugs provide rapid onset and prolonged analgesia but may be associated with several maternal and fetal adverse effects. The purpose of this study is to compare fentanyl and tramadol used in CSEA in terms of duration of analgesia and frequency of the adverse fetomaternal outcome. Materials and Methods: A total of 60 primiparas with a singleton pregnancy in active labor were given CSEA after randomly allocating them in two groups of 30 each. Group I received intrathecal 2.5 mg levobupivacaine + 25 μg fentanyl followed by epidural top ups of 20 ml 0.125% solution of the same combination. Group II received 25 mg tramadol instead of fentanyl. Epidural top ups were given when parturient complained of two painful contractions (visual analogue scale ≥ 4. Data collected were demographic profile of the patients, analgesic qualities, side- effects and the fetomaternal outcome. Results: Patients in Group II had significantly prolonged analgesia (145 ± 9 minutes than in Group I (95 ± 7 minutes. Patients receiving fentanyl showed rapid onset of analgesia, but there were more incidence of side-effects like shivering, pruritus, transient fetal bradycardia, hypotension, nausea and vomiting. Only side-effect in the tramadol group was nausea and vomiting. During labor, maternal satisfaction was excellent. Conclusions: Adding tramadol to local anesthetic provides prolonged analgesia with minimal side effects. Fentanyl, when used as adjuvant to local anesthetic, has a rapid onset of analgesia but has certain fetomaternal side-effects.

  8. 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;

    on whether to implement the NEWBORN program in a clinical setting also depend upon the trial effect on psycho-social outcomes which will be analysed in near future. Main messages (max 200 anslag): 1. No effect of antenatal education in small groups on use of epidural analgesia as pain relief during labour......Background: Epidural analgesia is widely used as pain relief during labour but has negative side effects, such as prolonged labour and increased risk of obstetric interventions. Antenatal education in small groups may increase trust in own ability to cope at home in the early stages of labour......, and 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...

  9. 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. ...

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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...

  12. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA?

    Directory of Open Access Journals (Sweden)

    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.

  13. 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

  14. 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.

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  17. 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

  18. 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

  19. 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...

  20. 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.

  1. Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

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    Venetiana Panaretou

    2012-01-01

    Full Text Available Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16 and the control group (Group B, n=14. After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO 2 levels and the calculation of regional-arterial CO 2 difference (ΔPCO 2 . Additional measurements included mean arterial pressure (MAP, cardiac output (CO, systemic vascular resistance (SVR, and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO 2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results.

  2. Combined general–epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Science.gov (United States)

    Panaretou, Venetiana; Siafaka, Ioanna; Theodorou, Dimitrios; Manouras, Andreas; Seretis, Charalampos; Gourgiotis, Stavros; Katsaragakis, Stylianos; Sigala, Fragiska; Zografos, George; Filis, Konstantinos

    2012-01-01

    Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16) and the control group (Group B, n=14). After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO2 levels and the calculation of regional–arterial CO2 difference (ΔPCO2). Additional measurements included mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results. PMID:23493852

  3. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    and two months later. The midwives were interviewed two hours after the birth. Method of analysis: The “Idealtype-” method, the “importance-” method and the “process-” method described by Bo Eneroth. Results: Two ideal-types were discovered: the worried and the unworried mother. Important and common...... factors influencing the relationship with the midwives were: the very choice of an epidural, the midwives accept of that choice, satisfaction with the presence of the midwifes, the continuity of the process, and a high level of information. Clearly, the establishment of an epidural implies important...... midwives handle the epidurals. Conclusion: In particular, the use of an epidural does not diminish the need for an individual approach. The woman’s level of consciousness and the entire situation makes her very sensitive to the midwives care....

  4. 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

  5. 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.

  6. 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;

    1988-01-01

    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-...

  7. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

    OpenAIRE

    Liu, E H C; Sia, A T H

    2004-01-01

    Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women.

  8. Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation

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    A. L. M. J. van der Knijff-van Dortmont

    2016-01-01

    Full Text Available SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.

  9. [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

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

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    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.

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

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    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.

  12. Effect of epidural analgesia with 0.075% ropivacaine versus 0.1%ropivacaine on the maternal temperature during labor:a randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    YUE Hong-li; SHAO Liu-jiazi; LI Jin; WANG Ya-nan; WANG Lei; HAN Ru-quan

    2013-01-01

    Background A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever.Recently,evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever.The aim of the present study was to investigate the effects of epidural analgesia with 0.075% or 0.1%ropivacaine on the maternal temperature during labor.Methods Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine.Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 μg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine,and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlled epidural analgesia.The measurements included the maternal oral temperature,visual analog scale pain scores,labor events and neonatal outcomes.Results Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation of analgesia and the oxytocin administration during labor compared with the one with 0.1%ropivacaine.Moreover,0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes.Conclusion Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor.

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

    Directory of Open Access Journals (Sweden)

    Neha Baduni

    2016-01-01

    Full Text Available 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.

  14. 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

  15. 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, ...

  16. [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

  17. 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.

  18. 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;

    1988-01-01

    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......-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.......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 infusion...

  19. 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

  20. 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

  1. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery

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    Mehta Yatin

    2008-01-01

    Full Text Available Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA technique with paravertebral block (PVB technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG. TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

  2. 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

  3. CLINICAL STUDY OF PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH TETRACAINE HYDROCHLORIDE AFTER PULMONARY LOBECTOMY

    Institute of Scientific and Technical Information of China (English)

    郭向阳; 李勇; 叶铁虎; 任洪智; 黄宇光; 罗爱伦

    2003-01-01

    Objective.To investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia(PCEA)after pulmonary lobectomy. Methods. Forty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group(22 patients)or ropivacaine group(21 patients). In the tetracaine group,0.15% tetracaine was used for postoperative PCEA,while 0.3% ropivacaine was used in the ropiva-caine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visual analogue scale(VAS). Forced expired volume at the 1st second(FEV1.0),forced vital capacity(FVC),FEV1.0/ FVC and peak expired flow(PEF)were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study. Results. VAS scores in both groups decreased significantly after a bolus injection of local anesthetics. There was no significant difference between the two groups in VAS either before or after the administration of PCEA. On the 1st and 2nd days after the operation,pulmonary function was reduced in both groups. However,there were no significant differences between the percentage of the changes of FEV1.0,FEV1.0/FVC and PEF in the two groups. There were also no significant differences between the percentage of the changes of heart rate,mean arterial blood pressure and SpO2 after administration of local anesthetics. There was no significant difference in overall satisfaction with pain relief.Conclusions. The analgesic effect of 0.15% tetracaine is similar to that of 0.3% ropivacaine used in pa-tient-controlled epidural analgesia after thoracotomy. No serious side effects were observed.

  4. Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies

    Directory of Open Access Journals (Sweden)

    Giuseppe Borzellino

    2016-01-01

    Full Text Available Introduction. Epidural analgesia has been a cornerstone of any ERAS program for open colorectal surgery. With the improvements in anesthetic and analgesic techniques as well as the introduction of the laparoscopy for colorectal resection, the role of epidural analgesia has been questioned. The aim of the review was to assess through a meta-analysis the impact of epidural analgesia compared to other analgesic techniques for colorectal laparoscopic surgery within an ERAS program. Methods. Literature research was performed on PubMed, Embase, and the Cochrane Library. All randomised clinical trials that reported data on hospital stay, postoperative complications, and readmissions rates within an ERAS program with and without an epidural analgesia after a colorectal laparoscopic resection were included. Results. Five randomised clinical trials were selected and a total of 168 patients submitted to epidural analgesia were compared to 163 patients treated by an alternative analgesic technique. Pooled data show a longer hospital stay in the epidural group with a mean difference of 1.07 (95% CI 0.06–2.08 without any significant differences in postoperative complications and readmissions rates. Conclusion. Epidural analgesia does not seem to offer any additional clinical benefits to patients undergoing laparoscopic colorectal surgery within an ERAS program.

  5. Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies.

    Science.gov (United States)

    Borzellino, Giuseppe; Francis, Nader Kamal; Chapuis, Olivier; Krastinova, Evguenia; Dyevre, Valérie; Genna, Michele

    2016-01-01

    Introduction. Epidural analgesia has been a cornerstone of any ERAS program for open colorectal surgery. With the improvements in anesthetic and analgesic techniques as well as the introduction of the laparoscopy for colorectal resection, the role of epidural analgesia has been questioned. The aim of the review was to assess through a meta-analysis the impact of epidural analgesia compared to other analgesic techniques for colorectal laparoscopic surgery within an ERAS program. Methods. Literature research was performed on PubMed, Embase, and the Cochrane Library. All randomised clinical trials that reported data on hospital stay, postoperative complications, and readmissions rates within an ERAS program with and without an epidural analgesia after a colorectal laparoscopic resection were included. Results. Five randomised clinical trials were selected and a total of 168 patients submitted to epidural analgesia were compared to 163 patients treated by an alternative analgesic technique. Pooled data show a longer hospital stay in the epidural group with a mean difference of 1.07 (95% CI 0.06-2.08) without any significant differences in postoperative complications and readmissions rates. Conclusion. Epidural analgesia does not seem to offer any additional clinical benefits to patients undergoing laparoscopic colorectal surgery within an ERAS program. PMID:27642630

  6. 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

    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......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...... 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...

  7. 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;

    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....

  8. 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

  9. [Pressure Ulcer Caused by Long-term Keeping of the Same Body Position during Epidural Labour Analgesia].

    Science.gov (United States)

    Naruse, Satoshi; Uchizaki, Sakiko; Mimura, Shinichiro; Taniguchi, Mizuki; Akinaga, Chieko; Sato, Shigehito

    2016-06-01

    We report the case of a 34-year-old woman (height: 153 cm, weight : 62.4 kg, non-pregnant weight : 52 kg, uniparous) without underlying diseases who developed pressure ulcer due to keeping a similar body position during long-term epidural delivery. Induction of childbirth was started in gestational week 40, causing reduction of fetal heart rate, which improved after adoption of a right lateral recumbent position. Severe contractions occurred and epidural labour analgesia was started. The fetal heart rate decreased again and induction of childbirth was suspended, but the right lateral recumbent position was maintained. Epidural administration was continued due to persistent contractions. Next morning, induction of childbirth was restarted and birth occurred in approximately 6 hours. The right lateral recumbent position was maintained for approximately 20 hours. At childbirth, a pressure ulcer was present in the intertrochanteric part of the right femur. The causes included insufficient knowledge of medical staff about the risk of pressure ulcer during epidural delivery, and no position change. A decreased sensation and blocked motor nerve caused by epidural anesthesia might have accelerated pressure ulcer development. This case suggests that preventive measures against pressure ulcer are required in epidural anesthesia in pregnant women. PMID:27483666

  10. 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.

  11. Investigation of the Effects of Continuous Low-Dose Epidural Analgesia on the Autonomic Nervous System Using Hilbert Huang Transform

    Directory of Open Access Journals (Sweden)

    Wei-Ren Chuang

    2010-01-01

    Full Text Available Effects of continuous low-dose epidural bupivacaine (0.05-0.1% infusion on the Doppler velocimetry for labor analgesia have been well documented. The aim of this study was to monitor the activity of the autonomic nervous system (ANS for women in labor based on Hilbert Huang transform (HHT, which performs signal processing for nonlinear systems, such as human cardiac systems. Thirteen pregnant women were included in the experimental group for labor analgesia. They received continuous epidural bupivacaine 0.075% infusion. The normal-to-normal intervals (NN-interval were downloaded from an ECG holter. Another 20 pregnant women in non-anesthesia labor (average gestation age was 38.6 weeks were included in the comparison group. In this study, HHT was used to decompose components of ECG signals, which reflect three different frequency bands of a person's heart rate spectrum (viz. high frequency (HF, low frequency (LF and very low frequency (VLF. It was found that the change of energy in subjects without anesthesia was more active than that with continuous epidural bupivacaine 0.075% infusion. The energy values of the experimental group (i.e., labor analgesia of HF and LF of ANS activities were significantly lower (P < 0.05 than the values of the comparison group (viz. labor without analgesia, but the trend of energy ratio of LF/HF was opposite. In conclusion, the sympathetic and parasympathetic components of ANS are all suppressed by continuous low-dose epidural bupivacaine 0.075% infusion, but parasympathetic power is suppressed more than sympathetic power.

  12. 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

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

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    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.

  14. A comparative study of efficacy of epidural versus interpleural bupivacaine for post operative analgesia after open cholecystectomy

    Directory of Open Access Journals (Sweden)

    RK Yadav

    2014-04-01

    Full Text Available Background The conventional methods of administering the prescribed doses of intramuscular or intravenous analgesics at fixed time intervals results in widely fluctuating and inadequate plasma level leads to poor post operative pain relief. Despite all advances made in the field of medicine, this symptom called “Pain” has not been combated well. Objective The present study was carried out to compare the efficacy of epidural verses interpleural administration of bupivacaine(0.5% with adrenaline for post operative pain relieve in patients undergoing open cholecystectomy. Methods We prospectively randomized and compared the post operative pain relieve with the reference of visual analog score (VAS in patients undergoing elective open cholecystectomy in college of medical sciences-teaching hospital, Bharatpur, Chitwan. Forty adult patients undergoing elective cholecystectomy were divided into two groups. Twenty patients in each group were subjected to a different technique of post-operative analgesia, namely thoracic epidural and interpleural instillation of 0.5% bupivacaine. These two groups were then compared in relation to changes produced in the pain scores, vital parameters and complication and side effects associated with the two techniques. The study was conducted for 24 hour postoperatively. Observation: Both thoracic epidural and interpleural instillation of 0.5% bupivacaine compared favorably with regard to analgesia in the present study. In general, the pain relief following thoracic epidural was more complete compared to interpleural but this was not clinically significant. Conclusion The present study shows that both the techniques are equally effective in providing analgesia following cholecystectomy. However, neither technique rendered the patients completely pain free at all times during first 24 hours. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 15-23 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10232

  15. 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

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

    Directory of Open Access Journals (Sweden)

    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

  17. 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

  18. 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

    Directory of Open Access Journals (Sweden)

    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

  19. 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

  20. 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...

  1. The Effects of Thoracic Epidural Analgesia on Postoperative Pain and Myocardial Protection in Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Bestami Barış Çelik

    2015-03-01

    Full Text Available Aim: Thoracic epidural analgesia (TEA in cardiac surgery provides stable hemodynamics and postoperative analgesia by reducing stress response. The aim of this study was to investigate the effects of TEA in coronary artery bypass grafting (CABG on postoperative pain, myocardial protection, intensive care unit (ICU and hospital length of stay. Methods: After receiving approval from the hospital scientific committee and obtaining written informed consent from the participants, 40 patients, who were undergoing elective CABG, were included in the study. The patients were prospectively randomized into two groups as TEA group (n=20 and control group (n=20. Epidural catheters were placed one day before surgery at the T5-T6 level, levobupivacaine 2 µg/mL and fentanyl 5 mL/hr infusions were initiated in the ICU. Control group received intravenous infusion of fentanyl 8 µg/kg/hr. Infusions continued for 24 hours in both groups. Results: Time to extubation was shorter, postoperative hypertension was less frequent and pain scores were lower in TEA group than in control group (p<0.01. There was no difference in length of stay in the ICU, CK-MB and troponin I levels between the groups, however, length of hospital stay was shorter in TEA group. Conclusion: TEA with levobupivakain in CABG was found to provide stable hemodynamics, effective analgesia and to shorten length of hospital stay. (The Medical Bulletin of Haseki 2015; 53: 72-6

  2. 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;

    1994-01-01

    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......) with unchanged pulmonary function. Nocturnal episodic oxygen desaturation, hyperthermia, and postoperative fatigue were prevented. Defecation occurred on the first postoperative day and oral caloric intake was normal after 24 hours with no postoperative weight loss. Self care was normalized on the third...

  3. ROPIVACAINE CONTINUOUS WOUND INFUSION VERSUS CONTINUOUS EPIDURAL VERSUS SYSTEMIC ANALGESIA FOR POST CAESAREAN DELIVERY UNDER SPINAL ANAESTHESIA: A PROSPECTIVE RANDOMISED CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Paleti

    2014-07-01

    Full Text Available BACKGROUND: Opioid based analgesic regimens have been the gold standard for post caesarean analgesia until recently. Regional techniques like local intra-wound infusion techniques are becoming popular now. Our aim is to evaluate the efficacy of 0.2% Ropivacaine continuous wound infusion versus continuous epidural versus conventional systemic analgesia for post caesarean delivery. METHODOLOGY: 60 healthy parturients of ASA I/II were randomized after elective caesarean section into 3 groups of 20 each. Group-A: Received 0.2% Ropivacaine via an epidural catheter placed into subcutaneous tissue and fascia before skin closure at the rate of 5ml/hr. through infusion pump. Group-B: Received 0.2% Ropivacaine continuous epidural infusion via an epidural catheter at the rate of 8ml/hr. An initial bolus of 10ml was given in groups A&B. Group-C: Received standard systemic analgesia with diclofenac sodium and rescue opioid. Post operatively parturients were assessed for VAS scores for pain at rest and during movement, total Ropivacaine consumption, Tramadol consumption and side effects. Data were analyzed using SPSS software version 22. RESULTS: There were no significant differences in the mean VAS scores at rest and at movement between groups A or B and C. The consumption of Tramadol was significantly greater in Group C (p value AC=0.025, BC=0.0000 than A or B. Mean Ropivacaine consumption is significantly higher in Group B (p=0.000 than Group A. CONCLUSION: Continuous local intra-wound analgesia with Ropivacaine produced comparable analgesia to that of continuous epidural and superior analgesia compared to standard systemic analgesia.

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

    Directory of Open Access Journals (Sweden)

    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

  5. The use of botulinum toxin and epidural analgesia for the treatment of spasticity and pain in a patient with maple syrup urine disease

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    Abdullah M Kaki

    2012-01-01

    Full Text Available A 7-year-old boy, weighing 18 kg, was diagnosed with maple syrup urine disease (MSUD. He suffered from spasticity of the lower limbs and pain that did not respond to oral medications. Injections of botulinum toxin A (BTX-A at 10 sites and epidural analgesia with 0.125% bupivacaine were used to treat spasticity with good results. We conclude that BTX-A combined with epidural analgesia may be a useful treatment option for incapacitating, painful spasticity related to MSUD. This treatment modality allowed a comprehensive rehabilitation program to be completed and it lasted longer than 9 months.

  6. 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

  7. 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.

  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......, 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. 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 ...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Differences in the Frequency of Use of Epidural Analgesia between Immigrant Women of Turkish Origin and Non-Immigrant Women in Germany – Explanatory Approaches and Conclusions of a Qualitative Study

    Science.gov (United States)

    Petruschke, I.; Ramsauer, B.; Borde, T.; David, M.

    2016-01-01

    Introduction: The starting point of this study was the considerably lower rate of epidural analgesia use among women of Turkish origin in Germany compared to non-immigrant women in the German Research Foundation (DFG)-funded study entitled “Perinatal Health and Migration Berlin”. The study aimed to identify possible differences in the womenʼs attitudes towards epidural analgesia. Methods: Exploratory study with semi-structured interviews, interviews lasting 17 minutes on average were conducted with 19 women of Turkish origin and 11 non-immigrant women at a Berlin hospital. The interviews were subjected to a qualitative content analysis. Results: Immigrant women of Turkish origin in Germany more frequently ascribe meaning to the pain associated with vaginal delivery. They more frequently categorically reject the use of epidural analgesia, 1) for fear of long-term complications such as paralysis and back pain and 2) based on the view that vaginal delivery with epidural analgesia is not natural. Information on epidural analgesia is frequently obtained from a variety of sources from their social setting, in particular, by word of mouth. The women in both groups stated that they would take the decision to use epidural analgesia independent of their partnerʼs opinion. Discussion: The differences in epidural analgesia use rates observed correspond to the womenʼs attitudes. For the immigrant women of Turkish origin in Germany, the attitude towards using epidural analgesia is based in part on misinformation. In order to enable the women to make an informed decision, epidural analgesia could receive a stronger focus during childbirth courses. PMID:27681522

  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. 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 improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. CONCLUSIONS......: Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity....

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

    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

  17. Effect of ropivacaine-fentanyl combined with spinal-epidural labor analgesia on maternal serum markers andTXB2/6-Keto-PGF1α proportion

    Institute of Scientific and Technical Information of China (English)

    Yan Huang

    2015-01-01

    Objective:To study the effect of ropivacaine-fentanyl combined with spinal–epidural labor analgesia on maternal serum markers and TXB2/6-Keto-PGF1α proportion.Methods:40 cases of puerperas intending to receive vaginal delivery in our hospital were randomly divided into two groups. Combined group received fentanyl subarachnoid injection combined with ropivacaine epidural injection and control group received fentanyl combined with ropivacaine epidural injection. Then levels of serum pain mediators and inflammation related factors as well as TXB2/6-Keto-PGF1α proportion of both groups were detected. Results:In delivery process, contents of serum pain mediatorsβ-EP, NO, SP, PGE2, TNF-α, IL-6, CCL2 and CCR2 of combined group were significantly lower than those of control group, and IL-10 and TGb-βcontents were significantly higher than those of control group; In and after labor, serum TXB2 content and TXB2/6-keto-PGF1α proportion of combined group were lower than those of control group, while 6-keto-PGF1α content was higher than that of control group.Conclusion:Ropivacaine-fentanyl combined with spinal–epidural labor analgesia can achieve more precise analgesia effect, reduce contents of pain mediators, pro-inflammatory cytokines and chemokines, and regulate TXB2/6-Keto-PGF1ααbalance.

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

    Directory of Open Access Journals (Sweden)

    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

  20. Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

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    Clark K. Choi

    2013-01-01

    Full Text Available Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients.

  1. PDCA循环在硬膜外分娩镇痛管理中的应用%Application of PDCA Cycle to the Management of Epidural Labor Analgesia

    Institute of Scientific and Technical Information of China (English)

    王晓霞; 朱广球; 陈玲萍

    2014-01-01

    Objective To explore the application of PDCA cycle to the quality management of epidural labor analgesia. Methods We applied PDCA cycle to the management of epidural labor analgesia from June, 2013 to January, 2014 and analyzed current situation. With plan, implementation, examination and action, we found out the problems in epidural labor analgesia and improved its quality continuously. Results The valid control rate of labor pain, satisfaction rating of pain-relieving and puerperae' satisfaction had been significantly improved after the application of PDCA cycle. Conclusion The application of PDCA cycle in epidural labor analgesia management could well improve the analgesic effect and patients' satisfaction.%目的探讨PDCA循环在硬膜外分娩镇痛质量管理中的应用。方法我们自2013年6月至2014年1月将PDCA循环应用于硬膜外分娩镇痛管理,进行现状调查分析,采用计划、执行、检查、处理循环,寻找硬膜外分娩镇痛中存在的问题并进行持续质量改进。结果与施行PDCA循环前(2013年4~5月)相比,施行PDCA循环后硬膜外分娩镇痛质量改进明显,疼痛有效控制率、镇痛满意度评分及产妇满意度均明显提高(P<0.05)。结论 PDCA循环应用于分娩镇痛质量管理,可较好地提高镇痛效果和产妇满意度。

  2. 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 study was prospective, controlled, and randomized and was performed in a tertiary health care center associated with a university. PARTICIPANTS: One hundred sixty-three patients scheduled for coronary artery bypass graft surgery. INTERVENTIONS: In this 2 x 2 factorial-designed study the patients were...... 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...

  3. 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

    BACKGROUND: Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. RESULTS......: 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...

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

    Directory of Open Access Journals (Sweden)

    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

  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

    Directory of Open Access Journals (Sweden)

    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.

  6. Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis

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    Huan Yan

    2016-05-01

    Full Text Available Pain management after total knee arthroplasty (TKA and total hip arthroplasty should permit early mobilization with minimal pain. Local infiltration analgesia (LIA is a new popular method for decreasing postoperative pain. The goal of this meta-analysis is to evaluate the efficacy of LIA in comparison with epidural analgesia. A literature search was performed in PubMed, EMBASE, the OVID database, Web of Science, and the Cochrane Library databases. The risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included visual analog scale score, range of flexion, length of stay, and complications. Nine trials involving 537 patients met the inclusion criteria. LIA provides better pain relief and larger range of motion in TKA patients compared to epidural analgesia at the late postoperative period. No significant difference was observed in regard to the length of stay and complications. The current evidence shows that the use of local infiltration is effective for postoperative pain management in TKA patients. More high-quality randomized controlled trials with long-term follow-up are required for examining the long-term efficacy and safety of local infiltration. 

  7. 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...

  8. 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.

  9. 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

    Directory of Open Access Journals (Sweden)

    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

  10. 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

    Directory of Open Access Journals (Sweden)

    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

  11. 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 ...

  12. 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.

  13. 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

  14. 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.

  15. COMPA RATIVE EVALUATION OF INTRATHECAL, EPIDURAL AND INTRAVENOUS BOLUS SUFENTANIL FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERY

    Directory of Open Access Journals (Sweden)

    Sudhakar

    2015-06-01

    Full Text Available In clinical experience sufentanil is more effective when given epidurally than intrathecally and intravenously. To test this hypothesis we compare the analgesic characteristic of 10μgm of epidural, intrathecal and intravenous single shot sufenta nil for pain relieve after elective lower limb surgeries. A randomized double blind trial was conducted on 60 patients who were under - going elective lower limb surgery in epidural anesthesia with bupivacaine. In recovery room as soon as pain score higher than 3 on the scale of 10 on visual analogue score was reported 10μgm intravenous, intrathecal and epidural was given respectively. We concluded that epidural sufentanil is better as compared to intrathecal and intravenous in terms of duration of pain reli ef, vital complications and side effects for post - operative pain relief.

  16. COMPARATIVE STUDY OF 0.0625% BUPIVACAINE WITH FENTANYL VERSUS 0.1% ROPIVACAINE WITH FENTANYL AS CONTINUOUS EPIDURAL INFUSION IN LABOUR ANALGESIA

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    L. Raghavan

    2016-07-01

    Full Text Available BACKGROUND We undertook this study to see whether ropivacaine offers any significant advantage over bupivacaine in our institutional practice with regards to obstetrical outcome and whether a changeover from bupivacaine to ropivacaine was warranted. This study compares the efficacy of Ropivacaine and Bupivacaine regarding pain relief, motor block and labour characteristics. AIM The objective of the current study is to compare the efficacy of equipotent doses of ropivacaine with fentanyl and bupivacaine with fentanyl as continuous infusion in labour epidural analgesia with respect to Quality of pain relief, Motor Block, Duration of labour, Mode of delivery - Spontaneous Vaginal/Assisted with forceps/Caesarean Section, Neonatal outcome – APGAR score, Complications if any. METHODS AND MATERIALS The study was a prospective randomized double blinded trial involving 60 parturients (30 in each group attending the Dept. of Obstetrics and Gynaecology, Chengalpattu Medical College Hospital. Informed consent was obtained. Detailed history of the patient was collected. Routine investigations were done as per our hospital labour protocol. Patients fulfilling the inclusion criteria and who gave consent were then randomly allocated to one of the study groups on the basis of computerized randomized list. STATISTICAL ANALYSIS The statistical analysis was done using SPSS version 16 for windows. The profiles of the cases were compared with the treatment allocation in order to check if there was any significant difference. Chi-square test for association was used to compare categorical variables between treatment allocations. RESULTS The observations of this study show that pain relief offered by epidural ropivacaine is as good and effective as epidural bupivacaine. Also the duration of labour, mode of delivery, neonatal outcome and complications are comparable between the two groups. CONCLUSION Findings suggest that the use of epidural ropivacaine for labour

  17. 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

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    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..

  18. COMPARATIVE STUDY ON POST - OPERATIVE ANALGESIA IN LOWER LIMB ARTHROPLASTIES WITH CONTINUOUS EPIDURAL INFUSION OF 0.125% BUPIVACAINE AND TWO DIFFERENT NARCOTIC ANALGESICS FENTANYL AND SUFENTANIL

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    Rajeev

    2015-02-01

    Full Text Available Present study was carried out to compare and evaluate the effect of fentany and sufentanil in combination of bupivacaine on postoperative pain relief and possible side effects if any in patients operated for hip and knee arthroplasties. We randomly selected sixty patients of ASA grade I - III of age 18 to 75 years divided in to two groups. Group – I Received2.5 μg/ml fentanyl along with 0.125% bupivacaine as a continuous epidural infusion at the rate of 5 ml/hr up to 48 hr after the surgery. Group - II Received 0.25 μg/ml sufentanil along with 0.125% bupivacaine as a continuous epidural infusion at the rate of 5 ml/hr up to 48 hr after the surgery. Analgesia was assessed by Visual analogue scale and motor block if any by Bromage scale. Haemodynamics and respiratory parameters were recorded and side effects if any were noted. In group I mean VAS score during rest was 27.0 +/ - 4.8 and mean VAS score during movement was 33.5+/ - 4.9 in group II mean VAS score during rest was 20.8+/ - 4.9 and mean VAS score during movement was 27.7+/ - 5.2. T he dynamic pain VAS score showed a statistically significant difference between two groups . haemodynamics parameters were similar in both groups. Thus group II patients received sufentanil along with 0.125% bupivacaine had better post - operative analgesia d uring movement as well as at rest without respiratory depression or significant side effects.

  19. Use of local anaesthetics and adjuncts for spinal and epidural anaesthesia and analgesia at German and Austrian University Hospitals: an online survey to assess current standard practice

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    Roewer Norbert

    2010-04-01

    Full Text Available Abstract Background The present anonymous multicenter online survey was conducted to evaluate the application of regional anaesthesia techniques as well as the used local anaesthetics and adjuncts at German and Austrian university hospitals. Methods 39 university hospitals were requested to fill in an online questionnaire, to determine the kind of regional anaesthesia and preferred drugs in urology, obstetrics and gynaecology. Results 33 hospitals responded. No regional anaesthesia is conducted in 47% of the minor gynaecological and 44% of the urological operations; plain bupivacaine 0.5% is used in 38% and 47% respectively. In transurethral resections of the prostate and bladder no regional anaesthesia is used in 3% of the responding hospitals, whereas plain bupivacaine 0.5% is used in more than 90%. Regional anaesthesia is only used in selected major gynaecological and urological operations. On the contrary to the smaller operations, the survey revealed a large variety of used drugs and mixtures. Almost 80% prefer plain bupivacaine or ropivacaine 0.5% in spinal anaesthesia in caesarean section. Similarly to the use of drugs in major urological and gynaecological operations a wide range of drugs and adjuncts is used in epidural anaesthesia in caesarean section and spontaneous delivery. Conclusions Our results indicate a certain agreement in short operations in spinal anaesthesia. By contrast, a large variety concerning the anaesthesiological approach in larger operations as well as in epidural analgesia in obstetrics could be revealed, the causes of which are assumed to be primarily rooted in particular departmental structures.

  20. 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:

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

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    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.

  2. 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

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    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

  3. 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.

  4. 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

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    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

  5. 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.

  6. 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

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

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    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...

  8. 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。

  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. 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

  11. Analgesia after cesarean section and epidural anaesthesia clinical study of the impact of maternal lactation%护理干预对剖宫产及硬膜外麻醉术后产妇泌乳的影响

    Institute of Scientific and Technical Information of China (English)

    温艳艳

    2014-01-01

    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:The240 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 ofⅣ 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.

  12. 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.

  13. Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle: A Randomized Controlled Trial.

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    Ji-Juan Xing

    Full Text Available Combined spinal-epidural analgesia (CSEA is sometimes used for difficult births, but whether it contributes to postpartum pelvic muscle disorder is unclear. This randomized controlled trial examined whether CSEA given during labor affects the electrophysiological index of postpartum pelvic floor muscle function.A consecutive sample of primiparous women who delivered vaginally at term were randomly assigned to a CSEA group (n = 143 and control group (n = 142 between June 2013 and June 2014. All were assessed 6-8 weeks later for electrophysiological function of pelvic floor muscle.The two groups were similar in the degree of muscle strength, muscle fatigue, and pelvic dynamic pressure of pelvic floor muscle. The CSEA and control groups showed similar proportions of women with normal muscle strength (score ≥4 in type I pelvic fibers (23.1% vs. 14.1%, P = 0.051 and type II pelvic fibers (28.0% vs. 24.6%, P = 0.524. The groups also contained similar proportions of women who showed no fatigue in type I fibers (54.5% vs. 48.6%, P = 0.315 or type II fibers (88.8% vs. 87.3%, P = 0.699. Similarly low proportions of women in the CSEA group and control group showed normal pelvic dynamic pressure (11.2% vs. 7.7%, P = 0.321. However, women in the CSEA group spent significantly less time in labor than those in the control group (7.25 vs. 9.52 h, P <0.001.CSEA did not affect the risk of postpartum pelvic muscle disorder in this cohort of primiparous women who gave birth vaginally. A significant shorter duration of labour was observed in the CSEA-group.ClinicalTrials.gov NCT02334150.

  14. 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.

  15. 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 ...

  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. 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.

  19. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  20. Remifentanilo vs. bloqueo central epidural para control del dolor postoperatorio en cirugía vascular de urgencias Remifentanyl versus epidural central blockade for the management of postoperative pain in emergency vascular surgery

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    A. Quirante

    2004-12-01

    Full Text Available El correcto tratamiento del dolor postoperatorio constituye una prioridad dentro de los objetivos del anestesiólogo. En pacientes con patología vascular severa quirúrgica, el tratamiento analgésico efectivo se suele realizar mediante bloqueo continuo epidural. Sin embargo, la administración de analgésicos, tanto opiáceos como no opiáceos, por vía intravenosa, es una alternativa a la vía epidural cuando esta es desestimada. Caso clínico: Presentamos el caso de un paciente varón de 63 años portador de un bypass fémoro-poplíteo a primera porción en miembro inferior izquierdo, el cual es intervenido quirúrgicamente y con carácter urgente tras el diagnóstico de falso aneurisma séptico de arteria iliaca izquierda con rotura de anastomosis fémoro-poplítea. Se optó por una anestesia general basada en la analgesia con remifentanilo frente a bloqueo central epidural dado el carácter urgente de la cirugía y la ingesta habitual de antiagregantes plaquetarios. Se planificó como estrategia analgésica postoperatoria la administración de remifentanilo a dosis sedoanalgésicas (Introduction: The appropriate management of postoperative pain is a priority among the objectives of the anesthesiologist. In patients with severe surgical vascular pathology, an effective analgesic treatment is usually provided with epidural continuous blockade. However, the intravenous administration of analgesics, either opiates or non opiates, is an alternative to the epidural route when this has to be dismissed. Clinical case: We present the case of a 63-years old male patient carrying a femoro-popliteus bypass in the first portion of the left lower limb that underwent emergency surgery after being diagnosed of a false septic aneurysm in the left iliac artery with breakage of the femoro-popliteus anastomosis. General anesthesia based on remifentanyl was decided instead of epidural central blockade due to the urgent nature of the surgery and the regular

  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. 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.

  3. 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

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    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.

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

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    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. 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.

  6. Epidural catheter fragment entrapment: a case report

    Directory of Open Access Journals (Sweden)

    Mohammadi M

    2010-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Epidural catheters are seldom difficult to remove from patients. The breakage of the catheters is uncommon, troublesome and occasionally dangerous. "n"nCase presentation: A lumbar epidural catheter inserted in a 17 year-old man for applying anesthesia for internal fixation of femur fracture and subsequent postoperative epidural analgesia. In the third postoperative day, during unsuccessful attempt for removing the catheter, it was broken and was retained in his back. A CT- scan was performed and shows a fragment of catheter in the sub- laminar ligament between L3 and L4 without any connection with epidural space. As the patient had no complaint the fractured fragment was left in site and he was just followed up in the clinic."n"nConclusion: The knowledge of practical method in locating the retained epidural catheter, and the indication for surgical removal are very important. CT- scan is useful in showing the mechanism and locating the epidural catheter entrapment and facilitating surgical follow-up.

  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. Epidural abscess

    Science.gov (United States)

    ... intracranial epidural abscess if it is inside the skull area. It is called a spinal epidural abscess if it is found in the ... of infection is found. An abscess inside the skull is called an ... is called a spinal epidural abscess. It may be seen in people ...

  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. Clinical observation of epidural block in metaphase induced labor analgesia%硬膜外阻滞在中期妊娠引产镇痛时机选择的临床观察

    Institute of Scientific and Technical Information of China (English)

    王玥; 康凯; 车向明; 徐铭军

    2014-01-01

    Objective To compare the epidural block in metaphase induced labor at different points of analgesia and its related data. Methods Sixty cases who had termination of pregnancy in our hospital due to unplanned pregnancy or a birth defect were selected and were randomly divided into two groups for epidural block age after conventional treat-ment:group A, in which the anaesthesia was initiated when the maternal had pain, while women in group B had anesthesia (incubation period) after regular contractions began and were treated in the ward for routine treatment. Thirty cases were included in each group. The vital signs, VAS score at each point, motor nerve block classification, induced labor time, blood loss and adverse reactions were recorded before and after analgesia. Results Compared with group B, the VAS score in group A at each point was lower, the labor time was slightly longer and the difference was statistically significant (P 0.05). Conclusion Since it is unnecessary to consider the status of fetus during metaphase induced labor, it is reasonable to start analgesic anaesthesia early. This approach does not increase the frequency of blood loss but the induced labor time is slightly prolonged.%目的:比较硬膜外阻滞在中期妊娠引产不同时点开始镇痛的临床效果。方法选取我院60例因计划外妊娠或有胎儿畸形等妊娠合并症要求终止妊娠者,随机分为两组实施硬膜外阻滞,A组为病房常规处理后产妇有疼痛感即开始实施麻醉,B组为病房常规处理后有规律宫缩开始实施麻醉,每组30例;记录镇痛开始前及镇痛后生命体征、各时点孕妇的VAS评分和运动神经阻滞分级、引产时间、出血量及不良反应情况。结果与B组比较,A组在镇痛后各时点VAS评分降低、引产时间延长,差异均有统计学意义(P<0.05);两组间孕妇引产期间生命体征平稳,出血量及不良反应差异无统计学意义(P>0.05)。

  12. 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

    BACKGROUND: Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation of the evide......BACKGROUND: Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation...... of the 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...

  13. Comparison of epidural morphine and morphine combined with ketaming inpostoperative patient contralled analgesia%硬膜外吗啡与吗啡氯胺酮术后病人自控镇痛

    Institute of Scientific and Technical Information of China (English)

    孙艳林; 陈亚军

    2000-01-01

    目的:探讨手术后应用吗啡与吗啡复合氯胺酮行 PCEA 的效果以及氯胺酮对吗啡镇痛作用和不良反应的影响。方法:40 例 ASA 1~2 级择期在腰麻复合硬膜外麻醉下行妇科手术的患者,随机分为单纯吗啡(M)和吗啡复合氯胺酮(KM)两组,每组 20 例,术后连接 GRASEBY9300 型 PCA 泵,镇痛药液中 M 组合吗啡 20mg,KM 组含吗啡 10mg+氯胺酮 100mg。分别于术后 4、8、12、24h 进行随访,记录病人首次按压时间、各时间点视觉模拟评分(VAS)、有效按压次数、不良反应及病人综合满意度。结果:两组患者术后首次按压时间、有效按压次数无显著性差异。吗啡用量 M 组明显高于 KM 组(P<0.05)。所有患者 4、8、12、24h 各时间点 VAS 评分均低于 4 分,且组间比较无显著性差异。M 组患者恶心、呕吐发生率显著高于 KM 组(P<0.05)。两组均未发现有皮肤搔痒。另外两组患者对镇痛效果综合满意度评估优良率为 100%。结论:氯胺酮可以增强吗啡的镇痛作用,减少吗啡用量,降低吗啡不良反应发生率。%Objective: To discuss the effect of epidural morphine and morphine combined with ketamine in PECA, and of ketamine effects on analgesia and side effects of morphine. Methods: 40 patients ASA grade 1~2, under subarachnoid combined with epidural anaesthesia for selective gynaecological surgery were randomly assigned into two groups, morphine group (M) and morphine/ketamine group (KM). At the end of operation, a GRASEBY9300 PCA was connected to the epidural catheter. Analgesic solution contained morphine 20mg in group M and morphine 10mg + ketamine 100mg in group KM. The patients were followed up at 4, 8, 12, 24h after operation and first pressing time, VAS, effective pressing numbers, side effects and patients general satisfactory degree were recorded. Results: First pressing time and effective pressing numbers showed no significantly

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

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    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...... should aim at including physical rehabilitation programs in the pain treatment regimen....

  15. Clinical observation of physiology and psychology of combined spinal and epidural block for total labor course analgesia%全产程腰硬联合阻滞分娩镇痛产妇生理及心理的临床观察

    Institute of Scientific and Technical Information of China (English)

    全伟斌; 周朝明; 劳诚毅; 彭丽; 劳慧娟; 韦洁; 胡兰丹; 曾艳玲

    2011-01-01

    目的 探讨全产程腰硬联合阻滞分娩镇痛对孕妇生理及心理的影响.方法 选择住院分娩孕妇160例,按知情同意、自主选择的方法,随机分为观察组和对照组各80例.观察组实施全产程腰硬联合阻滞分娩镇痛,对照组未实施分娩镇痛,比较两组孕妇的焦虑程度、镇痛效果、产程时间、产后出血、分娩方式和Apgar评分等.结果 两组孕妇的焦虑程度、镇痛效果、产程时间、剖宫产率等情况比较差异有显著性(P<0.05).结论 实施全产程腰硬联合阻滞分娩镇痛,可缓解孕妇焦虑情绪,缩短产程,降低剖宫产率,对孕妇和新生儿无不良影响.%Objective To investigate the affect of physiology and psychology of combined spinal and epidural block for total labor course analgesia. Methods 160 gravidas were randomly divided into Treated Group (80 cases) and Control Group (80 cases). Treated Group received combined spinal and epidural block for total labor course analgesia, while Control Group did nothing. The anxiety level, effect of analgesia, time of labor course, volume of postpartum hemorrhage,mode of delivery and Apgar scores were analyzed. Results The anxiety level, effect of analgesia, time of labor course,cesarean section rate in both groups were statistically different ( P<0. 05 ). Conclusion Combined spinal and epidural block for total labor course analgesia can ease anxiety, decrease the time of labor course and cesarean section rate, while there aren,t adverse effects to gravidas and neonates.

  16. Comparison of the Effects of General Anesthesia and Epidural Combined Anesthesia on Postoperative Early Cognitive Function in Elderly Patients with Postoperative Epidural Analgesia%全身麻醉与硬膜外复合麻醉继以术后硬膜外镇痛对老年患者非心脏手术后早期认知功能的影响比较

    Institute of Scientific and Technical Information of China (English)

    隋金玲; 邓蓉蓉

    2015-01-01

    Objective To probe into the effect of general anesthesia and epidural combined anesthesia on postoperative early cognitive function in elderly patients with postoperative epidural analgesia. Methods 115 patients who accepted heart operation treatments in our hospital from January, 2011 to December, 2014 and these patients were randomly divided into the control group and the observation group.In the observation group of 60 patients were received general anesthesia and epidural combined anesthesia and postoperative epidural analgesia while in the control group of 55 patients were received general anesthesia and intravenous analgesia after surgery. Then, the postoperative neurological and mental function and other indicators of two groups of patients were observed and the early postoperative cognitive function of patients was comparative analyzed.Results The incidence of cognitive dysfunction seven days after surgery in the observation group and control group was 51.67% (31/60) and 49.09% (27/55).Conclusion After non cardiac surgery, the elderly patient wil have some early cognitive dysfunction due to surgical operation and education, while the effect of epidural anesthesia and epidural anesthesia on early cognitive function in elderly patients is not obvious.%目的:探讨全身麻醉与硬膜外复合麻醉继以术后硬膜外镇痛对老年患者非心脏手术后早期认知功能的影响。方法选择2011年01月~2014年12月在我院进行非心脏手术的老年患者115例分为对照组和观察组,观察组60例患者接受全身麻醉与硬膜外复合麻醉和术后硬膜外镇痛,对照组55例患者仅接受全身麻醉和术后静脉镇痛。观察两组患者术后神经及精神功能等各项指标,就患者术后早期认知功能情况作对比分析。结果观察组和对照组患者在术后七天的认知功能障碍发生率为51.67%(31/60)、49.09%(27/55)。结论在进行非心脏手术后,老年患者会因外科手

  17. 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

  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. Efeitos adversos do sufentanil associado ao anestésico local pelas vias subaracnóidea e peridural em pacientes submetidas à analgesia de parto Efectos adversos del sufentanil asociado al anestésico local por las vías subaracnoidea y peridural en pacientes sometidas a la analgesia de parto Side effects of subarachnoid and epidural sufentanil associated with a local anesthetic in patients undergoing labor analgesia

    Directory of Open Access Journals (Sweden)

    Isabel C.F. Salem

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A associação do opióide ao anestésico local melhora a qualidade da analgesia de parto e reduz o risco de toxicidade sistêmica pelo anestésico local. Os opióides, entretanto, podem determinar efeitos colaterais. O objetivo desta pesquisa foi comparar os efeitos adversos determinados pelo sufentanil, administrado por via subaracnóidea, associado à bupivacaína, com aquele determinado pelo sufentanil por via peridural, associado à ropivacaína, nas doses utilizadas no Serviço de Anestesia, em gestantes submetidas à analgesia de parto. MÉTODO: Participaram do estudo 60 pacientes, estado físico ASA I e II, com idade entre 15 e 42 anos, com gestação a termo e fetos saudáveis, submetidas à analgesia de parto. Foram distribuídas de forma aleatória em dois grupos: G1 - Duplo bloqueio - bupivacaína a 0,5% (2,5 mg e sufentanil (5 µg pela via subaracnóidea, G2 - Peridural - ropivacaína a 0,2% (20 mg e sufentanil (10 µg pela via peridural. Para doses complementares foi administrada ropivacaína a 0,2% (12 mg e para resolução do parto, ropivacaína a 1% (50 mg. As pacientes foram avaliadas após analgesia (M1 com relação a hipotensão arterial, bradicardia materna, prurido, náusea, vômito, depressão respiratória e sedação. No pós-operatório (M2, quanto à presença de náusea, vômito, prurido, sedação, retenção urinária e dor. Os recém-nascidos foram avaliados pelo índice de Apgar. Para análise estatística, foram utilizados teste t de Student, Mann-Whitney e Qui-quadrado. RESULTADOS: Os grupos foram similares com relação à idade, ao peso, à altura, à duração do período de trabalho de parto após analgesia, ao Apgar dos recém-nascidos, à ocorrência de hipotensão arterial, bradicardia, náusea, vômito, prurido e retenção urinária. A sedação foi mais freqüente nas pacientes de G2, em M1 (50% com diferença estatística significativa. CONCLUSÕES: O sufentanil nas doses

  20. 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

  1. Sufentanil versus Fentanyl for Postoperative Patient-Controlled Epidural Analgesia:A Systematic Review%舒芬太尼与芬太尼用于术后硬膜外自控镇痛的系统评价

    Institute of Scientific and Technical Information of China (English)

    唐轶洋; 张兴安; 阳婷婷; 徐波

    2012-01-01

    Objective To systematically evaluate effectiveness, dosage and adverse reaction of sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia (PCEA), so as to provide evidence for rational drug use in clinic. Methods Databases including The Cochrane Library, the special trials registered in the Cochrane anesthesia group, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched by the end of 2012, and the relevant periodicals were also manually searched to collect the randomized controlled trials (RCTs) on sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia. According to the Cochrane Handbook 5.0, literature was screened, data were extracted, and quality of the included studies was critically assessed. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 25 RCTs involving 1 944 patients were included. The results of meta-analyses showed that: a) as for visual analog scale (VAS), compared with the fentanyl group, the postoperative VAS at 2-hour, 4-hour, 8-hour, 12-hour, 24-hour and 48-hour was decreased in the sufentanil group; b) as for sedation scale, the fentanyl group, the postoperative sedation at 12-hour and 24-hour was lower in the sufentanil group when adopting 0 to 3 points scoring method, but there were no significant differences at other time points; c) as for drug dosage, compared with the fentanyl group, the postoperative drug consumption at 24-hour and 48-hour was less in the sufentanil group; d) as for adverse reaction, the incidence of postoperative nausea, vomiting, dizziness and somnolence in the sufentanil group was lower than those in the fentanyl group. But there was no significant difference in other adverse reactions such as skin itching, limbs numbness and motor disturbance between the two groups; and e) as for the demands of additional analgesic drugs, compared with the fentanyl group, the incidence of demanding additional analgesic drugs was lower in the

  2. Analgesia postoperatoria en cirugía mayor: ¿es hora de cambiar nuestros protocolos?

    Directory of Open Access Journals (Sweden)

    N. Esteve Pérez

    2009-05-01

    Full Text Available La analgesia postoperatoria es uno de los componentes básicos en la recuperación funcional tras una intervención quirúrgica. No obstante, es difícil aislar los efectos de la analgesia postoperatoria de otros aspectos relacionados con la técnica quirúrgica, la práctica clínica, el tipo de seguimiento analgésico o los factores organizativos del equipo quirúrgico. La introducción de la laparoscopia, la toracoscopia y las técnicas quirúrgicas mínimamente invasivas está modificando los protocolos analgésicos clásicos en la cirugía compleja. La analgesia intravenosa controlada por el paciente e incluso los opioides por vía oral están desplazando a la analgesia epidural en este tipo de técnicas. La evaluación del riesgo/beneficio para la selección de cada tipo de analgesia postoperatoria dependerá de la severidad del dolor dinámico y de los potenciales efectos secundarios de las técnicas y los fármacos analgésicos. Es difícil demostrar el impacto de la analgesia postoperatoria en grandes resultados quirúrgicos como la mortalidad, la morbilidad o la estancia media, que dependen de factores múltiples y heterogéneos. El efecto del tipo de analgesia en el proceso quirúrgico debería investigarse sobre otros resultados orientados al paciente, como la calidad analgésica, los efectos adversos o el bienestar postoperatorio. Otras áreas en las que se plantea el posible impacto de la analgesia postoperatoria son la recurrencia oncológica y el dolor crónico postoperatorio.

  3. 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.

  4. 硬膜外镇痛和静脉镇痛对脊柱融合术后镇痛效果比较的Meta分析%Comparison of the analgesic efficacy between the epidural and intravenous analgesia after spinal fusion:a Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    梁林; 姜为民

    2014-01-01

    Objectives: To compare the efficacy of patient-controlled epidural analgesia and patient-controlled intravenous analgesia in postoperative analgesia after spinal fusion. Methods: The CNKI, Wanfang, CBM, Pubmed, Embase, Ovid, Cochrane library databases were searched by computer. The randomized controlled trails with patient-controlled epidural analgesia or patient-controlled intravenous analgesia after spinal fusion published from May 1985 to July 2013 were selected. All of them were assessed by the standard of Cochrane systematic review. Data of postoperative VAS and the rate of side effects after using the analgesic drugs were extracted into an electrical sheet, which was synthesized by a Meta-analysis with RevMan 5.2 software. Re-sult: Eight randomized controlled trails involving 482 patients met the inclusion criteria. And the quality grade of 3 literatures was A, 5 literatures was B. The result of meta-analysis showed that: ①Visual analogue score(VAS). The postoperative first day′s VAS[WMD=-0.47, 95%CI(-0.74, -0.20)], second day′s VAS[WMD=-0.66, 95%CI(-1.14, -0.19)] showed that the patient-controlled epidural analgesia had a good analgesic effect compared with the patient-controlled intravenous analgesia, and both had statistic differences(P0.05); ②The side effects. The patient-controlled epidural analgesia had a higher incidence of skin itch[RR=1.53, 95%CI(1.08, 2.16)], paresthesia[RR=3.34, 95%CI(1.12, 9.98)] after surgery than the patient-controlled intravenous analgesia, and both had statistic differences(P0.05). Conclusions: The patient-controlled epidural analgesia has better analgesic effects on the postoperative first and second day after spinal fusion, but obviously has a high-er incidence of skin itch and paresthesia than the patient-controlled intravenous analgesia.%目的:采用Meta分析方法比较硬膜外镇痛和静脉镇痛两种自控镇痛方式对脊柱融合术后的镇痛效果。方法:计算机检索中国知网、万方数

  5. 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

  6. 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...

  7. 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...

  8. Pleural puncture with thoracic epidural: A rare complication?

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2011-01-01

    Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

  9. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ali Uzuner

    2011-01-01

    Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

  10. 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 ...

  11. Epidural fentanyl decreases the minimum local analgesic concentration of epidural lidocaine

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian; ZHENG Yue-ying; FENG Zhi-ying; CHEN Chao-qin; ZHU Sheng-mei

    2012-01-01

    Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly,but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration(MLAC)of lidocaine is not known.We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults.Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions:lidocaine,or lidocaine plus fentanyl 1 μg/ml,2 μg/ml,or 3 μg/ml.The first patient in each group was administered 1% lidocaine weight by volume;subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments.Efficacy was assessed using a visual analog pain scale,and accepted if this was ≤10 mm on a 100 mm scale within 30 minutes.The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery,respectively.Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785%(95%C/0.738-0.864).A significant dose-dependent reduction was observed with the addition of fentanyl:the MLAC of lidocaine with fentanyl at 2 μg/ml was 0.596%(95%Cl 0.537-0.660)and 0.387% with fentanyl at 3 μg/ml(95%Cl 0.329-0.446,P<0.001).Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects.

  12. [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.

  13. 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.

  14. 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;

    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 99m...

  15. 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

  16. 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

  17. 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

  18. 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%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

    Institute of Scientific and Technical Information of China (English)

    熊桂生; 潘丽莉; 王玉珏

    2014-01-01

    目的:探讨自控腰硬联合分娩镇痛麻醉下,初产妇分娩过程中不同的停泵时机对产程、分娩结局和产妇满意度的影响。方法选择2013年4月~2013年12月间符合条件的初产妇120例,按先后顺序分到A、B、C三组,每完成10个另起一组,每组40例,腰硬联合麻醉分娩镇痛,A组宫口开全停泵,不再开泵;B组宫口开全停泵,胎儿娩出后立即开泵;C组一、二、三产程持续镇痛,三组均于第三产程结束,会阴缝合术毕结束镇痛并拔硬外镇痛管。观察比较产妇基本情况、镇痛效果(VAS)评分、第1、2、3产程时间、产后2h内出血量、缩宫素使用、剖宫产率、钳产率、羊水性质、产妇满意度,新生儿Apgar评分。结果三组间产后2h出血、新生儿Apgar评分、第三产程时间差异无统计学意义;A、B组产妇分娩痛比例较C组增加,会阴缝合痛或不适者较C组多,C组产妇满意度较A、B组增加,差异有统计学意义,A、B组间各项指标间差异无统计学意义。结论不同的停泵时机不增加第二产程,不影响新生儿Aparg评分,不增加产后出血,持续用药组增加缩宫素使用率,差异有统计学意义(P<0.05),可能增加剖宫产趋势,但可提高产妇满意度。%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

  19. Occult Spinal Dysraphism in Obstetrics: A Case Report of Caesarean Section with Subarachnoid Anaesthesia after Remifentanil Intravenous Analgesia for Labour

    Directory of Open Access Journals (Sweden)

    A. Valente

    2012-01-01

    Full Text Available Neuraxial techniques of anaesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anaesthesia in patients with occult neural tube defects, regarding both labour analgesia and anaesthesia for Caesarean section. Recently, remifentanil infusion has been proposed as an analgesic technique alternative to lumbar epidural, especially when epidural analgesia appears to be contraindicated. Here, we discuss the case of a pregnant woman attending at our institution with occult, symptomatic spinal dysraphism who requested labour analgesia. She was selected for remifentanil intravenous infusion for labour pain and then underwent urgent operative delivery with spinal anaesthesia with no complications.

  20. 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

  1. 连续硬膜外自控镇痛对剖宫产术后产妇恢复及血清泌乳素的影响%Effect of patient controlled epidural analgesia on recovery and serum prolactin of parturient after undergoing cesarean section

    Institute of Scientific and Technical Information of China (English)

    唐萍

    2011-01-01

    Objective To discuss the effect of patient controlled epidural analgesia on recovery and serum prolactin of parturient after undergoing cesarean section.Methods Eighty-six cases with cesarean section patients were classified into two groups by random digits table,which observation group with 43 cases were used patient controlled epidural analgesia,and control group with 43 cases were used intramuscular pethidine.The analgesic effect and serum prolactin between the two groups were compared.Results The good rate in observation group was 79.1%(34/43 ),significantly higher than that in control group [20.9%( 9/43 ) ](P < 0.05 ).Compared with pre-operation,the level of prolactin in observation group was significantly increased [ ( 542.17 ± 46.75 ) μ g/L vs.( 351.13 ± 20.92 ) μ g/L] ( P < 0.05 ).Moreover,the level of prolactin in observation group after operation was significantly higher than that in control group [ (362.12 ± 24.33)μ g/L ] ( P < 0.05 ).The colostrum time in observation group was ( 15.21 ± 3.26 ) h which was shorter than that in control group [ (21.16 ± 4.78) h ] (P < 0.05).Conclusion The analgesic effect of patient controlled epidural analgesia on parturient after undergoing cesarean section is good,which can help patients recovery and improve the level of serum prolactin,which can be applied in clinic.%目的 探讨连续硬膜外自控镇痛对剖官产术后产妇恢复及血清泌乳素的影响.方法将86例行剖宫产术产妇按随机数字表法分为两组,观察组43例采用连续硬膜外自控镇痛,对照组43例采用哌替啶肌肉注射,比较两组的镇痛效果及血清泌乳素水平变化.结果观察组镇痛优良率[79.1% (34/43)]明显高于对照组[20.9% (9/43)](P<0.05).观察组术后泌乳素水平[(542.17±46.75)μg/L]较术前[(351.13±20.92)μg/L]明显升高(P<0.05),且明显高于对照组术后[(362.12±24.33)μ g/L](P< 0.05).观察组的初乳时间[(15.21±3.26)h

  2. 哌替啶-氟哌利多防治腰麻下剖宫产术寒战及胃牵拉痛的临床研究%Clinica research of pethidine and droperidor on chills and analgesia stomach-involving undergoing parturient with spinal epidural ansthesia

    Institute of Scientific and Technical Information of China (English)

    罗水莲

    2010-01-01

    目的 探讨哌替啶-氟哌利多防治腰麻下行剖宫产术寒战及胃牵拉痛的临床效果.方法 选择腰麻行剖宫产术患者ASAI~Ⅱ 160例,随机平均分成四组,每组40例,胎儿取出后即刻,A组静脉注射哌替啶25 mg和氟哌利多1.25 mg,B组静脉注射哌替啶50 mg和氟哌利多2.5 mg,C组静脉注射哌替啶10 mg和氟哌利多0.5 mg,D组静脉注射0.9%氯化钠2 ml.观察注药时(T0)、注药后5 min(T1)、10 min(T2)、20 min(T3)时平均动脉压(MBP)、血氧饱和度(SpO2)、心率(HR)、呼吸(RR),患者术中术后出现寒战的例数,停止寒战的时间,注药后患者RSS评分,患者术中清理腹腔时胃牵拉痛的VAS评分.结果 A组MBP、SpO2、HR、RR比A、C、D组平稳(P﹤0.05);注药后5min C组5例,D组33例有寒战,明显多于A、B组(P﹤0.01);术中RSS评分,评2~3分,A组例数明显多于其他组(P﹤0.01);A组患者胃牵拉痛的VAS评分明显低于C、D组(P﹤0.01).结论 哌替啶25 mg和氟哌利多1.25 mg合剂是有效防治腰麻下剖宫产术寒战及清理腹腔时胃牵拉痛的最优剂量.%Objective To investigate the clinical effectiveness of pethidine and droperidor on chills and analgesia stomach- involving undergoing parturient with spinal epidural ansthesia. Methods 160 cases of parturient women with shivering(all under combined-spinal epidural anesthesia,ASAI~Ⅱ) were divided randomly into four groups.childbirth immediate: group A ( 40 cases) treated with 25 mg pethedine and 1.25 mg droperidor; group B (40 cases) treated with 50 mg pethedine and 2.5 mg droperidor ;group C (40 cases) treated with 10 mg pethedine and 0.5 mg droperidor;group D treated with 2 ml 0.9% sodium chloride. Observe four groups patients inject drug (T0)、after 5 min inject drug (T1)、10 min(T2)、20 min(T3) MBP、SpO2、HR、RR,the cases with shivering undergoing parturient, the time of shivering arrest,the RSS scores of the patient after inject drug, the VAS scores of the patient analgesia

  3. Effect of Epidural Labor Analgesia on Placental Secretion of Cortisol and Prostaglandin E2%硬膜外分娩镇痛对胎盘组织中皮质醇、前列腺素E2水平的影响

    Institute of Scientific and Technical Information of China (English)

    徐家丽; 冯丹

    2013-01-01

    目的 研究硬膜外分娩镇痛对分娩时胎盘组织中皮质醇(Cortisol)、前列腺素E2(PGE2)等的影响.方法 40例单胎初产妇随机均分成两组,即对照组(未施任何镇痛措施)和镇痛组(行硬膜外分娩镇痛).两组产妇分别在"宫口开3 cm、宫口开3 cm后1 h、胎儿娩出时"各抽取肘静脉血10 mL,胎儿娩出后抽取脐血和羊水各10 mL,用ELISA分析法测量血、羊水中Cortisol、PGE2的浓度,以研究硬膜外分娩镇痛对胎盘分泌Cortisol、PGE2的影响.同时监测第一、二产程时间、分娩方式以及VAS镇痛评分等.结果 与对照组相比,行硬膜外分娩镇痛后镇痛组产妇VAS镇痛评分明显下降,差异有统计学意义(P0.05);两组外周血、脐血以及羊水中PGE2的水平差异无统计学意义(P>0.05);两组产妇第一、二产程时间、分娩方式等指标差异无统计学意义.结论 分娩镇痛明显减轻了产妇的疼痛应激反应,降低产妇外周血中Cortisol的水平,但不影响胎盘组织中Cortisol、PGE2的水平,对产程、分娩方式无明显影响,是一项安全有效的镇痛方法.%Objective To investigate the effect of epidural labor analgesia on placental secretion of cortisol and prostaglan -din E2 (PGE2). Methods Forty full-term primiparous parturients who were at ASA physical status Ⅰ or Ⅱ were randomly divided into two groups in terms of the application of epidural analgesia or not:control group and analgesia group (n= 20 each ). A 10 mL blood sample was drawn from the elbow venous of each parturient at the time of "3 cm cervical dilation" ,"one hour after 3-cm cervical dilation" and "fetal disengagement". A 10 mL umbilical cord blood sample and a 10 mL sample of amniotic fluid were collected separately after delivery. The ELISA method was used to measure the concentration of cortisol and PGE2 in the collected samples. Time frame for the first and the second stage of labor, VAS scores and mode of delivery were measured

  4. 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...

  5. 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

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 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...

  9. Developments in labour analgesia and their use in Australia.

    Science.gov (United States)

    Eley, V A; Callaway, L; van Zundert, A A

    2015-07-01

    Since the introduction of chloroform for labour analgesia in 1847, different methods and medications have been used to relieve the pain of labour. The use of heavy sedative medication in the early 1900s was encouraged by enthusiastic doctors and by women empowered by the women's suffrage movement in America. Nitrous oxide by inhalation has been used in Australia since the 1950s and improved methods of administration have made this method of analgesia safe and practical. Caudal epidural analgesia and lumbar epidural analgesia were first made popular in America and by the 1970s these techniques were more widely available in Australia. In 1847, physicians and the public were unsure whether relieving labour pains was the 'right' thing to do. However, many medical and social changes have occurred thanks to the clinical connection between Australia and the United Kingdom and those first settlers to land on Australian shores. Thanks to this historical connection, in today's Australia there is no question that women should use analgesia as a pain relief if they wish. Currently, the majority of women worldwide use some form of analgesia during labour and different methods are widely available. This paper discusses the four milestones of the development of obstetric analgesia and how they were introduced into patient care in Australia. PMID:26126071

  10. [Perioperative analgesia in adults : The concept of balanced analgesia.].

    Science.gov (United States)

    Jage, J

    1993-09-01

    The spectrum of perioperative pain treatment is discussed in the present review. The analgesic efficacy of various drugs and the dosage methods of administration and side effects reported for them in such reference works as the practical guide on the management of acute pain recently published by the International Association for the Study of Pain (IASP) are described. Effective postoperative analgesia can diminish stress reactions following surgery. Recovery and physical mobilization are improved as the result of adequate treatment. Results obtained in recent studies have demonstrated that primary adaptive hyperalgesia in the peripheral nociceptive area may develop into secondary maladaptive hypersensibility with a high degree of nociceptive excitability and pain. Chronic pain can develop following acute alterations. Increasing nociceptive activity of primary afferents induces alterations in the dorsal horn of the spinal cord. These alterations imply an increase in the excitability of nociceptive neurons, which has been described as neuronal plasticity. Clinical results have demonstrated prevention or delay of acute postoperative pain after injection of local anaesthetics, analgesic premedication or epidural injection of opioids just before the start of surgery. Continuous perioperative spinal analgesia has contributed significantly to the prevention of phantom limb pain in patients undergoing amputation of extremities. The development of pain memory may be prevented as a result of effective acute pain treatment. Several changes to the terminology of acute pain treatment for animal and clinical studies have recently been proposed, including such new terms as preemptive analgesia and pain prevention, which indicate new strategies in the treatment of postoperative pain. The concept of balanced analgesia refers to a strategy for the improvement of analgesic efficacy as a result of a combination of drugs with different local actions on nociception. The combination of

  11. 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

  12. 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...

  13. 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

  14. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Blemmer, T;

    1993-01-01

    Thirty-one patients scheduled for elective cholecystectomy performed through a mini-laparotomy, were randomized to received either combined thoracic epidural anaesthesia/light general anaesthesia and postoperative balanced analgesia with continuous epidural bupivacaine 10 mg.h-1 and morphine 0.2 mg.......h-1 for 38 h after surgery plus systemic ibuprofen 600 mg x 8 h-1 (N = 15) or general anaesthesia and postoperative analgesia with systemic morphine and ibuprofen 600 mg x 8 h-1 (N = 16). During postoperative epidural infusion sensory blockade to pinprick was Th4 to L1, and analgesia at rest...... lower heart rate (approximately 10 bpm) 48 h after surgery at rest and during orthostatic stress in the epidural group. There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group...

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. 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

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    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

  20. 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.

  1. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation

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    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD and ropivacaine + clonidine (RC, comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS version 10.0 for windows and value of P 0.05. Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia.

  2. Estudo comparativo entre tratamento convencional e tratamento com heparina tópica para a analgesia de queimaduras Comparative study of conventional and topical heparin treatments for burns analgesia

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    Marcos Guilherme Praxedes Barretto

    2010-01-01

    Full Text Available OBJETIVOS: Este estudo prospectivo, randomizado, aberto e controlado por comparador ativo teve o objetivo de avaliar a eficácia analgésica e tolerabilidade da heparina não-fracionada administrada topicamente no tratamento de queimaduras. MÉTODOS: Cinquenta e oito pacientes do sexo masculino ou feminino foram randomizados para tratamento convencional (C ou tratamento com heparina tópica (HT. Foram incluídos pacientes com: idade entre 18 e 55 anos, queimaduras de 2º e 3º graus por fogo ou escaldo em 10% a 30% da superfície corpórea (SC, sem história de diáteses hemorrágicas ou hipersensibilidade à heparina e com área queimada em 3º grau menor de 10% da SC. O grupo C realizou periodicamente balneoterapia terapêutica para desbridamento das lesões seguida de curativos com sulfadiazina de prata. O grupo HT realizou o primeiro desbridamento e teve suas áreas queimadas deixadas expostas para receber três vezes ao dia heparina não fracionada em spray na dose de 4200 UI para cada 1% de SC queimada. A eficácia analgésica foi avaliada nos 38 pacientes que completaram o estudo pela demanda de medicamentos analgésicos e pela Escala Analógico Visual de Dor (EAV. A tolerabilidade foi avaliada nos 58 pacientes randomizados pela incidência comparativa de reações adversas nos dois grupos. RESULTADOS: O grupo HT solicitou menos analgésicos (11,83 ± 9,38 por paciente no grupo HT contra 33,35 ± 20,63 no grupo C, pOBJECTIVE: This was a prospective, randomized, open-label study controlled by active comparator. The aim was to assess analgesic efficacy and overall tolerability of a burn treatment based on topic administration of unfractionated heparin. METHODS: Fifty eight male or female patients were randomized for conventional treatment (group C or topical heparin treatment (group TH. Ages of patients enrolled ranged from 18 to 55 years. They had 2nd and 3rd degree burns on 10% to 30% of the body surface (BS caused by fire or scald, no

  3. 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

  4. Bloqueo de los nervios iliohipogástrico e ilioinguinal para analgesia posquirúrgica en cesárea tipo Pfannenstiel realizada bajo anestesia general: ¿qué concentración del anestésico local usar? Iliohypogastric and ilioinguinal block for postsurgical analgesia after pfannenstiel cesarean section performed under general anaesthesia

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    Héctor Iván García García

    1998-03-01

    Full Text Available El bloqueo bilateral de los nervios Iliohipogástrico e Ilioinguinal con bupivacaína al 0.5% puede proveer analgesia luego de cesárea con incisión de Pfannenstiel aunque la cantidad de droga usada está cerca de la dosis máxima segura. Diseñamos este estudio para comparar el efecto analgésico de la bupivacaína al 0.5% y diluida al 0.25%. Se incluyeron treinta pacientes aleatoriamente asignadas a un grupo de estudio (bupivacaína 0.25%, n= 15 y uno de control (bupivacaína 0.5%, n=15. Se evaluaron las pacientes con una Escala Visual Análoga (EVA a las O, 4, 8, 12 y 24 horas posoperatorias por médicos que no sabían a qué grupo pertenecían y sólo en caso de necesidad se prescribió analgesia IM con Diclofenaco. Los puntajes de analgesia y los requerimientos de anal. gesia complementaria fueron notoriamente simila. res en ambos grupos y no hubo diferencias estadísticamente significativas. Concluimos que el bloqueo de estos nervios es una técnica analgésica efectiva (el dolor siempre estuvo en promedio por debajo de 4 en la EVA, que no es afectada por la dilución del anestésico y que además es segura pues no se presentaron complicaciones. The Iliohypogastric and Ilioinguinal bilate. ral block with 0.5% bupivacaine can provide analgesia after Pfannenstiel cesarean section although the required amount of the drug is near the maximum secure dose. We designed this study in order to compare the analgesic effect of 0.5% bupivacaine and diluted 0.25% bupivacaine. Thirty patients were included in the study and asigned in aleatory form to either a study (0.25% bupivacaine n=15 or a control group (0.5% bupivacaine n=15. They were evaluated with the Visual Analogue Scale (VAS at 0,4,8,12,24 postoperative hours by physicians who did not know the group of the patient and prescribed intramuscular analgesia with Dicofenac only if required. The analgesia scores and the complementery analgesia requirements were similar in both groups and there were

  5. 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...

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

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    were selected for inclusion in the review. In THA, no additional analgesic effect of LIA compared with placebo was reported in trials with low risk of bias when a multimodal analgesic regimen was administered perioperatively. Compared with intrathecal morphine and epidural analgesia, LIA was 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 analgesia...

  7. Effects of combined perioperative epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine on postoperative pain, pulmonary, and endocrine-metabolic function after minilaparotomy cholecystectomy

    DEFF Research Database (Denmark)

    Dahl, J B; Hjortsø, N C; Stage, J G;

    1994-01-01

    BACKGROUND AND OBJECTIVES. The study investigates the effects of combined perioperative continuous epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine, compared with intermittent systemic morphine, ibuprofen, and incisional bupivacaine, on postoperative pain, respiratory...... function, and endocrine-metabolic alterations associated with minilaparotomy cholecystectomy. METHODS. Thirty-two patients scheduled for cholecystectomy, performed through a minilaparotomy, were randomized to receive general anesthesia with pre- and postoperative thoracic (T7-9) epidural analgesia...... cholecystectomy improves pain relief in the immediate postoperative period, compared to intramuscular morphine. Pulmonary and endocrine-metabolic function is not changed to such degree after minicholecystectomy that epidural analgesia can be demonstrated to have beneficial effects....

  8. 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

    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......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...

  9. 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

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

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    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...

  11. 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.

  12. 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

  13. 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.

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

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    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

  15. 罗比卡因与布比卡因用于小儿术后镇痛的比较%To compare the differences in analgesia effect and complication of the same concentrated ropivacaine and Bupivacaine after epidural anaesthesia in children

    Institute of Scientific and Technical Information of China (English)

    岳玲; 范荣

    2009-01-01

    目的 比较相同浓度的罗比卡因与布比卡因用于小儿硬膜外术后镇痛的镇痛效果和并发症.方法 选择60例行腰硬联合麻醉的腹部手术患儿随机分成两组行硬膜外术后镇痛,A组用0.1%罗比卡因,B组用0.1%布比卡因,每组分别复合芬太尼2 ug/ml,镇痛泵容量为100 ml,泵速为2 ml/h,维持镇痛时间48 h.观察指标有运动神经阻滞评分、手术后各时段的SpO2、BP、HR,OPS法镇痛效果评分、并发症情况.结果 A组和B组比较,下肢运动阻滞程度两者相比差异有统计学意义(P0.05),并发症两者相似(P>0.05).结论 0.1%罗比卡因复合芬太尼2 ug/ml具有同0.1%布比卡因复合芬太尼2 ug/ml同样的镇痛效应,而且对运动神经影响轻微,有利于患儿早期下床活动,用于小儿术后镇痛值得推广.%Objective To compare the differences in analgesia effect and complication of the same concentrated ropivacaine and Bupivacaine after epidural anaesthesia in children. Methods Divide 60 children randomly into group A and group B ,perform anagesia after epidural anaethesia with 0.1%ropivacaine in group A and 0.1% Bupivacaine in group B.Pump Fentanyl 2 ug/ml with the speed of 2 ml/h and the total dosage of 100 ml in 48 h simultaneously. The observation index includes motor nerve block score/SpO2,BP,HR in different periods after operation、anagesia effect score of OPS and complication. Results It has a significant difference in inferior extremity motor nerve block(P0.05) between the two groups. Conclusion 0.1% ropivacaine has the same level of anagesia effect as 0.1% Bupivacaine combinated by Fentanyl 2 ug/ml,and it has smaller influence on motor nerve.It is profit for children' early ambulation,so it is worth of generalization.

  16. 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...

  17. 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...

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

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    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.

  19. 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

  20. 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.

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

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    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

  2. Effect of patient-controlled epidural analgesia with opioids on serous myelin basic protein and somatosensory evoked potential of lower limbs in puerperants%阿片类药物硬膜外术后镇痛对产妇血清髓鞘碱性蛋白和下肢体感诱发电位的影响

    Institute of Scientific and Technical Information of China (English)

    宋杰; 杜伯祥; 崔志明; 周峰; 杨许丽; 保国峰; 刘麟

    2011-01-01

    Objective To investigate the effect of patient-controlled epidural analgesia(PCEA) with opioids on serous myelin basic protein(MBP) and somatosensory evoked potential(SEP) of lower limbs in puerperants.Methods A total of 120 puerperants,after receiving cesarean section,were divided into four groups by random number table method as group B,BR,MR and R randomly,and each group included 30 cases.After surgery,each case received PCEA:group B received 0.008% butrophanol;group BR received 0.008% butrophanol + 0.2% ropivacaine;group MR received 0.004% morphine +0.2% ropivacaine and group R received 0.2% ropivacaine only.VAS score,OAA/S score,adverse effect occurrence,concentration changes of serous MBP,SEP of both lower limbs and neurological function were observed at 2h(T1 ),4h(T2),8 h(T3),12h(T4),24 h(T5) and 48h (T6) after surgery.Results VASscoresofgroupBR(1.64±0.38,1.86±0.62,1.93±0.67) and MR( 1.74 ±0.39,1.91±0.58,1.98 ±0.63) at T3,T4,T5 were lower than those of group B(4.6 ±0.5,4.6 ±0.3,4.7 ±0.3)and R(2.64 ±0.41,2.83 ±0.91,3.37 ±0.87) (P<0.05).There was no significance in four groups in OAA/S score at each point (P > 0.05 ).Incidence of nausea ( 6 cases),vomiting ( 2 cases) and abdominal distention ( 5cases) of group M was higher than that of other three groups(P<0.05).There was no significant difference in concentrations of serous MBP,SEP and neurological function in all four groups between preoperative time and 48h after operation(P>0.05).Conclusion Lower-dose and lower- concentration opioids used for PCEA have no influence on serum MBP and SEP.%目的 观察阿片类药物用于刮宫产硬膜外术后自控镇痛(Patient-controlled epidural analgesia,PCEA)对血清髓鞘碱性蛋白(myelin basic protein,MBP)和下肢体感诱发电位(somatosensory evoked potential,SEP)的影响.方法 术后行PCEA的剖官产产妇120例,随机数字表法分为4组,每组30例:B组:0.008%布托啡诺;BR组:0.008%布托啡诺+0.2

  3. 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

  4. 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.

  5. 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

  6. [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

  7. 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

  8. A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic non-cancer pain.

    Science.gov (United States)

    Glynn, C; Dawson, D; Sanders, R

    1988-08-01

    In a randomised double-blind study of 20 patients with chronic pain, epidural morphine 5 mg in 5 ml of saline was compared with epidural clonidine 150 micrograms in 5 ml of saline. Thirteen patients had a clinical and radiological diagnosis of arachnoiditis, 6 had low back pain and 1 had post-operative scar pain. There were 18 females and 2 males with an average age of 52 years, range 22-76 years. There was no difference found between the 2 solutions in the resultant analgesia measured by the visual analogue scale for pain, pain relief or the pain word score during the 3 h period of the study. No difference was found in the patient's mood which was also measured with the visual analogue scale. Two patients had no analgesia from either injection, 2 patients did not obtain any relief from clonidine and another 2 obtained no relief from morphine. Six patients reported that clonidine was better than morphine, 5 reported that morphine and clonidine were the same and 3 reported that morphine was better than clonidine. The duration of analgesia from the clonidine varied from 6 h to 1 month; the duration of analgesia from morphine varied from 6 to 24 h. Clonidine was associated with sedation and a fall in blood pressure of greater than 20 mm Hg in all patients, 1 patient required ephedrine to treat hypotension. Twelve patients had pruritus, 7 nausea and 2 vomiting following the morphine. Statistically there was no difference found between morphine and clonidine for short-term (3 h) analgesia in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. 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 acetaminophen regimen. Patients undergoing knee- or hip arthroplasty treated with epidural analgesia had significantly lower pain scores during mobilization under the 48 h epidural infusion compared with patients receiving conventional treatment, while no important differences were observed after cessation...... of the epidural regimen. However, the achieved pain relief had no impact on postoperative convalescence parameters, such as ambulation, patient activity including need for nursing care, fatigue or hospital stay. Late postoperative pain, fatigue and conservative attitudes and routines in the postoperative care...

  10. 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

  11. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Epidural analgesia in patients with traumatic rib fractures

    DEFF Research Database (Denmark)

    Duch, P; Møller, M H

    2015-01-01

    (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures. METHODS: We performed a systematic review with meta-analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic...... ventilation (MD -7.53, 95% CI -16.32 to 1.26; P = 0.09; I(2)  = 91%) or pneumonia (RR 0.49, 95% CI 0.19-1.25; P = 0.13; I(2)  = 0%) between CEA and other analgesic interventions. Subgroup analyses and sensitivity analyses, including TSA confirmed the results. CONCLUSION: The quality and quantity of evidence...

  14. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove;

    1995-01-01

    of 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...... 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...

  15. 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

  16. 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

  17. 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

  18. 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...

  19. 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...... better analgesic effects, and also fewer unwanted side effects. Although opioids have played a prominent role in postoperative analgesia for centuries and are still often administered as a matter of routine, their frequent minor side effects and the increasing availability of suitable alternatives may...... relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. For this debate, controlled clinical studies on the opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies with multiple dosing...

  20. 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

  1. Comparative study of epidural bupivacaine with butorphanol and bupivacaine with tramadol for postoperative pain relief in abdominal surgeries

    Science.gov (United States)

    Swathi, N.; Ashwini, N.; Shukla, Mukesh I.

    2016-01-01

    Introduction: To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries. Aims: To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine. Materials and Methods: A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student's t-test using IBM SPSS software version 20. P ≤0.05 was considered to be statistically significant. P ≤ 0.001 was considered to be statistically highly significant. Results: Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group. Conclusions: Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients. PMID:27746533

  2. 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

  3. CLINICAL STUDY OF LOW-DOSE KETAMINE ASSOCIATING MORPHINE PATIENT CON-TROL EPIDURAL OR SUBCUTANEOUS ANALGESIA FOR MODERATE AND SEVERE LATE PHASE CANCER PAIN PATIENT%小剂量氯胺酮辅助吗啡硬膜外/皮下自控镇痛用于顽固性中、重度晚期癌痛治疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    陈付强; 胡丹; 时飞; 谢平; 王昕; 艾登斌

    2009-01-01

    Objective:To observe the analgesic effects and the side effects of low-dose ketamine associa- ting morphine with patient control epidural analgesia(PCEA)and patient control subcutaneous analgesia (PCSA)for patients late cancer pain.Methods:54 cases late-phase cancer pain patients were divided in to two groups,with low-dose ketamine associating morphine PCEA Was used in the first group and low- dose ketamine associating morphine PCSA in the second group.The VAS(Visual Analogue Scale)Was used to evaluate the pain level,and the side effects in two groups.Results:The pain degrees of the two groups were alleviated significantly,the VAS at every period were no different(P>0.05),the morphine and ketamine dosage in the PCSA group was more than that in the PCEA group.The life satisfactory rate in PCEA group Was higher obviously than that in PCSA group;side effects such as the incidence of nause- a,vomiting,somnolence,itch and urine retention in the PCSA group was higher than those in the PCEA group;the incidence of respiration depression and hallucination was no different between the two groups. Conclusions:Both low-dose ketamine associating morphine with patient-control epidural analgesia (PCEA)and PCSA Call provide patient with safe and effective pain relief for moderate to severe late- phase cancer pain.PCEA is an optimas approach for moderate to severe late-phase concer pain with bet- ter pain relief and less side-effect and PCSA can serve as a complementary analgesia.%目的:观察小剂量氯胺酮辅助吗啡硬膜外或皮下自控镇痛(PCEA/PCSA)用于顽固性中、重度晚期癌痛患者的可行性及止痛效果.方法:选择54例中、重度晚期癌痛患者,均为虽经三阶梯药物治疗方案治疗未能很好地控制疼痛,同时毒副作用较大的患者.按是否可以行硬膜外穿刺置管分成两组,硬膜外自控镇痛(PCEA)组(n=28例)和皮下自控镇痛(PCSA)组(n=26例).采用硬膜外自控镇痛组,镇痛液为200ml,内含吗啡20mg

  4. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.

    Science.gov (United States)

    Moucha, Calin Stefan; Weiser, Mitchell C; Levin, Emily J

    2016-02-01

    Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

  5. Traumatic epidural hematoma in children.

    Science.gov (United States)

    Rocchi, Giovanni; Caroli, Emanuela; Raco, Antonino; Salvati, Maurizio; Delfini, Roberto

    2005-07-01

    The purpose of this study was to investigate the characteristics of childhood acute epidural hematoma and to report our experience in recent years. A series of 35 patients below the age of 15 years treated for acute epidural hematoma at our institution between June 1991 and December 2000 was analyzed in detail. Pediatric epidural hematoma presents both age-related and atypical features when compared with epidural hematoma in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Outcomes seem to be directly related to the patient's preoperative neurologic status and the presence of associated intracranial lesions.

  6. 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

  7. A COMPARATIVE STUDY OF THE EFFECT OF EPIDURAL BUPIVACAINE (0.125% VERSUS EPIDURAL BUPIVACAINE (0.125% AND BUTORPHANOL (2mg FOR POST-OPERATIVE PAIN RELIEF IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

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    Krishna

    2014-08-01

    Full Text Available BACKGROUND: Postoperative pain gives rise to various physiological and psychological phenomenons. Epidural analgesia with combination of local anesthetics and opioids provides better pain relief than local anesthetics alone in the postoperative period. Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. AIMS: The study was conducted to evaluate the efficacy of addition of opioids to local anesthetics for postoperative pain relief. METHODS: Fifty patients of American society of anesthesiology grade and physical status undergoing lower abdominal surgeries & lower limb surgeries in narayana general hospital, Nellore, were divided into two groups B and BB. Group B was given 0.125% bupivacaine alone and Group BB was given 0.125% bupivacaine plus 2mg of butorphanol postoperatively when the patients first complained of pain. Onset of Analgesia, duration of analgesia, visual analog scores and side effects were compared. RESULTS: The onset of analgesia in group B patients (10ml of 0.125% Bupivacaine was varied from 4-8 minutes (mean 5.2 minutes and duration of analgesia lasted for 2-4 hours (mean 2.98(p<0.0001 where as in group BB patients (2mg butorphanol + 0.125% bupivacaine the onset was 2-4 minutes (mean 2.69 and duration of analgesia lasted for 6-8 hours (mean 6.98 (p<0.0001.The Visual Analog Scores of Group B were in the range of 7 to 9 and Group BB were in the range of 5 to 6 (P<0.0001. CONCLUSION: This study concludes that addition of butorphanol (2mg to bupivacaine (0.125% gives more effective and prolonged duration of postoperative pain relief when administered epidurally, without significant side effects.

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

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    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.

  9. 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

    2016-01-01

    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

  10. 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.

  11. Regional analgesia for video-assisted thoracic surgery – a systematic review

    DEFF Research Database (Denmark)

    Julia Steinthorsdottir, Kristin; Wildgaard, Lorna; Jessen Hansen, Henrik;

    2013-01-01

    Video-assisted thoracic surgery (VATS) is emerging as the standard surgical procedure for both minor and major oncologic lung surgery. Thoracic epidural analgesia (TEA) and paravertebral block (PVB) are established analgesic golden standards for open surgery such as thoracotomy; however...... unique 1542 abstracts, 17 articles were included for qualitative assessment, of which 3 were studies on VATS lobectomy. The analgesic techniques included TEA, multilevel- and single PVB, paravertebral catheter, intercostal catheter, interpleural infusion and long thoracic nerve block. Overall the studies...

  12. The efficacy of epidural ropivacaine 0.75% and levobupivacaine 0.5% in abdominal and lower limb surgeries- a comparative study

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    Kiran Kumar S.

    2016-09-01

    Conclusions: The present study concludes that 0.5% levobupivacaine and 0.75% ropivacaine were clinically similar with respect to sensory block characteristics and duration of analgesia, quality of motor blockade with minimal side effects in both the groups. Both drugs could be better alternatives to bupivacaine in epidural anaesthesia. [Int J Res Med Sci 2016; 4(9.000: 4101-4107

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

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    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

  14. Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery

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    Aruna Parameswari

    2010-01-01

    Full Text Available Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesia produced by caudal bupivacaine in children undergoing sub-umbilical surgery. One hundred children, age one to three years, undergoing sub-umbilical surgery, were prospectively randomized to one of two groups: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 1 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group B (593.4 ± 423.3 min than in Group A (288.7 ± 259.1 min; P < 0.05. The pain score assessed using FLACC scale was compared between the two groups, and children in Group B had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group B. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects.

  15. Portable optical epidural needle-a CMOS-based system solution and its circuit design.

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    Cihun-Siyong Alex Gong

    Full Text Available Epidural anesthesia is a common anesthesia method yet up to 10% of procedures fail to provide adequate analgesia. This is usually due to misinterpreting the tactile information derived from the advancing needle through the complex tissue planes. Incorrect placement also can cause dural puncture and neural injury. We developed an optic system capable of reliably identifying tissue planes surrounding the epidural space. However the new technology was too large and cumbersome for practical clinical use. We present a miniaturized version of our optic system using chip technology (first generation CMOS-based system for logic functions. The new system was connected to an alarm that was triggered once the optic properties of the epidural were identified. The aims of this study were to test our miniaturized system in a porcine model and describe the technology to build this new clinical tool. Our system was tested in a porcine model and identified the epidural space in the lumbar, low and high thoracic regions of the spine. The new technology identified the epidural space in all but 1 of 46 attempts. Experimental results from our fabricated integrated circuit and animal study show the new tool has future clinical potential.

  16. 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

  17. Ethanol-induced analgesia

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    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.

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

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    Rolando T. Espín González

    >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

  19. 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

  20. 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 ...

  1. TRAMADOL VIA EPIDURAL EM CÃES SUBMETIDOS À SUBSTITUIÇÃO DO LIGAMENTO CRUZADO CRANIAL

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    Guedes Alonso Gabriel Pereira

    2002-01-01

    Full Text Available Dez cães foram submetidos à substituição experimental do ligamento cruzado cranial e receberam tramadol (1mg/kg pela via epidural lombo-sacra como técnica analgésica trans e pós-operatória. Avaliaram-se as funções cardiovascular e respiratória, o consumo de halotano e a analgesia pós-operatória. Observou-se estabilidade hemodinâmica e respiratória, analgesia adequada durante e após a cirurgia, bem como a possibilidade de redução no consumo de anestésico inalatório. Conclui-se que o tramadol epidural é efetivo como adjuvante anestésico em cães submetidos à substituição do ligamento cruzado cranial.

  2. Patient controlled intravenous analgesia with tramadol for labor pain relief

    Institute of Scientific and Technical Information of China (English)

    龙健晶; 岳云

    2003-01-01

    Objective To evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA)+ patient controlled epidural analgesia (PCEA). Methods Eighty American Society of Anesthesiologist (ASA) Ⅰ-Ⅱ at term parturients in active labor were randomly divided into 3 groups: the control group (n=30) received no analgesia; group A (n=30) received spinal administration with ropivacaine 2.5 mg and fentanyl 5 μg, then with PCEA; group B (n=20) received 1 mg/kg tramadol loading dose I.v.. PCIA with 0.75% tramadol and it included: PCA dose 2 ml, lockout time 10 minutes, background infusion 2 ml/h, total dose no more than 400 mg. The intensity of pain was evaluated using Visual Analogue Scale (VAS). Results Both group A and B showed good pain relief. VAS pain scores were significantly decreased in group A and B compared with those in the control group (P<0.01). In comparison with group B, the VAS pain scores decreased in group A (P<0.05). The onset times of analgesia in group A were shorter than those in group B (P<0.05). Apgar scores in group B were lower than those in group A (P<0.05). The periods of second stage of labor in group A were longer than those in the control group and group B (P<0.05). The cesarean delivery rate was significantly higher in the control group (16.7%) than in group A (3.3%) and group B (5.0%), but it did not differ between group A and B. There were no significant differences in vital signs, fetal heart rate, degree of motor block, and uterine contractions among the 3 groups. Conclusions PCIA with tramadol is now a useful alternative when patients are not candidates for CSEA for labor, or do not want to have a neuraxial block anesthesia. However, sometimes it may not provide satisfactory analgesic effect.

  3. Analgesia controlada pelo paciente com fentanil e sufentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo Analgesia controlada por el paciente con fentanil o sufentanil en el pós-operatorio de reconstrucción de ligamentos de la rodilla: estudio comparativo Patient controlled analgesia with fentanyl or sufentanil in the postoperative period of knee ligament reconstruction: comparative study

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    Marcelo Negrão Lutti

    2002-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os opióides têm sido utilizados por via peridural associados ou não a anestésicos locais para analgesia pós-operatória de forma contínua e/ou em bolus controlado pelo paciente. O objetivo deste estudo foi comparar a analgesia pós-operatória entre o fentanil e sufentanil em infusão contínua e em bolus por via peridural, em pacientes submetidos à reconstrução de ligamento do joelho. MÉTODO: Participaram do estudo 70 pacientes com idades entre 16 e 47 anos, estado físico ASA I e II, divididos aleatoriamente em dois grupos: Grupo F (fentanil e Grupo S (sufentanil. Todos os pacientes foram submetidos à anestesia peridural com bupivacaína a 0,5% (100 mg com epinefrina 1:200.000 associada a fentanil (100 mg. Ao final da cirurgia, os pacientes receberam fentanil (Grupo F ou sufentanil (Grupo S por via peridural em regime de infusão contínua mais bolus liberados pelo paciente. No Grupo F foi utilizada solução fisiológica (85 ml contendo fentanil 500 µg (10 ml e bupivacaína (5 ml a 0,5%. No Grupo S foi utilizada solução fisiológica (92 ml contendo sufentanil 150 µg (3 ml e bupivacaína (5 ml a 0,5%. Para os dois grupos a bomba de infusão foi programada inicialmente em 5 ml.h-1, com dose de 2 ml em bolus liberado pelo paciente num intervalo de 15 minutos. Foram comparados os seguintes parâmetros: dor, número de bolus acionados, consumo de opióides, bloqueio motor, sedação e efeitos colaterais. RESULTADOS: Não houve diferença entre os grupos quanto à qualidade da analgesia, sendo a maioria de boa qualidade (EAV 0 a 2. Houve diferença quanto ao número de bolus liberados. No Grupo F solicitou mais bolus que o Grupo S. Não houve diferença quanto ao volume total e tempo de infusão total. Não houve bloqueio motor após a instituição da analgesia controlada pelo paciente. A incidência de vômitos e retenção urinária foi maior no Grupo S e quanto à sedação e ao prurido, não houve

  4. 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

  5. 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

  6. 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

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    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

  7. Bupivacaína-buprenorfina vs. bupivacaína por vía caudal para analgesia postoperatoria en el paciente pediátrico en cirugía ortopédica Bupivacaine-buprenorphine vs. caudal bupivacaine as postoperative analgesia for pediatric patients undergoing orthopedic surgery

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    M. E. Flores Arana

    2011-04-01

    Full Text Available Introducción: el dolor postoperatorio en el niño constituye una entidad especial ya que en el influyen varios factores, por tanto es una experiencia no esperada por el niño y más difícil de tratar. Objetivos: evaluar y comparar la duración y calidad de la analgesia postoperatoria caudal así como la estabilidad hemodinámica y los efectos adversos entre bupivacaína-buprenorfina contra bupivacaína. Material y método: ensayo clínico controlado, prospectivo, longitudinal y comparativo; se estudian 40 pacientes de 1 a 7 años, para cirugía ortopédica bajo bloqueo caudal en el HTO No 21 de Monterrey, Nuevo León, de mayo 2009 a enero 2010. Se asignan en forma aleatoria a dos grupos: grupo A bupivacaína 0,25% 1,4 ml/kg y grupo B se le administrará bupivacaína al 0,25% 1,4 ml/kg adicionada de 1 μg/kg de buprenorfina. La intensidad del dolor postoperatorio se medirá a través del EVA, NIPS Y CRIES a las 2, 4, 6, 12 y 24 horas posteriores. Análisis estadístico: T de Student, U de Mann-Whitney; y prueba de Chi cuadrado. Resultados: el tiempo de administración del primer analgésico posterior a cirugía fue más corto en el grupo A (5,33 vs. 8,46 horas, con una diferencia a favor del grupo B (p Background: postoperative pain in children is a special entity and that the influence various factors, therefore it is an unexpected experience for the child and more difficult to treat. Objective: to evaluate and compare the length and quality of post-operative caudal analgesia and hemodynamic stability and adverse effects between bupivacaine-buprenorphine against bupivacaine. Material and methods: a controlled clinical trial, prospective, longitudinal, comparative study included 40 patients 1-7 years for orthopedic surgery under caudal block in the HTO No 21, of Monterrey, Nuevo Leon, from May 2009 to January 2010. Are assigned at random to two groups: group A 0.25% bupivacaine 1.4 ml/kg, and group B bupivacaine mL/kg 0.25% 1.4 mg/kg of

  8. Estudo comparativo entre bupivacaína a 0,5%, mistura enantiomérica de bupivacaína (S75-R25 a 0,5% e ropivacaína a 0,75% associadas ao fentanil em anestesia peridural para cesarianas Estudio comparativo entre bupivacaína a 0,5%, mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y ropivacaína a 0,75% asociadas al fentanil en anestesia peridural para cesáreas Comparative study between 0.5% bupivacaine, 0.5% enantiomeric mixture of bupivacaine (S75-R25 and 0.75% ropivacaine, all associated to fentanyl, for epidural cesarean section anesthesia

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    Carlos Alberto Figueiredo Côrtes

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudos clínicos com enantiômeros levógiros dos anestésicos locais demonstraram maior segurança em função de menor cardiotoxicidade. Este estudo visou avaliar a qualidade da anestesia e as repercussões maternas e fetais com o emprego da bupivacaína a 0,5%, com a mistura enantiomérica da bupivacaína (S75-R25 a 0,5% e com a ropivacaína a 0,75% associadas ao fentanil, por via peridural em cesarianas. MÉTODO: Foram avaliadas 90 gestantes, estado físico ASA I, submetidas à cesariana eletiva sob anestesia peridural e divididas em 3 grupos: no grupo I receberam 23 ml de bupivacaína a 0,5% com epinefrina; no grupo II receberam 23 ml da mistura enantiomérica de bupivacaína (S75-R25 a 0,5% com epinefrina e no grupo III receberam 23 ml de ropivacaína a 0,75%. Associaram-se 2 ml de fentanil aos anestésicos locais. Foram avaliados: tempo de latência, duração da analgesia, grau de bloqueios motor e sensitivo, tempos de histerotomia e delivramento, relaxamento muscular e qualidade da anestesia, alterações hemodinâmicas e respiratórias maternas, presença de efeitos colaterais e vitalidade dos recém-nascidos através do índice de Apgar e da gasometria do cordão umbilical. RESULTADOS: Não houve diferença entre os grupos, exceto na qualidade da anestesia. Nos grupos com predominância da fração levógira foi clinicamente inferior, havendo necessidade de complementação da anestesia em 3 casos. A duração da analgesia foi maior no grupo da ropivacaína. CONCLUSÕES: A mistura enantiomérica (S75-R25 da bupivacaína a 0,5% e a ropivacaína a 0,75% por via peridural proporcionaram boas condições, tanto quanto a bupivacaína a 0,5%, para a realização do ato anestésico-cirúrgico. As repercussões nos neonatos mostraram que os agentes anestésicos foram igualmente seguros.JUSTIFICATIVA Y OBJETIVOS: Estudios clínicos con enantiómeros levógiros de los anestésicos locales demostraron mayor seguridad

  9. 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

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    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

  10. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine

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    Tanmoy Ghatak

    2010-01-01

    Full Text Available For treatment of intra and postoperative pain, no drug has yet been identified that specifically inhibits nociception without associated side effects. Magnesium has antinociceptive effects in animal and human models of pain. The current prospective randomised double-blind study was undertaken to establish the effect of addition of magnesium or clonidine, as adjuvant, to epidural bupivacaine in lower abdominal and lower limb surgeries. A total of 90 American Society of Anesthesiology (ASA grade I and II patients undergoing lower abdominal and lower limb surgeries were enrolled to receive either magnesium sulphate (Group B or clonidine (Group C along with epidural bupivacaine for surgical anaesthesia. All patients received 19 ml of epidural bupivacaine 0.5% along with 50 mg magnesium in group B, 150 mcg clonidine in Group C, whereas in control group (Group A, patients received same volume of normal saline. Onset time, heart rate, blood pressure, duration of analgesia, pain assessment by visual analogue score (VAS and adverse effects were recorded. Onset of anaesthesia was rapid in magnesium group (Group B. In group C there was prolongation of duration of anaesthesia and sedation with lower VAS score, but the incidence of shivering was higher. The groups were similar with respect to haemodynamic variables, nausea and vomiting. The current study establishes magnesium sulphate as a predictable and safe adjunct to epidural bupivacaine for rapid onset of anaesthesia and clonidine for prolonged duration of anaesthesia with sedation.

  11. 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...

  12. Analgesia adjuvante e alternativa

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    Vale Nilton Bezerra do

    2006-01-01

    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.

  13. 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

  14. 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

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

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    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

  16. 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...

  17. 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

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    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

  18. 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.

  19. 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 ...

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

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    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

  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. 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.

  3. [The effect of combination epidural anesthesia techniques in upper abdominal surgery on the stress reaction, pain control and respiratory mechanics].

    Science.gov (United States)

    Wiedemann, B; Leibe, S; Kätzel, R; Grube, U; Landgraf, R; Bierwolf, B

    1991-11-01

    Twenty-eight patients undergoing upper abdominal operations (mainly selective proximal vagotomy [SPV]) were referred for assessment of the hormonal metabolic reaction (adrenocorticotropic hormone [ACTH], arginine vasopressin [AVP], cortisol, and glucose), the postoperative pain reaction, and respiration according to the method of anesthesia (group 1: neuroleptanesthesia [NLA], group 2: NLA in combination with epidural opiate analgesia, group 3: NLA in combination with local anesthesia). To alleviate postoperative pain piritramide was systematically administered in group 1, whereas in groups 2 and 3 a thoracic epidural catheter was injected with morphine or bupivacaine. Postoperative analgesia was better in patients with epidural administration than in those with systemic application. On the 1st and 2nd postoperative days the vital capacity was statistically significantly higher by 10%-15% in groups 2 and 3 than in group 1. As expected, the neurohormonal and metabolic stress response was highest in all patients in the intraoperative and immediate postoperative phases: ACTH, AVP, and glucose levels were in most cases significantly higher compared with the initial values. However, cortisol levels decreased intraoperatively, probably as a result of the generally used induction agent etomidate. Comparison of the three methods of anesthesia revealed that all mean hormone levels analyzed in group 2 patients were lower both intraoperatively and 2 h postoperatively, which implies that epidurally administered morphine reduces the stress reaction, probably indirectly through additional selective alleviation of pain at the spinal cord level. The various differences in hormonal reactions of patients in groups 1 and 3 gave no clear evidence, however, of possible mitigation of the stress reaction by epidural local anesthetics in upper abdominal operations.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. Effect of thoracic epidural analgesia on coagulation and fibrinolysis dynamic balance in patients undergoing major thoracic surgery%胸段硬膜外镇痛对胸科手术患者凝血-纤溶动态平衡的影响

    Institute of Scientific and Technical Information of China (English)

    雷蕾; 刘丹彦

    2009-01-01

    目的:用凝血-纤溶动态图(Coagulation-fibrinolysis dynamic-pattern,CF)观察胸段硬膜外镇痛(Thoracic epiduralanalgesia,TEA)对胸科手术患者凝血-纤溶动态平衡的影响.方法:选择开胸手术(食管癌根治术和肺叶切除术)患者40例,随机分为全麻复合硬膜外镇痛(General-epidural anesthesia,GEA)组和全麻(General anaesthesia,GA)组(n=20).分别于麻醉诱导前(基础值)、关胸时、术后1、3 d晨空腹抽取前臂静脉血测血小板计数(Platelet,PLT)、纤维蛋白原(Fibrinogen,FIB)及凝血-纤溶动态描记图,并于术前及术后4~7d分别行下肢深静脉彩超检查.结果:两组FIB、凝固启动时间(Concretion startuptime,CST)、最大凝固程度(Maximum extent of coagulation,MCE)差异无统计学意义(P>0.05);在关胸及术后,GEA组较GA组的凝血达峰值时间(Maximum coagulation time,MCT)明显延长(P<0.05),PLT明显减少(P<0.01),平衡时间(Balance time,BLT)和全反应时间(whole time of fibrinolysis reaction,WFT)明显缩短(P<0.01);术后下肢深静脉血栓(Deep venous thrombosis,DVT)发生率明显降低(P<0.05).结论:TEA可抑制开胸手术后应激引起的凝血功能增强,改善术后纤溶抑制,维持体内凝血-纤溶功能的动态平衡.

  10. 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

    Directory of Open Access Journals (Sweden)

    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

  11. 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

  12. Bacteriological Profile of Epidural Catheters

    Directory of Open Access Journals (Sweden)

    B. M. Sahay, Sanjot Dahake, D. K Mendiratta*,Vijayshree Deotale*,B. Premendran, P.S.Dhande, Pratibha Narang*

    2010-01-01

    Full Text Available The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterizationand before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, theportion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bitjust before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and theanaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcusepidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures fromskin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal actionof the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tipculture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 casesthe cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  15. 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

  16. 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.

  17. 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.

  18. Infektioner i forbindelse med epidural kateterisation

    DEFF Research Database (Denmark)

    Holt, H M; Gahrn-Hansen, B; Andersen, S S;

    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...

  19. 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

  20. 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

  1. 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.

  2. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Pfeiffer-Jensen, Mogens; Haraldsted, Viggo;

    2007-01-01

    BACKGROUND: Epidural analgesia gives excellent pain relief but is associated with substantial side effects. We compared wound infiltration combined with intraarticular injection of local anesthetics for pain relief after total hip arthroplasty (THA) with the well-established practice of epidural....../mL at the conclusion of surgery combined with one postoperative intraarticular injection of the same substances through an intraarticular catheter (group A). RESULTS: Narcotic consumption was significantly reduced in group A compared to group E (p = 0.004). Pain levels at rest and during mobilization were similar...

  3. 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

  4. 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) ...

  5. 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

  6. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Loubert, C; O'Brien, P J; Fernando, R; Walton, N; Philip, S; Addei, T; Columb, M O; Hallworth, S

    2011-05-01

    We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section.

  7. 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.

  8. 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;

    2011-01-01

    for multiple testing, there was no statistically significant postoperative difference between the LINFA group and the placebo group regarding pain and tiredness. We found some evidence of a short-term effect on nausea and vomiting. Opioid consumption and length of stay were similar in the two groups......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...... with local infusion analgesia (LINFA) into the soft tissue in the hip region through a catheter in the first postoperative days has gained major interest in THA fast-track settings within a short period of time. LIA at the time of surgery is a validated treatment. We investigated the additional effect...

  9. 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, Kirsten; Leonhardt, Jane Schwartz; Revald, Peter;

    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...... with local infusion analgesia (LINFA) into the soft tissue in the hip region through a catheter in the first postoperative days has gained major interest in THA fast-track settings within a short period of time. LIA at the time of surgery is a validated treatment. We investigated the additional effect...... of giving postoperative LINFA after THA in patients already having LIA during surgery. Patients and methods 60 consecutive patients undergoing non-cemented THA were randomized into two groups in a double-blind and controlled study. During surgery, all patients received standardized pain treatment with LIA...

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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...

  15. 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.

  16. 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

  17. 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

  18. 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

  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. In vitro comparison of epidural bacteria filters permeability and screening scanning electron microscopy

    Directory of Open Access Journals (Sweden)

    Aysin Sener

    2015-12-01

    Full Text Available BACKGROUND AND OBJECTIVES: Epidural catheter bacteria filters are barriers in the patient-controlled analgesia/anaesthesia for preventing contamination at the epidural insertion site. The efficiency of these filters varies according to pore sizes and materials. METHOD: The bacterial adhesion capability of the two filters was measured in vitro experiment. Adhesion capacities for standard Staphylococcus aureus (ATCC 25923 and Pseudomonas aeruginosa (ATCC 27853 strains of the two different filters (Portex and Rusch which have the same pore size were examined. Bacterial suspension of 0.5 Mc Farland was placed in the patient-controlled analgesia pump, was filtered at a speed of 5 mL/h. in continuous infusion for 48 h and accumulated in bottle. The two filters were compared with colony counts of bacteria in the filters and bottles. At the same time, the filters and adhered bacteria were monitored by scanning electron microscope. RESULTS: Electron microscopic examination of filters showed that the Portex filter had a granular and the Rusch filter fibrillary structure. Colony counting from the catheter and bottle showed that both of the filters have significant bacterial adhesion capability (p < 0.001. After the bacteria suspension infusion, colony countings showed that the Portex filter was more efficient (p < 0.001. There was not any difference between S. aureus and P. aeruginosa bacteria adhesion. In the SEM monitoring after the infusion, it was physically shown that the bacteria were adhered efficiently by both of the filters. CONCLUSION: The granular structured filter was found statistically and significantly more successful than the fibrial. Although the pore sizes of the filters were same - of which structural differences shown by SEM were the same - it would not be right to attribute the changes in the efficiencies to only structural differences. Using microbiological and physical proofs with regard to efficiency at the same time has been

  2. 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.)

  3. 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

  4. 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

  5. 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

  6. Epidural steroid injection for lumbosacral radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Mi Sook [The Catholic University of Korea, Pucheon (Korea, Republic of)

    2006-06-15

    Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections.

  7. Solitary Spinal Epidural Metastasis from Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Taisei Sako

    2016-01-01

    Full Text Available Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered.

  8. 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...

  9. 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...

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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

  16. 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...

  17. 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...

  18. Postoperative epidural hematoma. Five cases of epidural hematomas developed after supratentorial craniotomy on the contralateral side

    Energy Technology Data Exchange (ETDEWEB)

    Sato, M. (Shiga Univ. of Medical Science, Ohtsu (Japan)); Mori, K.; Handa, H.

    1981-10-01

    Postoperative epidural hematomas developed far from the operative field are generally recognized as a complication of ventriculo-peritoneal shunt, ventricular drainage or suboccipital craniotomy. It is very rare but may occur after supratentorial craniotomy on the contralateral side. Five such cases are presented with a review of the relevant literature. The mechanism of this complication is not clearly understood. In hydrocephalus, these massive epidural hematomas are probably caused by dura-skull detachment when the brain volume is strikingly reduced by a decompressive procedure. On rare occasions, pins of head rest may detach the dura and cause epidural hematomas. When sudden brain swelling during craniotomy is encountered, attention should be directed not only to intracerebral hemorrhage but also epidural hematoma developed on the contralateral side.

  19. Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.

    Science.gov (United States)

    van Rappard, Juliaan R M; Tolenaar, Jip L; Smits, Anke B; Go, Peter M N Y H

    2015-08-20

    We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. A photon emission tomography scan revealed increased activity of the spinal canal, suggesting S. aureus meningitis. A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery.

  20. 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.

  1. [Pneumoencephalotomography under diaz-analgesia and narco-analgesia].

    Science.gov (United States)

    Bergeron, J L; Renou, A M; Boulard, G; Vernhiet, J; Nicod, J

    1978-01-01

    The authors reported 92 observations of anesthesia for gaseous encephalotomography interest the adult. The contrast produce is air. 49 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, pancuronium bromide N2O to 60 p. 100. 25 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, succinylcholine, N2O to 60 p. 100. 18 under narco-analgesia and myoresolution. +Fentyl, pancuronium bromide N2O to 60 p. 100. The conditions of the study are described in the first part. The results and their analysis permit the appreciation of: - the patient confort, the quality of the examination; -the respect of the hemodynamics for this examination, reputed to be "difficult"; -the immediatly noticeable diminution of side effects; -the absence of side effects; -the justification and interesting of the control ventilation; -the quality of waking up. In the conclusion the authors underline the interest of their different techniques and the possibility of using them in operations in sitting position in neurosurgery, and all important chirurgical intervention. PMID:677506

  2. [Pneumoencephalotomography under diaz-analgesia and narco-analgesia].

    Science.gov (United States)

    Bergeron, J L; Renou, A M; Boulard, G; Vernhiet, J; Nicod, J

    1978-01-01

    The authors reported 92 observations of anesthesia for gaseous encephalotomography interest the adult. The contrast produce is air. 49 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, pancuronium bromide N2O to 60 p. 100. 25 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, succinylcholine, N2O to 60 p. 100. 18 under narco-analgesia and myoresolution. +Fentyl, pancuronium bromide N2O to 60 p. 100. The conditions of the study are described in the first part. The results and their analysis permit the appreciation of: - the patient confort, the quality of the examination; -the respect of the hemodynamics for this examination, reputed to be "difficult"; -the immediatly noticeable diminution of side effects; -the absence of side effects; -the justification and interesting of the control ventilation; -the quality of waking up. In the conclusion the authors underline the interest of their different techniques and the possibility of using them in operations in sitting position in neurosurgery, and all important chirurgical intervention.

  3. A COMPARATIVE STUDY OF LEVOBUPIVACAINE WITH CLONIDINE AND LEVOBUPIVACAINE WITH DEXMEDETOMIDINE IN THORACIC EPIDURAL BLOCK FOR LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Aditya Kumar

    2016-02-01

    Full Text Available Laparoscopic cholecystectomy has traditionally been performed under general anaesthesia, regional anaesthetic techniques like spinal and epidural anaesthesia has emerged as a more suitable alternative for the minimally invasive laparoscopic cholecystectomy. We conducted a clinical study comparing levobupivacaine with clonidine and a combination of levobupivacaine with dexmedetomidine in thoracic epidural anaesthesia for laparoscopic cholecystectomy as sole anaesthetic. MATERIAL AND METHODS After taking approval from Institutional Ethical Committee, 100 adult patients of ASA grade I and II were divided into two groups; Group 1 where levobupivacaine 0.5% (2mg/kg with 1.5µg/kg clonidine was given and in Group 2 levobupivacaine 0.5% (2mg/kg with 0.5μg/kg of dexmedetomidine. Thoracic epidural was given at the T10-T11 interspace to obtain a sensory block of T4-L2 dermatome, which was judged every minute by pinprick method till complete sensory block was established. Hemodynamic parameters like heart rate, non-invasive blood pressure, electrocardiogram, oxygen saturation were monitored and readings were recorded initially then at every 5 mins after administration of drug intraoperatively. RESULT Duration of block was longer in group 2 patients, onset of block was comparable in both the groups. Also fall in blood pressure and heart rate was greater in group 2 patients. Less incidence of shoulder pain was found in group 2 patients. Oxygen saturation (Spo2 was comparable in both the groups and no respiratory distress was seen. More post-operative analgesia was required in group 1. Also no complications were seen postoperatively in both the groups. CONCLUSION Levobupivacaine with dexmedetomidine provides better anaesthesia than levobupivacaine with clonidine in thoracic epidural for laparoscopic cholecystectomy.

  4. Estudo comparativo entre bupivacaína a 0,25% e ropivacaína a 0,2% em anestesia peridural para cirurgia torácica Estudio comparativo entre bupivacaína a 0,25% y ropivacaína a 0,2% en anestesia peridural para cirugía de tórax Comparison between 0.25% bupivacaine and 0.2% ropivacaine in epidural anesthesia for thoracic surgery

    Directory of Open Access Journals (Sweden)

    Marcus Vinícius Martins Novaes

    2001-12-01

    ventilatorios de la anestesia peridural torácica con bupivacaína a 0,25% y ropivacaína a 0,2% asociada a anestesia general en pacientes sometidos a toracotomia. MÉTODO: Participaron de este estudio prospectivo, comparativo y aleatorio, cuarenta pacientes divididos en dos grupos de veinte. Cada grupo recibió un volumen de 10 ml de anestésico local, por vía peridural torácica. Grupo B (Bupivacaína 0,25% y el Grupo R (Ropivacaína 0,2%. El bloqueo peridural fue realizado con los pacientes en decúbito lateral, punción paramediana y catéter para inyección de los fármacos A seguir, todos los pacientes recibieron anestesia general con IOT. Fueron analizados parámetros hemodinámicos y ventilatorios en 9 momentos. RESULTADOS: La presión arterial sistólica fue menor en el momento 5 y la presión arterial diastólica en los momentos 1 y 5, ambas en el grupo B. La necesidad de efedrina para corregir hipotensión arterial fue de 8/20 en el grupo B, contra 6/20 en el grupo R. La presión de pico en las vías aéreas superiores fue siempre mas elevada en el grupo R y los valores de la CAM del isoflurano fueron mas elevados en los momentos 5 y 6 también en el Grupo R. CONCLUSIONES: La técnica combinada peridural torácica y anestesia general se mostró eficaz y segura en los pacientes sometidos a toracotomia. Cuando se utilizó bupivacaína, la diminución de la presión arterial fue mayor y la presión máxima en las vías aéreas fue menor de que cuando fue utilizada ropivacaína.BACKGROUND AND OBJECTIVES: Combined general/epidural anesthesia has been used for several surgical procedures. Little has been published in the literature about its use in thoracic surgery. This study aimed to evaluate hemodynamic and ventilatory effects of combined general/epidural anesthesia with 0.25% bupivacaine and 0.2% ropivacaine in patients submitted to thoracotomy METHODS: Participated in this prospective, comparative and randomized study 40 patients divided in two groups of 20. Each

  5. 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.

  6. Spontaneous extracranial decompression of epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Neely, John C. [Marshall University School of Medicine, Huntington, WV (United States); Jones, Blaise V. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Crone, Kerry R. [Cincinnati Children' s Hospital Medical Center, Division of Neurosurgery, Cincinnati, OH (United States)

    2008-03-15

    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.)

  7. 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

  8. 腰硬联合麻醉与笑气吸入分娩镇痛的临床研究%Clinical studies CSEA labor analgesia with nitrous oxide inhalation

    Institute of Scientific and Technical Information of China (English)

    田丽云

    2015-01-01

    Objective:To analyze the clinical effect of epidural anesthesia and nitrous oxide inhalation analgesia and its impact on maternal and newborn. Methods:A retrospective analysis of 294 cases of maternal epidural group of 92 cases in which the use of epidural anesthesia; 92 cases of inhalation of nitrous oxide group using mixed gas containing 50% nitrous oxide and 50% oxygen; the control group did not use any methods of analgesia. Analgesic effect was observed in each group. Results:epidural group and nitrous oxide analgesia group were significantly better than the control group, and the group of spinal epidural analgesia cervix (T3) was significantly higher than the intensity of the contractions nitrous oxide group, the active phase of the first stage of labor in pregnant women short;mode of delivery epidural group and nitrous oxide were significantly better than the control group;postpartum hemorrhage , neonatal adverse reactions, Apgar score three groups no significant difference. Conclusion:nitrous oxide inhalation analgesia inferior to epidural anesthesia, but simple, affordable, primary hospitals should be popularized; CSEA rapid onset of analgesia, the best results can be used as the preferred method of analgesia .%目的:观察研究腰硬联合麻醉镇痛法和笑气吸入法的临床效果及对产妇和新生儿的影响。方法:回顾性分析330例产妇,每组110例;其中硬膜外组采用腰硬联合麻醉,笑气组采用吸入含50%笑气和50%氧气的混合气体,对照组未用任何镇痛方法。观察各组的镇痛效果。结果:硬膜外组与笑气组镇痛效果显著优于对照组,硬膜外组镇痛效果、宫口开全(T3)后宫缩强度明显高于笑气组,第一产程孕妇活跃期短;分娩方式硬膜外组与笑气组显著优于对照组;新生儿不良反应、产后出血量、新生儿Apgar评分比较3组无明显差异。结论:笑气吸入的镇痛效果次于腰硬

  9. 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.......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....

  10. 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...

  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. 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.)

  13. Recurrent acute low back pain secondary to lumbar epidural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

    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.)

  14. 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.)

  15. 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...

  16. 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.

  17. 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.

  18. 胸段硬膜外麻醉的研究进展及应用%Research Progress and Application of Thoracic Epidural Anesthesia

    Institute of Scientific and Technical Information of China (English)

    冯志佳; 郭慕真; 孙颖; 席宏杰

    2012-01-01

    硬膜外应用局麻药为手术提供麻醉与镇痛,同时胸段硬膜外麻醉与镇痛也被广泛应用于心脏,大血管,胸部和腹部的手术中.它不仅可以加快病人麻醉后的苏醒,而且可以提供很好的术后镇痛.除了上述优点,许多基础及临床研究发现硬膜外麻醉还有许多其它方面的作用,如:减轻神经内分泌系统的应激反应、减少围术期并发症的发生,以及通过暂时性的阻滞胸交感神经提供心肺及胃肠道的保护作用,改善免疫和凝血功能.本文就近年来胸段硬膜外麻醉应用及研究进展作一综述.%The epidural administration of local anaesthetic agents was primarily designed to provide perioperative anaesthesia and analgesia. Meanwhile, thoracic epidural anaesthsia (TEA) and analgesia are practiced extensively by many anaesthesiologists for cardiac, thoracic and abdominal surgery. Not only can it speed up awakening after anesthesia, and can provide good postoperstive analgesia. However, many experimental and clinical studies have shown that epidural anaesthesia may have effects far beyond pain relief. Regional anaesthesia may decrease the neuroendocrine stress response and therefore reduce the number of perioperative complications. Furthermore, transient thoracic sympathectomy by TEA has been suggested to offer protective cardiac, pulmonary and gastrointestinal effects as well as positive immunological and coagulation properties. The technique is thus thought to have a significant impact on the outcome of major surgical procedures. This review will focus on research progress and application of thoracic epidural anesthesia.

  19. Involvement of connexin 43 in acupuncture analgesia

    Institute of Scientific and Technical Information of China (English)

    HUANG Guang-ying; ZHENG Cui-hong; YU Wei-chang; TIAN Dai-shi; WANG Wei

    2009-01-01

    Background Connexin 43 (Cx43) is one of the major components of human keratinocyte gap junctions. To study whether gap junctional intercellular communication participates in the transfer of acupoint signals and acupuncture analgesia, the expression of Cx43 was studied in Zusanli (ST36) acupoints compared with control non-acupoint regions in rats after acupuncture. In addition, Cx43 heterozygous gene knockout mice were used to further explore the relationship between Cx43 and acupuncture analgesia. Methods The expression of Cx43 was detected by immunohistochemistry, immunoblotting, and RT-PCR for the Cx43 protein and mRNA. The influence of the Cx43 gene knockout on acupuncture analgesia was measured by a hot plate and observing the writhing response on Cx43 heterozygous gene knockout mice. Results Immunohistochemistry showed abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat ST36 acupoints. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those in the control points in the non-acupuncture group, and even more so after acupuncture. The hot plate and writhing response experiments showed that partial knockout of the Cx43 gene decreased acupuncture analgesia. Conclusion Cx43 expression and acupuncture analgesia showed a positive correlation.

  20. 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

  1. Vecuronium and fentanyl requirement in abdominal surgery under combined epidural-general anaesthesia and general anaesthesia alone.

    Science.gov (United States)

    Hossain, M; Hoq, M F; Rahman, M S; Yeasmeen, S; Ahmed, A; Huda, M R; Rahman, M M

    2012-01-01

    Individual effect of epidural block and general anaesthesia is well established in the field of anaesthesiology. But adequate literature is yet not available to give decisive answer regarding the requirement of muscle relaxants and opioid analgesic when the two methods are combined together. In the present study, sixty patients, aged 18-50 years of both sexes with ASA (American Society of Anesthesiologists) grading I and II scheduled to undergo for major abdominal surgery were assigned randomly into two groups (30 in each group), where Group A received general anesthesia and Group B received combined epidural-general anesthesia. The patients with combined technique, epidural catheter tip were placed between T9-10. Ten ml of 0.125% bupivacaine was administered through the epidural catheter. Peripheral nerve stimulator was used to monitor neuromuscular transmission and subsequently to administer incremental dose of neuromuscular blocking drugs. All the patients were pre-medicated with fentanyl (2μg/kg) to reduce intubation reflex. Then the patients of both groups were pre-oxygenated for 3 minute and anaesthesia was induced with thiopental sodium 3-5 mg/kg body weight. Endotrachial intubation was facilitated by vecuronium 0.1mg/kg body weight. Anaesthesia was maintained with 60% N2O in O2 and halothane (0.4 to 0.8%). Fentanyl was given in incremental dose of 0.5 μg/kg to maintain an adequate analgesia. The vecuronium was given at the dose of 0.02 mg/kg, when TOF return to 25% of the base line. The mean±SD requirement of vecuronium in general anaesthesia group was 0.0016±0.00013 mg/kg/min and whereas in combined epidural-general anaesthesia, it was 0.0011±0.00014 mg/kg/min. The requirement of fentanyl was 0.71μg/kg/hr in general anaesthetic group whereas in combined group it was 0.31μg/kg/hr. These findings prompt us to place optimal dosing guidelines so as to avoid overdosing and thus delay recovery and help to get the excellent outcome of the surgery.

  2. Pectoralis Minor Nerve Block versus Thoracic Epidural and Paravertebral Block in Perioperative Pain Control of Breast Surgery - Mini Review

    Directory of Open Access Journals (Sweden)

    Rafik Sedra

    2015-03-01

    Full Text Available Pectoralis minor blocks are still relatively new and require further evaluation, but may have a place in peri-operative pain management for the appropriate cases. Still considered as less invasive procedure in comparison to thoracic epidurals and para-vertebral blocks. Complications of thoracic epidural and para-vertebral blocks like spinal cord injury and pneumothorax makes many anaesthetists interested in practising pectoralis minor block guided by ultrasound. Blanco first introduced the pectoralis minor block in 2011, he did study on 50 patients within 2 years. Results were very promising, all patients did not need any opiates but only paracetamol and non-steroidal anti-inflammatory (NSAID drugs got used.

  3. 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.

  4. 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

  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

    Directory of Open Access Journals (Sweden)

    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. 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...

  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 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...

  11. 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...

  12. 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 arthrofibrosis after TKA is correlated with a high likelihood of functional success postoperatively as measured by range of motion improvement. PMID:25300008

  13. 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

  14. 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.

  15. The Epidural Treatment of Sciatica: Its Origin and Evolution.

    Science.gov (United States)

    Ter Meulen, Bastiaan C; Weinstein, Henry; Ostelo, Raymond; Koehler, Peter J

    2016-01-01

    Epidural injection with corticosteroids is a common treatment option for patients with lower back pain or sciatica. In this paper we review its origin and evolution. The first injections were given around 1900 in Paris by Jean Sicard (1872-1929) and Fernand Cathelin (1873-1945), who worked independently. They both injected small volumes of cocaine into the sacral hiatus. After a slow start, the epidural treatment of back pain and sciatica gradually spread to other parts of Europe and Northern America. In the early 1950s, corticosteroids were introduced for epidural use. Since the 1970s, there have been numerous clinical trials that show a significant, although small, effect of epidural corticosteroid injections compared with placebo for leg pain in the short term. Despite an ongoing debate about effectiveness and safety, epidural injections remain popular. PMID:26820578

  16. 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

  17. 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 < 0.01). At examination 6 weeks postoperatively, 94.4% of patients met the 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 < 0.01) at 6 weeks postoperative in the 12 patients with this data recorded. On the basis of this data, use of tunneled epidurals with arthroscopic lysis of adhesions for arthrofibrosis after TKA is correlated with a high likelihood of functional success postoperatively as measured by range of motion improvement.

  18. 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

  19. 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) ...

  20. Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy.

    Science.gov (United States)

    Zeng, X Z; Xu, Y M; Cui, X G; Guo, Y P; Li, W Z

    2014-03-01

    Thoracic epidural anaesthesia alone is an applied technique of anaesthesia for nephrectomy which has both advantages and limitations. Dexmedetomidine is a highly selective alpha2-adrenoreceptor agonist which has both central and peripheral analgesic properties. Forty patients undergoing nephrectomy were enrolled in this clinical trial and allocated randomly to two groups, a control group (C group) and a dexmedetomidine group (D group). The C group received epidural 0.75% levobupivacaine 12 ml with 1 ml of isotonic sodium chloride solution, while the D group received epidural 0.75% levobupivacaine 12 ml with 1 ml (0.5 µg/kg) of dexmedetomidine. Haemodynamic changes, onset time and duration of sensory and motor block, muscle relaxation score, verbal rating score for pain, sedation score and the total postoperative analgesic consumption were evaluated. Sensory blockade duration was longer in the D group than in the C group (P=0.01). The incidence of motor block and the muscle relaxation score were significantly higher in the D group compared with the C group (P=0.01). Compared with the C group, pain scores were significantly lower in the first four postoperative hours in the D group (two hours rest P=0.038; two hours activity P=0.009; four hours rest P=0.044; four hours activity P=0.003). The total amount of flurbiprofen analgesic was significantly lower in the D group compared with the C group (P=0.03). Epidural dexmedetomidine 0.5 µg/kg appears to intensify thoracic epidural anaesthesia with levobupivacaine.

  1. 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

  2. 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...

  3. 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

  4. 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.

  5. Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

    Directory of Open Access Journals (Sweden)

    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. 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

  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

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    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. 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.

  9. 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

  10. 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...

  11. Central temperature changes are poorly perceived during epidural anesthesia.

    Science.gov (United States)

    Glosten, B; Sessler, D I; Faure, E A; Karl, L; Thisted, R A

    1992-07-01

    Hypothermia and shivering are common during epidural anesthesia for cesarean delivery but are not always accompanied by a sensation of coldness. To test the hypothesis that central temperature changes are not perceived during epidural anesthesia, we measured central and skin temperatures and thermal perception in 30 patients undergoing cesarean delivery with epidural anesthesia. Central temperature decreased 1.0 +/- 0.6 degrees C from control values during anesthesia and surgery, but thermal perception scores did not reflect central temperatures (P = 0.56) or changes in central temperature (P = 0.63). A feeling of warmth was significantly correlated with increased mean skin temperature (P = 0.02) and increased upper body skin temperature (P = 0.03). We conclude that central temperature is poorly perceived and is less important than skin temperature in determining thermal perception during high levels of epidural anesthesia.

  12. Analgesia controlada pelo paciente reduz consumo de bupivacaína no bloqueio femoral no tratamento da dor pós-operatória após reconstrução do ligamento cruzado anterior do joelho Analgesia controlada por el paciente reduce consumo de bupivacaína en bloqueo femoral para manejo de dolor postoperatorio en reconstrucción de ligamento cruzado anterior de rodilla Patient controlled analgesia reduces the consumption of bupivacaine in femoral nerve block for the treatment of postoperative pain after reconstruction of anterior cruciate ligament of the knee

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    Victor A. Contreras-Domínguez

    2007-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (BFC é utilizado na analgesia pós-operatória das substituições articulares de quadril e joelho com bom resultado. O objetivo deste estudo foi avaliar a utilidade do BFC, comparando três esquemas de administração de bupivacaína após reconstrução do ligamento cruzado anterior (LCA do joelho por artroscopia. MÉTODO: Estudo prospectivo controlado de 90 pacientes estado físico ASA I e II. Os pacientes foram divididos em três grupos: Grupo 1 (n = 30: 10 mL.h-1 em infusão contínua (IC de bupivacaína 0,125% + clonidina 1µg.mL-1 (B + C; Grupo 2 (n = 30: 5 mL.h-1 em IC + 2,5 mL de B + C em PCA a cada 30 min; Grupo 3 (n = 30: 5 mL.h-1 de B + C em PCA cada 30 min. A anestesia foi por via subaracnóidea. A dor pós-operatório foi registrada às 2, 4, 6, 24 e 48 horas após a operação avaliada pela Escala Analógica Visual (VAS. Anotou-se também consumo de bupivacaína e morfina. RESULTADOS: Não foram registradas diferenças nas variáveis demográficas entre ambos os grupos. O VAS pós-operatório entre 2 e 48 horas não mostrou diferenças. O consumo de morfina entre 4 e 48 horas foi similar nos três grupos (p = 0,07. No grupo em que só foi utilizado o modo PCA, o consumo de bupivacaína foi significativamente menor (p JUSTIFICATIVA Y OBJETIVOS: El bloqueo femoral continuo (BFC se utiliza en la analgesia postoperatoria de los reemplazos articulares de cadera y rodilla con buen resultado. El objetivo es evaluar la utilidad del BFC, comparando 3 esquemas de administración de bupivacaína en reconstrucción de ligamento cruzado anterior (LCA de rodilla asistida por artroscopía. MÉTODO: Estudio prospectivo controlado de 90 pacientes estado físico ASA I y II estables. Los pacientes fueron divididos en tres grupos. El Grupo 1 (n = 30: 10 mL.h-1 en infusión continua (IC de bupivacaína 0,125% + clonidina 1µg.mL-1 (B + C; Grupo 2 (n = 30: 5 mL.h-1 en IC + 2,5 mL de B + C en PCA

  13. 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.

  14. 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...

  15. 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...

  16. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    Institute of Scientific and Technical Information of China (English)

    Lorella; Fanti; Pier; Alberto; Testoni

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endosc...

  17. Intrathecal analgesia and palliative care: A case study

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    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.

  18. Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas Post-surgical analgesia in hip surgery: A comparison of three techniques

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    M.I. Segado Jiménez

    2010-09-01

    Full Text Available Introducción: Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos: Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, inicio de rehabilitación y costes económicos en cada grupo. Pacientes y método: Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en 3 grupos aleatorios: A: solo analgesia intravenosa, B: bloqueo iliofascial y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y satisfacción analgésica, tiempo transcurrido hasta el inicio de la sedestación, necesidad de analgésicos postoperatorios, efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados: La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (EVA medio 2,14±1,24, satisfacción 3,75±0,8 que en los que solo recibieron analgesia intravenosa (EVA medio 5,57±0,64, satisfacción 2,83±0,7 (pIntroduction: The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives: Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods: Prospective study of 90 patients undergoing hip surgery

  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. 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.

  1. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Science.gov (United States)

    Chouchou, Florian; Chauny, Jean-Marc; Rainville, Pierre; Lavigne, Gilles J

    2015-01-01

    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.

  2. 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...

  3. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con 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

  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. Epidural anesthesia in repeated cesarean section. Anestesia epidural en la cesárea iterativa.

    Directory of Open Access Journals (Sweden)

    Norma Mur Villar

    2003-05-01

    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.

    Fundamento: La anestesiología ha experimentado durante los últimos años un desarrollo espectacular en las diferentes áreas de su competencia, entre las que se encuentra sin lugar a dudas, la que centra su actividad asistencial en la paciente obstétrica y todo lo relacionado con su práctica adecuada en estas. Objetivo: Evaluar la eficacia de la anestesia epidural en la cesárea iterativa. Métodos: Estudio descriptivo retrospectivo de una serie de casos (112 en que fue

  6. 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

  7. 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...

  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

    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 ...

  9. 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.)

  10. Epidural anaesthesia with levobupivacaine and ropivacaine : effects of age on the pharmacokinetics, neural blockade and haemodynamics

    NARCIS (Netherlands)

    Simon, Mischa J.G.

    2006-01-01

    Epidural neural blockade results from processes after the administration of a local anaesthetic in the epidural space until the uptake in neural tissue. The pharmacokinetics, neural blockade and haemodynamics after epidural anaesthesia may be influenced by several factors, with age as the most impor

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. Cerebrospinal fluid drainage through the diploic and spinal epidural veins.

    Science.gov (United States)

    Tsutsumi, Satoshi; Ogino, Ikuko; Miyajima, Masakazu; Ito, Masanori; Arai, Hajime; Yasumoto, Yukimasa

    2015-09-01

    The aim of this study was to quantitatively evaluate the function of the cranial diploic and spinal epidural veins as cerebrospinal fluid (CSF) drainage pathways by measuring lipocalin-type prostaglandin D synthase (PGDS) and cystatin C (CysC) dissolved in the blood of these veins. This was a prospective study involving 51 consecutive patients, 31 males and 20 females, who underwent 41 cranial and 10 spinal surgeries. Intraoperatively, peripheral venous blood and diploic venous blood, or peripheral venous blood and spinal epidural venous blood samples were simultaneously collected and immediately centrifuged. For all samples, dissolved albumin (for reference), PGDS and CysC were measured using an enzyme-linked immunosorbent assay. The diploic vein/peripheral vein ratios in five cranial locations and epidural vein/peripheral vein ratios were calculated and statistically evaluated for the three biomarkers. For PGDS, the diploic vein/peripheral vein ratio was significantly increased in the frontal (P = 0.011), temporal (P = 0.028), parietal (P = 0.046) and skull base (P = 0.039), while it did not reach statistical significance for CysC. For patients older than 45 years, the diploic vein/peripheral vein ratio for PGDS was significantly decreased in the frontal region (P = 0.028), and the epidural vein/peripheral vein ratio for CysC was significantly decreased (P = 0.014). These results show that the diploic veins constitute CSF drainage pathways with heterogeneous functional intensity at different cranial locations. Compared with the diploic veins, spinal epidural veins seem to drain less CSF. The cranial diploic and spinal epidural veins may jointly function as an alternative, age-related trans-dural CSF drainage system. PMID:26184099

  19. 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.)

  20. Spontaneous Rapid Resolution of Acute Epidural Hematoma in Childhood

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    Ismail Gülşen

    2013-01-01

    Full Text Available Acute epidural hematoma is a critical emergency all around the world, and its aggressive diagnosis and treatment are of vital importance. Emergent surgical evacuation of the hematoma is known as standard management; however, conservative procedures are also used for small ones. Spontaneous rapid resolution of these hematomas has also been reported in eight pediatric cases. Various theories have been proposed to explain the underlying pathophysiology of this resolution. Herein, we are reporting a new pediatric case with spontaneously resolving acute epidural hematoma 12 hours after admission to the emergency room.

  1. 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.)

  2. 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 ...

  3. 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

  4. Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section.

    Science.gov (United States)

    Goel, Shubhra; Burkat, Cat Nguyen

    2011-01-01

    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.

  5. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

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    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.

  6. Intravenous analgesia with opioids versus femoral nerve block with 0.2% ropivacaine as preemptive analgesic for fracture femur: A randomized comparative study

    Science.gov (United States)

    Singh, Arvinder Pal; Kohli, Vaneet; Bajwa, Sukhminder Jit Singh

    2016-01-01

    Background and Objective: Femoral fractures are extremely painful and pain invariably worsens on any movement. Anesthesia for fracture femur surgery is usually provided by spinal block. This study was undertaken to compare the analgesic effects of femoral nerve block (FNB) using nerve stimulator with 0.2% ropivacaine (15 ml) and intravenous (I.V.) fentanyl before patient positioning for fracture femur surgery under spinal anesthesia. Materials and Methods: A prospective, randomized, double-blind, comparative study was conducted on 60 American Society of Anesthesiologists I and II patients (18–60 years) scheduled for femur surgery under combined spinal epidural anesthesia. Patients in Group I (n = 30), were administered FNB using nerve stimulator with 0.2% ropivacaine (15 ml) and in Group II patients (n = 30), I.V. fentanyl 0.5 μg/kg was given as preemptive analgesia. Parameters observed included time to spinal anesthesia, intra-operative and postoperative visual analog scale (VAS) for any pain and postoperative epidural top-ups dosages. Results: Demographic profile was comparable in both the groups. VAS at 2 min in Group I was 5.63 and in Group II it was 8.00. Satisfaction score was better in Group I as compared to Group II patients. Time to administer subarachnoid block was 17.80 min in patients of Group I as compared to 25.03 min in Group II patients. Postoperatively, VAS scores were lower in Group I than Group II patients. The frequency of epidural top-ups was higher in Group II than in Group I patients. Conclusions: FNB is comparatively better in comparison to I.V. fentanyl when used as preemptive and postoperative analgesic in patients being operated for fracture femur. PMID:27212771

  7. 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...

  8. 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.

  9. Epidural hematoma after ventriculoperitoneal shunt surgery: report of two cases

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    PEREIRA CARLOS UMBERTO

    1998-01-01

    Full Text Available Ventriculoperitoneal shunt operations represent the most used choice for treating hydrocephalus, although some related complications have been reported. Due to its rarity, potential dangers, and mortality rate, we present two cases of epidural hematoma following ventriculoperitoneal shunt, discussing its pathophysiology and prophylaxis.

  10. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    International Nuclear Information System (INIS)

    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  11. Multiple remote epidural hematomas following pineal gland tumor resection

    OpenAIRE

    Jeong-Wook Lim; Seung-Hwan Yang; Jong-Soo Lee; Shi-Hun Song

    2010-01-01

    In cases of pineal tumor combined with obstructive hydrocephalus, preoperative ventriculostomy or ventriculoperitoneal shunting is typically required prior to tumor resection. The objectives of preoperative ventriculostomy are gradual reduction of intracranial pressure and consequent preoperative brain protection. Here we report a case of pineal tumor resection with preoperative ventriculostomy that was complicated by multiple epidural hematomas. While postoperative intracranial hemorrhage ma...

  12. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Han, Moon Hee; Kim, Hyun Beom [College of Medicine, Seoul National University, Seoul (Korea, Republic of)] [and others

    2000-01-01

    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  13. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes

    Science.gov (United States)

    Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Said, Imed Ben; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh

    2016-01-01

    Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated.

  14. Spinal epidural angiolipomas: Clinical characteristics, management and outcomes

    Science.gov (United States)

    Bouali, Sofiene; Maatar, Nidhal; Bouhoula, Asma; Abderrahmen, Khansa; Said, Imed Ben; Boubaker, Adnen; Kallel, Jalel; Jemel, Hafedh

    2016-01-01

    Purpose: The spinal epidural angiolipomas are rare expansive processes made of mature lipomatous and angiomatous elements. They often have a benign character. Their etiology, pathogenesis remains uncertain, and it is a cause of spinal cord compression. The magnetic resonance imaging is the most important neuroradiological examination. Histological examination is the only examination to confirm the diagnosis. Surgery is the treatment of choice. Methods: A retrospective study of all patients operated on for a spinal epidural angiolipoma at the Department of Neurosurgery at the National Institute of Neurology of Tunis between January 2000 and December 2014 (15 years) was performed. The aim of this study is to describe the clinical, radiological, histological characteristics and the treatment of this tumor. Results: A total of nine patients were operated from January 01, 2000 to November 30, 2014. The average age of our patients was 51 years with ages that ranged from 29 to 65 with a male predominance. The period between onset of symptoms and diagnosis ranged from 24 months with an average 12 months. Posterior localization of the tumor was seen in all patients. Surgical resection was performed for all cases. The postoperative course has been satisfactory, with a complete recovery of neurological functions in all patients. Conclusions: The spinal epidural angiolipomas is rare expansive process causing spinal cord compression. Treatment is exclusively surgical resection. The functional outcome of spinal epidural angiolipomas is particularly favorable with a complete neurological recovery is if the patient was quickly operated. PMID:27695535

  15. Evaluation of a single-dose, extended-release epidural morphine formulation for pain control after lumbar spine surgery.

    Science.gov (United States)

    Vineyard, Joseph C; Toohey, John S; Neidre, Arvo; Fogel, Guy; Joyner, Robert

    2014-01-01

    DepoDur, an extended-release epidural morphine, has been used effectively for postoperative pain control following many orthopaedic and general surgery procedures and has provided prolonged analgesia when compared with Duramorph. The goal of this article was to compare the safety and analgesic efficacy of DepoDur versus Duramorph after lumbar spine surgery. A prospective, randomized, double-blind clinical study was completed at a single extended-stay ambulatory surgery center. All patients over 18 undergoing posterior lumbar spine fusions were considered for the study. Sixty patients were randomly assigned to a control or treatment group. The control group received DepoDur before surgery, while the treatment group received Duramorph. Although results show no significant differences between the two groups in postoperative visual analog pain scale scores, use of pain medication, and adverse events, subjects receiving DepoDur were less likely to receive Naloxone and oxygen supplementation, experience nausea or fever, and were more likely to experience hypotension. DepoDur proved to be safe and effective, offering similar prolonged analgesic activity when compared with Duramorph.

  16. Using Computed Tomography Scans and Patient Demographic Data to Estimate Thoracic Epidural Space Depth

    Directory of Open Access Journals (Sweden)

    Alyssa Kosturakis

    2015-01-01

    Full Text Available Background and Objectives. Previous studies have used varying methods to estimate the depth of the epidural space prior to placement of an epidural catheter. We aim to use computed tomography scans, patient demographics, and vertebral level to estimate the depth of the loss of resistance for placement of thoracic epidural catheters. Methods. The records of consecutive patients who received a thoracic epidural catheter were reviewed. Patient demographics, epidural placement site, and technique were collected. Preoperative computed tomography scans were reviewed to measure the skin to epidural space distance. Linear regression was used for a multivariate analysis. Results. The records of 218 patients were reviewed. The mean loss of resistance measurement was significantly larger than the mean computed tomography epidural space depth measurement by 0.79 cm (p<0.001. Our final multivariate model, adjusted for demographic and epidural technique, showed a positive correlation between the loss of resistance and the computed tomography epidural space depth measurement (R2=0.5692, p<0.0001. Conclusions. The measured loss of resistance is positively correlated with the computed tomography epidural space depth measurement and patient demographics. For patients undergoing thoracic or abdominal surgery, estimating the loss of resistance can be a valuable tool.

  17. MR epidurography: distribution of injectate at caudal epidural injection

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Darra T. [Cappagh National Orthopedic Hospital, Dublin 11 (Ireland); St Paul' s Hospital, Department of Radiology, Vancouver, BC (Canada); Kavanagh, Eoin C.; Moynagh, Michael R.; Eustace, Stephen [Cappagh National Orthopedic Hospital, Dublin 11 (Ireland); Mater Misericordiae University Hospital, Dublin 7 (Ireland); Poynton, Ashley; Chan, Vikki O. [Cappagh National Orthopedic Hospital, Dublin 11 (Ireland)

    2014-08-02

    To (a) evaluate the feasibility of MR epidurography (MRE) and (b) assess the distribution of injectate using two different volumes at caudal epidural steroid injection. Twenty patients who were referred with symptomatic low back pain for caudal epidural steroid injection were assigned to have either 10 ml (9/20) or 20 ml (11/20) of injectate administered. Gadolinium was included in the injection. The patients proceeded to MRI where sagittal and coronal T1-weighted fat-saturated sequences were acquired and reviewed in the mid-sagittal and right and left parasagittal views at the level of the exit foramina. Gadolinium was observed at or above the L3/4 disc level in all 11 patients who received 20 ml (100 %), compared with only five of nine patients who received 10 ml (56 %). Injectate was seen to the L4 nerve root level in all 11 patients who received 20 ml (100 %) but only four out of nine patients who received 10 ml (44 %), not even reaching the L5 nerve root level in four further of these nine patients (44 %). Overall, there was a trend to visualize gadolinium at higher levels of the epidural space with higher volumes injected. Firstly, MR epidurography is a safe technique that allows excellent visualization of the distribution of gadolinium in the epidural space following injection via the caudal hiatus. Secondly, a volume of 10 ml is unlikely to treat L5/S1 disease in almost half of patients at caudal epidural steroid injection and at least 20 ml of injectate is likely required for any medication to reach the desired level. (orig.)

  18. Evaluation with CT scans of gas collection in the epidural space. Evaluacion mediante TC de colecciones de gas en el espacio epidural

    Energy Technology Data Exchange (ETDEWEB)

    Rebolledo Vicente, J.; Martinez San Millan, J.; Trujillo Peco, M.; Aunion Diaz, P.; Millan Juncos, J.M. (Hospital Ramon y Cajal. Departamento de Radiodiagnostico. Madrid (Spain))

    1993-01-01

    We present 9 cases of gas collection in the epidural space, revealed in CT scans of the spinal column. Five cases of herniated disc with accompanying vacuum, three of ''aerogen pseudocyst'' and a case of gas introduced iatrogenically via epidural installation catheter are included. (Author)

  19. Sedação e analgesia em colonoscopia eletiva: propofol-fentanil versus propofol-alfentanil

    Directory of Open Access Journals (Sweden)

    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 colonoscopia.

  20. 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...

  1. 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

    Directory of Open Access Journals (Sweden)

    Neuber Martins Fonseca

    2003-04-01

    Full Text Available 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 75 anos, distribuídos em 2 grupos (M e BPL. Foi realizada anestesia subaracnóidea em todos os pacientes, em L3-L4 ou L4-L5, com 20 mg de bupivacaína isobárica a 0,5%. No grupo M (n = 20 foi associado 50 µg de morfina ao anestésico local. No grupo BPL (n = 20 foi realizado o bloqueio 3 em 1 ao término da cirurgia, utilizando 200 mg de ropivacaína a 0,5%. Avaliou-se a analgesia e a intensidade da dor às 4, 8, 12, 14, 16, 20 e 24 horas após o término da cirurgia, o nível do bloqueio subaracnóideo, o tempo cirúrgico e as complicações. RESULTADOS: A duração da analgesia no grupo BPL foi de 13,1 ± 2,47, enquanto no grupo M todos os pacientes referiam dor e ausência de bloqueio motor no primeiro instante avaliado (4 horas. Houve falha do bloqueio de um dos 3 nervos em 3 pacientes. A incidência de náusea e prurido foi significativamente maior no grupo M. Quanto à retenção urinária, não houve diferença significante entre os grupos. Não houve depressão respiratória, hipotensão arterial ou bradicardia. A analgesia pós-operatória foi mais efetiva no grupo BPL, comparada ao grupo M às 4, 8, 12,14 e 16 horas. Às 20 e 24 horas não houve diferença significante entre os grupos. CONCLUSÕES: A analgesia pós-operatória proporcionada pelo bloqueio 3 em 1 apresentou efeitos colaterais inferiores à morfina subaracnóidea com tempo de analgesia semelhante.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar por el acceso

  2. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Aydingoez, Ue.; Oto, A.; Cila, A. [Department of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)

    1997-12-01

    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.) With 3 figs., 6 refs.

  3. Fluoroscope guided epidural needle insertioin in midthoracic region: clinical evaluation of Nagaro's method

    OpenAIRE

    Kim, Won Joong; Kim, Tae Hwa; Shin, Hwa Yong; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol; Kim, Jin Yun; Koo, Gill Hoi; Park, Sun Gyoo

    2012-01-01

    Background In the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region. Methods Twenty four patients were scheduled to receive an epidural block at the T6-7 intervertebral space. The patients were plac...

  4. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

    OpenAIRE

    Shubhra Goel; Cat Nguyen Burkat

    2011-01-01

    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 des...

  5. 右美托咪定和可乐定硬膜外给药对硬膜外罗哌卡因麻醉效果的影响%The influence of epidural dexmedetomidine and clonidine on ropivacaine epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    裘学; 张兆平; 房宁宁; 顾美蓉; 姚敏; 孙国华

    2013-01-01

    Objective The aim of this study was to evaluate the efficacy of epidural dexmedetomidine (Dex) and clonidine on ropivacaine epidural anesthesia.Methods Seventy-five patients ASA Ⅰ or Ⅱ,aged 55 y-65 y,scheduled for elective vaginal hysterectomy under epidural anesthesia with ropivacaine were randomly allocated into three groups:patients in group RD were administered 15 ml of 0.75% epidural ropivacaine and 100 μg of Dex,while group RC received admixture of 15 ml of 0.75%ropivacaine and 100 μg of clonidine,and group C received 15 ml of 0.75% ropivacaine and saline.Results The patient in group RD exhibited an earlier onset of sensory analgesia at T10 [(8.5±2.4) min] as compared to group RC and group C [(10.4±3.4) min and (12.7±4.3) min].Dex not only provided a higher dermatomal spread but also helped in achieving the maximum sensory anaesthetic level in a shorter period [(13±4) min compared to clonidine (15±4) min and (18±4) min].Bromage scale 3 was achieved earlier in group RD [(18±5) min] than in group RC and group C [(21±4) min and (24±4) min,P<0.05].Less tramadol consumed in group RD [(87±17) mg] than that in group RC and in group C [(101±21) min and (146±19) mg,P<0.01] for postoperative analgesia of 24 h(P<0.05).Sedation scores in group RD and group RC were better than in group C(P<0.05).The incidence of shivering was lower in group RD and group RC than that in group C (P<0.05).Respiratory depression was not observed in each group.Conclusions Epidural Dex may reinforce the effect of epidural anaesthesia with ropivacaine and analgesia.Dex is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia,stable cardio-respiratory parameters and a prolonged post-operative analgesia.%目的 比较右美托咪定(dexmedetomidine,Dex)和可乐定硬膜外给药对罗哌卡因阻滞效果的影响. 方法 全组75例患者美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄55岁~65岁,拟行阴式

  6. Psychophysical testing of spatial and temporal dimensions of endogenous analgesia: conditioned pain modulation and offset analgesia.

    Science.gov (United States)

    Honigman, Liat; Yarnitsky, David; Sprecher, Elliot; Weissman-Fogel, Irit

    2013-08-01

    The endogenous analgesia (EA) system is psychophysically evaluated using various paradigms, including conditioned pain modulation (CPM) an