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Sample records for analgesia epidural sobre

  1. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. Question: How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? Methods: A field study and semi......-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......: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers...

  2. Epidural Analgesia in the Postoperative Period

    Science.gov (United States)

    2001-10-01

    epidurally. They are opiods and local anesthetics. The pharmacokinetics and pharmacodynamics of each class are different, and they may act...overall pharmacodynamics of the drug. Epidural Opioids Brown (2000) states that opioids are one class of drug that may be used for epidural analgesia...morphine with lidocaine or bupivacaine with the effects of these medications when administered alone in mice. They used various tests to measure

  3. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    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.

  4. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

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

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

    Science.gov (United States)

    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.

  6. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  7. 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

  8. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural...

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

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from...... the epidural to the birth, and the relationship to the midwife. Place of origin: The labor ward, Aalborg Sygehus Nord, Aalborg. The homes of the women. Method: Field study and interviews. Nine women were observed from the establishment of the epidural until birth. They were interviewed the day after the birth...

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

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    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 interm

  11. 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.

  12. Epidural analgesia in cattle, buffalo, and camels.

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-12-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  13. Epidural analgesia in cattle, buffalo, and camels

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-01-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed. PMID:28096620

  14. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

    Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  17. Hands-and-knees positioning during labor with epidural analgesia.

    Science.gov (United States)

    Stremler, Robyn; Halpern, Stephen; Weston, Julie; Yee, Jennifer; Hodnett, Ellen

    2009-01-01

    Hands-and-knees position has shown promise as an intervention to improve labor and birth outcomes, but no reports exist that examine its use with women laboring with epidural analgesia. Concerns of safety, effects on analgesia, and acceptability of use may limit use of active positioning during labor with regional analgesia. This article presents a case study series of 13 women who used hands-and-knees position in the first stage of labor.

  18. 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 .

  19. 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...

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    Freeman Liv M

    2012-07-01

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

  2. Labor analgesia: An update on the effect of epidural analgesia on labor outcome

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    Samina Ismail

    2013-01-01

    Full Text Available Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS. There is no ideal study on the effect of epidural analgesia (EA on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

  3. EPIDURAL ANALGESIA DURING LABOR Analgesia epidural para el trabajo de parto

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    Juan Carlos Zafra Pedone

    2008-12-01

    Full Text Available Introduction: The labor pain affect to all pregnant woman and it has biochemical and physiological changes that affect to mother and fetus and interact with your normal evolution. Currently there are analgesic techniques to less effectively labor pain, to provide a high satisfaction level and supply clinical and laboratory beneficial outcomes. In own context these techniques are very low used. Objective: To describe the use of epidural analgesic procedures in a pregnancy woman group during labor at the Universitarian Hospital San Jose – Popayan, Colombia. Materials and methods: Case series design. We recollected information of patients from Obstetric service during two months of 2006. The patient’s information was recollected from medical history with an instrument that content variables related with the analgesic technique and labor. The analyses were performed using descriptive statistics Results: 41 pregnant woman with a mean age of 23,4 were included. 65,9% were nulliparous and 85,4% were term pregnancy. At the moment of dural puncture the dilation and EVA pain scale mode was 6 and 8 respectively. The latency mean was 14,1 minutes. 95,1% were require a booster applied in a mean of 80 minutes and 61% were required a second booster applied in a mean of 49 min after that. The way of termination of pregnancy was vaginal predominantly. Conclusions: The results of this study are congruent to reporting in the world literature. These conclusions support the effectiveness of epidural analgesia and its favorable benefit/risk relation to the control of labor pain. Introducción: El dolor asociado con el trabajo de parto afecta a todas las pacientes e involucra alteraciones que afectan a la madre y al feto e interactúan interfiriendo con su evolución normal. Actualmente disponemos de alternativas analgésicas peridurales que han demostrado controlar en forma efectiva el dolor, proporcionar un alto grado de satisfacción de las pacientes y proveer

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

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W. M.; Franssen, Maureen T. M.; Papatsonis, Dimitri N. M.; Hajenius, Petra J.; van Huizen, Marloes E.; Bremer, Henk A.; van den Akker, Eline S. A.; Woiski, Mallory D.; Porath, Martina M.; van Beek, Erik; Schuitemaker, Nico; van der Salm, Paulien C. M.; Fong, Bianca F.; Radder, Celine; Bax, Caroline J.; Sikkema, Marko; van den Akker-van Marle, M. Elske; van Lith, Jan M. M.; Lopriore, Enrico; Uildriks, Renske J.; Struys, Michel M. R. F.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2012-01-01

    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 res

  5. 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.

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

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk;

    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...

  7. Update on epidural analgesia during labor and delivery.

    Science.gov (United States)

    Lurie, S; Priscu, V

    1993-05-01

    Properly administered epidural analgesia provides adequate pain relief during labor and delivery, shortens the first stage of labor, avoids adverse effects of narcotics, hypnotics, or inhalation drugs and it could be used as anesthesia in case a cesarean section is required. Epidural analgesia should be provided to all patients who need and ask for it with an exception of contraindications such as coagulation disorders, suspected infection or gross anatomic abnormality. The technique must be carried out with care if serious life-threatening complications, such as intravenous or intrathecal injection of local anesthetic, are to be avoided. The aim of many recent investigations has been to reduce the total dose of local anesthetic used. Supplementation of an opioid (mainly fentanyl) and introduction of the patient controlled epidural pump may not only serve this goal, but also reduce the demands on the time of obstetric anesthetists. We conclude that properly and skillfully administered epidural is the best form of pain relief during labor and delivery and we hope that more mothers could enjoy its benefits.

  8. 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.

  9. 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...

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

    DEFF Research Database (Denmark)

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

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... for 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...

  11. [High thoracic epidural analgesia in the postoperative period after correction of congenital heart defects in children].

    Science.gov (United States)

    Slin'ko, S K

    1999-01-01

    The effects and side effects of thoracic epidural analgesia on the respiratory response, awakening time, and cooperation with nurses were studied. Forty children received epidural analgesia after open-heart surgery. Lidocaine was injected in a dose of 1.5-2 mg/kg every 1.5-2 h. Controls (16 pts) received intravenous fentanyl + diazepam analgesia. Respiratory response and awakening were significantly earlier (p < 0.001) in the epidural group. Cooperation with nurses was much better in this group, too. No side effects were observed in the epidural group. Therefore, thoracic epidural analgesia is a safe and effective method of postoperative analgesia for children subjected to open-heart surgery.

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

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    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

  13. 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...

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

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    Akanksha Lamba

    2016-06-01

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

  15. [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.

  16. [Epidural anesthesia and analgesia in the perioperative treatment of a patient with Kartagener syndrome].

    Science.gov (United States)

    Errando, C L; Sifre, C; López-Alarcón, D

    1998-12-01

    Kartagener's syndrome is an inherited disease characterized by a triad of symptoms--bronchiectasis, situs inversus and sinusitis--and is classified as an immotile cilia syndrome. Patients may experience specific airway problems when undergoing anesthesia for surgical procedures. We report the case of a woman with Kartagener's syndrome who underwent surgery under epidural anesthesia with postoperative epidural analgesia, both techniques proving successful.

  17. 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

  18. Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia

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    Vivian P. Kamphuis

    2015-01-01

    Full Text Available We describe the case of a 32-year-old woman who developed bilateral heel numbness after obstetric epidural analgesia. We diagnosed her with bilateral neuropathy of the medial calcaneal nerve, most likely due to longstanding pressure on both heels. Risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy. Padded footrests decrease pressure and can possibly prevent this neuropathy.

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

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    Nagesh

    2015-02-01

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

  20. A COMPARISON OF ANALGESIA AND FOETAL OUTCOME IN TERM PARTURIENTS WITH AND WITHOUT LOW DOSE COMBINED SPINAL EPIDURAL LABOUR ANALGESIA

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    Manjunath

    2015-11-01

    Full Text Available : STUDY OBJECTIVE: We aimed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus using combined ‘low dose’ spinal and epidural (CSE. DESIGN: prospective case control study. SETTING: Labour suite of a tertiary care hospital. PATIENTS: study population included 120 pregnant women of ASA physical status I and II parturients in active labor who requested analgesia, 60 of these patients were given labour analgesia - ‘GROUP T’ and 60 of who underwent a delivery without labour analgesia -‘GROUP C’. MEASUREMENTS AND MAIN RESULTS: Maternal hemodynamics, degree of pain relief, duration of labour, fetal heart rate, Apgar scores, mode of delivery, intervention to relieve pain, Adverse effects because of procedure and drugs used were also noted. Low dose epidural analgesia does not prolong labour and does not increase the incidence of instrumental deliveries when compared to parturients undergoing delivery without labour analgesia. Even with the reduced dose of fentanyl the parturients had acceptable pain relief and a decreased incidence of intervention for pain. It does not cause more fetal depression when compared to normally laboring term parturients. ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome. CONCLUSION: ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome.

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

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    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.

  2. 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;

    , 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......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...... 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...

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

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    Omid Azari

    2014-02-01

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

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers.

    Science.gov (United States)

    Collis, R E; Baxandall, M L; Srikantharajah, I D; Edge, G; Kadim, M Y; Morgan, B M

    1994-04-01

    Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). The initial dose was given into the subarachnoid space and analgesia maintained via an epidural catheter. A subarachnoid injection of 2.5 mg bupivacaine and 25 mug fentanyl was successfully given in 268 women (89.3%). Completely pain-free contractions within 3 min of this injection occurred in 195 women (65%) and in all 300 within 20 min and there was no associated motor block in 291 (97%). 141 women chose to stand, walk or sit in a rocking chair at some time during labour. Only 38 women (12.6%) were immobile during the first stage of labour. Analgesia was maintained via the epidural catheter with bolus doses of 10-15 ml of 0.1% bupivacaine and 0.0002% fentanyl. The mean bupivacaine requirement was 9.5 mg/h throughout the entire duration of analgesia. The incidence of post lumbar puncture headache was 2.3%. Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.

  9. Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

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    Rafael DeRossi

    2012-02-01

    Full Text Available PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1 ketamine (KE; 2.5 mg/kg, (2 magnesium sulphate (MG; 100 mg, and (3 KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD, that is, more than twice that obtained with KE (41 ± 7 min or MG (29 ± 5 min alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1 quetamina (KE; 2,5 mg/kg, (2 sulfato de magnésio (MG; 100 mg e (3 KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente. As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal e depois da administra

  10. 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

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

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne;

    2005-01-01

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

  12. Effect of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on maternal lactation

    Institute of Scientific and Technical Information of China (English)

    Hu Feng; Bao-Xia Chen; Xi Ren; Hong-Xia Zhu

    2016-01-01

    Objective:To observe the effect of application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on the lactation and neonates.Methods:The puerpera who were underwent cesarean section with different analgesia methods were observed. The included puerpera were performed with the cesarean section under combined spinal epidural anesthesia. A total of 30 puerpera who were given ropivacaine in combined with sufentanil epidural analgesia after operation were served as the observation group, while 30 cases who were intermittently given intramuscular injection of pethidine after operation were served as the control group. The postpartum analgesic effects in the two groups were observed. The radioimmunoassay was used to detect the plasma PRL level. The postpartum colostrum time, 24 h lactation number, and NBNA scores in the two groups were compared.Results:The postoperative VAS score in the observation group was significantly lower than that in the control group (P<0.05), while the plasma PRL level was significantly higher than that in the control group (P<0.05). The postoperative colostrum time in the observation group was significantly earlier than that in the control group (P<0.05), while the lactation number was significantly greater than that in the control group (P<0.05).Conclusions:Application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section can effectively alleviate the postoperative pain, and improve the lactation, with no obvious adverse reactions on the neonates and reliable effects.

  13. 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...

  14. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    1996-01-01

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine 0.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 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.

  17. 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

  18. Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

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    Marcelo Soares Privado

    Full Text Available CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING: A randomized double-blind study was performed in Hospital São Paulo. METHODS: During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14 received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15 received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS: The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4% than in group 2 (100%: 95% confidence interval (CI = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07. Epidural bupivacaine supplementation was also lower in group 1 (14.3% than in group 2 (53.3%: 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26. There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups. CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used. CLINICAL TRIAL REGISTRATION NUMBER: NCT00635986

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

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    Kalpana S Vora

    2012-01-01

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

  20. Comparison of Interpleural and Thoracic Epidural Bupivacaine with Buprenorphine for Post-Thoracotomy Analgesia

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    S K Mathur

    2008-01-01

    Full Text Available The study was designed to compare the efficacy of interpleural and thoracic epidural analgesia after thorac-otomy with regard to quality of analgesia and complications. Sixty patients undergoing elective thoracotomy were randomly and equally placed into either interpleural (IP or thoracic epidural (TE group. In IP group an interpleural catheter was placed in paravertebral space under direct vision during surgery and received 0.25% bupivacaine 20 ml with buprenorphine 150 mcg. In TE group an epidural catheter was inserted in the T6-7 / T7-8 interspace and received 0.25% bupivacaine 10 ml with buprenorphine 150 mcg. Dosage were repeated in both the groups to keep a VAS score < 40 for 48 hours post-operatively. Spirometry was done preoperatively and 12, 24 and 36 hours post-opera-tively. Vital parameters were monitored for 48 hours. The mean analgesia time was 331.73±94.03 min and 567.33±127.33 min in IP and TE groups respectively. The VAS score was significantly reduced within the first 30 minutes of injection in both the groups. Post injection VAS was significantly better in TE group. Mean time taken for interpleural and epidural catheter placement was 5.0±0.0 min and 33.83±3.39 min respectively. Postoperative forced expiratory volume in 1 second(FEV1, forced vital capacity (FVC and forced expiratory ratio (FER were similar in both the groups while peak expiratory flow rate (PEFR, maximal expiratory flow (MEF and F50 were slightly better in TE group. Vital parameters showed similar changes in both the groups. The TE group had more complications. Interpleural analgesia, though of shorter duration, is a safe and effective alternative technique for post-thoracotomy analgesia and has a low complication rate.

  1. 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

  2. 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.

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    Jamil S Anwari

    2015-01-01

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

  5. [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.

  6. 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.

  7. 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.

  8. 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.

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

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    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.

  10. 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

    Directory of Open Access Journals (Sweden)

    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

  11. PROSPECTIVE RANDOMISED CONTROL STUDY OF POST OP EPIDURAL ANALGESIA WITH BUPIVACAINE AND FENTANYL VS. BUPIVACAINE AND CLONIDINE

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    Rachana

    2014-07-01

    Full Text Available The aim of the study was to compare the relative potencies and clinical characteristics of epidural Clonidine and Fentanyl with Bupivacaine in lower limb and lower abdominal surgeries using patient-controlled analgesia. In a randomised double-blinded study, 60 ASA I or II patients requiring epidural analgesia for post- operative pain relief were allocated to receive either 0.125% Bupivacaine with Clonidine 1µg/kg or 0.125% Bupivacaine with Fentanyl 1µg/kg via a sterile syringe by trained anaesthesiologists. Analgesia was established with 10-15 ml bolus of study solution. There were significant differences in onset time, duration and quality of analgesia, local anaesthetic consumption, between the two groups. We conclude that 0.125% Bupivacaine with Clonidine 1µg/kg group of patients clinically had better quality of analgesia and for a longer duration in comparison with patients receiving 0.125% Bupivacaine with Fentanyl 1µg/kg.

  12. 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.

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

    OpenAIRE

    M. I. Segado-Jiménez; J. Arias-Delgado; F. Domínguez-Hervella; M. L. Casas-García; A. López-Pérez; C. Izquierdo-Gutiérrez

    2011-01-01

    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 duran...

  14. 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

    OpenAIRE

    Calvo, M.; Gilsanz, F; Palacio, F.; I. Fornet; N. Arce

    2005-01-01

    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 suj...

  15. 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...

  16. Thoracic epidural analgesia in a child with multiple traumatic rib fractures.

    Science.gov (United States)

    Keech, Brian M

    2015-12-01

    The morbidity and mortality associated with blunt thoracic trauma are significant and can be multisystem in nature. Of these, pulmonary complications, including ventilatory impairment secondary to pain, have been recognized to be the most consequential. Although several analgesic strategies have emerged, thoracic epidural analgesia (TEA) has arguably demonstrated superior efficacy and is used frequently in adults. Unfortunately, TEA is rarely used in children after blunt thoracic trauma, but may be of considerable benefit. This low rate of use likely reflects one or more of several factors potentially encountered when considering the use of TEA in pediatric chest wall trauma. Among them are (1) uncertainty regarding safety and efficacy; (2) the technical challenges of pediatric thoracic epidural placement, including technique and equipment concerns; and (3) drug selection, dosing, and toxicity. The following case review describes the successful application of TEA in a 4-year-old boy after multiple traumatic rib fractures and associated pneumothorax and pulmonary contusion.

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

    Science.gov (United States)

    Azari, Omid; Molaei, Mohammad M; Ehsani, Amir H

    2014-02-27

    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 dromedary camels compared with the effect of administering lidocaine alone.

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

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    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

  19. 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.

  20. Analgesia epidural com clonidina ou romifidina em cães submetidos à cirurgia coxofemoral

    Directory of Open Access Journals (Sweden)

    Brondani J.T.

    2004-01-01

    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 horas

  1. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

    2013-12-15

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

  2. Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia Efeitos maternos e fetais da analgesia de parto pelas técnicas peridural e duplo bloqueio

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    Giane Nakamura

    2009-01-01

    Full Text Available OBJECTIVE: Epidural (EA and combined spinal-epidural (CSE techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. METHODS: Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group and 5 µg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group. Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS developed by Amiel-Tison. RESULTS: There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination. CONCLUSION: EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.OBJETIVO: A peridural (AP e a técnica de duplo bloqueio (DB são utilizadas em analgesia para o trabalho de parto. Este estudo comparou os efeitos na mãe e no feto de ambas as técnicas em analgesia e anestesia para o parto. MÉTODOS: Quarenta parturientes ASA I e II receberam por via peridural 15 ml de ropivacaína a 0,125% (grupo AP e 5 µg de sufentanil com 2,5 mg bupivacaína por via subaracnóidea (grupo DB. Foram avaliados: intensidade de dor, altura do bloqueio sensitivo, tempo de latência, bloqueio motor, duração da analgesia de parto, tempo

  3. 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

  4. 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.

  5. Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis

    Directory of Open Access Journals (Sweden)

    Siddiqui A

    2016-05-01

    Full Text Available Asad Siddiqui,1 Andrew Tse,2 James E Paul,3 Peter Fitzgerald,4 Bernice Teh,51Department of Anesthesia, University of Toronto, Toronto, 2Department of Anesthesia, University of Ottawa, Ottawa, 3Department of Anesthesia, 4Department of Surgery, McMaster University, Hamilton, Ontario, Canada; 5Canterbury Anesthetic Services, Victoria, Australia Introduction: Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children's hospital, in patients undergoing the Nuss procedure. Methods: Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12 received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21 received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39 received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10, with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or

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

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    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.

  7. A comparison of the postoperative analgesic efficacy between epidural and intravenous analgesia in major spine surgery: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Meng Y

    2017-02-01

    Full Text Available Yichen Meng,* Heng Jiang,* Chenglin Zhang,* Jianquan Zhao, Ce Wang, Rui Gao, Xuhui Zhou Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Postoperative analgesia remains a challenge for orthopedic surgeons. The aim of this meta-analysis is to compare the efficacy of epidural analgesia (EA and intravenous patient-controlled analgesia (IV-PCA following major spine surgery. We searched electronic databases, including the PubMed, EMBASE, Ovid and Cochrane databases, for randomized controlled trials (RCTs published before June 2016. The quality of the included trials was assessed using the Cochrane risk-of-bias tool. Random effects models were used to estimate the standardized mean differences (SMDs and relative risks (RRs, with the corresponding 95% confidence intervals (CI. Subgroup analyses stratified by the type of epidural-infused medication and epidural delivery were also performed. A total of 17 trials matched the inclusion criteria and were chosen for the following meta-analysis. Overall, EA provided significantly superior analgesia, higher patient satisfaction and decreased overall opioid consumption compared with IV-PCA following major spine surgery. Additionally, no differences were found in the side effects associated with these two methods of analgesia. Egger’s and Begg’s tests showed no significant publication bias. We suggest that EA is superior to IV-PCA for pain management after major spine surgery. More large-scale, high-quality trials are needed to verify these findings. Keywords: adolescent idiopathic scoliosis, lumbar fusion, epidural analgesia, intravenous application, perioperative pain

  8. Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis

    Science.gov (United States)

    Siddiqui, Asad; Tse, Andrew; Paul, James E; Fitzgerald, Peter; Teh, Bernice

    2016-01-01

    Introduction Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children’s hospital, in patients undergoing the Nuss procedure. Methods Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12) received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21) received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39) received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10), with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or logistic regression adjusted for pain scores at baseline. The criterion for statistical significance was set a priori at alpha =0.05. Results Group A had significantly higher day-1 pain scores (score 5.42/10) than Group B (4.52/10; P=0.030) and Group C (4.49/10; P=0.015) after adjusting for baseline pain and age. No significant difference in maximum daily

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

    DEFF Research Database (Denmark)

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

    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...

  10. 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....

  11. Analgesic efficacy using loss of resistance to air vs. saline in combined spinal epidural technique for labour analgesia.

    Science.gov (United States)

    Leo, S; Lim, Y; Sia, A T H

    2008-09-01

    Identification of the epidural space is often performed using the loss of resistance technique to either air or saline. We sought to investigate if the medium used affected the quality of analgesia obtained by parturients who received labour epidurals. We conducted a retrospective audit of labour epidurals performed on nulliparous parturients in our institution from May 2003 to March 2005. All epidural catheters were inserted by senior obstetric anaesthetists using a combined spinal epidural technique. The following information was recorded: parturients' demographic data, loss of resistance technique used, type and amount of local anaesthetic solution administered, complications encountered during procedure, pre-block and post-block pain scores, incidence of breakthrough pain requiring supplemental medication and post-block side-effects. Data from 2848 patients were collected and analysed; 56% of patients made up the saline group and 44% the air group. Patients in both groups had similar demographic profiles and similar incidences of complications and post-block side-effects. However patients in the air group had a higher incidence of recurrent breakthrough pain P = 0.023). We also identified three other factors that were associated with an increased incidence of recurrent breakthrough pain; administration of pre-block oxytocin, sitting position of the parturient during the procedure and the use of intrathecal bupivacaine for induction of analgesia. Our findings suggest that a loss of resistance to air is associated with a higher incidence of recurrent breakthrough pain among parturients who received combined spinal epidural analgesia for labour than a loss of resistance to saline.

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

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    M. I. Segado-Jiménez

    2011-10-01

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

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

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    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

  14. A CLINICAL COMPARISON OF COMPOUNDED SOLUTION (2% XYLOCAINE & 0.5% BUPIVACAINE WITH 0.5% BUPIVACAINE IN EPIDURAL ANALGESIA

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    Sathesha

    2014-09-01

    Full Text Available Epidural Analgesia is used for relief of pain during and following surgical operations, for relief of chronic pain, for relief of pain in labour, reduction of bleeding by producing sympathetic blockade and hypotension during surgery or to supplement light general anaesthesia, thereby suppressing the transmission of afferent impulses and autonomic and hormonal response to surgery. The commonly used drugs for epidural analgesia are 2% xylocaine and 0.5% bupivacaine. Mixing of the local anaesthetics and altering the pH have been found to be safe and cost effective.1,2 our study was a prospective randomized controlled double blind study to investigate effect of the benefits of usage of a compounded solution (2% xylocaine and 0.5% bupivacaine in a 1:1 ratio over a single drug (0.5% bupivacaine and ascertain whether it can be recommended for routine use in epidural analgesia in regular anaesthetic practice.3,4,5 The following parameters are Studied 1 The time of onset of analgesia. 2 The quality of analgesia. 3 The degree of motor blockade. 4 Duration of analgesia. 5 Safety of compounding local anaesthetics. METHODS AND MATERIAL: One Hundred Adult Patients of either sex ranging between 20-60 years of age belonging to ASA grade 1 and II were studied. All patients were at random divided into 2 groups fifty in each group. Group A received 0.5% bupivacaine 15cc. Group B received a mixture of 0.5% bupivacine and 2% xylocaine (7.5cc + 7.5cc RESULTS: Mean time of onset of analgesia in group B was lower (11.50 + 2.05 as compared to group A (22.24 + 2.18 and this difference was statistically highly significant (P<0.001. 16% of group A and 6% of group B required to be changed over to general anaesthesia. Grade IV motor blockade was seen only in 24% of group A and 30% of the group B which is significant. Mean duration of action in group A was higher (128.90 + 6.70 than in group B (98.30 + 5.29 and this difference was statistically significant. CONCLUSIONS: The

  15. [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.

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

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    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.

  17. Effects of labor analgesia on maternal and neonatal outcome by epidural low concentration of bupivacaine combined with anisodamine

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar's score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was in...

  18. 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

  19. A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

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    P K Dilesh

    2014-01-01

    Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.

  20. Single dose oral clonidine premedication does not enhance postoperative, single low dose epidural morphine analgesia in hysterectomy patients.

    Science.gov (United States)

    Oofuvong, Maliwan; Chanvej, Laksamee; Thongsuksai, Paramee

    2005-03-01

    In this randomized, double blind placebo controlled study, the authors evaluated the effects of oral clonidine premedication on very low dose epidural morphine analgesia in 50 hysterectomy patients. Patients were randomized to receive a single oral clonidine 300 microg (n = 25) or a placebo (n = 25) 90 minutes before insertion of the epidural catheter. 3 ml of 2% lidocaine with adrenaline (5 microg ml(-1) mixed with 2 mg morphine were injected via epidural, followed by an additional volume of 2% lidocaine with adrenaline (5 microg ml(-1)) titrated to T6 block height before commencing general anesthesia. The postoperative analgesia regimen was 2 mg of intravenous morphine every 10 minutes for the first 48 hr and 1 gm of oral acetaminophen every 4-6 hr after initiation of oral diet at 24-48 hr as required. Morphine consumption, acetaminophen, pain scores, and side effects were recorded thoughout 48 hr after surgery. The results show patients in the clonidine and placebo groups were not different in terms of local anesthetics dose (p = 0.27), total morphine and acetaminophen requirement (p = 0.34, p = 0.1) respectively. Pain scores at rest and movement were also not different in both groups (p = 0.83, p = 0.64) respectively. No serious adverse effects were noted. The authors concluded that oral clonidine approximately 6 microg kg(-1) does not enhance the analgesic effect of epidural morphine 2 mg after hysterectomy.

  1. 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.

  2. Analgesia peridural para o trabalho de parto e para o parto: efeitos da adição de um opióide Effects of the association of an opioid with epidural analgesia for labor and delivery

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    José Guilherme Cecatti

    1998-07-01

    Full Text Available O objetivo deste estudo foi avaliar a eficácia e segurança da associação bupivacaína com sufentanil para a analgesia no trabalho de parto e do parto por meio de um bloqueio peridural contínuo. Realizou-se um ensaio clínico duplo-cego, prospectivo e aleatório, incluindo sessenta mulheres nulíparas da Maternidade do CAISM/UNICAMP. No momento da analgesia, as mulheres foram aleatoriamente alocadas em dois grupos: BS, recebendo 12,5 mg de bupivacaína com adrenalina mais 30 µg de sufentanil e BP, recebendo 12,5 mg de bupivacaína com adrenalina mais placebo. Foram avaliados os parâmetros relativos à qualidade e duração da analgesia, duração do trabalho de parto e também possíveis efeitos sobre o recém-nascido. Os resultados mostraram a superioridade da adição do sufentanil sobre o grau de analgesia durante o tempo de ação da primeira dose de anestésico local. Não houve aumento na duração do trabalho de parto depois do início da analgesia quando se compararam ambos os grupos, nem qualquer diferença quanto à via de parto. Não houve também diferenças entre os grupos com relação à avaliação dos recém-nascidos. Conclui-se que a associação de 30 µg de sufentanil à primeira dose de bupivacaína é segura e eficaz, melhorando a qualidade da analgesia, sua duração e não afetando a progressão do trabalho de parto e o resultado neonatal.The purpose of the present study was to evaluate the efficacy and safety of the association bupivacaine with sufentanil for labor and delivery analgesia through a continuous epidural blockade, for both mother and the neonate. A randomized double blind prospective clinical trial was performed including sixty nulliparous women at the Maternity of CAISM/UNICAMP. When requesting analgesia, the women were randomly allocated to two groups: BS, receiving 12.5 mg of bupivacaine with adrenaline plus 30 µg of sufentanil and BP, receiving 12.5 mg of bupivacaine with adrenaline plus placebo

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

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    F. Caba

    2010-05-01

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

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

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    Porika

    2015-09-01

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

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

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    F. Caba

    2010-05-01

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

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

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    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

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

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    Mir MC

    2013-10-01

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

  8. 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

    2016-06-01

    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.

  9. Thoracic epidural analgesia: a new approach for the treatment of acute pancreatitis?

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    Windisch, Olivier; Heidegger, Claudia-Paula; Giraud, Raphaël; Morel, Philippe; Bühler, Léo

    2016-05-04

    This review article analyzes, through a nonsystematic approach, the pathophysiology of acute pancreatitis (AP) with a focus on the effects of thoracic epidural analgesia (TEA) on the disease. The benefit-risk balance is also discussed. AP has an overall mortality of 1 %, increasing to 30 % in its severe form. The systemic inflammation induces a strong activation of the sympathetic system, with a decrease in the blood flow supply to the gastrointestinal system that can lead to the development of pancreatic necrosis. The current treatment for severe AP is symptomatic and tries to correct the systemic inflammatory response syndrome or the multiorgan dysfunction. Besides the removal of gallstones in biliary pancreatitis, no satisfactory causal treatment exists. TEA is widely used, mainly for its analgesic effect. TEA also induces a targeted sympathectomy in the anesthetized region, which results in splanchnic vasodilatation and an improvement in local microcirculation. Increasing evidence shows benefits of TEA in animal AP: improved splanchnic and pancreatic perfusion, improved pancreatic microcirculation, reduced liver damage, and significantly reduced mortality. Until now, only few clinical studies have been performed on the use of TEA during AP with few available data regarding the effect of TEA on the splanchnic perfusion. Increasing evidence suggests that TEA is a safe procedure and could appear as a new treatment approach for human AP, based on the significant benefits observed in animal studies and safety of use for human. Further clinical studies are required to confirm the clinical benefits observed in animal studies.

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

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    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

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

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    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

  12. Clinical assessment of epidural analgesia induced by xylazine-lidocaine combination accompanied by xylazine sedation in calves

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    Kamiloglu Alkan

    2005-10-01

    Full Text Available The aim of the present study was to investigate whether epidural administration of a xylazine-lidocaine combination accompanied by xylazine sedation would provide satisfactory analgesia for some surgical procedures on 10 calves admitted to the Department of Veterinary Surgery, University of Kafkas with perineal urolithiasis (n:2, rectovaginal fistula (n:1, atresia ani (n:2, omphalophlebitis (n:2, omphaloarteritis (n:1 and umbilical hernia (n:2. Following intramuscular injection of xylazine at a dose of 0.05 mg/kg for sedation, xylazine-lidocaine combination (0.2 mg/kg lidocaine + 0.02 mg/kg xylazine + 5 ml 0.9% NaCl was administrated into the lumbosacral (L6-S1, sacrococcygeal (S5-Co1 or intercoccygeal (Co1-Co2 space. Heart rate, respiratory rate and rectal temperature were recorded prior to and during analgesia at 5, 10, 15, 30 and 60 minutes. Furthermore, depth and duration of analgesia were evaluated during surgical intervention. The study revealed that the combination of epidural xylazine-lidocaine with xylazine sedation was highly satisfactory for surgery of the lower urinary tract and the perineal region, but it was less so for surgery of the umbilical area.

  13. Clinical assessment of epidural analgesia induced by xylazine-lidocaine combination accompanied by xylazine sedation in calves

    Science.gov (United States)

    2005-01-01

    The aim of the present study was to investigate whether epidural administration of a xylazine-lidocaine combination accompanied by xylazine sedation would provide satisfactory analgesia for some surgical procedures on 10 calves admitted to the Department of Veterinary Surgery, University of Kafkas with perineal urolithiasis (n:2), rectovaginal fistula (n:1), atresia ani (n:2), omphalophlebitis (n:2), omphaloarteritis (n:1) and umbilical hernia (n:2). Following intramuscular injection of xylazine at a dose of 0.05 mg/kg for sedation, xylazine-lidocaine combination (0.2 mg/kg lidocaine + 0.02 mg/kg xylazine + 5 ml 0.9% NaCl) was administrated into the lumbosacral (L6-S1), sacrococcygeal (S5-Co1) or intercoccygeal (Co1-Co2) space. Heart rate, respiratory rate and rectal temperature were recorded prior to and during analgesia at 5, 10, 15, 30 and 60 minutes. Furthermore, depth and duration of analgesia were evaluated during surgical intervention. The study revealed that the combination of epidural xylazine-lidocaine with xylazine sedation was highly satisfactory for surgery of the lower urinary tract and the perineal region, but it was less so for surgery of the umbilical area. PMID:21851664

  14. Bupivacaine in combination with fentanyl or sufentanil in epidural/intrathecal analgesia for labor: a meta-analysis.

    Science.gov (United States)

    Li, Bo; Wang, Huixia; Gao, Chengjie

    2015-05-01

    This study is to compare the effectiveness of combinational use of bupivacaine with fentanyl (BUPI-FEN) and sufentanil (BUPI-SUF) in epidural/intrathecal analgesia for labor. Electronic databases were searched for relevant research papers published between 1985 and 2014. Meta-analyses of mean differences or odds ratios were performed and statistical heterogeneity between the studies tested by I(2) index. Ten studies recruiting a total of 728 women in labor were selected. Concentrations of the anesthetics used as mean ± sd were bupivacaine 0.115 ± 0.056%, fentanyl 0.0007 ± 0.001%, and sufentanil 0.00017 ± 0.00022%. Duration of analgesia was not significantly different between BUPI-SUF and BUPI-FEN administered mothers (mean difference [95%CI] of -33.55 [-74.94, 7.83] minutes; P = .11) under random effects. The onset of analgesia was also not significantly different between both groups (mean difference [95%CI] of -0.61 [-1.38, 0.16] minutes; P = .12). The number of neonates with Apgar score bupivacaine provide similar analgesic properties via the epidural or intrathecal routes for labor pain relief.

  15. Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients

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    Robinson Yohan

    2011-05-01

    Full Text Available Abstract Background Epidural analgesia with bupivacain, epinephrine and fentanyl provides excellent pain control after lumbar fusion surgery, but pruritus and motor block are frequent side effects. Theoretically epidural ropivacain combined with oral oxycodone could decrease the incidence of these side effects. The two regimens were compared in a prospective randomized trial. Patients and methods 150 patients (87 women treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B and 74 to ropivacain and oxycodone (group R. Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred. Results The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R. Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p Conclusions Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks.

  16. Analysis of stages of labor, stress indexes and coagulation function in dexmedetomidine combined with regular discontinuous epidural injection for labor analgesia

    Institute of Scientific and Technical Information of China (English)

    Jing-Yi Zhang; Yu-Qiang Su; Ke-Xin Du

    2016-01-01

    Objective:To study the changes in stages of labor, stress indexes and coagulation function in dexmedetomidine combined with regular discontinuous epidural injection for labor analgesia. Methods:A total of 128 cases of full-term primiparas receiving epidural labor analgesia in our hospital between May 2013 and December 2015 were randomly divided into the dexmedetomidine (Dex group) and control group, the analgesia method for Dex group was dexmedetomidine combined with regular discontinuous epidural injection, and the analgesia method for control group was regular discontinuous epidural injection. The analgesic effect, time of stages of labor as well as stress indexes and coagulation function indexes in serum were evaluated.Results:The analgesic onset time and effective time of Dex group were significantly shorter than those of control group, the hold time was significantly longer than that of control group, latency time was not different from that of control group, and the time of the second stage of labor and the time of the third stage of labor were significantly shorter than those of control group; in the second and third stages of labor, blood glucose, blood cortisol, blood insulin, epinephrine and norepinephrine content of Dex group were significantly lower than those of control group; 24 h after childbirth, PT, APTT and TT of Dex group were significantly longer than those of control group, and FIB and D-D content were significantly lower than those of control group.Conclusions:Compared with epidural labor analgesia, the dexmedetomidine combined with regular discontinuous epidural injection can improve the analgesic effect, promote the progress of labor and reduce stress reaction as well as postpartum hypercoagulable state, and it is a more ideal solution for labor analgesia.

  17. 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...

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

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    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Survey of the Factors Associated with a Woman's Choice to Have an Epidural for Labor Analgesia

    Directory of Open Access Journals (Sweden)

    Jennifer Harkins

    2010-01-01

    Full Text Available Objectives. The purpose of this study was to determine the factors associated with whether a woman received an epidural in labor and to determine the main source used to obtain information about labor epidurals. Methods. Over a one-month period, we surveyed all patients who labored, the day after their delivery. We used multiple logistic regression to identify potential predictive factors after initial univariate analysis. Results. 320 women who met enrollment criteria delivered during the study period and 94% completed the study. Of the 302 patients surveyed, 80% received an epidural for labor. Univariate analysis showed the following variables were associated with whether women received an epidural (P<.01: partner preference, prior epidural, language, education, type of insurance, age, duration, and pitocin use. Using computed multiple logistic regression only partner preference and prior epidural were associated with whether women received an epidural. Conclusion. It was not surprising that a previous epidural was predictive of a patient receiving an epidural. The strong association with partner preference and epidural use suggests this is an important factor when counseling pregnant women with regard to their decision to have a labor epidural.

  1. 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

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O alívio da dor no trabalho de parto tem recebido atenção constante visando ao bem-estar materno, diminuindo o estresse causado pela dor e reduzindo as conseqüências deste sobre o concepto. Inúmeras técnicas podem ser utilizadas para analgesia de parto. Este trabalho teve como objetivo comparar a técnica peridural contínua com a combinada, ambas com o uso de bupivacaína a 0,25% em excesso enantiomérico 50% e fentanil como agentes. MÉTODO: Participaram do estudo 40 parturientes em trabalho de parto com dilatação cervical entre 4 e 5 cm que foram distribuídas em dois grupos iguais de forma aleatória. O Grupo I recebeu anestesia peridural contínua. O Grupo II recebeu anestesia combinada. Foram avaliados: medidas antropométricas, idade gestacional, dilatação cervical, tempo entre o bloqueio e a ausência de dor por meio da escala analógica visual, possibilidade de deambulação, tempo entre o início da analgesia e a dilatação cervical completa, duração do período expulsivo, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. Possíveis complicações, como depressão respiratória, hipotensão arterial materna, prurido, náuseas e vômitos, também foram observadas. Para a comparação das médias utilizou-se o teste t de Student e para a paridade e tipo de parto utilizou-se o teste do Qui-quadrado. RESULTADOS: Não houve diferença estatística significativa entre os dois grupos em relação ao tempo entre o início da analgesia e a dilatação cervical completa, bem como em relação ao tempo da duração do período expulsivo, incidência de cesariana relacionada com a analgesia, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. CONCLUSÕES: Ambas as técnicas se mostraram eficazes e seguras para a analgesia do trabalho de parto, embora a técnica combinada tenha proporcionado um rápido e imediato alívio da dor. Estudos clínicos com maior número de casos s

  2. A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

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    Vijay Kanna

    2015-10-01

    Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes. A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 and micro;g of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate. [Int J Res Med Sci 2015; 3(10.000: 2553-2560

  3. 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....

  4. [Factors justifying the choice of labor epidural analgesia by nulliparous women: experience at a maternity center in Antananarivo, Madagascar].

    Science.gov (United States)

    Ramorasata, J A C; Raveloson, N E; Randriamahavonjy, R; Tohaina, D; Keita, H

    2011-10-01

    Epidural analgesia is the most effective method for pain relief during labor. This 10-year exploratory descriptive study on factors underlying women's decisions to request or refuse labor epidural analgesia (LEA) was carried out at a level III maternity hospital in Antananarivo, Madagascar. All patients underwent a pre-anesthesia check-up (PAC) between 32 and 34 weeks of amenorrhea. During the PAC, a questionnaire was administered to determine socio-economic aspects, level of education, and knowledge about labor pain and LEA. In addition, LEA was proposed and patients were asked to explain their reasons for accepting or refusing the procedure. The purpose of this report was to describe the factors underlying acceptance or refusal of EA by nulliparous women. A total of 41 nulliparous women were included. Fourteen (34.14%) accepted LEA and 27 (63.86%) refused. Mean age was 27 years in the acceptance group and 25 years in the refusal group. No patient had good knowledge about LEA. Nulliparous women that accepted EA had a higher socio-economic level, expected stronger labor pain, were better informed about EA, and expressed greater confidence in medical care. In addition to economic aspects, the main reasons for refusing EA involved fear and family background.

  5. 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.

  6. 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

  7. Postoperative analgesia with intramuscular morphine at fixed rate versus epidural morphine or sufentanil and bupivacaine in patients undergoing major abdominal surgery

    NARCIS (Netherlands)

    Broekema, AA; Veen, A; Fidler, [No Value; Gielen, MJM; Hennis, PJ

    1998-01-01

    We assessed the efficacy and side effects of postoperative analgesia with three different pain regimens in 90 patients undergoing major abdominal surgery. The patients were randomly assigned to one of three groups: epidural morphine (EM) or sufentanil (ES), both combined with bupivacaine, or IM morp

  8. COMPARISON OF EPIDURAL BUPIVACAINE; FENTANYL AND THEIR COMBINATION FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL AND LOWER EXTREMITY SURGERY: A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND CONTROLLED TRIAL

    Directory of Open Access Journals (Sweden)

    Purba

    2016-03-01

    Full Text Available BACKGROUND Epidural analgesia with local anaesthetics and opioids provide good control of postoperative pain in lower abdominal and lower extremity surgery. AIM To evaluate and compare the analgesic action and adverse effects of epidural bupivacaine, fentanyl and their combination in postoperative period. METHODS 75 patients undergoing elective infraumbilical surgery were allocated in three groups in a randomized double blinded fashion. Postoperative analgesia was maintained with continuous infusion of epidural drug in the following manner: Group B: Injection Bupivacaine 0.125% @ 0.1mL/kg/hr through epidural route; Group F: Injection Fentanyl 4µg/mL @ 0.1mL/kg/hr through epidural route; Group BF: Injection Bupivacaine 0.0625% and Fentanyl 2µ/mL @ 0.1mL/kg/hr through epidural route. RESULTS VAS score were almost similar in all three groups at 00, 04, 08hrs and not clinically significant at that point of time. VAS score showed significant difference at 12, 20 and 24 hrs, being persistently lower in Gr BF than Gr B and Gr F. According to VRS Scale Score at 04 hrs majority of patients of all three groups had mild-to-moderate pain (p=0.278. At 08 hrs, 24% (p=0.082, 12 hrs 60% (<0.001, 16 hrs 68% (<0.001, 20 hrs 88% (<0.001 and 24 hrs 84% (<0.001 of Gr BF patients were pain free which are clinically significant. At the end of 08, 12, 16, 20, 24 postoperative hours, no patients of any groups had residual motor paralysis. Rescue analgesic needed in Gr BF patients were significantly less than other two groups. CONCLUSION Combined bupivacaine and fentanyl infusion through an epidural route provides better analgesia in comparison to bupivacaine and fentanyl alone. Total drug, rescue analgesic requirement and adverse effects are much lower in combined group.

  9. 蛛网膜下腔联合硬膜外腔阻滞用于分娩镇痛时机的探讨%Occasion of Administration of Combined Spinal Epidural Analgesia and Patient-control Epidural Analgesia on Labor—Latent Stage Analgesia versus Active Stage Analgesia

    Institute of Scientific and Technical Information of China (English)

    范建辉; 滕奔琦; 李萍; 李晓芸; 朱娟

    2011-01-01

    摘要:[目的]探讨实施蛛网膜下腔阻滞-硬膜外联合分娩镇痛时机对产程和分娩结局的影响.[方法]370例产妇按照宫颈口开张程度分为2组,潜伏期组130例在宫颈口开张l ~2 cm时开始实施蛛网膜下腔阻滞-硬膜外联合镇痛,活跃期组240例在宫颈口开张3~8cm时开始实施镇痛,记录2组产妇年龄、孕周、孕次、产程、分娩方式、缩宫素应用情况、产后24h出血量、胎儿窘迫、羊水粪染、新生儿体质量及新生儿生物物理评分(即1 min及5 min Apgar评分)、新生儿黄疸.[结果]潜伏期组和活跃期组比较,潜伏期延长[(453±203)min vs,(338±182)min,P=0.000].活跃期组的活跃期时间明显延长[(229±109) min vs (197±101)min,P=0.011].第2、3产程和总产程比较差异无统计学意义(P=0.200,P=0.222,P=0.091).潜伏期组的缩宫素使用率较高(43.08%vs 23.33%,P=0.012).两组器械助产率、剖宫产率、产后24h出血量比较差异无统计学意义(P>0.05).胎儿窘迫率、新生儿生物物理评分、新生儿高胆红素血症发生率2组比较差异无统计学意义(P>0.05).[结论]潜伏期实施联合分娩镇痛可能抑制子宫收缩、延长潜伏期,正确使用缩宫索可以减少分娩镇痛带来的不利影响.%[Objective]This study was designed to explore whether combined spinal-epidural analgesia (CSEA) and patient-control epidural analgesia (PCEA ) has influence on labor progress and adverse events between latent stage analgesia and active stage analgesia. [Methods] The subjects were divided into two groups; latent stage analgesia group ( 130 cases) received CSEA+PCEA in latent phase (cervical dilatation was 0.05). There were no significant differences in the rate of fetal distress or neonatal Apgar scorces and neonatal jaundice between the two groups (P > 0.05). [Conclusions] CSEA + PCEA in the latent phase was associated with an increased risk of inhibition of uterine contraction and prolonged

  10. 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

    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....

  11. 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.

  12. Effects of labor analgesia on maternal and neonatal outcome by epidural low concentration of bupivacaine combined with anisodamine

    Institute of Scientific and Technical Information of China (English)

    Yang Xiaoli; Zhou Chunqin; Li Xiaogang; Shen Xiaodong; Zou Yuliang

    2008-01-01

    Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar's score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivaeaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8 %), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar's score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocla and complications of delivery.

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

    OpenAIRE

    M.J. Mayorga Buiza; F. Caba Barrientos; F. Suárez Cordero; M. Echevarría Moreno

    2010-01-01

    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 mayo...

  14. Estudio comparativo de la eficacia analgésica del bloqueo continuo intercostal versus analgesia epidural torácica en la nefrectomía parcial abierta.

    OpenAIRE

    2014-01-01

    Un importante efecto secundario de la cirugía es el dolor agudo postoperatorio. La estrategia más utilizada en su control tras cirugía mayor abdominal ha sido la analgesia epidural. El desarrollo de las técnicas laparoscópicas ha provocado un aumento de casos que finalizan en cirugía abierta, para los que se están probando otras técnicas de control del dolor postoperatorio, como la analgesia perineural, utilizada en cirugía traumatológica, pero de la que hay poca experiencia en cirugía urológ...

  15. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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。

  18. 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...

  19. 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...

  20. A Comparison of Intrathecal and Epidural Analgesia and Its Effect on Length of Labor

    Science.gov (United States)

    2013-01-31

    SCIENCES October 1997 (vi) DEDICATION I dedicate the creation of this thesis to my mother, my father, and my husband. To my mother, a Registered...sensitivity produced by a local anesthetic injection into the nerve sheath or tissues. Opioids: Chemical substances which are either endogenous or...utilization of lumbar epidural pain control for labor and delivery at a much lower price. Cost effective in terms of man-hours, money , and 13 the

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

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    Kaushal

    2014-01-01

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

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

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    C. Campuzano

    2007-03-01

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

  3. COMBINED SPINAL EPIDURAL ANALGESIA IN LABOUR: COMPARISON OF BUPIVACAINE 1.25 MG WITH FENTANYL AND ROPIVACAINE 2.5 MG WITH FENTANYL INTRATHECAL

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    Prakash T. S. N

    2016-10-01

    , 105 and 120 mins., i.e. (every 5 mins. for 15 mins. and then every 15 mins. for 2 hrs. until the next request for analgesia. After positioning the patient in supine position, onset of analgesia and dermatome level were checked by loss of sensation to pinprick, time of onset and degree of motor blockade was checked by Bromage classification. VAS pain scores for all patients immediately before and after 15 mins. of the procedure at the next request for analgesia. Vitals were recorded and study was terminated. Continuation of epidural analgesia was done with 0.125% bupivacaine + 2 µg fentanyl in 10 mL. Monitoring - mother’s vital parameters, progress of labour, efficacy of analgesia and foetal welfare were watched in coordination with attending obstetrician. Pulse, NIBP, SpO2, respiratory rate were recorded before and after the start of procedure and every 5 mins. for first 15 mins. and then every 15 mins. for 2 hrs. If bradycardia occurred at any time (<60 bts./mins., Inj. Glycopyrrolate 0.2 mg was given. If hypotension occurred, then it was treated appropriately with IV fluids and vasopressor. If pruritus occurred, it was treated with pheniramine. Sensory blockade assessed by pinprick and motor blockade was assessed by Bromage scale. Statistical Analysis- In the present study, results are given as mean±standard deviation and range values for continuous data. Students test was used to compare the two groups, categorical data are expressed as number and percentages and difference between the groups was compared by chi-square test. A p value of 0.05 or less was set for statistical significance.RESULTS Maternal hypotension of 15% was noted in both groups, which was statistically significant. Onset of sensory analgesia in seconds showed a standard deviation of 38.12 with a mean difference of 47 seconds between the two groups was found to be statistically highly significant with a p value of <0.001. Maximal dermatomal level of sensory block achieved also showed

  4. 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

    2016-11-01

    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. 

  5. 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.

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

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    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.

  7. Analgesia peridural contínua: análise da eficácia, efeitos adversos e fatores de risco para ocorrência de complicações Analgesia peridural continua: análisis de la eficacia, efectos adversos y factores de riesgo para ocurrencia de complicaciones Continuous epidural analgesia: analysis of efficacy, side effects and risk factors

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    Leonardo Teixeira Domingues Duarte

    2004-06-01

    ,1%, 92,8% y 93,3% de la población estudiada. CONCLUSIONES: La analgesia peridural continua es efectiva y segura. Las complicaciones ocurridas no fueron consideradas graves. Todavía, no se puede dispensar rigurosa vigilancia a fin de obtenerse analgesia satisfactoria y diminuir las complicaciones.BACKGROUND AND OBJECTIVES: Epidural analgesia with local anesthetics and opioids has a reputation of high efficacy with low incidence of side effects. This study aimed at determining incidence, type and severity of postoperative complications related to epidural analgesia and catheter insertion. METHODS: Participated in this retrospective study 469 patients submitted to postoperative epidural analgesia in the period 10/18/99 to 10/18/01. Epidural analgesia was induced with 0.1% bupivacaine and fentanyl (1 to 5 µg.mL-1, at a 3 mL.h-1 rate. Infusion rate was adjusted according to patients' pain complaint. The following variables were evaluated: epidural infusion duration; incidence of side-effects and complications related to demographics, type of surgery and epidural catheter position; and quality of analgesia by means of a pain visual analog scale and a patients' satisfaction index. RESULTS: Epidural catheters remained in place 2.2 days in average, varying from 6 to 10 days. Global rate of technique-related complications was 46.3%, most of them minor complications without clinical repercussion. From these, 13.9% were directly related to the epidural catheter (disconnection, externalization, low back pain, inflammation and local infection. Other common complications were vomiting and urinary retention. Postoperative analgesia was effective in 97.2% of the patients which referred satisfaction with the technique. Patients without pain or slight pain during the first, second and third postoperative day represented 80.1%, 92.8% and 93.3%, respectively, of the studied population. CONCLUSIONS: Continuous epidural analgesia is effective and safe. Complications were not severe. However

  8. Research Progress in Epidural or Spinal Analgesia for Labor Pain%椎管内阻滞分娩镇痛的研究进展

    Institute of Scientific and Technical Information of China (English)

    余孔清

    2013-01-01

    With the development of medical technology,research on epidural or spinal analgesia for labor pain has become deeper and deeper. And it is a hot clinical research point in obstetrics. In recent years, researching in the field has developed from the approach of spinal blocking for labor analgesia to the commonly used drugs,and at last the influence on the maternal and child. Here is to make a review on the research status and development of spinal block for labor analgesia in accordance with the above three parts of contents.%随着医学技术的不断提高与进步,分娩镇痛的研究逐渐成为产科临床研究中的一个热点问题.近年来,该领域的研究越来越深入,由原来椎管内阻滞分娩镇痛方式的研究到椎管内阻滞分娩镇痛常用的药物,最后到椎管内阻滞分娩镇痛对母婴产生的影响.该文着重从上述三方面对椎管内阻滞分娩镇痛的研究现状及进展予以综述.

  9. Application of the epidural anesthesia in labor analgesia%硬膜外麻醉在分娩镇痛中的应用

    Institute of Scientific and Technical Information of China (English)

    王娟; 王昌合; 曲珣

    2014-01-01

    Objective:To explore the clinical effects of the epidural anesthesia in labor analgesia,and its effects on stages of labor and pregnancy outcome of maternal and child. Methods:Two hundred and sixteen natural childbirth puerperas with vaginal delivery, full term,single fetus,vertex presentation and no pregnancy complications and anesthesia contraindications,were randomly divided into the observation group and control group. The labor analgesia in observation group and control group were treated with epidural block anesthesia and non-drug,respectively. The delivery pain,duration of second and third labor,postpartum hemorrhage and Apgar scoring of neonate in two groups were observed. Results:The degree of delivery pain in observation group was significantly lower than that in control group(P0. 05). Conclusions:The epidural anesthesia is an ideal method in labor analgesia, which can accelerate labor progress,and is safe and worthy of spreading.%目的:探讨硬膜外麻醉用于分娩镇痛的临床效果及对产程、母婴分娩结局的影响。方法:选取自然分娩的产妇216例,全部足月、单胎、头位,无妊娠并发症,无麻醉禁忌证,评估经阴道分娩无困难者,随机分为观察组和对照组各108例,观察组采用硬膜外麻醉分娩镇痛,对照组采用非药物性分娩镇痛。观察2组产妇分娩疼痛的程度、第二产程和第三产程时间、产后出血量及新生儿Apgar评分。结果:观察组产妇分娩期疼痛程度明显低于对照组(P0.05)。结论:硬膜外阻滞麻醉用于分娩镇痛是较为理想的方法,对母婴均有较高的安全性,可加速产程进展,值得推广。

  10. 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

  11. The Clinical Analysis of Using Ropivacaine in Epidural Analgesia%罗哌卡因用于硬膜外分娩镇痛的临床分析

    Institute of Scientific and Technical Information of China (English)

    朱红仙

    2015-01-01

    目的:探讨罗哌卡因硬膜外阻滞分娩镇痛的效果及对产妇、新生儿的影响。方法选择自愿行分娩镇痛的180例初产妇为观察组,采用0.15%罗哌卡因自控硬膜外分娩镇痛泵观察产妇疼痛程度、副作用、产程时间、分娩结局及新生儿情况,同期未行任何分娩镇痛的180例产妇为对照组进行对比。结果观察组患者i、Ⅱ、Ⅲ级疼痛率分别为72.22%、26.67%、1.11%,无Ⅳ级疼痛患者,而对照组上述各级疼痛率分别为11.67%、16.11%、26.11%、46.11%,观察组i、Ⅱ级疼痛率显著低于对照组,而Ⅲ、Ⅳ级疼痛率显著低于对照组,且两组差异有统计学意义(P0.05)。结论硬膜外注射罗哌卡因达到产时镇痛的目的,且减少麻醉药用量,无运动阻滞,不影响产程的进展与分娩结局,更适用于分娩的镇痛,必要时可延续至剖宫产麻醉,且降低剖宫产率。%ABSTRACT:Objective:to investigate ropivacaine epidural labor analgesia effect and the effects on maternal, newborn. Methods:to choose voluntary labor analgesia primipara 180 cases as the observation group, with 0.15%ropivacaine patient controlled epidural analgesia pump observed maternal side effects, the degree of pain, duration of labor, delivery and neonatal outcomes, 180 cases of pregnant women during the same period without any labor analgesia for the compare group. Results:in the observation group, i, ii, iii grade pain rates were 72.22%, 26.67%, 1.11%, and no grade iV patients with pain, while the control group, the levels of pain were respectively 11.67%, 16.11%, 26.11%, 46.11%, to observe the level ii pain rate group of i, signiifcantly lower than the control group, while the iii, iV pain rate signiifcantly lower than the control group, and there was a statistically signiifcant difference between the two groups (P0.05). Conclusion:epidural injection of ropivacaine to achieve the purpose of intrapartum analgesia, and reduce the

  12. Incidência de depressão respiratória no pós-operatório em pacientes submetidos à analgesia venosa ou peridural com opioides Incidencia de depresión respiratoria en el postoperatorio en pacientes sometidos a la analgesia venosa o epidural con opioides The incidence of postoperative respiratory depression in patients undergoing intravenous or epidural analgesia with opioids

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    Leonardo Teixeira Domingues Duarte

    2009-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A analgesia controlada pelo paciente (PCA, por via venosa ou peridural, é técnica segura e eficaz no tratamento da dor pós-operatória. Todavia, o uso de opioides não é isento de risco, e a depressão respiratória é a complicação mais temida. Os objetivos deste estudo foram descrever a incidência de depressão respiratória associada à analgesia pós-operatória com opioides administrados por via peridural ou venosa e as características dos pacientes que apresentaram a complicação. MÉTODO: Estudo de incidência, retrospectivo, em pacientes operados no Hospital SARAH Brasília entre dezembro de 1999 e dezembro de 2007 e tratados com PCA com opioides por via venosa ou peridural. Foram definidos como casos de depressão respiratória: frequência respiratória JUSTIFICATIVA Y OBJETIVOS: La analgesia controlada por el paciente (PCA, por vía venosa o epidural, es una técnica segura y eficaz en el tratamiento del dolor postoperatorio. Sin embargo, el uso de opioides no está exento de riesgos y la depresión respiratoria es la complicación más temida. Los objetivos de este estudio fueron describir la incidencia de depresión respiratoria asociada a la analgesia postoperatoria con opioides administrados por vía epidural o venosa, y las características de los pacientes que presentaron la complicación. MÉTODO: Estudio de incidencia retrospectiva en pacientes operados en el Hospital SARAH Brasília entre diciembre de 1999 y diciembre de 2007 y tratados con PCA con opioides por vía venosa o epidural. Se definieron como casos de depresión respiratoria, frecuencia respiratoria d" 8 irpm, necesidad del uso de naloxona, o saturación periférica de oxígeno por debajo de un 90%. RESULTADOS: Fueron evaluados 2790 pacientes, de los cuales 635 pacientes recibieron PCA venosa y 2155, analgesia epidural. Se dieron siete casos de depresión respiratoria postoperatoria (incidencia de 0,25%. De ellos, seis pacientes

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

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    Gopal Reddy

    2015-06-01

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

  14. Clinical analysis on continuous epidural labor analgesia in 224 cases%224例连续硬膜外分娩镇痛临床分析

    Institute of Scientific and Technical Information of China (English)

    李思会; 高启俊

    2014-01-01

    Objective To explore the effect of continuous epidural labor analgesia and its impact on pregnancy outcome. Method A to-tal of 224 primiparous women receiving continuous epidural labor analgesia voluntarily were selected as study group;250 primiparous women not receiving continuous epidural labor analgesia during the same period were randomly selected as control group;the analgesic effects and pregnancy outcomes in the two groups were compared. Results VAS score in study group was significantly lower than that in control group;the incidence rate of uterine inertia during stages of labor in study group was significantly higher than that in control group;the duration time of the first stage of labor,the duration time of the second stage of labor,the total duration time of stages of labor in study group were signifi-cantly higher than those in control group;the rate of lateral episiotomy in study group was significantly lower than that in control group,there were statistically significant differences in the above-mentioned indexes between the two groups( P﹤0. 005 );there was no statistically significant difference in the incidence rates of cesarean section,surgical midwifery,postpartum hemorrhage,and neonatal asphyxia between the two groups(P>0. 05). Conclusion The effect of continuous epidural labor analgesia is good,the method can reduce the harms of deliv-ery to pregnant women and their babies,the safety is high,so the method is worthy to be popularized extensively.%目的:探讨连续硬膜外分娩镇痛的镇痛效果及对妊娠结局的影响。方法:选取自愿接受并实行连续硬膜外分娩镇痛的224例初产妇为研究组,随机选取同期不采用分娩镇痛的初产妇250例为对照组,比较分析两组镇痛效果及妊娠结局。结果:镇痛组的视觉模拟标尺( VAS)法评分明显低于对照组,产程中宫缩乏力的发生率高于对照组,的第一产程、第二产程、总产程时长高于对照组,会

  15. 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"

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    L. Biedma Velázquez

    2010-02-01

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

  16. 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

    Directory of Open Access Journals (Sweden)

    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.

  17. Estudo comparativo entre fentanil por vias peridural e venosa para analgesia de operações ortopédicas Estudio comparativo entre fentanil por vías peridural y venosa para analgesia de operaciones ortopédicas Comparative study of epidural and intravenous fentanyl for postoperative analgesia of orthopedic surgeries

    Directory of Open Access Journals (Sweden)

    Marcelo Soares Privado

    2004-10-01

    miembro inferior. MÉTODO: El estudio fue aleatorio y duplamente encubierto. Cuando presentaban dolor pos-operatorio, los pacientes del G1 (n = 14 recibieron 5 ml de solución (100 µg de fentanil en solución fisiológica a 0,9% por vía peridural y 2 ml de solución fisiológica a 0,9% por vía venosa, los del G2 (n = 15 recibieron 5 ml de solución fisiológica a 0,9%, por vía peridural y 2 ml de fentanil (100 µg por vía venosa. Fue evaluada la necesidad de complementación analgésica con tenoxicam (40 mg por vía venosa y con bupivacaína a 0,25% (5 ml por vía peridural (cuando no había alivio con tenoxicam. La intensidad del dolor fue evaluada por las escalas numérica y verbal en los momentos M30, M120 y M240 minutos. RESULTADOS: El número de pacientes que necesitaron de complementación analgésica, tanto con el tenoxicam (G1 = 10 y G2 = 15 pacientes cuanto con la bupivacaína (G1 = 2 y G2 = 8 pacientes fue mayor en el G2. No hubo diferencia estadística en la intensidad del dolor entre los grupos en los tiempos evaluados. CONCLUSIONES: En las condiciones de este estudio el efecto analgésico del fentanil peridural es mejor que por vía venosa.BACKGROUND AND OBJECTIVES: There are controversies about the action site of lipophylic opioids after epidural injection. Some authors believe that these drugs act at supraspinal level, while others propose a spinal action. This comparative study aimed at answering this question by comparing epidural and intravenous fentanyl for postoperative analgesia of lower limb orthopedic procedures. METHODS: This was a randomized double-blind study. At postoperative pain complaint, G1 patients (n = 14 received 5 mL epidural solution (100 µg fentanyl in 0.9% saline and 2 mL of intravenous 0.9% saline; G2 patients (n = 15 received 5 mL epidural 0.9% saline and 2 mL intravenous fentanyl (100 µg. Analgesic complementation with intravenous tenoxicam (40 mg and epidural 0.25% bupivacaine (5 mL (when there was no relief with tenoxicam

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Patrick Y Wuethrich

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

  20. 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

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

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus;

    1988-01-01

    -point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Clinical observation of epidural analgesia for labor pain in 428 cases%硬膜外阻滞镇痛应用于分娩镇痛428例的临床研究

    Institute of Scientific and Technical Information of China (English)

    谢尧; 江露; 王琳; 常青

    2012-01-01

    Objective To study the safty,effectiveness of epidural analgesia for labor pain and its influence on the labor course, and patients. Methods The clinic data from Nov. 2010 to Apr. 2011 were analysed to detect the differences between the epidural analgesia group and non-epidural analgesia group on labor course, delivery mode, incidence of postpartum hemorrhage, neonatal asphyxia. Results The epidural analgesia group had a prolonged latency and higher incidence of cesarean saction,but lower incidence of perineal laceration(P0. 05). Conclusion Eepidural analgesia for labor pain is safe, effective,and harmless for patients. It is worth popularizing. But more research were needed to find whether the epidural analgesia prolonged latency and make higher incidence of cesarean saction.%目的 探讨分娩镇痛的安全性、效果及对产程、母婴的影响.方法 回顾本院2010年11月至2011年4月采用硬膜外给药方式行分娩镇痛病例428例与同期未行分娩镇痛病例111例对比,观察镇痛效果、产程时间、分娩方式、产后出血的情况,以及会阴裂伤及新生儿窒息发生率.结果 行分娩镇痛组与未行分娩镇痛组比较,镇痛效果确切,分娩镇痛组潜伏期延长,会阴裂伤发生率降低(P0.05).对剖宫产率是否增高的影响尚不明确.结论 硬膜外镇痛的使用安全有效,对母婴无明显不良影响,值得推广.其是否延长产程、提高剖宫产率尚需进一步研究.

  4. 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

    Directory of Open Access Journals (Sweden)

    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

  5. 硬膜外分娩镇痛过程中不良反应观察及护理干预%Observation of adverse effects of epidural analgesia during childbirth and corresponding nursing interventions

    Institute of Scientific and Technical Information of China (English)

    韦冬英; 陈霞; 张海云

    2013-01-01

    Objective To discuss the adverse effects of epidural analgesia during childbirth and corresponding nursing interventions. Methods The study recorded the adverse effects of epidural analgesia on 49 parturients during childbirth, such as uterine inertia, supine hypotensive syndrome, fetal distress, urine retention and pain from perineal wound, and took corresponding nursing interventions. Results Satisfactory results were obtained after careful observation and prompt nursing interventions. Conclusion Careful observation, early discovery of adverse effects and prompt implementation of nursing interventions can improve the efficacy and safety of epidural analgesia during childbirth.%目的:探讨硬膜外分娩镇痛过程中不良反应及护理干预。方法记录49例孕妇进行硬膜外分娩镇痛过程中不良反应,如宫缩乏力、仰卧位低血压综合征、胎儿窘迫、尿潴留、会阴伤口疼痛等;针对不良反应进护理干预。结果通过仔细观察并及时护理干预,获得满意效果。结论仔细观察,及早发现不良反应,积极实施护理干预,可提高硬膜外分娩镇痛效果和安全。

  6. 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

    Directory of Open Access Journals (Sweden)

    Guilherme Antônio Moreira de Barros

    2003-02-01

    ás utilizado (54,2%, siendo la vía peridural la que tiene preferencia (49,5%. La escala numérica verbal media fue de 0,8 (0-10. Los efectos colaterales ocurrieron en 22,4% de los enfermos tratados. CONCLUSIONES: Los resultados fueron considerados excelentes en lo que se refiere a la calidad de la analgesia, no obstante con ocurrencia de efectos colaterales indeseables, siendo que hubo buena aceptación de la técnica de analgesia por las clínicas atendidas.BACKGROUND AND OBJECTIVES: The rapid development seen in recent years in surgical and anesthetic techniques allowed for an increased indication of invasive procedures. At the same time, with the aging of the population, the postoperative recovery period became the focus of major concern for the healthcare team. For such, new analgesic techniques were developed, among them, Patient Controlled Analgesia (PCA. In Brazil, the Acute Pain Service (SEDA of the Anesthesiology Department, Botucatu Medical School - UNESP, has been using PCA for many years. Aiming at verifying the quality of the service provided, this research has evaluated the efficacy and safety of the technique, in addition to identifying and characterizing patients submitted to PCA. METHODS: Participated in this retrospective study 679 patients treated by SEDA with the PCA method only, during a 3-year period. Patients were randomly included in the study with no restrictions concerning age, gender and type of surgery, considering only the possibility of PCA. The following parameters were evaluated: gender, age, type of surgery, pain score, treatment duration, analgesic drugs used, administration route, side effects and complications. RESULTS: The PCA technique was used in 3.96% of patients submitted to surgical procedures and in 1.64% of all hospitalized patients. Thoracic surgeries were the most frequent procedures and accounted for 25% of patients. Morphine was the most commonly used analgesics (54.2% and the epidural route was the most frequent route of

  7. Effect of epidural labor analgesia on labor process and the outcome of delivery%硬膜外分娩镇痛对产程进展及分娩结局的影响

    Institute of Scientific and Technical Information of China (English)

    王俊; 胡娟; 柯文娟

    2016-01-01

    Objective:To investigate the effects of epidural labor analgesia on labor and delivery outcome.Methods:200 cases of pregnant women with epidural analgesia were selected.They were randomly divided into the study group and the control group with 100 cases in each group.The control group took vaginal birth childbirth.The analgesia group took epidural analgesia in post parturient.Results:The level of pain of the control group was significantly higher than that of the analgesia group(P<0.05).The first production process time and the second production process time of the analgesia group were shorter than those of the control group(P<0.05).The maternal mode of delivery of the two groups had statistically significant(P<0.05).Conclusion:Epidural analgesia can significantly reduce maternal pain,reduce the rate of cesarean section,promote birth.%目的:探讨硬膜外分娩镇痛对产程及分娩结局的影响。方法:收治硬膜外分娩镇痛产妇200例,随机分成镇痛组和对照组各100例,对照组采取经阴道顺产分娩,镇痛组在产妇临产后进行硬膜外分娩镇痛。结果:对照组疼痛级别明显高于镇痛组(P<0.05),镇痛组第一产程时间和第二产程时间明显短于对照组(P<0.05),两组产妇分娩方式比较,差异有统计学意义(P<0.05)。结论:硬膜外分娩镇痛可以明显降低产妇的痛感,减少剖宫产率,促进顺产。

  8. 微信在术后使用PCEA患者中的应用%Application of Wechat in Patients Treated with Postoperative Epidural Controlled Analgesia (PCEA)

    Institute of Scientific and Technical Information of China (English)

    赖红燕; 沈洁; 邱小丹; 李军

    2016-01-01

    Objective To discuss the application effect of Wechat education in patient treated with postoperative epidural controlled analgesia (PCEA).Methods In total of 200 postoperative patients who need treated with PCEA were divided into two groups, control group and observation group. 100 patients in control group were educated routinely by nurses. 100 patients in observing group were educated by acute pain service group (APS) through Wechat. Routine education was adopted in control group and routine education combined with Wechat education during PCEA treatment until 24 hour after extubation was adopted in observation group.Results There was statistically significant difference in analgesic effect of the two groups (P0.05). According to the comparison of catheter care in the two groups, catheter extraction rate and pump loss rate in the two groups were similar, and there were no statistically significant differences (P>0.05). Catheter displacement rate in control group was 16%, and in observation group it was 14%. Catheter displacement rate in control group was higher, and the difference was statistically significant (P<0.01). According to the comparison of satisfaction degree, satisfaction rate in control group was 86% and in observation group was 100%. Satisfaction rate in observation group was higher and the difference was statistically significant (P<0.001).Conclusion Wechat education among postoperative patients treated with PCEA can improve the awareness of pain, self-management ability and nursing ability of patients, improve effect of analgesia, reduce the incidence rate of catheter displacement and increase satisfaction rate of patients.

  9. 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.

  10. Patient-controlled epidural analgesia for labor pain in primipara%初产妇PCEA分娩镇痛的临床观察

    Institute of Scientific and Technical Information of China (English)

    郑丽娟; 刘晶; 胡祖荣; 黎昆伟; 黄希照

    2013-01-01

    Objective To explore the effects of patient-controlled epidural anesthesia (PCEA) on labor pain,birth process,and newborns.Methods 1200 puerperas were randomly divided into analgesia group and control group (n =600).The analgesia group received PC EA with sufentanil and ropivacaine; the control group re ceived conventional childbirth care.The degree of labor pain,duration of labor process,rate of oxytocin uses,postpartum hemorrhage volumn,rate of Cesarean section,and newborn states were noted.Results The degree of labor painin analgesiagroup(VAS scores were 43.1 ± 112,33.2± 13.7,13.6±6.7,and 10.3±4.1,respectively after analgesia.) was significantly lower than that in the control group (VAS scores were 82.9 ± 18.5,83.7 ± 18.1,and 80.3 ±17.3,respectively after analgesia) (P < 0.05).The active period of first stage of labor (157.7 ± 31.9)min in analgesia group was evidently shorter than that in the control group (P< 0.05).Rate of Cesarean section was significantly lower in analgesia group than in the control group(43% vs.53%,P < 0.05).Rate of oxytocin uses was obviously greater in analgesia group than in control group (61% vs.31%,P< 0.05).Postpartum hemorrhage volumn and Apgar score did not differ significantly between the two groups (P>0.05).Conclusions Patient-controlled epidural anesthesia is safe and effective in relieving labor pain.It can meet the needs for maternal analgesia and has no adverse effects on mothers and babies.%目的 探讨硬膜外自控镇痛(PCEA)分娩镇痛对产痛、产程和新生儿的影响.方法 将1200例产妇随机分为镇痛组和对照组,每组600例;镇痛组行舒芬太尼复合罗哌卡因连续硬膜外分娩镇痛,对照组常规分娩处理.观察记录两组产痛程度、产程时间、缩宫素使用率、产后出血量、剖宫产率以及新生儿情况.结果 镇痛组镇痛后10 min、30 min、60 min、宫口开全时产痛VAS评分分别为(43.1±11.2)、(33.2±13.7)、(13.6±6.7)、(10

  11. Comparison of influence of high thoracic epidural anesthesia and central analgesia on hemodynamic during on-bypass coronary artery bypass grafting

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    V. A. Sobokar

    2015-06-01

    Full Text Available Objective. Despite some advantages, the use of high thoracic epidural anesthesia (HTEA during cardiac operations may be discouraged by fear of adverse hemodynamic effects. Aim. To compare the hemodynamic effects of HTEA and central analgesia (CA during on-bypass CABG. Methods. 132 patients were assigned into two groups – study group (n = 85, where the surgery was carried out under HTEA and control group (n = 47 - where the surgery was carried out under CA. Data of the intraoperative monitoring and trans-oesophageal cardiac ultrasound - cardiac index (CI, stroke index (SI, ejection fraction (EF and index of systemic vascular resistance (ISVR were obtained. Results. After induction and sternotomy patients in the study group had higher EF - 57(53, 65% vs 54 ± 7% (p = 0,013 and 55 ± 8 vs 52 ± 9%, (p = 0,031. After sternotomy CI and SI in the study group were also higher, respectively 2,42 (2,0;3,1 vs 2,23±0,63 l · min-1 · m-2, (p = 0,041 and 43 (34;46 vs 37±10 ml · m-2 (p = 0.014. Conclusion. We concluded that HTEA has advantages over CA by its influence on hemodynamics.

  12. 可行走硬膜外阻滞分娩镇痛的临床研究%Clinical study on walking epidural labor analgesia

    Institute of Scientific and Technical Information of China (English)

    夏继林; 刘兴业; 高显舜; 周伟; 周耀朝; 杨萱

    2013-01-01

    Objective To observe the effect ropivacaine mesylate combined with sufentanil on walking epidural laboranalgesia.Methods 360 puerperae who accepted 0.12% ropivacaine mesylate combined with sufentanil (0.5 μg/ml) epidural analgesia were analgesic group;at the same time and under the similar conditions,the 356 cases of puerprtae unused analgesic were control group.With visual analogue scale(VAS) assessing the uterine contraction pain and improved Bromage scale assessing lower limb movement block,recording the analgesic effect,every labor time,delivery mode,and the condition of postpartum hemorrhage,fetal distress and neonatal Apgar score in every group.Results Labor pain of pain group significant relief,the active period shorten and the vaginal eutocia percentage were higher than those in the control group; Labor time of the secend and the third stage,vaginal birth rate and oxytocin utilization rate had no differences between the two groups.Conclusion The effect of epidural block labor analgesia on 0.12% ropivacaine mesylate combined with sufentanil is obvious and security.There is no motor nerve block and do not affect the stage of labor and neonatal.It still can reduce the rate of cesarean section and improve maternal satisfaction.%目的 观察甲磺酸罗哌卡因复合苏芬太尼用于硬膜外阻滞可行走分娩镇痛的效果.方法 选择接受0.12%甲磺酸罗哌卡因复合苏芬太尼(0.5μg/ml)硬膜外镇痛的360例产妇作为镇痛组,在同期条件相似未行镇痛的356例产妇为对照组.采用视觉模拟评分(VAS)评估宫缩时疼痛,改良Bromage评分评估下肢运动阻滞,记录镇痛效果、产程时间、分娩方式、产后出血、胎儿窘迫和新生儿Apgar评分情况.结果 镇痛组较对照组在镇痛后30 min、宫口开全、胎儿娩出时疼痛明显缓解,活跃期缩短,阴道顺产率高,剖宫产率低(t=31.989、39.586、35.893、-12.382,x2=34.685、36.854,均P<0.05);两组第二产程、第三产

  13. 孕妇自控硬膜外镇痛分娩知识调查分析%Investigation and analysis about parturition related knowledge of patient-controlled epidural analgesia among pregnant women

    Institute of Scientific and Technical Information of China (English)

    王丽敏; 燕美琴; 胡燕利

    2015-01-01

    Objective To know the awareness level of patient-controlled epidual analgesia in labor related knowledge,and to provide evidence for health education,develop a comprehensive intervention program to reduce the rate of cesarean section.Methods Investigation on knowledge of patient controlled epidural analgesia during labor for a total of 400 pregnant women on Maternal and Child Health Hospital of Taiyuan City,MCH Hospital of Shanxi Province by questionnaire.Compared different characteristics of the pregnant women's scores about control epidural analgesia childbirth knowledge by nonparametric test,knowledge score of multi-factor analysis by multiple linear regression analysis.Results The maximum score of pregnant women-controlled epidural analgesia delivery knowledge was 13,the minimum score was 0,the median score was 4,range interquartile was 5.Different pregnant women with different age,education level,number of weeks of gestation,pregnancy,family income,and condition of parnatal care had different scores of knowledge of patient-controlled epidural analgesia,the difference was significant,P<0.05.Multiple linear regression analysis showed that:pregnant women's education,gestational age,the average monthly household income can be explained by maternal knowledge score of 61.4% of the variation.Conclusions The level of pregnant women-controlled epidural analgesia childbirth knowledge is low,we need to strengthen the natural childbirth education,and take a variety of modes of propaganda and increase their level of knowledge,enhance confidence of natural childbirth in pregnant women,so as to achieve the purpose of reducing cesarean section rate.%目的 了解孕妇自控硬膜外镇痛(patient-controlled epidural analgesia,PCEA)分娩相关知识的知晓水平,为更好地开展健康教育、制订降低剖宫产率的综合干预方案提供依据.方法 采用问卷调查法对山西省妇幼保健院、太原市妇幼保健院共410名孕妇进行PCEA分娩相

  14. Side effects of subarachnoid and epidural sufentanil associated with a local anesthetic in patients undergoing labor analgesia

    OpenAIRE

    Salem, Isabel C.F. [UNESP; Fernanda B. Fukushima; Giane Nakamura; Fábio Ferrari; Navarro,Laís C.; Yara Marcondes Machado Castiglia; Eliana Marisa Ganem

    2007-01-01

    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 Se...

  15. 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.

  16. 产妇自控硬膜外分娩镇痛的产科结局临床分析%Obstetric outcomes of patient-controlled epidural labor analgesia

    Institute of Scientific and Technical Information of China (English)

    倪倩; 陶敏芳; 周伟伟; 钱刚

    2012-01-01

    目的 探讨自控硬膜外分娩镇痛(patient-controlled epidural labor analgesia,PCEA)对产科结局的影响.方法 随机选取488例产妇,其中244例采用PCEA分娩镇痛,另外244例常规分娩为对照组,分别对两组在分娩疼痛程度、产程、产后出血、分娩过程中胎儿宫内窘迫发生、新生儿Apgar评分、剖宫产率等方面对照分析.结果 PCEA分娩镇痛组Mulleetr疼痛强度≤2有237例(97.13%),而对照组仅78例(31.97%),两组有显著差异.两组在产程、产后出血、分娩过程中胎儿宫内窘迫发生、新生儿Apgar评分、剖宫产率等方面比较无统计学差异.结论 PCEA分娩镇痛是一种对孕妇高效、安全、对胎儿无不良反应的分娩镇痛方法.PCEA分娩镇痛对产程的延长影响作用很小,并不增加剖宫产率及难产率.%Objective To evaluate the obstetric outcomes in lying-in women with patient-controlled epidural labor analgesia (PCEA). Methods Total 448 primiparae with a full term singleton fetus were randomly divided into patient-controlled epidural labor analgesia group ( PCEA group, n = 244) and normal labor without analgesia group (control group, n =244). The Mulleetr labor pain grade, stage of labor, flooding, fetal distress rate, newborn Apgar scores and rate of cesarean section were observed and compared in two groups. Results There were 237 parturients in PCEA group(97.13% ) and 78 in control group (31.97% ) having a Mulleetr labor pain grade ≤2 (p<0.0l). There were no statistically significant differences in rate of cesarean section, newborn Apgar scores, stage of labor and flooding between two groups. Conclusion Patient-controlled epidural labor analgesia is satisfactory and safe for parturients and infants.

  17. Perbandingan Analgesia Epidural Menggunakan Bupivakain 0,125% dengan Kombinasi Bupivakain 0,0625% dan Fentanil 2 μg/mL terhadap Nyeri dan Blok Motorik pada Persalinan Normal

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    Oktofina K. Mose

    2015-03-01

    Full Text Available Epidural analgesia became the gold standard to facilitate normal labor without pain. The purpose of this study was to compare bupivacaine 0.125% versus bupivacaine 0.0625% + fentanyl 2 μg/mL epidural analgesia in the reduction of pain during labor as measured by the numeric rating scale (NRS and motor block was assessed using the bromage score. A randomized double blind controlled clinical trial was conducted on 34 primigravida parturien with ASA physical status II planned for vaginal birth at delivery in delivery room Dr. Hasan Sadikin Hospital-Bandung within December 2011–June 2012. Subjects were randomly assigned into two groups. The research data were analyzed using of the chi-square and independent ttest with 95% confidence level and considered significant when p0.05. Bromage score B vs BF group significantly different with p value <0.05 at 90 minutes. This study concluded that the combination of 0.0625% bupivacaine + fentanyl 2 μg/mL produce analgesia similar to that provided by infusion of 0.125% bupivacaine and reduce the incidence of motor block during labor.

  18. Clinical analysis on application of continuous epidural analgesia in multiparous women%连续硬膜外阻滞分娩镇痛法应用于经产妇的临床分析

    Institute of Scientific and Technical Information of China (English)

    贾国占; 崔世红; 程国梅; 张婷; 刘萍萍; 蔡一鸣

    2011-01-01

    目的:探讨连续硬膜外阻滞分娩镇痛法的镇痛效果和对产程、母婴的影响以及经产妇有无必要采用镇痛分娩.方法:选择自愿要求分娩镇痛无禁忌证的足月经产妇80例作为观察组(A组),给予连续硬膜外分娩镇痛;同期要求分娩镇痛无禁忌证的足月初产妇80例作为对照1组(B组),同样给予连续硬膜外分娩镇痛;另设同期未行分娩镇痛的足月经产妇80例作为对照2组(C组),观察产妇生命体征、胎心,记录第一、二、三产程时间,疼痛的视觉模拟评分(VAS评分)、Bromage评分、分娩方式、缩宫素使用率、新生儿Apgar评分、产妇出血量等.结果:连续硬膜外阻滞分娩镇痛方法效果确切有效,A组与B组相比VAS评分差异无统计学意义,与C组相比差异有统计学意义,PA-C<0.01;A组产程快于C组,C组快于B组,经统计学分析,A组和C组第一产程活跃期和第二产程差异有统计学意义,PA-C<0.05,A、C两组与B组相比差异均有统计学意义,PA-B<0.05、PC-B<0.05;3组阴道手术产率和剖宫产率比较,差异无统计学意义;3组的Bromage评分比较,差异无统计学意义;A组和B组的缩宫素使用率高于C组,差异有统计学意义,PA-C<0.05、PB-c<0.05,A、B两组之间相比,B组较高,但差异无统计学意义;3组出血量差异无统计学意义;3组的新生儿Apgar评分相比,差异无统计学意义;结论:连续硬膜外阻滞分娩镇痛法安全有效,且运动阻滞轻,用药量少,适用于初产妇,同样也适用于经产妇,经产妇亦应根据情况和需要采用分娩镇痛.%Objective :To explore the analgesic effect of continuous epidural analgesia (CEA) and its effect on stages of labor, mothers and fetuses, and whether it is necessary for multiparous women to adopt continuous epidural analgesia for labor analgesia or not Methods:80 full term multiparous women adopting labor analgesia voluntarily and without contraindication of labor analgesia

  19. 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

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    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.

  20. 连续硬膜外腔阻滞在分娩镇痛中应用%Application of Continuous Epidural Analgesia during Labor

    Institute of Scientific and Technical Information of China (English)

    鲍月茹; 华伟

    2001-01-01

    目的:通过30例产妇应用连续硬膜外腔注药行分娩镇痛,观察镇痛效果及对宫缩、产程、宫口开大、儿 头下降的影响,并行母血、脐血的血气分析。方法:在放置硬膜外腔管后产妇连续接受:(1)10ml0.125%布匹卡 因,(2)10ml 0.2%罗哌卡因,二者任选其一直至分娩。结果:注入初始量镇痛药后子宫收缩轻度抑制,持续10~15 分恢复。此后在连续输注及第二产程中无宫缩抑制现象。结论:低浓度硬膜外腔阻滞麻醉,可缩短产程、使儿头下 降及宫口扩张速率加快,降低产妇体力消耗,缓解胎儿循环系统,减少新生儿酸中毒发生率。%Objective: To observe the effects of continuous epidural analgesia during labor on uterine contraction,stages of labor,di- latation of cervix,descent of fetal head and blood gas analysis in mother and cord blood. Methods:After putting down an epi- dural catheter,each patient continuously received 10 ml of 0.125% bupivacaine or 10 ml of 0.2% lopicaine until the labor was over. Results:As the top-up dose was given,a mild depression of uterine activity lasting 10~15 minutes was noted. There was no depression of uterine activity during infusion period and second stage of labor. Conclusion: The continuons epi- dural analgesia during labor can shorten stages of labor,quicken rates of dilatation of cervix and descent of fetl head,reduce mother's physical consumption,relieve fetal blood circulation and decrease the incidence of neonatal acidosis.

  1. Clinical Observation of Epidural Analgesia for Labor Pain%硬膜外阻滞麻醉用于无痛分娩的临床观察

    Institute of Scientific and Technical Information of China (English)

    李仁兰; 周玮

    2012-01-01

      目的探讨分娩镇痛的效果及对产程、母婴的影响.方法采用PECA泵硬膜外腔给药用于分娩镇痛,观察产程时间、分娩方式、产后出血、胎儿宫内窘迫及新生儿窒息情况.结果观察组和对照组产程比较、两组分娩方式比较有显著性差异(P0.05).结论 PECA泵用于持续硬膜外腔给药镇痛,疼痛阻滞完善,加速了产程的进展,降低了剖宫产率阴道难产率,对母婴均无不良影响.%  Objective To study the pain relief effectiveness and its influence on the labor course, and both the mothers and the newborns. Methods The pump of PECA (patient controlled epidural analgesia) was used during labor in the study group. The labor course, the methods of delivery, the incidence of post partum hemorrhage, fetal distress and neonatal asphyxia were observed respectively in the groups. Results There were significant differences between both groups in the stage of labor and delivery modes. There were no significant differences in the incidences of post partum hemorrhage, fetal distress and neonatal asphyxia(P>0.05).Conclusion The pump of PECA during labor is safe and effective, which accelerates course of labor and reduce the rates of cesarean and dystocia.

  2. 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.

  3. Analysis Effect of 120 Cases With Continuous Epidural Anesthesia for Labor Analgesia on Birth Process%持续硬膜外阻滞麻醉分娩镇痛对产程的影响120例分析

    Institute of Scientific and Technical Information of China (English)

    何红霞

    2015-01-01

    Objective To analysis the effect of continuous epidural anesthesia for labor analgesia on birth process.Methods Clinical data of 120 cases with continuous epidural anesthesia for labor analgesia and 120 cases without continuous epidural anesthesia for labor analgesia were respectively analyzed. birth process, pain, satisfaction, and adaptability of two groups were compared.ResultsPain, satisfaction, and adaptability scores of two groups,P<0.01, had difference statistically significance. In non pillow before entering the basin of maternal, the average time of miyaguchi 2 cm wide to full of labor analgesia group was longer than non-labor analgesia group,P<0.01, had difference statistically significance. In outlet diameter < BPD, the second stage of labor of labor analgesia group was longer than non-labor analgesia group,P<0.01, had difference statistically significance.Conclusion Continuous epidural anesthesia for labor analgesia can release maternal pain, and improve maternal degree of cooperation and satisfaction, and with less effect on birth process.%目的分析持续硬膜外阻滞麻醉分娩镇痛对产程的影响。方法回顾性分析采用持续硬膜外阻滞麻醉分娩产妇120例及选择分娩镇痛的产妇120例的临床资料。比较两组产妇产程、产程过程的疼痛程度、满意度、配合度情况。结果两组产程疼痛程度、分娩过程中配合度评分、产程过程的满意度评分比较,P<0.01,差异具有统计学意义。非枕前位入盆的产妇,镇痛组产妇平均宫口开大2 cm到开全时间长于未镇痛产妇,P<0.01,差异具有统计学意义。出口横径<双顶径的产妇,镇痛组第二产程时间长于未镇痛组的产妇,P<0.01,差异具有统计学意义。结论持续硬膜外阻滞麻醉分娩镇痛能够缓解产妇疼痛程度,提高产妇配合度及满意度,对产程的影响较小。

  4. Subcutaneously tunneled epidural catheters for postoperative analgesia in iabetes patients with tumor%经皮下放置硬膜外导管应用于糖尿病肿瘤患者的术后止痛

    Institute of Scientific and Technical Information of China (English)

    蒲斌

    2013-01-01

    Objective To investigate the effects of subcutaneously tunneled epidural catheters on epidural bacterial translocation in the management of postoperative analgesia for diabetes patients with tumor. Methods A total of 100 diabetes patients who were going to undergo Dixon operation were equally divided into two groups: tunneled epidural catheters group( group T )and control group( group C ). After the epidural puncture in an aseptic condition, the epidural catheters were placed between L1 and L2 spine clearance. Dilute local anesthetic and fentanyl infusions were used for postoperative analgesia. The epidural catheters were removed with aseptic technique and the tips( 2cm )were sent for microbiological culture after 3 days. Results In group C, bacteriological examination revealed the ratio of bacteria colonization was 26% ,mainly staphylococcus epidermidis( 61.5% ),followed by enterococcus( 15.4% ),gram-negative ba-cilli( 15.4% )and yeasts( 7. 7% ). In group T,the bacteria colonization only occurred in 8% of the patients, mainly staphylococcus epidermidis( 50% ),followed by enterococcus( 25% )and gram-negative ba-cilli( 25% ). Compare with the group C,the difference was significant(P <0. 01 ). Conclusion Subcutaneously tunneled epidural catheter can decrease the risk of bacteria colonization associated with postoperative epidural analgesia in diabetes patients with cancer.%目的 观察经皮下隧道头向放置硬膜外导管对伴有糖尿病的肿瘤患者行术后止痛时导管尖端细菌异生情况.方法 将100例伴有糖尿病拟行Dixon手术的直肠癌手术患者随机等分为经皮下隧道放置硬膜外导管组(T组)和对照组(C组),选取L1-2棘间隙在无菌条件下行硬膜外穿刺、置管,术后用0.75%布比卡因、恩丹西酮及芬太尼行硬膜外术后止痛,3d后在无菌条件下拔除硬膜外导管,剪取尖端2cm送细菌培养.结果 C组中硬膜外导管细菌异生发生率为26%,其中表皮葡萄球菌61.5%;肠球菌15

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

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    Durval Campos Kraychete

    2007-04-01

    un catéter peridural se pone, y esa vigilancia debe mantenerse después de su retirada.BACKGROUND AND OBJECTIVES: Psoas muscle abscess is a rare complication of epidural analgesia. The adequate approach to this complication is fundamental for a good resolution. The objective of this report was to discuss the diagnosis and treatment of psoas muscle abscess. CASE REPORT: A female patient, 65 years old, with neuropathic pain in the lower limbs, difficult to control with systemic drugs. The patient was treated with epidural opioid and local anesthetic as an alternate treatment. Twenty days after the continuous epidural administration, the patient complained of lumbar pain, headache, and fever. A CT scan of the pelvis showed an abscess of the psoas muscle, thus, closed drainage and antibiotics were indicated. CONCLUSIONS: An adequate, continuous supervision of the patient is necessary when an epidural catheter is placed, and it should continue after its removal.

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

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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.

  7. 硬膜外镇痛联合导乐方式在初产妇分娩镇痛中的效果%Effects of epidural analgesia combined with Doula method (导乐) on labor analgesia in primiparous women

    Institute of Scientific and Technical Information of China (English)

    苏松德; 付丽华; 黄淑平; 倪洪湖; 曾晖; 黄小花

    2016-01-01

    目的 观察硬膜外镇痛联合导乐方式在初产妇分娩镇痛中的效果.方法 初产妇分娩600例,ASA Ⅰ级,随机分为3组:硬膜外镇痛组(A组)、导乐组(助产士指导,B组)、硬膜外镇痛联合导乐组(C组),各组分别完成产道分娩者168、166、170例.记录各组产妇的镇痛情况,采用视觉模拟评分法(VAS)评价其镇痛效果、采用改良Bromage评分评价其神经阻滞情况,记录各组产妇的产程、满意度、分娩方式、新生儿Apgar评分与不良反应.结果 A、C两组镇痛后15 min时VAS评分较镇痛前降低(P<0.05).B、C组第一、第二产程较A组短(P<0.05).C组产妇的满意度较A、B两组高(P<0.05).结论 硬膜外镇痛联合导乐方式应用于分娩镇痛效果好,对产妇及新生儿无影响,产程缩短.%Objective To observe the clinical effects of epidural analgesia combined with Doula method (导乐) on labor analgesia in primiparous women.Methods Six hundred ASA Ⅰ primiparas were randomly divided into three groups.Epidural analgesia was used in group A,Doula method (guiding by midwife) in group B,and epidural analgesia combined with Doula method was used in group C.168,166 and 170 cases finished the vaginal delivery in the three groups respectively.The visual analogue scale (VAS),modified Bromage score (MBS),duration of labor,maternal satisfaction,mode of deliveries and neonatal Apgar score were recorded.Results VAS was significantly lower than pre-analgesia at 15 min after analgesia in group A and C (P< 0.05).Duration of the first and second stages of parturition in group B and C was significantly shorter than that in group A(P< 0.05).The maternal satisfaction score was significantly higher in group C than that in group A and B (P< 0.05).Conclusion Epidural analgesia combined with Doula method for labor analgesia is effective,and can shorten the labor stage with little impact on the primiparas and the neonates.

  8. 硬膜外预置管用于经产妇分娩镇痛临床分析%Clinical analysis of epidural preset tube in multipara labor analgesia

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    赵燕峰; 李斌; 欧阳雨芳

    2015-01-01

    Objective To investigate the validity, timeliness and security of epidural preset tube to block multipara la-bor analgesia, and to improve maternal labor analgesia rates and quality. Methods A total of 270 cases of mature ma-ternal in our hospital from May 2013 to October 2014 were chosen for the study, according to the study requirements, and they were divided into three groups. The observation group(group A) received PCEA labor analgesia method, and the control group1 (group B) received continuous epidural labor analgesia method, and the control group 2 (group C) did not undergo analgesia. Maternal vital signs and fetal heart rate in the three groups were observed, and the first stage of labor, the second stage of labor and the third stage of labor, pain visual analog scale (VAS score), Bromage score, mode of delivery, oxytocin usage rate, newborn Apgar score, maternal hemorrhage amount and the incidence of perineal lac-eration were recorded. Results There were not statistically significant differences in comparing general information of the 3 groups such as age, height, weight, gestational age(P>0.05). The differences in stage of labor and the incidence of perineal laceration in the three groups were statistically significant (P0.05). The differences were statistically significant in com-paring oxytocin usage rate, cesarean section rate, neonatal asphyxia score and postpartum hemorrhage amount in the observation group and the control group 2 (P0.05);三组的产程、会阴裂伤发生率相比差异有统计学意义(P0.05);观察组与对照2组在缩宫素使用率、剖宫产率、新生儿窒息率评分、产后出血量比较有统计学意义(P<0.05). 结论 连续硬膜外预置管法阻滞用于经产妇分娩镇痛安全有效,可以提高对产科并发症的手术麻醉处理的及时性、有效性,减少会阴裂伤发生率,增加经产妇分娩的安全性 .

  9. 腰硬联合阻滞麻醉在分娩镇痛中的应用分析%Application of combined splnal - epidural analgesia for labor pain relief

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    王天文

    2011-01-01

    目的 观察120例腰硬联合阻滞麻醉在分娩镇痛中的临床效果.方法 以120例腰硬联合阻滞麻醉镇痛的分娩产妇为治疗组,观察其临床疗效,并与对照组120例未行任何麻醉的产妇相比较,观察其产程、产后情况及胎儿情况.结果 两组在产后出血、新生儿窒息、胎儿窘迫、窒息方面无显著差异(P>0.05),在分娩方式及产程方面差异显著,有统计学意义(P<0.05).结论 腰硬联合麻醉分娩镇痛的方法能够加速第二产程快速进展,降低了阴道难产率及剖宫产率,对胎儿情况及产妇产后情况无明显影响,是消除分娩疼痛的有效措施.%Objective To assess the Application of combined splnal - epidural analgesia for labor pain relief. Methods 120 cases of lumbar epidural anesthesia for the treatment of maternal labor analgesia group, clinical efficacy and 120 patients with the control group of mothers received no anesthesia, compared to observe the birth process, post - natal conditions and fetal conditions. Results Two groups of postpartum hemorrhage, neonatal asphyxia, fetal distress, asphyxia no significant difference( P > 0.05 ), in the mode of delivery and birth process or its significant difference was statistically significant( P < 0.05 ). Conclusion Analgesia lumbar epidural anesthesia method can accelerate the second stage of rapid progress in reducing the rate of vaginal childbirth and planing Palace yield of postpartum fetal conditions and no significant effect on the situation, is an effective measure to eliminate labor pain.

  10. 潜伏期硬膜外阻滞分娩镇痛临床分析%A clinical analysis of epidural anesthesia in latency of labor for labor analgesia

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    尹春艳; 毛邱娴; 郭云怀; 张玲

    2011-01-01

    Objective To explore clinical characteristics and feasibility of epidural anesthesia parturition analgesia in latency (labor analgesia in brief). Methods 272 term primiparae with cephalic presentation who tried to deliver vaginally were divided into 3 groups according to their willings: group A ( n = 92, who didn't receive any analgesia in delivery), group B ( n = 85, who received labor analgesia in active stage of labor when their external cervical orifice dilated to 3cm) and group C ( n = 95, who received labor analgesia in latency when the external cervical orifice opened to 1 ~2cm). The term primiparae in groups B and C received catheter setting in epidural space plus parturient controlled analgesia (CSE + PCA ) for labor analgesia. The labor duration, pattern of delivery, incidences of postpartum hemorrhage and neonatal asphyxia of primiparae were compared among the three groups. Results The duration of latency of primiparae in group C (345 + 58 min) was shorter than that in group A (386 + 98 min) and group B ( 388 + 79 min) ( F = 9.77, P =0. 001 ), and the duration of active stage of labor of primiparae in group A ( 219 + 69 min) was longer than that in group B ( 147 + 59 min)and group C ( 141 + 72 ) ( F = 37.99, P < 0. 001 ). The proportion of primiparae in group A who were given oxytocin in delivery( 19.6% )was less than that in group B ( 80.0% ) and group C ( 85.3% ), the differences were statistically significant (X2 = 28. 9544, P <0. 0001 ). Among the three groups, there were no significant differences in durations of the second and the third stages of labor, rates of cesarean section, forceps delivery and spontaneous delivery, incidence of neonatal asphyxia and amount of postpartum hemorrhage ( all P >0.05 ). Conclusion Labor analgesia starting from latency of labor can effectively shortens duration of labor pain. Increased use of oxytocineffectively shortens durations of latency and active stages of labor. It does not increase the

  11. Estudo comparativo entre bupivacaína (S75-R25 e ropivacaína em bloqueio peridural para analgesia de parto Estudio comparativo entre la bupivacaína (S75-R25 y la ropivacaína en bloqueo epidural para analgesia de parto A comparative study between bupivacaine (S75-R25 and ropivacaine in spinal anesthesia for labor analgesia

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    Celso Schmalfuss Nogueira

    2010-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia peridural é utilizada para alívio da dor no trabalho de parto e está associada a baixos índices de complicações. Estudos com enantiômeros levógiros dos anestésicos locais demonstraram maior segurança em função da menor cardiotoxicidade. Este estudo teve o objetivo de avaliar a latência e a duração da analgesia e as repercussões maternas e fetais com o emprego da bupivacaína (S75-R25 e da ropivacaína quando utilizadas para analgesia de parto por bloqueio peridural. MÉTODOS: Realizou-se um ensaio clínico prospectivo, duplamente encoberto e aleatório, de 49 pacientes gestantes de termo, apresentando baixo risco, com indicação de parto vaginal, idade entre 15 e 35 anos, ASA I ou II distribuídas em dois grupos: GI - bupivacaína (S75-R25 0,25%; GII - ropivacaína a 0,20%. RESULTADOS: Evidenciou-se diferença estatisticamente significante entre os dois grupos 30 minutos após a instalação da peridural, sendo os escores de dor maiores no grupo que utilizou a ropivacaína. Não foram encontradas diferenças estatísticas significativas quanto a latência de analgesia, nível sensorial do bloqueio, volume de anestésico local, dose de resgate, duração do trabalho de parto e da analgesia, frequência de parto instrumental, alterações hemodinâmicas, escores de Apgar ou pH do cordão umbilical e incidência de eventos adversos. CONCLUSÕES: O uso de bupivacaína (S75-R25 e ropivacaína para a analgesia de parto proporcionou boas condições para a realização da anestesia peridural com pequenas ocorrências de eventos adversosJUSTIFICATIVA Y OBJETIVOS: La anestesia epidural se usa para el alivio del dolor en el parto y está asociada a bajos índices de complicaciones. Estudios con enantiómeros levógiros de los anestésicos locales, han demostrado una seguridad más elevada en función de una menor cardiotoxicidad. Este estudio quiso evaluar la latencia y la duración de la analgesia y

  12. 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

  13. Epidural Naloxone to Prevent Buprenorphine Induced PONV

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    Ashok Jadon

    2008-01-01

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

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

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    Ferdinand Edson de Castro

    2005-02-01

    fue posible demostrar efecto preemptivo con la utilización peridural de S(+cetamina y bupivacaína en las dosis utilizadas en histerectomía abdominal.BACKGROUND AND OBJECTIVES: This study investigates the ability of epidural S(+ketamine, NMDA receptor antagonist, plus local anesthetic (bupivacaine injection to promote preemptive analgesia in patients undergoing total abdominal hysterectomy, when this solution is administered before surgical incision. METHODS: Participated in this prospective double-blind study 30 patients were randomly assigned in two equal groups. Epidural injection and catheter insertion were performed at L1-L2 interspace. Group 1 (G1 patients received 17 mL bupivacaine 0.25% plus 3 mL S(+ketamine (30 mg, 30 min before surgical incision, followed by 20 mL saline 30 min after incision. Group 2 (G2 patients received 20 mL saline 30 min before surgical incision, followed by 17 mL bupivacaine 0.25% plus 3 mL S(+ketamine (30 mg 30 min after incision. General anesthesia was induced with propofol, pancuronium, O2 and isoflurane. Postoperative analgesia consisted of epidural fentanyl plus bupivacaine bolus with 4h minimal interval. If necessary, IV dipyrone supplementation was administered. Patients were evaluated for analgesia by a verbal and numeric scale (at recovery and every six hours until 24 postoperative hours. Time to first analgesic request and total analgesic requirements were recorded. RESULTS: There were no significant differences between groups in time to first analgesic request, total analgesic consumption and numeric or verbal scale pain scores. CONCLUSIONS: This study failed to demonstrate a preemptive effect of epidural administration of bupivacaine and S(+ketamine in the doses tested for abdominal hysterectomy.

  15. Study on clinical application of Lamaza delivery method combined with spinal-epidural anesthesia analgesia for labor analgesia%拉玛泽分娩法联合腰硬联合阻滞分娩镇痛的临床应用研究

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    宁丰; 韦凤莲; 周霓

    2012-01-01

    Objective: To explore the clinical effect of Lamaza delivery method combined with spinal - epidural anesthesia analgesia for labor analgesia. Methods: A total of 400 primiparous women were selected and divided into group A ( Lamaza delivery method combined with spinal - epidural anesthesia analgesia) , group B ( Lamaza delivery method) , group C ( spinal - epidural anesthesia analgesia) , and group D ( Doula labor, control group) , 100 primiparous women in each group; the degrees of pain during delivery, stages of labor, delivery modes, indications of cesarean section, doses of oxytocin, amount of postpartum hemorrhage, neonatal Apgar scores in the four groups were observed. Results; Compared with the other three groups, the degree of pain during delivery in group A relieved significantly, the stages of labor shortened, the rate of spontaneous delivery increased, the rate of cesarean section decreased, the dose of oxytocin increased, there were statistically significant difference in the above - mentioned indexes (P 0. 05 ) . Conclusion: Lamaza delivery method combined with spinal -epidural anesthesia analgesia used for labor analgesia can effectively relieve labor pain, shorten stages of labor, increase the rate of spontaneous delivery, and reduce the rate of cesarean section, which doesnt affect the amount of postpartum hemorrhage and neonatal Apgar score, but it can increase the dose of oxytocin.%目的:探讨拉玛泽分娩法联合腰硬联合阻滞分娩镇痛在分娩中应用的临床效果.方法:选择400例初产妇,分为拉玛泽联合腰硬联合阻滞分娩镇痛组(A组)、拉玛泽组(B组)、腰硬联合阻滞分娩镇痛组(C组)和导乐陪伴组(对照组D组),每组100人,观察产妇产时疼痛程度、产程时间、分娩方式、剖宫产指征、缩宫素使用、产后出血、新生儿Apgar评分等.结果:A组产妇与其他3组比较,产时疼痛程度明显减轻,产程时间缩短,自然分娩率上升,剖宫产率下降,缩宫素

  16. Bloqueio combinado para analgesia de parto: a adição de sufentanil ao anestésico local influencia o apgar dos recém-nascidos? Bloqueo combinado para analgesia de parto: ¿la adición de sufentanil al anestésico local influye en el apgar de los reciÿn nacidos? Combined spinal-epidural for labor analgesia: does the addition of sufentanil to the local anesthetic influence apgar scores of the newborns?

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    Domingos Dias Cicarelli

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado (BC é uma técnica muito utilizada em anestesia obstétrica. Porém não há na literatura padronização com relação à técnica, doses e anestésicos utilizados, além da controvérsia sobre a possibilidade da adição do opióide ao anestésico local causar bradicardia fetal e alteração de sua vitalidade. O objetivo deste estudo foi identificar as técnicas e anestésicos utilizados no Serviço de Anestesiologia do Hospital Universitário da Universidade de São Paulo (USP e avaliar se a utilização de sufentanil associado ao anestésico local no BC altera o Apgar dos recém-nascidos. MÉTODO: Foram analisadas as fichas de anestesia em que foram realizados BC para analgesia de parto durante 12 meses no Hospital Universitário da USP. Foram registrados o uso e dose de sufentanil, a via de parto utilizada e os escores de Apgar do 1°, 5° e 10° minutos dos recém-nascidos. RESULTADOS: Dos 635 BC avaliados, 307 utilizaram sufentanil e anestésico local (Grupo SUF e 328, só anestésico local (Grupo AL. Cento e vinte e sete (20% foram realizados através da técnica de agulha por dentro de agulha e os outros 508 (80% foram realizados pela técnica de duas punções. Não foi verificada diferença entre o Apgar dos grupos estudados no 1°, 5° e 10° minutos. CONCLUSÕES: O sufentanil utilizado no bloqueio combinado não alterou o Apgar dos recém-nascidos.JUSTIFICATIVA Y OBJETIVOS: El bloqueo combinado (BC es una técnica muy utilizada en anestesia obstétrica. Sin embargo no existe en la literatura una estandarización con relación a la técnica, dosis y anestésicos utilizados, además de la controversia sobre la posibilidad de la adición del opioide al anestésico local causar una bradicardia fetal y la alteración de su vitalidad. El objetivo de este estudio fue identificar las técnicas y anestésicos utilizados en el Servicio de Anestesiología del Hospital Universitario de la

  17. Clinical analysis of effect of combined spinal - epidural anesthesia in labor analgesia%腰硬联合麻醉分娩镇痛临床效果分析

    Institute of Scientific and Technical Information of China (English)

    李如霞; 柯善高; 徐晓俊; 朱桃花

    2011-01-01

    目的 分析腰硬联合麻醉分娩镇痛对母儿的影响,并比较芬太尼和舒芬太尼的效果.方法 选择2010年3~9月行分娩镇痛的192例初产妇,与同期未行镇痛的98例(对照1组)和开展分娩镇痛前107例(对照2组)初产妇比较.结果 与对照1、2组比,镇痛组第二产程和活跃期时间延长,缩宫素使用率高,产钳助产率高,新生儿1 min Apgar评分轻度窒息率升高,差异有统计学意义(P<0.05);因胎儿窘迫剖宫产率、第三产程时间组间比较差异无统计学意义(P>0.05).镇痛组较对照1组,第一产程时间、因头盆不称剖宫产率、产后出血量差异明显(P<0.05).使用芬太尼及舒芬太尼镇痛产妇,副作用主要是皮肤瘙痒,前者虽高于后者,但无统计学意义(P>0.05).结论 腰硬联合麻醉分娩镇痛效果确切,镇痛药对新生儿评分稍有影响,但预后良好.%Objective To analyze the effect of combined spinal - epidural anesthesia (CSEA) for labor analgesia and the impact on mothers and children and to compare the effects of fentanyl and sufentainl. Methods From march 2010 to september 2010 192 primiparity with labor analgesia were choosed, and 98 cases without analgesia in the same period ( control 1 group) , and 107 cases before labor analgesia (control 2 group) for comparison. Results Compared with the 1 and 2 groups, the duration of the second stage of labor and active phase in the analgesia group were longer, the rates of oxytocin use and forceps delivery were higher, and one minute Apgar score newborn asphyxia increased slightly, and there were significant differences (P < 0. 05 ); cesarean section rate of fetal distress, the labor time of the third stage had no significant differences ( P > 0.05 ) in groups. Compared with the 1 group, the labor time of the first stage, the rate of cephalopelvic disproportion cesarean section, the volume of postpartum hemorrhage had significant differences (P <0.05 ). Side effect is

  18. Clinical Effects of Patient-controlled Epidural Analgesia in Children%小儿术后硬膜外自控镇痛的临床效果

    Institute of Scientific and Technical Information of China (English)

    刘继云; 佘守章; 谢晓青

    2000-01-01

    Objective: To evaluate the feasibility and safety of postoperative patient-controlled epidural analgesia (PCEA)in children. Methods: Forty postoperative pediatric patients(5-11 years old)were divided into two groups. A and B. Both wereinstituted with postoperative PCEA with LCP model (loading dose 2.05 + 0.13ml), continuos infusion rate 0.82 + 0.15mi/h, PCA dose 0.81 + 0.16ml)by Graseby-9300 PCA pump. The PCEA solution of group A was 0.075% bupivacaine plus0.0012 % buprenorphine, that of group B was same while 0. 005% droperidol was added as an adjuvant. Results:The volumeof PCEA sdution consumption in group B was significantly less than that in group A on the first and second postoperative day (P< 0.01-0.05). Good analgesic efficiency with little side effects was obtained, as evaluated by the VASF emasay or D/D score and complications in two groups, but the analgesic effect of group B was better than that of group A. Conclusion: Thepediatric PCEA with low concentration of bupivaeaine plus buprenorphine is feasible and safe. Droperidol may enhance theanalgesic effects of PCEA.%目的:探讨小儿术后硬膜外自控镇痛(PCEA)的可行性和安全性。方法:术后5~11岁的小儿40例,分成A、B两组。A组镇痛液配方为0.075%布比卡因+0.0012%丁丙诺啡(12μg/ml),B组配方与A组相同并加入小剂量氟哌啶(50μg/ml)。以LCP模式(负荷量2.05±0.13ml,持续量0.82±0.15ml,PCA量0.81±0.16m1)实施PCEA。结果:B组2天用量均少于A组(P<0.01~0.05)。从三种评分指标(VASF、ramsay、D/D)和并发症综合比较分析,提示两组均能达到满意的镇痛效果,但B组优于A组。结论:小儿术后用0.075%布比卡因+丁丙诺啡行PCEA是安全有效的,辅助少量氟哌啶可进一步增强PCA效果。

  19. Clinical Observation of the Effect of Epidural Analgesia duringSpontaneous elivery%硬膜外镇痛应用于自然分娩的临床观察

    Institute of Scientific and Technical Information of China (English)

    何天琼; 方光萍; 邓忠琼; 龙莉; 陈丽

    2012-01-01

    Objective To observe the effect of epidural analgesia on puerpera and newborn during spontaneous delivery. Method 118 puerpera through spontaneous delivery in our hospital were divided into two groups (according to their own choice), the observation group (54 puerpera which voluntary spontaneous delivery) and the control group (64 puerpera without spontaneous delivery). Then the pain degree of puerpera, total stage of labor, postpartum hemorrhage volume, Apgar score of the newborn were compared in the two groups. ResultsThe total stage of labor and the pain degree of puerpera were significantly decreased in the observation group (P0.05). Conclusions Epidural analgesia can shorten the total stage of labor, ease the pain of puerpera and it dosen’t have negative effect on the postpartum hemorrhage volume and Apgar score of the newborn.%目的观察硬膜外镇痛应用于分娩镇痛对产妇和新生儿的影响.方法选择同期自然分娩产妇118例,按产妇自愿选择的原则,分为观察组:要求实施分娩镇痛54例,对照组:选择自然分娩64例.观察项目:产妇疼痛程度,总产程时间,产后出血量,新生儿Apgar评分.结果两组比较产妇总产程时间观察组短于对照组(p0.05).结论分娩镇痛能缩短总产程、基本消除产痛,对产力、产后出血量及新生儿Apgar评分不产生负面影响.

  20. 365例硬膜外阻滞分娩镇痛母婴安全性临床研究%Clinical safety study of mothers and infants with epidural analgesia in labor

    Institute of Scientific and Technical Information of China (English)

    刘兴业; 夏继林; 杨煊; 潘海娟

    2013-01-01

    目的 研究小剂量低浓度的甲磺酸罗哌卡因注射液复合小剂量的舒芬太尼注射液实施硬膜外阻滞分娩镇痛的镇痛效果以及对产程、分娩方式、母儿的影响.方法 选择2011年6月至2012年5月之间在安康市妇幼保健院分娩,经自愿要求签署硬膜外阻滞分娩镇痛知情同意书者共365例作为研究对象(镇痛组);随机抽取同时期住院条件相似不愿采用硬膜外阻滞分娩镇痛的产妇365例为对照组,分别观察两组的镇痛效果、产程、分娩方式、剖宫产率、缩宫素应用、新生儿窒息及软产道损伤等母儿并发症.结果 镇痛组镇痛后疼痛程度明显减低(t=163.130,P<0.01),且活动不受限,活跃期比对照组明显缩短(t=-12.878,P<0.01),第二产程两组无差异.镇痛组改剖宫产率明显低于对照组(χ2=38.814,P<0.01).两组缩宫素应用、新生儿窒息、软产道损伤、产后出血及尿潴留差异均无统计学意义.结论 小剂量低浓度的甲磺酸罗哌卡因注射液复合小剂量的舒芬太尼注射液用于硬膜外阻滞分娩镇痛效果好,可缩短产程,无母儿并发症,能促进自然分娩,降低剖宫产率.%Objective To study the effect of small dose low-concentration of ropivicaine mesylate injection and sufentanil injection used in epidural analgesia in labor and their influence on labor, delivery mode and maternal and infant outcomes. Methods From June 2011 to May 2012 365 cases, willing to sign informed consent for epidural analgesia in labor and giving birth in Maternal and Child Health Hospital of Ankang, were selected as study subjects ( analgesia group ). Over the same period another 365 cases with similar conditions but not willing to accept epidural analgesia in labor were randomly selected as control group. The analgesia effect, labor process, delivery mode, rate of cesarean section, use of oxytocin and the complications of mothers and infants such as neonatal asphyxia and birth canal

  1. Analysis of 80 cases of Doula combined with Epidural anesthesia in labor analgesia%导乐陪伴联合硬膜外麻醉镇痛分娩80例分析

    Institute of Scientific and Technical Information of China (English)

    张锦华

    2014-01-01

    Objective:To discuss the effectiveness of Doula combined with epidural anesthesia in labor analgesia. Methods: 80 cases of primipara without obvious cephalopelvic disproportion , pregnancy complications or pregnancy complications were selected,they were performed Doula and epidural anesthesia when their cervix open 2-3cm,anal-gesic effect,labor,mode of delivery ,blood losing after delivery,and Apgar's score were recorded.Results: All the cases have good effect of analgesics, high rate of natural delivery , shorter labor,low rate of neonatal asphyxia,and no adverse reaction .Conclusion: Doula combined with epidural anesthesia in labor analgesia can significantly reduce the labor pain, the cesarean section rate ,shorten the labor and reduce bleeding, but does not increase the rate of neonatal as-phyxia, or has side effects on mother and child,so it is worth widely applied .%目的:探讨导乐陪伴联合硬膜外麻醉用于分娩镇痛的效果。方法:选择80例无明显头盆不称,无妊娠并发症和妊娠合并症的初产妇,宫口开大2~3cm时施行导乐陪伴及硬膜外麻醉镇痛,记录镇痛效果、产程、分娩方式、产后出血及新生儿Apgar评分等。结果:所有产妇镇痛效果良好,阴道自然分娩率高,总产程缩短,新生儿窒息率低,无不良反应。结论:导乐陪伴联合硬膜外阻滞镇痛分娩,可显著减轻产时疼痛,降低剖宫产率,缩短产程,减少出血量,但不增加新生儿窒息率,对母婴无副作用,值得推广应用。

  2. 潜伏期硬膜外分娩镇痛对产程和分娩方式的影响%Epidural analgesia in latent phase of labor: effects on length of labor and mode of delivery

    Institute of Scientific and Technical Information of China (English)

    耿志宇; 吴新民; 李萍; 符莹莹

    2009-01-01

    Objective To compare the outcome of ropivaeaine plus sufentanil for patient-controlled epidural analgesia between nulliparous women presenting in latent and active labor. Methods 360 nulliparous parturients were randomized according to cervix dilation. Latent group (cervix dilation < 3 cm) received 0.1% ropivacaine with 0.5 μg/ml sufentanil and active proup (cervix dilation≥3 cm) receive0.15% ropivaeaine with 0. 5 μg/ml sufcntanil, both followed by an infusion of 0.1% ropivaeaine with 0.5 μg/ml sufentanil through PCEA. The PCEA pump was programmed to infuse a 6 ml bolus with a lockout interval of 15-20 min. The following were recorded: (1) pain intensity evaluated using VAS (0-10), (2) motor block assessed using modified Bromage scale, (3) onset of analgesia after epidural injection, (4) fetal heart rate, (5) maternal vital signs, (6) apgar score, (7) labor process, (8) mode of delivery and (9) the total amount of analgesic consumed. Results Both groups provided good analgesia. Early administration of epidural analgesia did not prolong the duration of first and second stage of labor. However, group L had a significant higher caesarean section rate and a significant lower instrumental delivery rate than group A. The reasons of cesarean section in both groups were arrested active phase and fetal distress. The reasons of instrumental delivery in both groups were fetal distress. The neonates had good outcome in both groups. Conclusions Compared with epidural analgesia in active phase of labor, early administration of epidural analgesia in latent phase did not prolong labor, however, the caesarean section rate was increased and instrumental delivery rate was decreased.%目的 比较初产妇潜伏期和活跃期分娩镇痛的产程和分娩方式.方法 自愿接受分娩镇痛无产科及硬膜外阻滞禁忌证的单胎孕初产妇360例,按宫口扩张度分为两组.潜伏期组(L组):当宫口<3 cm时进行硬膜外穿刺,注入0.1%罗哌卡因和0.5

  3. Clinical research on different concentrations of ropivacaine in walking epidural labor analgesia%不同浓度罗哌卡因用于可行走性硬膜外分娩镇痛的临床研究

    Institute of Scientific and Technical Information of China (English)

    袁庆明; 周传华; 莫洁平; 梁鉴华; 曾馨文

    2014-01-01

    Objective To compare the different concentrations of ropivacaine combined with fentanyl infusion analgesia labor in walking labor analgesia in maternal BP,HR,SpO2,labor,fetal heart,uterine contractions and oxytocin usage and the visual analogue scale (VAS) and maternal motor nerve block.Methods 180 cases of primipara volunteered for labor analgesia,ropivacaine with different concentration of patient controlled epidural analgesia (PCEA),and compared with parturients without analgesia,were randomly divided into group A,group B and group C with 60 cases in each group,three groups were respectively injected into the epidural 0.075% ropivacaine and fentanyl 2 μ g/ml (group A,n=60),0.125% ropivacaine plus fentanyl 2 μ g/ml (group B,n=60),0.20% ropivacaine and fentanyl 2 μ g/ml (group C,n=60).With the cervix opening to the 2-3 cm,L2-3 epidural cephalad catheter,injection of 0.8% lidocaine,5 mins to the load of 8-10 resistant analgesic liquid,confirming the analgesic plane,pain significantly reduced with analgesia pump.Continuous infusion of 6-8 ml,a single push volume of 3 ml,interval time of 15 min,wide open withdrawal.Results The results of three groups of maternal analgesia labor walk at each time point after VAS score was significantly lower with significant difference (P < 0.05); feasible implementation of labor analgesia in group A,group B motor nerve block,in class 0,grade 1,2 cases of group C,and the difference was statistically significant (P < 0.05);additional anesthesia compound liquid of three groups had no significant difference (P > 0.05); there was no significant difference between three groups of maternal mode of delivery and use of oxytocin and neonatal Apgar score (P > 0.05).Conclusion 0.125% ropivacaine + fentanyl was 2 μg/ml continuous infusion for labor analgesia when walk good analgesic effect,motor nerve block light,is worth the clinical promotion.%目的 比较不同浓度罗哌卡因复合芬太尼持续输注在可行走性

  4. Estudo comparativo entre concentrações de bupivacaína a 0,125% e a 0,25% associada ao fentanil para analgesia de parto por via peridural Estudio comparativo entre concentraciones de bupivacaína a 0,125% y a 0,25% asociada al fentanil para analgesia de parto por vía peridural Comparison between 0.125% and 0.25% bupivacaine associated to fentanyl for epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    Marcos Emanuel Wortmann Gomes

    2004-08-01

    (0,25% [n = 23] ó 0,125% [n = 28]. Para la mensuración de la analgesia, fue utilizada la escala numérica de dolor, y para la evaluación del bloqueo motor, la escala de Bromage. Para la comparación de las medias, fue utilizado el teste t de Student, y, para la comparación de las proporciones, el teste Qui-cuadrado, con p BACKGROUND AND OBJECTIVES: Epidural analgesia aims at decreasing or even abolishing maternal suffering during labor. It is considered a safe and effective method for pain relief. This study aimed at comparing two bupivacaine concentrations (0.25% and 0.125% associated to fentanyl in epidural labor analgesia to determine its efficacy on pain relief and its effect on motor block. We have also observed the influence of these two concentrations on labor duration, fetal outcome and maternal satisfaction. METHODS: Participated in this prospective and double blind study 51 primiparous women who were randomized to receive one out of two bupivacaine concentrations for epidural labor analgesia (0.25% [n = 23] or 0.125% [n = 28]. Analgesia was measured using a numeric pain scale, and motor block was verified using Bromage scale. Means were compared using Student's t test, while proportions were compared using Qui-square test, with p < 0.05. RESULTS: There has been no statistical difference in pain, degree of motor block and fetal outcome between groups. Cesarean delivery rate was statistically higher in the group receiving 0.25% bupivacaine (p < 0.05. Lower concentration group patients were more satisfied with the procedure (p < 0.01. CONCLUSIONS: The association of fentanyl and 0.125% bupivacaine proved to be more beneficial as compared to 0.25% concentration. With this dose, there has been a lower incidence of adverse effects without compromising analgesia, and yet a higher rate of maternal satisfaction.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. 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...

  8. 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

    la duración del período de trabajo de parto después de la analgesia, al Apgar de los recién nacidos, a la existencia de hipotensión arterial, bradicardia, náusea, vómito, prurito y retención urinaria. La sedación fue más frecuente en las pacientes de G2, en M1 (50% con diferencia estadística significativa. CONCLUSIONES: El sufentanil en las dosis utilizadas, administrado por vía subaracnoidea o peridural, asociado a los anestésicos locales, determinó similitud en la duración del trabajo de parto después de la analgesia y en el Apgar de los recién nacidos. La sedación fue el efecto adverso más frecuente en las pacientes que recibieron el opioide por vía peridural.BACKGROUND AND OBJECTIVES: The association of an opioid with a local anesthetic improves the quality of labor analgesia and reduces the risk of systemic toxicity of the local anesthetic. However, opioids are not devoid of side effects. The aim of this study was to compare the side effects of subarachnoid sufentanil associated with bupivacaine to those caused by epidural sufentanil associated with ropivacaine in the doses used in the Anesthesiology Department in pregnant women undergoing labor analgesia. METHODS: Sixty pregnant women, ASA physical status I and II, ages between 15 and 42 years, at term and with healthy fetuses, undergoing labor analgesia were enrolled in this study. They were randomly divided in two groups: G1 - combined spinal epidural anesthesia - 0.5% bupivacaine (2.5 mg and subarachnoid sufentanil (5 µg; G2 - Epidural Block - 0.2% ropivacaine (20 mg, and epidural sufentanil (10 µg. Complementary doses of 0.2% ropivacaine (12 mg were administered whenever necessary, and 1% ropivacaine (50 mg was administered for labor resolution. Patients were evaluated after analgesia (M1 regarding the presence of hypotension, maternal bradycardia, pruritus, nausea, vomiting, respiratory depression, and sedation. They were also evaluated postoperatively (M2 regarding the presence of

  9. The Value of Full Doula Combined with Epidural Analgesia in Natural Childbirth%全程导乐陪伴分娩联合硬膜外镇痛在自然分娩中的应用价值

    Institute of Scientific and Technical Information of China (English)

    刘晓艳

    2014-01-01

    目的:探讨全程导乐陪伴分娩联合硬膜外镇痛在自然分娩中的应用价值。方法:选取2010年1月-2013年6月本院收治的80例足月妊娠产妇,按照随机数字表法将其分为观察组和对照组各40例,观察组给予导乐分娩联合硬膜外镇痛处理,对照组则密切观察产妇产程进行常规方式分娩,比较两组产妇围产期疼痛VAS评分及两组顺产率、胎儿窘迫发生率和新生儿窒息率。结果:观察组第一、二和三产程疼痛VAS评分均明显低于对照组,且观察组顺产率明显高于对照组,胎儿窘迫发生率及新生儿窒息率均明显低于对照组,比较差异均有统计学意义(P<0.05)。结论:全程导乐分娩联合硬膜外镇痛能更好地缓解患者产痛,提高分娩安全性。%Objective:To explore the value of full doula combined with epidural analgesia in natural childbirth.Method:80 cases of maternal were selected in our hospital from January 2010 to June 2013,they were randomly divided into the observation group and the control group,40 cases in each group,the observation group was given the treatment of doula combined with epidural analgesia,the control group was observed the birth process routine methods maternal childbirth,then maternal perinatal pain VAS score and birth rate,incidence of fetal distress and neonatal asphyxia were compared between the two groups.Result:The observation group in the first,second and third stage of labor with pain VAS scores were significantly lower than the control group ,the observation group with birth rate was higher than the control group,the incidence of fetal distress and neonatal asphyxia rate were significantly lower than control group,the differences were statistically significant(P<0.05).Conclusion:Throughout full doula combined with epidural analgesia in natural childbirth,it has better ease labor pain and it can improve labor safety.

  10. 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.

  11. Effects of epidural analgesia on maternal and infant by vaginal delivery%硬膜外分娩镇痛对经阴道分娩母婴影响的临床研究

    Institute of Scientific and Technical Information of China (English)

    杨絮; 杨泳; 吕国义

    2015-01-01

    目的:探讨硬膜外镇痛对经阴道分娩母婴的安全性和有效性,为临床大范围开展分娩镇痛提供参考依据。方法选取2013年5月至2013年8月非合并其他系统疾病及产科合并症、拟经阴道分娩足月临产孕妇60例,随机分为硬膜外镇痛( EA)组和非镇痛( NA)组,每组30例。入待产室常规监测两组孕妇无创测量血压( NBP)、心率( HR)、脉搏血氧饱和度( SpO2);胎儿娩出即刻采集脐静脉血作血气分析;新生儿出生后1、5、10 min行Apgar评分;记录各产程时间,是否使用缩宫素,宫口扩张至6~7 cm时VAS评分及Bromage评分,产后24 h内出血量,初乳始动时间,新生儿神经行为评分。结果两组孕妇一般资料比较差异未见统计学意义。EA组第一产程和第二产程较NA组延长( P均0.05);EA组新生儿生后1 min/5 min Apgar评分为9.2±0.7/9.2±0.6,低于NA组(9.6±0.5/9.6±0.5,P0.05)。结论本研究所采用硬膜外分娩镇痛方法效果确切,不影响产后泌乳过程,不增加产后出血,不影响产妇下肢活动,对经阴道分娩产妇无不良影响,未见有实际临床意义的新生儿不良影响,对新生儿安全,值得推广。%Objective To investigate the security and effectiveness of epidural analgegia on virginal delivery maternal-neo-nates,in order to provide basis for widely carrying out labor analgesia. Methods Sixty parturient cases in the term of maternal, scheduled for virginal delivery from May to August in 2013,who had no systemic diseases or obstetric complications,were ran-domly divided into epidural analgesia( EA)group and non-analgesia( NA)roup,with 30 cases in each group. In the two groups,gravida with labour signs were sent into labor room,and the values of noninvasive blood pressure( NBP),heart rate ( HR)and pulse oxygen saturation( SpO2 )were recorded. The umbilical venous blood was drawn for blood gas analysis at the

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

    Directory of Open Access Journals (Sweden)

    B. Mugabure

    2005-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Souza Martins

    2004-08-01

    fentanil, grupo III (lidocaína, fentanil y clonidina y grupo IV (lidocaína y clonidina. Se compararon las características de los bloqueos sensitivo y motor. RESULTADOS: No hubo diferencia entre la latencia, bien como en el nivel máximo de bloqueo entre los grupos. La ausencia de bloqueo motor fue el resultado más frecuente, encontrado en cerca de 64% de los pacientes. El intervalo de analgesia fue diferente entre los grupos, siendo más significativo en el grupo III. CONCLUSIONES: El uso de la clonidina, asociada o no al fentanil, prolongó el tiempo de analgesia pós-operatoria en la anestesia peridural sacral con lidocaína.BACKGROUND AND OBJECTIVES: The association of different substances to local anesthetics aims to improve the blockade quality and prolonging analgesia. The aims of this study were to compare the effectiveness of the association of clonidine, clonidine and fentanyl, and fentanyl, to lidocaine for postoperative analgesia. METHODS: Participated in this study 64 patients aged 23 years or above, physical status ASA I or II, undergoing to orificial proctologic surgery under epidural caudal anesthesia. Patients were distributed in 4 groups of 16: group I (lidocaine alone; group II (lidocaine and fentanyl; group III (lidocaine, fentanyl and clonidine; and group IV (lidocaine and clonidine. The quality of sensory and motor blockade were compared. RESULTS: There has been no difference in onset and maximum block level among groups. Absence of motor block was the most frequent result, found in about 64% of patients. Analgesia length was different among groups, being more significant in group III. CONCLUSIONS: Clonidine, associated or not to fentanyl, has prolonged postoperative analgesia after epidural caudal blockade with lidocaine.

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

    Directory of Open Access Journals (Sweden)

    Monica Rossi Rodrigues

    2009-12-01

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

  15. Analgesia perioperatória com infusão peridural contínua da combinação de morfina e clonidina em crianças submetidas a procedimentos cirúrgicos abdominais Analgesia perioperatoria con infusión peridural continua de la combinación de morfina y clonidina en niños sometidos a procedimientos quirúrgicos abdominales Perioperative analgesia with continuous epidural infusion of morphine combined with clonidine in children undergoing abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O presente estudo foi desenvolvido para avaliar o efeito analgésico da combinação de morfina e clonidina administrada por via peridural, cuja eficácia foi demonstrada em pacientes adultos, sobre o consumo de isoflurano e o consumo de medicação analgésica no período pós-operatório em crianças. MÉTODO: Vinte e seis crianças escaladas para operações intra-abdominais foram alocadas de forma aleatória em dois grupos. Os dois grupos receberam, por via peridural, bolus de morfina (8 µg.kg-1 e de clonidina (0,8 µg.kg-1 antes do início da intervenção cirúrgica, seguidos de infusão contínua de clonidina (0,12 µg.kg-1.h-1 mais morfina (1,2 µg.kg-1.h-1 no Grupo I e o dobro dessas doses no Grupo II, durante 24 horas. Foram medidas as concentrações inspiratórias de isoflurano durante a operação e o número de doses (1 mg.kg-1 de tramadol durante 24 horas no pós-operatório. RESULTADOS: As concentrações de isoflurano foram significativamente menores em relação aos valores observados antes da incisão cirúrgica após 60 e 90 minutos nos Grupos II e I, respectivamente, porém não houve diferença entre os dois grupos. O consumo de tramadol foi muito menor no Grupo II, e sete (53,8% não necessitaram analgesia de resgate, porém foram observadas maior sedação e hipotensão arterial. Não foi observada depressão respiratória nos dois grupos. CONCLUSÕES: A infusão peridural da combinação de baixas doses de clonidina e morfina promoveu redução da necessidade de isoflurano no período intra-operatório e analgesia pós-operatória de boa qualidade.JUSTIFICATIVA Y OBJETIVOS: El presente estudio fue desarrollado para evaluar el efecto analgésico de la combinación de morfina y clonidina administrada por vía peridural, cuya eficacia fue demostrada en pacientes adultos, sobre el consumo de isoflurano y el consumo de medicación analgésica en el período postoperatorio en niños. MÉTODO: Veinte

  16. Comparison of the clinical effect of combined spinal epidural anesthesia and epidural anesthesia for labor analgesia%腰麻联合硬膜外麻醉与硬膜外麻醉用于分娩镇痛的临床效果比较

    Institute of Scientific and Technical Information of China (English)

    陈日亮

    2015-01-01

    目的:比较腰麻联合硬膜外麻醉(CSEA)与硬膜外麻醉(CEA)在分娩镇痛中的临床效果。方法选择2013年12月-2015年1月医院接受分娩镇痛的足月、单胎、头位初产妇60例,根据麻醉方式不同分为腰麻联合硬膜外麻醉(CSEA 组)和单纯硬膜外麻醉(CEA 组)各30例。观察2组孕妇麻醉起效时间、麻醉至手术开始时间、痛觉恢复时间、运动恢复时间、术中孕妇视觉模拟疼痛评分(VAS)、不良反应发生率、新生儿1min Apgar 评分。结果与CEA 组比较,CSEA 组麻醉起效时间、麻醉至手术开始时间较短,而痛觉恢复时间、运动恢复时间及术中孕妇视觉模拟疼痛评分(VAS)长于或优于 CEA 组,比较差异均有统计学意义(P ﹤0.05);2组不良反应发生率以及新生儿1min Ap-gar 评分比较差异无统计学意义(P ﹥0.05)。结论腰麻联合硬膜外麻醉时间短于单纯应用硬膜外麻醉,但恢复时间较长,临床可视患者情况而应用。%Objective To compare the clinical effect of lumbar anesthesia combined with epidural anesthesia (CSEA)and epidural anesthesia(CEA)for labor analgesia. Methods Select 60 cases of pregnant women in labor analgesia. According to different anesthesia,60 cases of pregnant women were divided into CSEA group and CEA group,30 cases in each group. The onset time of anesthesia,the onset time of anesthesia,the recovery time of pain,recovery time of pain,the visual an-alog pain score(VAS),the incidence of adverse reactions,and the Apgar 1min score of neonates were observed in the 2 groups. Results Compared with group CSEA,the onset time of anesthesia,the onset time of anesthesia,the recovery time of pain,recovery time of exercise,and the visual analog pain score(VAS)of pregnant women were significantly higher than those in CEA group,The difference was statistically significant(P ﹤ 0. 05);There was no significant difference in the incidence of

  17. 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

    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.%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.

  18. Catheter-related epidural abscesses -- don't wait for neurological deficits.

    NARCIS (Netherlands)

    Royakkers, A.A.; Willigers, H.; Ven, A.J.A.M. van der; Wilmink, J.T.; Durieux, M.; Kleef, M. van

    2002-01-01

    Epidural abscess is a rare but serious complication of epidural anesthesia for peri- and postoperative analgesia. It is feared because of possible persistent neurological deficits. Epidural abscess presents mostly with a classic triad of symptoms: back pain, fever and variable neurological signs and

  19. 使用硬膜外镇痛分娩与传统分娩产妇焦虑程度的比较研究%The use of epidural analgesia with traditional childbirth puerpera childbirth a comparative study of anxiety

    Institute of Scientific and Technical Information of China (English)

    聂梅; 熊怡

    2015-01-01

    Objective Observed using epidural analgesia childbirth than traditional delivery whether maternal anxiety level is lower, understand labor epidural analgesia effect of interference from the maternal anxiety.Methods Were divided into control group and experimental group, control group of conventional childbirth puerpera, the experimental group for the use of analgesia childbirth puerpera, the two groups of maternal and cesarean section rate compared to the scores of SAS questionnaire. Results Divided the experimental group is significantly higher than control group maternal anxiety group standard (P0.05)。对照组产妇焦虑群体标准均分显著高于实验组(P<0.01)。对照组产妇焦虑发生率显著高于实验组(P<0.01),且对照组产妇剖宫产率显著高于实验组(P<0.01)。结论:使用硬膜外镇痛分娩,可减轻分娩过程中因宫缩引起的疼痛,降低由于疼痛所导致焦虑的程度,提高分娩质量,从而降低剖宫产率。

  20. The effects of maternal labour analgesia on the fetus.

    Science.gov (United States)

    Reynolds, Felicity

    2010-06-01

    Maternal labour pain and stress are associated with progressive fetal metabolic acidosis. Systemic opioid analgesia does little to mitigate this stress, but opioids readily cross the placenta and cause fetal-neonatal depression and impair breast feeding. Pethidine remains the most widely used, but alternatives, with the possible exception of remifentanil, have little more to offer. Inhalational analgesia using Entonox is more effective and, being rapidly exhaled by the newborn, is less likely to produce lasting depression. Neuraxial analgesia has maternal physiological and biochemical effects, some of which are potentially detrimental and some favourable to the fetus. Actual neonatal outcome, however, suggests that benefits outweigh detrimental influences. Meta-analysis demonstrates that Apgar score is better after epidural than systemic opioid analgesia, while neonatal acid-base balance is improved by epidural compared to systemic analgesia and even compared to no analgesia. Successful breast feeding is dependent on many factors, therefore randomized trials are required to elucidate the effect of labour analgesia.

  1. Effects of epidural ropivacaine labor analgesia on duration of labor and maternal-fetal%罗哌卡因用于分娩镇痛对产程和母婴的影响

    Institute of Scientific and Technical Information of China (English)

    贾亚楠; 白华; 李明静; 李帆; 孟凡杰

    2014-01-01

    目的:探讨罗哌卡因用于分娩镇痛时对产程和母婴的影响。方法采用回顾性研究的方法,将本院198例产妇分为镇痛组和对照组,观察两组产妇产程、产后2小时出血量及两组新生儿的Apgar评分情况。结果较对照组而言,镇痛组第一产程有所缩短(t=2.343,P<0.05),第二产程有所延长(t=2.391,P<0.05)。两组在产后2小时出血量及两组新生儿的Apgar评分情况上差异无显著性(t=2.343,P>0.05)。结论罗哌卡因用于产妇的镇痛分娩是安全有效的,但实际使用时仍需要结合产妇实际情况,进行合理用药。%Objective To study the effects of epidural ropivacaine labor analgesia on duration of labor and maternal-fetal. Methods 198 maternals from one of third-grade class-A hospital were divided into analgesia group and the control group to observe two groups of maternal labor, postpartum 2 hours blood loss and two groups of neonatal Apgar score by using retrospective study method. Results Compare matched control but speech, the town was painful the set produce a distance to have to shorten in the ifrst (t=2.343, P<0.05) and produce in the second distance up had extension (t = 2.391, P < 0.05). Show differences on nonentity of two sets of the circumstances of Apgar grade points that bleed quantity and two sets of new borns in the postnatal period 2 hours. Conclusion The ropivacaine is a safety because of useding for the pregnant woman's town pain childbearing effective of, but still need to combine a pregnant woman actual circumstance while physically using, carry on reasonable to use a medicine.

  2. 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)。

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

    OpenAIRE

    Francés González, Sonia

    2015-01-01

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

  4. 蛛网膜下隙-硬膜外间隙联合阻滞(CSEA)应用于分娩镇痛的临床观察%A CLINICAL STUDY OF COMBINED SPINAL-EPIDURAL ANALGESIA FOR LABOR PAIN

    Institute of Scientific and Technical Information of China (English)

    陈富强; 胡丹; 宋文阁; 付志俭; 艾登斌

    2004-01-01

    目的:研究蛛网膜下隙-硬膜外间隙联合阻滞(Combined Spinal Epidural Analgesia, CSEA)应用于分娩镇痛的临床效果.方法:90例初产妇按入院前后及个人同意分成三组.C组:对照组,未用任何镇痛方法.CEA 组: 0.125%罗哌卡因+2μg /ml芬太尼组.CSEA组:L2/3 CSEA联合穿刺成功后,蛛网膜下腔注入0.17%布比卡因1ml+2.5μg芬太尼1ml,常规向头端置入硬膜外导管.观察产妇的分娩、镇痛情况及镇痛前后对产妇应激及泌乳的影响.结果: 1.CEA组和CSEA组产妇镇痛效果满意,和对照组比较有显著性差异(P0.05),对照组镇痛后比镇痛前的皮质醇含量明显升高,有统计学差异(P0.05).结论:CSEA和CEA都是行之有效的分娩镇痛方法,但CSEA起效迅速、镇痛完善、缩短活跃期产程、不增加器械助产率及剖宫产率,不影响产妇泌乳始动时间,更具有优越性.

  5. 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

  6. 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....

  7. 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.

  8. 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.

  9. 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

  10. 分娩镇痛后产妇血清IL-6、IL-8、IL-10的变化%Effect of analgesia with continued epidural block on the serum IL-6, IL-8 and IL-10 in parturients

    Institute of Scientific and Technical Information of China (English)

    修玉芳; 黄东林; 王颖; 肖龙

    2013-01-01

    目的:观察罗哌卡因连续硬膜外阻滞进行分娩镇痛对产妇血清中IL-6、IL-8、IL-10的影响.方法:将200例产妇随机分为观察组和对照组各100例.观察组在宫口开至2 ~3 cm时,开始采用连续硬膜外阻滞进行分娩镇痛;对照组按产科常规处理.观察两组产妇分娩镇痛前30 min、分娩镇痛后2h、分娩后24 h、48 h和72 h等5个时点的IL-6、IL-8、IL-10水平的变化.结果:两组产妇分娩镇痛后血清IL-6、IL-8、IL-10水平与分娩镇痛前比较均有升高(P<0.01),且多在分娩后24 h达峰值,对照组较观察组升高更为明显(P<0.05).结论:罗哌卡因连续硬膜外阻滞进行分娩镇痛可有效降低产妇分娩后炎性应激反应.%Objective:To observe the effect of labor analgesia with continued epidural block on the serum IL-6,IL-8 and IL-10 in parturients.Methods:Two hundreds of labor women were divided into two groups with 100 cases each group.One hundred parturients were selected as labor analgesia group (group I) and the others were as nature delivery group without analgesia (group II).Analgesia was used when utero-cervical was opened to 2 ~ 3 cm.The levels of serum IL-6,IL-8 and IL-10 were observed at five time points:before labor analgesia,at 2 h after the labor analgesia,at 24,48,72 h after delivery.Results:The levels of serum IL-6,IL-8 and IL-10 were increased significantly after labor analgesia,reached at peak values at 24 h (P < 0.05),and then gradually declined but still higher than the baseline values.The serum IL-6,IL-8 and IL-10 were significantly higher at 2 and 24 h in group Ⅱ than those in group I (P < 0.05).Conclusion:Labor analgesia with continued epidural block is safe and effective.Epidural analgesia can reduce the level of serum IL-6,IL-8 and IL-10 and inflammatory response during delivery.

  11. 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...

  12. 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

  13. 硬膜外自控镇痛泵防治前列腺术后膀胱痉挛失败原因分析%Analysis of the failure causes of bladder spasm of patient-controlled epidural analgesia pump treatment after prostatectomy

    Institute of Scientific and Technical Information of China (English)

    刘华平; 张欲晓; 张继邦; 黄永斌; 张海涛

    2013-01-01

    目的:观察硬膜外自控镇痛泵(PCEA)防治前列腺术后膀胱痉挛的失败原因,探讨补救措施。方法总结10年来PCEA防治前列腺术后膀胱痉挛的临床资料,分析PCEA防治前列腺术后膀胱痉挛的失败原因。结果本组11例,2例自控泵电源不足,3例硬膜外导管滑脱,1例导管阻塞,1例接头漏液,3例麻药配方剂量不足,1例硬膜外腔粘连。以上问题出现分别予以更换电池、静脉自控泵镇痛、更换三通管接头和应用盐酸屈他维林以补救。11例均达到防治膀胱痉挛的满意效果,未出现严重血尿和术后切口感染等严重并发症。结论 PCEA防治前列腺术后膀胱痉挛效果肯定,一旦发现术后镇痛效果不佳,及时分析原因,并予以纠正或采取其他方法防止膀胱痉挛,以免引起出血、感染等严重并发症。%Objective To investigate the failure causes and remedial measures of bladder spasm of patient-controlled epidural analgesia pump treatment after prostatectomy. Methods Clinical data of patient who received controlled epidural analgesia pump treatment of bladder spasm after prostatectomy in last ten years were summarized and reviewed retrospectively, andthe failure causes for bladder spasm of patient-controlled epidural analgesia pump treatment after prostatectomy were analzed. Results The group of 11 cases, 2 cases of controlled pump power supply, 3 cases of epidural catheter slippage, catheter obstruction in 1 cases, 1 cases of joint leakage, 3 cases of deficiency of anesthetic dose formula, 1 cases of epidural adhesion. All of the above problems are to replace the battery, patient-controlled intravenous analgesia, joint replacement and application of three pipe Drotaverine to remedy. All 11 cases achieved satisfactory effect in the prevention of bladder spasm, no severe hematuria and serious complication after incision infection. Conclusion Sure of bladder spasm after prostatectomy PCEA

  14. Headache and seizures after cervical epidural injection in a patient undergoing coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dheeraj Arora

    2012-01-01

    Full Text Available Epidural analgesia is widely used in cardiothoracic surgery. Most of the complications associated with epidural analgesia are related to the insertion techniques of epidural catheter. A 68-year-old obese patient posted for coronary artery bypass grafting surgery developed headache followed by seizures after insertion of the thoracic epidural catheter. Magnetic resonance imaging revealed air in the basal cisterns and in the left frontal region. The patient was managed conservatively and the symptoms subsided after 24 h. Later, the patient underwent coronary angioplasty.

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

    OpenAIRE

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

    2009-01-01

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

  16. 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

  17. 自控硬膜外镇痛用于腹部手术后病人的护理评价%Nursing evaluation on patients with patient control epidural analge-sia after abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    赵泽芹; 孙学君; 周承孝

    2008-01-01

    Objective To evaluate the effects of patient control epidural analgesia (PCEA) on analge-sia,sedation.Psychology,HR,BP and life quality in patients after abdominal surgery.Methods Patients were consecutively randomized in to analgesia group (n=70) in which PCEA were used,analgesic solution (0.5% bubivacaine 20 ml,fentany 10.4 mg,ondansetron 8 mg diluted to 100 ml with 0.9% NaCl) were continuously infusion in to epidural Cavity with electronic pump; Those patients without PCEA were control group (n=70),VAS,Ramsay sedation scal and changes of BP,HR were monitor in 2,6,10,16,24 h post operation and SAS.SDS were investigate before operation and 2d after surgery respectively.Simultaneously.The life quality and dependence with nurse were observation by nurses.Results All patients in analgesic group presented the best an-algesic sedation efficacy,VAS scores < 1,Ramsay sedation scale in between 2.1~3.2,SAD (40.6),SDS (39.8) post operation were significantly less than SAD (42.5),SDS (42.8) before operation (P < 0.05),BP,HR were reladve stability at various time points,life quality have been obviously improved; In the control group,VAS scores.Ramsay scale were 4.70,Ramsay sedation scale in between 0.89~1.22,the SAS (44.5),SDS (43.8) of post operation were oberviously increase (P<0.05) than before operation,HR were increased in various time point expertly 2 h post operation and there were severe anxious reaction have been obser-vation,wheares patient life quality dependence were reduction than analgesic group.There were significantly difference (P<0.05) for VAS Ramsay sedation seal and SAS.SDS between two groups compared in various time points after surgery (except 2 h post operation).Conclusion PCEA may be provided effective postoperative an-algesia,reduce psychological reaction,and improve life quality,in which beneficial for patient recovery.%目的 对采用自控硬膜外镇痛病人的镇痛镇静效果及心理学变化等进行评价.方法 随机选择施行腹

  18. 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.

  19. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case......Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... 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 has not been...

  20. Analysis of 108 cases of anesthesia for labor analgesia with ropivacaine epidural fentanyl%罗呱卡因联合芬太尼硬膜外阻滞麻醉用于分娩镇痛108例分析

    Institute of Scientific and Technical Information of China (English)

    李丽; 孙建群

    2014-01-01

    Objective To investigate the ropivacaine epidural anesthesia combined with fentanyl analgesia effect and the impact on the safety of mother and child,the incubation period to analyze the feasibility of labor analgesia.Methods Voluntary requirements of lumbar epidural anesthesia for labor analgesia of 108 cases of women in the observation group,did not implement the same period 100 cases of mater-nal pain control group.Comparison of two maternity analgesia,duration of labor,use of oxytocin,neonatal asphyxia,and postpartum hemor-rhage.Analgesic timing of different latencies group active phase group were compared childbirth labor time,oxytocin use,neonatal asphyxia, and postpartum hemorrhage.Results The visual analog scale (Visual analogue scale,VAS)scores were significantly lower than the control group (P0.05);between the timing of different analgesic latencies group and active group of neo-natal asphyxia,postpartum hemorrhage,duration of labor was not statistically significant (P>0.05).Conclusion Ropivacaine fentanyl an-algesia epidural anesthesia effect is good,no adverse effects on mother and child,the incubation period analgesia feasible to meet the needs of the entire production process,is worthy of further promotion.%目的:探讨罗呱卡因联合芬太尼硬膜外阻滞麻醉分娩镇痛的效果及对母儿安全性的影响,潜伏期进行分娩镇痛可行性的分析。方法选择自愿要求硬膜外阻滞麻醉分娩镇痛的108例产妇为观察组,同期未实施镇痛的100例产妇为对照组。比较两组产妇分娩镇痛效果、产程时间、催产素使用、新生儿窒息及产后出血情况。镇痛时机的选择不同的潜伏期组与活跃期组,比较两组分娩产程时间、催产素使用、新生儿窒息及产后出血情况。结果观察组视觉模拟评分明显低于对照组(P<0.05),但增加催产素使用率(P<0.05);两组新生儿窒息、产后出血、产程时间比较差异无统计

  1. 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.

  2. 改良埋入式注射泵联合硬膜外自控镇痛在晚期癌痛的疗效观察%Analgesic effect of Modified Embedded Injection Pump Combined with Patient-controlled Epidural Analgesia Pump with Late Cancer Pain

    Institute of Scientific and Technical Information of China (English)

    何敏琪; 周瑞仁

    2011-01-01

    目的 观察改良埋入式注射泵联合硬膜外自控镇痛(PCEA)对晚期癌痛患者的镇痛效果.方法 晚期癌痛患者25例,用改良埋入式注射泵植入皮下疏松结缔组织连接大容量镇痛泵持续注药止痛.药物配方:0.125%盐酸罗哌卡因、0.0002%芬太尼、0.0125%地塞米松、0.003%氟哌啶,流量1 ml/h-1,PCA 0.5 ml/30 min-1.结果 25例患者治疗前后VAS评分比较差异具有统计学意义(P<0.05),镇痛满意程度优良率84%~96%,患者生命体征稳定.结论 改良埋入式注射泵联合硬膜外自控镇痛术治疗于晚期癌痛安全有效.%Objective To observe the analgesia effect of modified embedded injection pump combined with patient-controlled epidural analgesia in 25 patients with late cancer pain. Methods Modified embedded injection pump ,which implanted under the skin loose connective tissue connect big capacity analgesia pump continue inject drugs to reduce pain. Drug composition: 0. 125% ropivacaine, 0. 0002% fentanyl, 0. 0125% dexamethasone, and 0. 0125% droperidol. The continuous was 1 ml per hour,0.5 ml per 30 minutes, respectively. Results The VAS scores before and after treatment were significantly different( P< 0.05 ). The good or excellent rate was 84% - 96%for satisfaction degree evaluation. Patient's vital signs were stability. Conclusion Modified embedded injection pump combined with patient-controlled epidural analgesia provide a safe and effective method for late cancer pain treatment.

  3. 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

    Directory of Open Access Journals (Sweden)

    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

  4. 天枢穴药物敷贴联合硬膜外镇痛泵对痔疮术后疼痛患者VAS评分及血清β-内啡肽的影响%Effect of VAS Score and Serumβ-endorphin on Post-operation Pain of Hemorrhoids by Application at Tianshu Combined with Epidural Analgesia Pump

    Institute of Scientific and Technical Information of China (English)

    洪顺垣

    2016-01-01

    Objective:To observe the effect of VAS score and serum β-endorphin on post -operation pain of hemorrhoids by application at Tianshu combined with epidural analgesia pump .Methods:Sixty cases were ran-domly divided into a treatment group and a control group ,with thirty cases in each group .The treatment group received the application at tianshu combined with epidural analgesia pump ,and the control group received epi-dural analgesia pump .Both groups received the postoperative routine treatment .Their VAS score and serum β-endorphin were observed and analyzed comparatively .Results:The VAS score of both groups were increased in 2 h,6 h,24 h,48 h after haemorrhoidectomy compared with that 30 minutes before haemorrhoidectomy ( P 0 .05 );the serum β-endorphin of both groups was descended in 24 h,48 h after haemorrhoidectomy .The treatment group was higher than the control group ,and there was a statistical difference between two groups ( P<0 .05 ) .Conclusion:Application at Tianshu combined with epi-dural analgesia pump can effectively relieve post -operation pain of hemorrhoids ,and its mechanism may be re-lated to the increase of serum β-endorphin .%目的:探讨天枢穴药物敷贴联合硬膜外镇痛泵对痔疮术后疼痛患者VAS评分及血清β-内啡肽的影响。方法:将60例患者按随机数字表法分为观察组和对照组,每组30例。观察组予天枢穴药物敷贴联合硬膜外镇痛泵,对照组予硬膜外镇痛泵,且两组术后予常规处理。观察治疗前后的VAS评分及血清β-内啡肽含量,进行对比分析。结果:术后2 h、6 h、24 h、48 h两组的VAS评分较本组术前30 min均升高(P<0.05),术后24 h、48 h两组间的VAS评分比较,观察组低于对照组,差异有统计学意义(P<0.05),而术后2 h、6 h两组间的VAS评分比较,差异无统计学意义(P>0.05);术后24 h、48 h两组的血清β-内啡肽含量较本组术前均降低(P<0

  5. The effect of ropivacaine plus sufentanil on maternal and neonatal serum nitric oxide and cortisol in patient with controlled epidural analgesia during labor%0.1%罗哌卡因复合舒芬太尼用于无痛分娩对母婴一氧化氮及皮质醇的影响

    Institute of Scientific and Technical Information of China (English)

    杨世辉; 黄希照; 胡祖荣; 贾杰; 黎昆伟; 邓恋

    2012-01-01

    Objective To observe the analgesic efficacy and safety of ropivacaine ( 0. 1% ) plus sufentanil ( 0. 5 ug/mL ) for parturients with controlled epidural analgesia during labor. Methods One hundred healthy primiparas were randomized to two groups: PCEA group and control group. In the PCEA group, 15 mL loading dose and continuous background infusion by 5 mlVh of ropivacaine ( 0. 1% ) plus fentanyl ( 0. 05 μg/mL ), with controlled epidural analgesia were given to subjects. Maternal vital signs, visual analog scale ( VAS ) score, modified bromage scale ( MBS ) of motor block neonate and neonatal Apgar scores were recorded. Serum nitric oxide and cortisol of mothers and neonates were assessed. Results There was no significant difference in maternal demographic data, duration of labor, mode of delivery, Apgar score, and maternal vital signs between the two groups. VAS score was significantly higher in control group than that in PCEA group ( 7. 92 ± 1. 46 vs 0. 73 ± 0. 64, P 0.05).P组镇痛前后与C组相应时点VAS评分差异有统计学意义(P<0.05).分娩情况比较差异无统计学意义(P>0.05).两组均未观察到不良反应或椎管内麻醉的并发症.P组分娩后NO无明显变化,皮质醇浓度降低(P<0.05); C组NO下降(P<0.05),皮质醇浓度升高(P<0.05).结论 用0.1%罗哌卡因复合舒芬太尼PCEA用于无痛分娩,安全有效,降低皮质醇浓度,延缓母婴NO水平降低.

  6. [Combined epidural and spinal anesthesia for cesarean section].

    Science.gov (United States)

    Hody, J L

    1994-01-01

    Combined spinal epidural block has proven its efficacy in skilled hands. This technique allies advantages of spinal anaesthesia, regarding its speed of action and intensity of motor blockade and advantages of postoperative epidural analgesia. This block must be performed with great care and method to reach a success rate of almost 100%. Local anaesthetics and additives are reviewed and commented. The two main complications, hypotension and post dural puncture headache can be contained in very low limits.

  7. 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.

  8. Application of combined spinal-epidural anesthesia and analgesia in patients with hypertension during pregnancy%腰-硬联合阻滞镇痛在合并妊娠期高血压疾病产妇中的应用

    Institute of Scientific and Technical Information of China (English)

    于坚伟; 鲁花丽

    2016-01-01

    Objective To explore the safety and effectiveness of combined spinal-epidural anesthesia ( CSEA) and analgesia in the application of patients with hypertension during pregnancy. Methods 175 patients with pregnancy-induced hypertension syndrome and preeclampsia treated in grand hospital of Shanxian County from January 2012 to December 2015 were selected. Patients were divided into labor analgesia group (105 cases) and control group (70 cases) according to whether accepted combined spinal-epidural anesthesia and analgesia. Patients in the two groups were given the same blood pressure control and production process management, and patients in labor analgesia group were treated by combined spinal-epidural anesthesia for labor analgesia after 4 cm. Observational index including the women 's general situation, average arterial pressure in labor and birth process at each time point, delivery, maternal and infant complications and treatment situation. Results Compared to control group, patients in labor analgesia group had lower average arterial pressure at 60 min[(103. 7 ± 5. 7)mmHg vs (118. 2 ± 5. 5)mmHg], 120 min after active period[(104. 7 ± 4.3)mmHg vs (119.3 ±5.1)mmHg], the second stage of labor[(107.8 ±5.3)mmHg vs (114.8 ±6.1)mmHg], postpartum 120 min[(98.2 ±5.9)mmHg vs (103.8 ±6.7)mmHg] (P<0.05). The cesarean section rate of patients in labor analgesia group was 19. 0 %, lower than that in control group (34. 3 %) (P<0. 05). Compared to control group, patients in labor analgesia group had longer time of second stage of labor[(50. 3 ± 20. 5)min vs (42. 1 ± 19. 9)min] and higher rate of oxytocin use(60. 0 % vs 44. 3 %) (P<0. 05). Compared to control group, patients in labor analgesia group had lower rate of headache(6. 7 % vs 18. 6 %) and dizziness and antihypertensive therapy(12. 4% vs 38. 6%)(P<0. 05). Conclusion CSEA analgesia can reduce the cesarean section rate of patients with pregnancy-induced hypertension syndrome and preeclampsia, reduce puerperal

  9. Study on the Therapeutic Effect of 0.1% Levobupivacaine HCl on Ambulatory/Walking Epidural Analgesia in Labor%0.1%盐酸左旋布比卡因用于可行走镇痛分娩的疗效探讨

    Institute of Scientific and Technical Information of China (English)

    程娟; 王庆云; 王莲; 张亚娜

    2011-01-01

    Objective To investigate the therapeutic effect of0.1% levobupivacaine HCl on ambulatory or walking epidural analgesia in labor. Methods Based on the individual intention,200 hospitalized cases from February 2010 to March 2011 of full-term, singleton pregnancy,head delivery and primiparity,were divided into the observation group and the control group equally, which were then observed on stages of labor,changes of pain before and after analgesia, ways of delivery, use of oxytocin and the Apgar scores of newborns at one minute. Results The total stage of labor of observation groups was shorter than the control group, especially the active phase of the first stage, and the differences were statistically significant( P < 0.01 ); the pain after analgesia of experimental groups was less ,which was significantly contrast with pain before analgesia( P < 0.01 ) ;the difference of cesarean section rate between the two groups was significant( P < 0.05 );and the differences in use of oxytocin and newborns' Apgar scores at one minute were not statistically significant( P > 0.05 ). Conclusion 0.1% levobupivacaine HCl using in Epidural Analgesia is safe and effective for labor analgesia that it can shorten the stage of labor, reduce pain, lower the cesarean section rate, and has no effect on newborns.%目的 探讨0.1%盐酸左旋布比卡因硬膜外给药用于可行走镇痛分娩的临床效果.方法 根据个人意愿,将2010年2月至2011年3月在我院住院的足月妊娠、单胎、头位、初产200例分为实验组和对照组,每组各100例,实验两组产妇产程、镇痛前后疼痛变化、分娩方式、缩宫素使用情况及新生儿出生1分钟Apgar评分情况.结果 实验组总产程缩短,尤其是第一产程活跃期明显短于对照组,差异有统计学意义(P<0.01);实验组镇痛后疼痛程度明显减轻,与镇痛前比较差异有统计学意义(P<0.01);剖宫产率两组比较差异有统计学意义(P<0.05);实验组

  10. [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.

  11. [Horner syndrome following combined spinal-epidural anesthesia].

    Science.gov (United States)

    Karaca, Ömer; Kumaş Solak, Sezen; Demirgan, Serdar; Bademci, Mehmet

    2016-07-01

    Horner syndrome is rarely observed in connection with epidural anesthesia. It is characterized by ptosis, enophthalmos, miosis, anisocoria, and conjunctival hyperemia in the affected eye, as well as anhydrosis and flushing on the affected side of the face. It is usually a complication spontaneously resolved without permanent neurological deficits. Intraoral anesthesia; stellate ganglion, cervical or brachial plexus blocks; thoracic, lumbar or caudal epidural anesthesia, and intrapleural analgesia are the main causes for Horner syndrome related to anesthesia. Among other causes of Horner syndrome are head and neck surgery, trauma, and puncture of internal jugular vein. The present case of unilateral Horner syndrome appeared in the aortobifemoral bypass after lumbar spinal- epidural anesthesia.

  12. 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...

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

    Directory of Open Access Journals (Sweden)

    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

  14. 不同浓度罗哌卡因在硬膜外镇痛分娩中应用效果比较%The clinical analysis of different concentrations of domestic ropivacaine of epidural analgesia in labor

    Institute of Scientific and Technical Information of China (English)

    朱鸣萍; 虞文青; 吴萍; 刘稚媛; 杨瑾

    2015-01-01

    目的 比较不同浓度罗哌卡因在硬膜外镇痛分娩中的应用效果及价值.方法 将300例住院分娩的产妇随机数字表法分为A、B、C三组,其中A组给予0.125%罗哌卡因复合苏芬太尼镇痛,B组给予0.1%罗哌卡因复合苏芬太尼镇痛,C组未要求镇痛分娩,观察三组分娩情况.结果 A组产程用时(261.38±19.87) min,产后2h出血量(241.03±34.57) rmL;B组产程用时(260.09±19.69) min,产后2h出血量(238.66±35.01) mL;C组产程用时(270.46±20.86)min,产后2h出血量(251.75±36.79) mL;组间差异均无统计学意义(t=0.472、1.035,均P>0.05).A组胎儿心率(142.34±21.57)次/min,新生儿Apgar评分(9.77±0.21)分,脐动脉血pH值(7.27±0.06);B组胎儿心率(145.21 ±21.49)次/min,新生儿Apgar评分(9.79±0.20)分,脐动脉血pH值(7.26±0.08);C组胎儿心率(143.78±22.01)次/min,新生儿Apgar评分(9.64±0.24)分,脐动脉血pH值(7.28±0.07);组问差异均无统计学意义(t=0.763、0.360、0.114,均P>0.05).A组镇痛起效时间(12.13±1.76) min,疼痛评分(1.03±0.46)分,镇痛后宫缩持续时间(22.39±3.21)s,镇痛后宫缩间隔时间(3.26±1.49) min,剖宫产率为8.00%;B组镇痛起效时间(12.04±1.69) min,疼痛评分(1.01±0.52)分,镇痛后宫缩持续时间(21.04±3.18)s,镇痛后宫缩间隔时间(3.49±1.51) min,剖宫产率为9.00%;C组镇痛起效时间(16.77 ±2.51) min,疼痛评分(3.76±1.23)分,镇痛后宫缩持续时间(26.98 ±5.87)s,镇痛后宫缩间隔时间(2.65±0.75) min,剖宫产率为48.00%;组间差异均有统计学意义(x2或t =6.148、8.522、5.749、4.095、61.316,均P<0.05).结论 采用0.1%罗哌卡因复合苏芬太尼进行分娩镇痛即能够有效减轻患者疼痛、缩短产程并减少产后2h出血量,同时对宫缩影响小,降低剖宫产率,对新生儿无影响,值得在临床上推广应用.%Objective To compare the effect of different concentrations of ropivacaine in epidural analgesia of childbirth

  15. A “ COMPARATIVE STUDY BETWEEN BUPIVACAINE 0.5% AND ROPIVACAINE 0.75% IN EPIDURAL ANALGESIA IN PATIENTS U NDERGOING ELECTIVE LOWER ABDOMINAL AND LOWER LIMB SURGERIES ”

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    Sachidanand

    2015-09-01

    Full Text Available BACKGROUND : Regional anaesthesia is noted for its simplic ity, safety and effectiveness. Though spinal anaesthesia provides an efficient block it has some limitations. Epidural anaesthesia is one of regional techniques for lower abdominal and lower limb surgeries. Bupivacaine is the drug of choice for providing e ffective epidural analgesia. Ropivacaine is new long acting local anaesthetic with similar chemical structure but with less cardio toxicity and CNS toxicity. We did a Prospective Randomised control study to c o m p a r e between t wo g r o u ps - 20 m l o f 0.75% R op i v ac a i ne ( I sob ar i c a nd 20 m l 0. 5 % B up i v a ca i ne ( I sob ar i c f o r e p i du ra l a n ae s t h e s i a i n l ow e r a bdo mi n a l a nd l ow e r li m b su r g er i e s i n a du lt s a g e d 1 8 t o 60 y e ar s. AIM : To compare in two groups - 20 m l o f 0.75% R op i v aca i ne ( I sob ar i c a nd 20 m l 0. 5 % B up i v a ca i ne ( i sob ar i c f o r e p i du ra l a n ae s t h e s i a i n l ow e r a bdo mi n a l a nd l ow e r li m b su r g er i e s i n a du lt s DESIGN : A Prospective randomized control study . METHODS : Th e s t ud y p o p ul a t i on w as r a nd o m l y di v id e d in t o 2 g r o up s w i t h 30 p a t i e n t s i n e a c h g r o up . S t ud y g r o u p R - rece i v e d 20 m l of 0.75% Ro pi v a c a in e ( I so b a r i c b y e pidu r al r o u t e S t ud y g r o u p B - rece i v e d 20 m l of 0.5% B upi v a c a in e ( i so b a r i c b y e pidu r al r o u t e and compared 1. Ons e t of s e nso r y a nd m o t or b l o c k, 2. H i g h e st l e v e l of s e nso r y b l o c k, 3. D e g r e e of m o t or b l o c k a d e ( U s i ng Mod i f i e d B r o m a g e s c a l e 4. Du ra ti on of m o t or b l o c k a de. 5. Du ra ti on of s e nso r y a n a l g e s i a. 6. Haemodynamic changes heart rate, blood pressure, respiratory rate. 7. S ide effects if any . R ESULTS : 0.75% R op i v aca i ne h a s a sho r t e r du ra ti on of m o t o r b l o c k

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

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    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. 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

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

    Science.gov (United States)

    Valente, A.; Frassanito, L.; Natale, L.; Draisci, G.

    2012-01-01

    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. PMID:22844625

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

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    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

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    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. 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

    ón por vía intravenosa o epidural de morfina, bupivacaína o ropivacaína en el tratamiento del dolor pos toracotomía. MÉTODOS: Sesenta pacientes sometidos a procedimientos de toracotomía electiva fueron aleatoriamente ubicados en cuatro grupos con el uso de la técnica de sobres lacrados. Los grupos MIV, ME, MEB y MER recibieron morfina controlada por el paciente por vía intravenosa, epidural, morfina-bupivacaína y morfina-ropivacaína, respectivamente. La frecuencia cardíaca, presión arterial y la saturación de oxígeno perioperatorias y el dolor postoperatorio en reposo y durante la tos, los efectos colaterales y la necesidad de analgésicos de rescate fueron registrados a los 30 y 60 minutos y las 2, 4, 6, 12, 24, 36, 48 y 72 horas. RESULTADOS: La necesidad de sodio diclofenaco durante el estudio fue menor en el grupo ME. El área bajo la curva de tiempo en la VAS fue menor en el grupo ME en comparación con el Grupo MIV, pero similar al Grupo MEB y MER. Las puntuaciones de dolor en reposo fueron mayores en los tiempos 12, 24, 36 y 48 horas en el Grupo MIV en comparación con el grupo ME. Las puntuaciones de dolor en reposo fueron mayores a los 30 y 60 minutos en los Grupos ME y MIV en comparación con el Grupo MEB. Las puntuaciones de dolor durante la tos a los 30 minutos fueron mayores en el grupo ME en comparación con el Grupo MEB. No hubo diferencia entre los Grupos MIV y MER. CONCLUSIONES: La morfina administrada por vía epidural fue más eficaz que por la vía intravenosa. La eficacia fue mayor en el grupo EM en el período postoperatorio tardío y en el Grupo MEB en el período postoperatorio inicial. Concluimos entonces que la morfina administrada por vía epidural fue la más eficaz y nuestra preferida.BACKGROUND AND OBJECTIVEs: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management

  2. Comparison of the antalgic effects of epidural and intravenous patient-controlled analgesia with fentanyl after cesarean section%芬太尼静脉和硬膜外自控镇痛在剖宫产术后的对比观察

    Institute of Scientific and Technical Information of China (English)

    冯雪容; 李淑; 邹振宇

    2011-01-01

    Objective To compare the effects of patient-controlled intravenous analgesia( PCIA) with patient-controlled epidural analgesia (PCEA) with fentanyl after cesarean section.Methods 60 patients undergoing cesarean section were randomly assigned into two groups: group PCIA and group PCEA, 30 cases for each group.The analgesic solution for PCIA was fentanyl (20ug/kg) plus tropisetron (5mg), and that for PCEA was fentanyl (5ug/kg) plus 1.192% ropivacaine.The analgesia and sedation efficacy was assessed by visual analogue scale ( VAS) and Ramsay sedation score (RSS).The plasma prolaction concentrations, the recovery of bowel movement, the adverse effects during analgesia period were observed.Results The efficacy of analgesia in group PCEA was better than that in group PCIA.The RSS score was significantly higher in group PCIA than that in group PCEA.No significant difference was found in the overall satisfaction on analgesia therapy.The incidence of dizziness in group PCIA was higher than that in group PCEA.There was no significant difference between two groups in the recovery of bowel movement, the plasma level of prolactin, nausea,vomiting, pruritus and respiration frequency.Conclusions PCIA with PCEA could provide similar analgesia efficacy using fentanyl in patients undergoing cesarean section.Both PCIA and PCEA have less adverse effects.%目的 观察剖宫产术后芬太尼静脉自控镇痛(PCIA)和硬膜外自控镇痛(PCEA)的镇痛效果.方法 60例剖宫产手术患者随机分为PCLA组和PCEA组,每组30例.PCLA组术毕应用芬太尼20μg/kg、托烷司琼5 mg静脉镇痛;PCEA组术毕应用芬太尼5 μg/kg、1.192%甲磺酸罗哌卡因20ml硬膜外镇痛.采用视觉模拟评分(visual analogue scale,VAS)和Ramsay镇静评分(Ramsay sedation score,RSS)观察两组患者术后的镇痛、镇静效果.并观察术后血浆泌乳素浓度、肠蠕动恢复时间和镇痛期间可能出现的不良反应.结果 PCEA组镇痛效果优于PCIA组,PCIA组RSS

  3. 硬膜外注射右美托咪定、芬太尼用于下肢手术镇痛的效果评价%Evaluation of the effects of dexmedetomidine and fentanyl for epidural analgesia in lower limb surgeries

    Institute of Scientific and Technical Information of China (English)

    汪涛; 王志春; 朱安祥; 张奎; 陈树秀; 周巧林

    2015-01-01

    目的 观察和评价硬膜外注射右美托咪定、芬太尼复合罗哌卡因用于下肢手术的镇痛效果.方法 美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级患者100例,按随机数字表法分为两组(每组50例):罗哌卡因+右美托咪定组(RD组)和罗哌卡因+芬太尼组(RF组).除记录循环、呼吸指标及镇静评级外,于硬膜外给药后即刻观察T1o痛觉消失时间、最高感觉阻滞平面、完全运动阻滞时间、感觉阻滞消退两个节段的时间、首次追加镇痛药物的时间及副作用的发生情况等.结果 两组患者一般情况差异无统计学意义(P>0.05).RD组T10痛觉消失和完全运动阻滞时间[(7.1±1.2)min和(18.0±3.6) min]明显早于RF组[(9.2±1.8) min和(22.0±3.0) min](P<0.05),RD组术后镇痛时间[(361±20) min]长于RF组[(259±32) min],且硬膜外局麻药总用量[(76±10)mg]显著少于后者[(97±l4)mg](P<0.01);镇静效果评级RD组(76%)显著好于RF组(18%)(P<0.01).RF组恶心、呕吐的发生率(28%和14%)较RD组(16%和6%)明显升高(P<0.05),而RD组口干的发生率(16%)显著高于RF组(4%)(P<0.01).结论 硬膜外注射右美托咪定用于下肢手术镇痛,可提供较为稳定的血流动力学,感觉神经阻滞起效快,术后镇痛时间延长,药物用量少,镇静效果良好.%Objective To observe and evaluate the analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine.Methods One hundred ASA Ⅰ-Ⅱ patients undergoing lower limb orthopedic surgery were randomly divided into two groups (n=50):ropivacaine+dexmedetomidine group (RD group) and ropivacaine+fentanyl group (RF group).Besides cardio-respiratory parameters and sedation scores,various block characteristics were also observed including the onset of T10 analgesia time,maximum sensory analgesic time,complete motor blockade time,two segmental dermatomal regressions time,first rescue analgesic time,and the

  4. Analgesia e sedação da associação da clonidina e ropivacaína a 0,75% por via peridural no pós-operatório de colecistectomia aberta Analgesia y sedación de la asociación de la clonidina y ropivacaína a 0,75% por vía peridural en el pos-operatorio de colecistectomia abierta Analgesia and sedation with epidural clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy

    Directory of Open Access Journals (Sweden)

    Antonio Mauro Vieira

    2003-09-01

    edades variando de 18 a 50 años, con peso entre 50 y 100 kg, estado físico ASA I y II, sometidos a colecistectomia, y que fueron distribuidos en dos grupos: Control (GC, en que fue administrada ropivacaína a 0,75% (20 ml, asociada al clorato de sodio a 0,9% (1 ml; Experimento (GE, en que fue inyectada ropivacaína a 0,75% (20 ml, asociada a la clonidina (1 ml = 150 µg. La analgesia y la sedación fueron observadas 2, 6 y 24 horas después del término del momento operatorio. RESULTADOS: La media de edad en el GC fue de 41 años y de 37 años en el GE. La media de peso fue de 67 kg en el GC y de 64 kg en el GE. La sedación en el pos-operatorio fue significativamente mayor en los pacientes a las 2 y 6 horas del grupo de experimento. La analgesia fue observada en mayor número de pacientes del grupo de experimento, cuando comparada al grupo control. CONCLUSIONES: La asociación de clonidina y ropivacaína produjo analgesia que dura más, y sedación en pacientes, en los horarios de observación de 2 y 6 horas.BACKGROUND AND OBJECTIVES: Epidural clonidine has analgesic properties and potentiates local anesthetic effects; there are, however, some side effects including: arterial hypotension, bradycardia and sedation. This study aimed at evaluating analgesia and sedation of clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy. METHODS: Participated in this study 30 patients of both genders, aged 18 to 50 years, weighing 50 to 100 kg, physical status ASA I or II, submitted to cholecystectomy, who were distributed in two groups: Control Group (CG received 0.75% ropivacaine (20 ml with saline solution (1 ml; Experimental Group (EG received 0.75% ropivacaine (20 ml with clonidine (1 ml = 150 µg. Analgesia and sedation were observed at 2, 6 and 24 postoperative hours. RESULTS: Mean age was 41 yr in CG and 37 yr in EG. Mean weight was 67 kg in CG and 64 kg to EG. Postoperative sedation was significantly higher at 2 and 6 hours in the

  5. 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...

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. COMPARATIVE STUDY OF EPIDURAL BUPIVACAINE AND BUPIVACINE WITH NEOSTIGMINE

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    Pavani

    2015-05-01

    Full Text Available BACKGROUND: Many drugs have been used to prolong analgesic effects of epidural local anesthetics. These are called adjuvants. We studied the epidural effect of Neostigmine when adminstered with Bupivacaine in comparison with Bupivacaine . OBJECTIVE: The objective for the study was to find a drug which enhances the onset of action, increases the duration of action of the local anesthetic with minimal or no side effects, instead of increasing the dose of local anaesthetic. MATERIALS AND METHODS: A prospecti ve study was conducted on 100 adult patients, selected at random of either sex, of age between 20 - 65 years and belonging to ASA grade I or II. The study was designed to compare the effects of epidural Neostigmine with Bupivacaine and epidural Bupivacaine u sed alone with regard to onset, duration of analgesia, hemodynamic stability and level of anaesthesia. Patients were divided into two groups of 50 each. Group I received 19ml of 0.5% Bupivacaine+1ml of normal saline. Group II received 19ml of 0.5% Bupivaca ine+100μg of Neostigmine in 1ml of normal saline. In the operating room the patients were assessed for time of onset of analgesia, duration of anaesthesia, level of analgesia and complications. RESULTS : The addition of Neostigmine resulted in significant r apid onset of action, longer duration of analgesia and motor blockade. There was no incidence of respiratory depression, pruritus, fluctuations in blood pressure, or change in pulse rate, except one patient who developed bradycardia. CONCLUSION : Co adminis tration of epidural Neostigmine and Bupivacaine appears to be a useful technique for epidural anaesthesia as it provides faster onset, longer duration of action and haemodynamic stability.

  11. 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.

  12. Spinal and epidural anesthesia

    Science.gov (United States)

    ... you epidural or spinal anesthesia is called an anesthesiologist. First, the area of your back where the ... Chan VWS. Spinal, epidural, and caudal anesthesia. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: ...

  13. Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna?

    Directory of Open Access Journals (Sweden)

    Muh. Rumli Ahmad

    2013-09-01

    Full Text Available Preemptive analgesia is initiating an analgesic regimen before the onset of the noxious stimulus. Damages to the tissue caused by surgical trauma generate noxious response conveyed to the central nervous system (CNS by two pathways, neural pathway and circulatory pathway. This study is a double- blinded clinical trial that included 48 patients undergoing lower extremity orthopedic surgery. The subjects were divided into two groups: group I (n=24 received 10 mL bupivacaine 0.25% from epidural route, and group II (n=24 received 10 mL NaCl 0.9% from epidural route as the control group before induction of anesthesia. Both groups were anesthetized under general anesthesia. Group I received 5 mL bupivacaine 0,5% every 90 minutes and group II received 5 mL NaCl 0,9 with similar time intraoperatively. Post-operatively, both groups received continuous bupivacaine 0,25% 4 mL/ hour until 24 hours after surgery. Measurements of cytokine levels: tumor necrosis factor-α (TNF-α, interleukin- 1β (IL-1β, IL-6 and IL-10 were done before induction of anesthesia, in the early post-operative period, at 4, 8, and 24 hours after surgery. Group I showed lower level proinflammatory cytokines level compared with group II but the difference was not statistically significant (p>0.05. The level of anti-inflammatory cytokine was higher in group I, but the difference was not statistically significant (p>0.05. Pain intensity at 4 hours, 8 hours, 24 jam hours post operative was lower significantly (p0.05 excepst at early postoperative period (p<0.05. Generally, preemptive epidural analgesia was able to suppress the cytokine responses, but not completely. In conclusion, preemptive epidural analgesia is associated with better analgesia and better hemodynamic stability compared without preemptive epidural, but unable to suppress the production of proinflammatory and anti-inflammatory cytokines.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Epidural tramadol via intraoperatively placed catheter as a standalone analgesic after spinal fusion procedure: An analysis of efficacy and cost

    Science.gov (United States)

    Ilangovan, Vijaysundar; Vivakaran, Thanga Tirupathi Rajan; Gunasekaran, D.; Devikala, D.

    2017-01-01

    Objective: This was a prospective analysis of epidural tramadol as a single analgesic agent delivered through intraoperatively placed epidural catheter for postoperative pain relief after spinal fusion procedures in terms of efficacy and cost. Materials and Methods: Twenty patients who underwent spinal fusion procedures were included in the study. After completion of the procedure, an epidural catheter was placed at the highest level of exposed dura and brought out through a separate tract. Postoperatively, tramadol was infused into the epidural space via the catheter at a dose of 1 mg/kg diluted in 10 ml of saline. The dosage frequency was arbitrarily fixed at every 6 h during the first 2 days and thereafter reduced to every 8 h after the first 2 days till day 5. Conventional intravenous analgesics were used only if additional analgesia was required as assessed by visual analog scale (VAS). Results: Patients’ VAS score was assessed every 4 h from the day of surgery. Patients with a VAS score of 6 or more were given additional analgesia in the form of intravenous paracetamol. Of the twenty patients, eight patients needed additional analgesia during the first 24 h and none required additional analgesia after the first 24 h. The median VAS score was 7 within the first 24 h and progressively declined thereafter. Epidural tramadol was noted to be many times cheaper than conventional parenteral analgesics. Conclusion: Epidural tramadol infusion is safe and effective as a standalone analgesic after open spinal fusion surgery, especially after the 1st postoperative day. Intraoperative placement of the epidural catheter is a simple way of delivering tramadol to the epidural space. The cost of analgesia after spinal fusion surgery can be reduced significantly using epidural tramadol alone. PMID:28149082

  16. Myelopathy with syringomyelia following thoracic epidural anaesthesia.

    Science.gov (United States)

    Aldrete, J A; Ferrari, H

    2004-02-01

    Under general anaesthesia and muscle relaxation, a thoracic epidural catheter was inserted at the T8-T9 level in a 7-year-old boy scheduled to have a Nissen fundoplication to provide postoperative analgesia. After 4 ml of lignocaine 1.5% was injected through the catheter, hypotension resulted. Fifty-five minutes later 5 ml of bupivacaine 0.25% produced the same effect. In the recovery room a similar injection resulted in lower blood pressure and temporary apnoea. Sensory and motor deficits were noted the next day and four days later magnetic resonance imaging demonstrated spinal cord syringomyelia extending from T5 to T10. Four years later, dysaesthesia from T6 to T10 weakness of the left lower extremity and bladder and bowel dysfunction persist. The risks of inserting thoracic epidural catheters in patients under general anaesthesia and muscle relaxation are discussed, emphasising the possibility of spinal cord injury with disastrous consequences.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Efficacy of epidural administration of morphine with bupivacaine for orthopaedic surgery in sheep

    OpenAIRE

    Durej M.; Ledecký V.; Michalák D.; Hluchý M.; Kòazovický D.

    2012-01-01

    The aim of the study was to test the hypothesis that epidural administration of morphine with bupivacaine provides more intense and sufficient perioperative analgesia compared with parenterally administrated butorphanol during orthopaedic surgery. Sheep were assigned to group C (control group, 6 sheep) and group E (epidural, 5 sheep). Sheep from group C were pre-medicated with midazolam (0.3 mg/kg, i.m.) and butorphanol (0.2 mg/kg, i.m.). Propofol was used ...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Effect of sufentanil combined with different concentrations of ropivacaine for labor analgesia on maternal

    Institute of Scientific and Technical Information of China (English)

    Han-He Wang; Min-Jia Jiang; Wan-Dong Liao

    2016-01-01

    Objective:To study the effect of sufentanil combined with different concentration of ropivacaine for stepped analgesia on stage of labor, stress indexes and blood coagulation function.Methods:A total of 178 cases of full-term singleton primiparas who awaited delivery and received epidural labor analgesia in our hospital from January 2015 to June 2016 were selected and randomly divided into stepped analgesia group and routine analgesia group, and the stage of labor, levels of stress hormones and pain mediators during childbirth and blood coagulation function indexes after childbirth were observed between two groups.Results: The duration of latent phase of labor of stepped analgesia group was shorter than that of routine analgesia group while the duration of active phase of labor, the duration of second stage of labor and the duration of third stage of labor were not significantly different from those of routine analgesia group; serum PRL level of stepped analgesia group was significantly higher than that of routine analgesia group while PA, NE, E, DYN,β-EP, SP, PGE2, 5-HT, TF, TFPI, FPA, AT-III and DD levels were not significantly different from those of routine analgesia group.Conclusions: Sufentanil combined with different concentration of ropivacaine for stepped analgesia is with equivalent effect to routine analgesia, and can shorten the latent phase of labor and reduce the inhibitory effect of pain on prolactin without affecting the degree of stress during childbirth and the blood coagulation function after childbirth.

  2. 硬膜外泵入布托啡诺复合小剂量氯胺酮在分娩镇痛中的应用%Epidural in fasion butorphanol plus low dose of ketamine in labor analgesia

    Institute of Scientific and Technical Information of China (English)

    邓燕; 张勇; 王开祥

    2009-01-01

    目的 观察硬膜外持续泵入布托啡诺复合小剂量氯胺酮用于分娩镇痛的效果及其对分娩过程和胎儿的影响.方法 选择单胎足月初产妇60例,随机分为两组.A组(对照组)30例,硬膜外持续泵入0.1%罗哌卡因+芬太尼0.15μg/ml,泵速4 ml/h;B组(观察组)30例,硬膜外持续泵入布托啡诺0.1 mg/kg+氟胺酮0.7 mg/kg,泵速4 ml/h.连续监测呼吸,循环情况;采用视觉模拟疼痛评分(VAS)评估镇痛效应;运动神经阻滞程度按改良的Bromage标准进行测定;观察记录产程进展宫缩及胎儿情况、新生儿情况及不良反应.结果 A、B两组的VAS评分差异无统计学意义(P>0.05).新生儿各时点的Apgar评分两组间比较差异也无统计学意义(P>0.05).A组第二产程(67±51)min,较B组(41±20)min有所延长(P<0.05).产妇的生命体征、宫缩、胎儿及运动神经阻滞程度,两组差异无统计学意义.结论 硬膜外泵入布托啡诺复合小剂量氨胺酮可安全有效地应用于分娩镇痛.%Objective To evaluate the analgesic efficacy and safety of butorphanol combined with low dose of ketamine for labor analgesia.Methods Sixty ASA Ⅰ-Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentation and were expected to have avaginal deavery were randomly divided into two groups;control group (group A) received with ropicanine and fentany (n=30);observation group (group B) received with butorphanol 0.1 mg/kg in combination with ketamie 0.7 mg/kg in 100 ml normal saline.Both infusion in a rate of 4 ml/h.The intensity of pain was evaluated by patients using VAS and motor function was assessed using modified bromage score.The vital signs (BP,HR,SpO2),fetal neart rate,labor process,mode of delivery.Apgar score of neonates and side effects of analgesia were recorded.Results There was no significant differece in VAS score and fetal apgar score between group A and B(P>0.05) ;the duration of second stage of labor was longer

  3. Epidural fibrosis after permanent catheter insertion and infusion.

    Science.gov (United States)

    Aldrete, J A

    1995-11-01

    Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.

  4. Effect of epidural anesthesia using ropivacaine combined with remifentanil on delivery

    Institute of Scientific and Technical Information of China (English)

    Wen Cheng

    2016-01-01

    Objective:Tostudy the ropivacaine combined with remifentanil on analgesic effect and safety of painless labor requirements of maternal epidural anesthesia.Methods:Hospital obstetrics and gynecology scheduled for painless delivery of maternal were selected. 80 cases (analgesic group, the use of ropivacaine epidural analgesia with remifentanil), did not use any analgesia 80 cases of childbirth women as controls group, two groups of mothers underwent index difference childbirth pain were observed during childbirth, birth outcomes and other health care workers with the help of the same group under midwifery.Results:VAS score between T0 time analgesia group and the control group was not statistically significant; in the analgesic, T4, T5, T6 moments analgesia group VAS scores were significantly lower than T1, T2, T3 in the control group. Significantly lower than the control group the first stage of labor analgesia group, significantly longer than the second stage of labor analgesia group control group, two groups of maternal third stage of labor was no significant difference. Mode of delivery between the two groups, birth weight, the first and second 1 min, 5 min Apgar scores were not significantly different.Conclusion: Ropivacaine remifentanil requirements for painless childbirth maternal epidural anesthesia can significantly reduce maternal childbirth pain without causing adverse effects on childbirth and newborns.

  5. 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

    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.......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...

  6. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove

    1995-01-01

    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 an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of cen...... frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and suggest a proposal for prophylactic and diagnostic guidelines for epidural catheter-related infections. Comment in: J Hosp Infect. 1997 Mar;35(3):245....

  7. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

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

    1989-01-01

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

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    Raheleh Aligholipour Maleki

    2011-08-01

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

  12. Estudo comparativo entre bupivacaína racêmica (S50-R50 a 0,125% e bupivacaína em excesso enantiomérico de 50% (S75-R25 a 0,125% e 0,25% em anestesia peridural para analgesia de parto Estudio comparativo entre bupivacaina racémica (S50-R50 a 0,125% y bupivacaina en exceso enantiomérico de 50% (S75-R25 a 0,125% y 0,25% en anestesia peridural para analgesia de parto A comparative study of 0.125% racemic bupivacaine (S50-R50 and 0.125% and 0.25% 50% enantiomeric excess bupivacaine (S75-R25 in epidural anesthesia for labor analgesia

    Directory of Open Access Journals (Sweden)

    Nádia Maria da Conceição Duarte

    2008-02-01

    estudio fue comparar la analgesia y el bloqueo motor entre la Bupivacaina (S50-R50 a 0,125% y la Bupivacaina en exceso enantiomérico de 50% (S75-R25 a 0,125% e 0,25% en peridural continua para analgesia de parto. MÉTODO: Se realizó un ensayo clínico doblemente encubierto, con distribución aleatoria de 75 participantes en trabajo de parto, distribuidas en tres grupos: GI - Bupivacaina (S50-R50 a 0,125%, GII - Bupivacaina (S75-R25 a 0,125% y GIII - Bupivacaina (S75-R25 a 0,25%. La inclusión en el estudio fue hecha después de la firma del Consentimiento Libre y Aclarado. RESULTADOS: No se encontraron diferencias estadísticas significativas en cuanto a la latencia de la analgesia, nivel sensorial del bloqueo, volumen de anestésico local, duración del trabajo de parto y de la analgesia, frecuencia de parto instrumental, puntuaciones de Apgar o pH del cordón umbilical. El intervalo para la primera dosis rescate fue mayor y los puntajes de dolor en 45 minutos fueron menores en el grupo Bupivacaina (S75-R25 a 0,25%. La intensidad del bloqueo motor fue mayor en el grupo Bupivacaina (S50-R50 a 0,125%. CONCLUSIONES: La Bupivacaina (S75-R25 determinó un bloqueo motor menos intenso, incluso cuando se utilizó en mayor concentración (0,25%, resultando en una mejor calidad de analgesia, sin interferir en la evolución del trabajo de parto o en la vitalidad de los recién nacidos.BACKGROUND AND OBJECTIVES: Continuous epidural block is used for relief of labor pain and it is associated with a low incidence of complications. Studies with the levorotatory isomer of local anesthetics demonstrated that they are safer regarding the cardiotoxicity. The objective of this study was to compare analgesia and motor blockade of 0.125% bupivacaine (S50-R50 and 0.125% and 0.25% 50% enantiomeric excess bupivacaine (S75-R25 in continuous epidural block for labor analgesia. METHODS: Seventy-five patients in labor participated in this randomized, double-blind study after signing an informed

  13. Feasibility of whole-range epidural labor analgesia for parturient women with pregnancy-induced hypertension in natural delivery%全程硬膜外分娩镇痛用于妊娠期高血压产妇自然分娩可行性分析

    Institute of Scientific and Technical Information of China (English)

    齐俊巧; 张秀民; 邵俊涛; 吴侠; 郭丽魁; 李淑文

    2011-01-01

    目的 探讨全程硬膜外阻滞分娩镇痛对患有妊娠期高血压疾病产妇自然分娩结局及应激激素水平的影响.方法 选择妊娠期高血压疾病产妇80例,随机分为两组,各40例,全程分娩镇痛组(A组),活跃期分娩镇痛组(B组)行分娩镇痛,两组操作过程完全一致.采用视觉模拟疼痛评分(visual analogue score,VAS),记录镇痛前及镇痛后直至宫口开全时的疼痛评分,以及产程潜伏期、活跃期、第二产程、第三产程持续时间、宫缩药使用情况、分娩结局、产时出血量.产妇满意度及新生儿评分.两组分别于规律宫缩(T0),宫口开大3 cm(T1),宫口开全(T2)胎儿娩出(T3)抽取产妇静脉血,采用放射免疫法测定肾上腺素(adrenaline,ADR)皮质醇(cortisol,COR)的浓度,同时测定产妇血压,计算平均动脉压(mean arterial preasure,MAP).结果 镇痛前的VAS评分,A组低于B组(P0.05),缩宫素使用时间,A组高于B组(P0.05). However, there was significant difference in MAP and the concentrations of ADR and COR between stage Tt and To in group B ( P < 0. 05 ) . Conclusions Whole range epidural analgesia reduces stress reaction resulting from labor pain in parturient women with PIH, prevents the deterioration of PIH without increasing the rate of caesare-an section, shows fewer side effects and makes safer vaginal delivery of parturient women with PIH.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

  16. Differential blockade to assess surgical repair by intraoperative active mobilization in knee injuries-Beyond labour analgesia

    Directory of Open Access Journals (Sweden)

    G Vijay Anand

    2011-01-01

    Full Text Available Motor-sparing selective epidural analgesia has long been practised in the field of labour analgesia. However, the utility of such techniques in other fields remain limited. We present the successful use of a similar technique of differential blockade in a case of quadriceps plasty with realignment of patella for recurrent dislocation of patella. A very low concentration of bupivacaine and fentanyl was used through continous epidural. The adequacy of repair was assessed intraoperatively by active movement of operated limb by patient himself.

  17. 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

  18. 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.

  19. Spinal and Intracranial Epidural Abscess

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-03-01

    Full Text Available Presentation, epidemiology, diagnosis and treatment of spinal epidural abscess (SEA and intracranial epidural abscess (ICEA are reviewed by researchers at The John's Hopkins University School of Medicine, Baltimore, MD, and Universidad de Santander, Columbia.

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

    Directory of Open Access Journals (Sweden)

    L. M. Charco Roca

    2013-10-01

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

  1. Evidence for using air or fluid when identifying the epidural space.

    Science.gov (United States)

    Sanford, Curtis L; Rodriguez, Ricardo E; Schmidt, James; Austin, Paul N

    2013-02-01

    Lumbar epidural analgesia is frequently employed to provide pain relief for women during labor. Anesthesia providers use various methods to identify the epidural space. Some providers use air, some use fluid, and others use a combination of air and fluid during the loss of resistance technique. Loss of resistance to air has been speculated to result in a lesser quality of analgesia compared with loss of resistance to only fluid. A search strategy focusing on preappraised sources was used to locate evidence from interventional and observational studies. Four evidence sources were located, including a systematic review with meta-analysis of 4 older studies. The evidence reviewed was inconclusive in determining whether a difference in analgesia quality results from the use of air or fluid during the loss of resistance technique. Future studies should include an adequate number of subjects and address other problems such as operator experience, observer blinding, equivalence of subject characteristics, outcomes definition and measurement, and composition of epidural solution. Providers should consider other factors when selecting loss of resistance medium, such as the reported complications of large amounts of air injected into the epidural space and surrounding structures.

  2. 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)

  3. 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...

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

    Directory of Open Access Journals (Sweden)

    Gabriela Rocha Lauretti

    2014-01-01

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

  5. 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.

  6. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

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    Giane Nakamura

    Full Text Available CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group or 15 ml of ropivacaine 0.0625% plus 75 µg clonidine (RC group. Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination

  7. 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...

  8. ADMINISTRAÇÃO EPIDURAL DE OPIÓIDES EM CÃES EPIDURAL OPIOIDS ADMINISTRATION IN DOGS

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    Carlos Augusto Araújo Valadão

    2002-04-01

    Full Text Available Os opióides têm sido utilizados em Medicina Veterinária há vários anos como alternativa para o alívio da dor pós-operatória ou traumática. Atualmente, tem-se dado maior valor ao controle da dor nos animais, visando a oferecer melhores condições de recuperação ao paciente traumatizado ou recém-operado. A morfina foi o primeiro opióide usado em animais. Mais recentemente, a administração dessa substância, por via epidural, vem sendo empregada no controle da dor com resultados promissores. Assim, nesta revisão, abordam-se vários aspectos referentes aos efeitos e às indicações da administração epidural de opióides em cães.Opioids have been used for several years to relieve traumatic pain in Veterinary Medicine. The painful stimulus are implicated with delayed tissue recuperation of surgical wounds. Today, a great importance has been given to pre-emptive control of post operative pain in animals. Indeed, the use of epidural morphine, the first opioid substance used in animals, has provided excellent analgesia and good condition at the immediate post operative period. In addition, several aspects concerning the effects indications and forms of epidural opioids injections in dogs are considered in this review.

  9. Sobre a analgesia pós-operatória da morfina, cetamina ou da associação em cadelas submetidas à ovariossalpingohisterectomia eletiva

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    Maria Raquel de Almeida

    2013-07-01

    Full Text Available Este estudo objetivou avaliar a eficácia analgésica da morfina e cetamina, isoladas ou associadas, para tratar a dor pós-operatória de cadelas submetidas à ovariossalpingohisterectomia (OSH eletiva. Foram utilizadas 24 cadelas saudáveis, de raças variadas, idade de 27±17 meses e massa corpórea de 11±8,5kg. Os animais foram separados de forma igualitária e aleatória em três grupos: GM - morfina 0,5mg kg-1; GK - cetamina 2,5mg kg-1 ou GKM - morfina 0,5mg kg-1, associada à cetamina 2,5mg kg-1 . Os fármacos foram administrados por via intramuscular (IM imediatamente após a indução anestésica. A dor foi avaliada por meio de escala analógica visual (EAV e de Glasgow modificada (EGM e o grau de sedação pela escala de Dobbins, duas horas antes do procedimento cirúrgico (basal, 1, 2, 4, 8, 12 e 24 horas após a extubação (M1 a M24. Quando a pontuação da EGM era acima de 33% do valor total da avaliação, realizava-se resgates analgésicos com 1,0mg kg-1 de morfina e, após 40 minutos deste resgate, caso não fosse suficiente, 0,2mg kg-1 de meloxicam. Os dados não paramétricos foram submetidos ao teste de Friedman ou Kruskal-Wallis, seguidos do teste de Dunn. Para os paramétricos, foi empregada análise de variância unidirecional ANOVA, seguida do teste de Tukey (P<0,05. Não houve diferenças significativas entre os grupos para os escores de dor, exceto para EGM, na qual os valores no GM foram superiores ao GKM 1h após a extubação. O número de resgates analgésicos foi significativamente superior no GM (todos os animais, com 11 resgates no total, em relação ao GKM (3 e GK (um animal por duas vezes. A administração pré-incisional de cetamina foi mais efetiva do que a oferecida pela morfina e, dessa maneira, a cetamina pode ser empregada para analgesia preemptiva em cadelas submetidas à OSH, entretanto, pode ser necessária analgesia de resgate.

  10. Epidural injections of indomethacin for postlaminectomy syndrome: a preliminary report.

    Science.gov (United States)

    Aldrete, J Antonio

    2003-02-01

    Since there have been side effects reported with the administration of corticosteroids epidurally, their application has been limited. Because some nonsteroidal antiinflammatory drugs have central and spinal antinociceptive actions, we have compared the effects of indomethacin (INM) given by the epidural route to methylprednisolone (MTP). This was a prospective, comparative study in an ambulatory pain care center. Two hundred six patients with recurrent low back pain (Visual Analog Scale >7) and radiculopathy after they had had 2 or more lumbar laminectomies with the diagnosis of "postlaminectomy syndrome" were randomly assigned to 1 of 3 groups. Group I (64 patients) was given 2 epidural injections of lyophilized INM 1 mg. Group II (60 patients) received 2 injections of 2 mg of INM at the same intervals. Group III (82 patients) was treated by 2 epidural injections of MTP 80 mg. In every case, the medication was diluted in 3 mL of 0.5% bupivacaine. Reductions of pain were assessed by changes in the Visual Analog Scale; physical activities, attitude, and medication intake were graded by the Pain Progress Score recorded before each treatment and 2 wk after the last. After each injection, all patients had pain relief to Visual Analog Scale <3. Increased analgesia (P < 0.05) was noted when a double dose of INM was used (Group II) or when 80 mg of MTP was given. The total average scores of the Pain Progress Score showed significant differences at the second injection in Groups II and III only. Physical activity, emotional attitudes, and medication intake were also improved but the changes were not statistically significant. In conclusion, in this group of patients, INM produced adequate analgesia in Groups I and II, with evidence suggesting that 2 mg of INM may produce a similar degree of pain relief as 80 mg of MTP after the second injection. Other nonsteroidal antiinflammatory drugs may be explored in the future for the same purpose.

  11. Comparing the painlessness effects of spinal (sufentanil and epidural(bupivacaine plus lidocaine analgesic methods in labour and delivery

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    A. Shafiee

    2006-01-01

    Full Text Available Background and purpose: This study was designed in order to compare the effects of spinal and epidural analgesia on labour and also several maternal and fetal factors in vaginal delivery.Materials and Methods: The study was a randomized clinical trail and participatnts were 120 gravid 1 and gravid 2 women in the active phase of delivery, admitted to the labour room of Fatemieh Hospital in Hamedan in 1381-1382.Sixty patients were randomly divided into two groups of 30, analgesia was induced by single spinal sufentanil injection in one group and, bupivacaine plus lidocaine injection in the other group.Maternal vital signs and pain score were recorded (VAS at 1, 5, 15 and 30 minutes after administration of analgesia and every 30 minutes thereafter. Fetal heart rate every 15 minutes, vaginal examination every hour, urinary output every 4 hours after delivery and the incidence of headache and back pain, one week after delivery were the variables under study.Results: Both groups were matched regarding demographic, gravida and Parity factors. There was no significant difference between groups regarding pain score, (based on VAS,duration of the first and second delivery phase, the incidence of fetal distress, meconium excretion, apgar scores at 1 and 5 minutes after delivery, abnormal laboar, operative or assisted delivery. Average analgesic duration was longer in spinal analgesia than single epidural injection analgesia.Conclusion: Considering the difficulty of the technique, the need for anaestheticianHs supervision and injection repeatition in epidural analgesia, it seems that spinal analgesia is a suitable replacement which is more practical, less expensive, easy to perform and induces a desirable analgesia.

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

    OpenAIRE

    2013-01-01

    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 ...

  13. 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

  14. Analgesia regional em cuidados intensivos

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    Luísa Guedes

    2012-10-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A analgesia regional desempenha um papel importante na abordagem multimodal da dor no doente crítico e permite amenizar o desconforto do doente e reduzir os estresses fisiológico e psicológico associados. Ao diminuir as doses de opioides sistêmicos, reduz alguns dos seus efeitos colaterais, como a síndrome de abstinência, possíveis alterações psicológicas e disfunção gastrintestinal. Apesar desses benefícios, seu uso é controverso, uma vez que os doentes em unidades de cuidados intensivos apresentam frequentemente contraindicações, como coagulopatia, instabilidade hemodinâmica e dificuldade na avaliação neurológica e na execução da técnica regional. CONTEÚDO: Os autores apresentam uma revisão sobre analgesia regional em cuidados intensivos, com foco nas principais vantagens e limitações de seu uso no doente crítico, e descrevem as técnicas regionais mais usadas e a sua aplicabilidade nesse contexto.

  15. 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.

  16. 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

  17. 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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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.

  19. Combined Spinal-Epidural for Vaginal Delivery in a Parturient With Takayasu’s Arteritis

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    Sean Patrick Clifford MD

    2016-12-01

    Full Text Available Takayasu’s arteritis is a rare, progressive panendarteritis involving all layers of the arterial wall. This disease includes variable involvement of the aorta and its major branches. The most common complication with this condition is severe, uncontrolled hypertension, often leading to end organ dysfunction. We describe the management of a 27-year-old woman diagnosed with Takayasu’s arteritis that presented in labor with intense pain and underwent a combined spinal-epidural for anesthetic management. Per literature review, a combined spinal-epidural technique for planned vaginal delivery has not been described for a laboring Takayasu patient. Our technique, utilizing intrathecal opioids and a low-dose local anesthetic-opioid epidural infusion, provided adequate analgesia while maintaining hemodynamic stability throughout labor augmentation and successful vaginal delivery.

  20. Bilateral assymetric epidural hematoma

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    Edmundo Luis Rodrigues Pereira

    2015-01-01

    Full Text Available Background: Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-10% of all extradural hematomas. However, higher mortality rates have been reported in previous series. Case Description: The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29 th postoperative day with no neurological deficit. Conclusion: The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

  1. Aspergillus spinal epidural abscess

    Energy Technology Data Exchange (ETDEWEB)

    Byrd, B.F. III (Vanderbilt Univ. School of Medicine, Nashville, TN); Weiner, M.H.; McGee, Z.A.

    1982-12-17

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

  2. Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.

    Science.gov (United States)

    French, Keisha L; Daniels, Eldra W; Ahn, Uri M; Ahn, Nicholas U

    2013-01-01

    Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.

  3. Comparison of dexmedetomidine and clonidine as an adjuvant to ropivacaine for epidural anesthesia in lower abdominal and lower limb surgeries

    Directory of Open Access Journals (Sweden)

    Sruthi Arunkumar

    2015-01-01

    Full Text Available Background: The quality and duration of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Though, the effects of clonidine on local anesthetics have been extensively studied, there are limited studies demonstrating the effects of epidural dexmedetomidine on local anesthetics. The aim of our study is to compare the effect of clonidine and dexmedetomidine when used as an adjuvant to epidural ropivacaine in lower abdominal and lower limb surgeries. Materials and Methods: Patients were randomized into two groups-group ropivacaine with clonidine (RC received 15 ml of 0.75% ropivacaine with 1 μg/kg clonidine and group ropivacaine with dexmedetomidine (RD received 15 ml of 0.75% ropivacaine with 1 μg/kg dexmedetomidine epidurally. Onset of sensory analgesia using cold swab, onset of motor blockade using Bromage scale, time to 2 dermatome regression of sensory level, time to first demand for analgesia, sedation using Ramsay sedation scale, intra operative hemodynamic parameters and complications were assessed. Results: The onset (RD-8.53 ± 1.81, RC-11.93 ± 1.96 and duration of sensory blockade (RD-316 ± 31.5, RC-281 ± 37, sedation were found to be significantly better in the dexmedetomidine group. No significant difference was found in terms of onset of motor blockade and hemodynamic changes. Conclusion: Dexmedetomidine at doses of 1 μg/kg is an effective adjuvant to ropivacaine for epidural anesthesia, which is comparable to clonidine.

  4. 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

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

    Directory of Open Access Journals (Sweden)

    Minal Harde

    2016-01-01

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

  6. 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.

  7. Identification of the epidural space: loss of resistance with air, lidocaine, or the combination of air and lidocaine.

    Science.gov (United States)

    Evron, Samuel; Sessler, Daniel; Sadan, Oscar; Boaz, Mona; Glezerman, Marek; Ezri, Tiberiu

    2004-07-01

    The ideal technique for identifying the epidural space remains unclear. Five-hundred-forty-seven women in labor who requested epidural analgesia were randomly allocated to three groups according to the technique by which the epidural space was identified: 1) loss-of-resistance with air (air; n = 180), 2) loss-of-resistance with lidocaine (lidocaine; n = 185), and 3) loss-of-resistance with both air and lidocaine (air-plus-lidocaine; n = 182). We assessed ease of epidural catheter insertion, characteristics of the blockade, quality of analgesia, and complications. The inability to thread the epidural catheter occurred in 16% of the air, 4% of the lidocaine, and 3% of the air-plus-lidocaine patients (P air group had unblocked segments (6.6% versus 3.2% and 2.2%, respectively; P air group (1.7% versus 0% in the other two groups; P space with air was more difficult and caused more dural punctures than with lidocaine or air plus lidocaine. Additionally, sequential use of air and lidocaine had no advantage over lidocaine alone.

  8. 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

  9. 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

  10. Effects of thoracic epidural anesthesia on pulmonary venous admixture and oxygenation with isoflurane or propofol anesthesia during one lung ventilation

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    Reda S. Abdelrahman

    2012-10-01

    Conclusions: The administration of thoracic epidural anesthesia, either combined with propofol or isoflurane, was not associated with a relevant impairment of oxygenation during OLV. Therefore Pre-emptive analgesia via an epidural thoracic catheter can be used safely as a standard in lung surgery, decreasing the anesthesia requirements when combined with GA, maximizing the benefits of each form of anesthesia and improving the outcome in patients with cardiopulmonary diseases, hence it was found that it has no effect on oxygenation during OLV, and it is associated with stable hemodynamics.

  11. Remifentanil em analgesia para o trabalho de parto Remifentanil en analgesia para el trabajo de parto Remifentanil as analgesia for labor

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    Eliane C S Soares

    2010-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As técnicas neuroaxiais representam atualmente os métodos mais efetivos para controle da dor durante o trabalho de parto e a analgesia peridural utilizando soluções anestésicas ultradiluídas é considerada o padrão ouro, promovendo alívio adequado da dor com mínimos efeitos colaterais. Em algumas situações, no entanto, o emprego dessas técnicas é limitado pela existência de contraindicações maternas ou obstáculos estruturais e materiais. Nestes casos, as opções alternativas ainda são precárias e escassas, oferecendo resultados pouco otimistas e de eficácia questionável. CONTEÚDO: Este artigo apresenta, com base em uma revisão da literatura, as informações disponíveis relacionadas ao emprego do remifentanil como técnica alternativa para a analgesia de parto discutindo aspectos farmacocinéticos, farmacodinâmicos, eficácia analgésica, satisfação materna e efeitos colaterais maternos e fetais. CONCLUSÕES: Os dados iniciais apontam o remifentanil como uma opção promissora a ser empregada nas situações em que a gestante não quer ou não pode receber a analgesia neuroaxial.JUSTIFICATIVA Y OBJETIVOS: Las técnicas neuroaxiales representan actualmente los métodos más efectivos para el control del dolor durante el trabajo de parto, y la analgesia epidural utilizando soluciones anestésicas ultradiluidas se considera el estándar oro, promoviendo el alivio correcto del dolor con los mínimos efectos colaterales. En algunas situaciones, sin embargo, el uso de esas técnicas queda limitado por la existencia de contraindicaciones maternas u obstáculos estructurales y materiales. En esos casos, las alternativas todavía son precarias y escasas, ofreciendo resultados poco optimistas y de una eficacia cuestionable. CONTENIDO: Con base en una revisión de la literatura, este artículo muestra que las informaciones disponibles relacionadas a lo empleo de lo remifetanil como técnica alternativa

  12. 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.

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

    Science.gov (United States)

    Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Mandell, M Susan; Tsou, Mei-Yung; Chang, Yin; Ting, Chien-Kun

    2014-01-01

    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.

  14. 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.

  15. EFFECT OF INTRATHECAL CLONIDINE ON DURATION OF SPINAL ANALGESIA

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    Sourabh

    2015-06-01

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

  16. Avaliação da metadona e do tramadol sobre analgesia pós-operatória e parâmetros clínicos de cadelas submetidas a ovarioisterectomias e mastectomias

    OpenAIRE

    Ramirez Uscategui, Ricardo Andres [UNESP

    2012-01-01

    Com o objetivo de avaliar a analgesia pós-operatória, o consumo anestésico e os efeitos cardiorrespiratórios da analgesia pré, intra pós-operatória usando metadona e pré-operatória usando tramadol, durante a mastectomia, foram realizados dois estudos clínicos experimentais prospectivos de tipo cego em 88 cadelas, submetidas à mastectomia unilateral terapêutica, anestesiadas com propofol e isofluorano. O grupo TRAM (34 animais) recebeu 5 mg/kg de tramadol IM no período pré-operatório, o grupo ...

  17. Ethanol-induced analgesia

    Energy Technology Data Exchange (ETDEWEB)

    Pohorecky, L.A.; Shah, P.

    1987-09-07

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

  18. [Epidural emphysema complicating bronchial asthma].

    Science.gov (United States)

    Rouetbi, N; Ben Saad, A; Joobeur, S; Skhiri, N; Cheikh Mhamed, S; Mribah, H; El Kamel, A

    2012-12-01

    Epidural emphysema is an exceptional complication of bronchial asthma, revealed by an incidental finding in chest tomography. We report a case of a 21-year-old man admitted with asthma attack complicated by subcutaneous and mediastinal emphysema. Chest tomography confirmed the mediastinal emphysema and also revealed the epidural emphysema within the vertebral canal. Neurological examination was negative. The patient showed complete recovery 10days after the onset of symptoms. The epidural emphysema is a rare complication during asthma attacks. The benignity of this complication should not require a systematic chest tomography.

  19. Thoracic epidural catheter for postoperative pain control following an ineffective transversus abdominis plane block using liposome bupivacaine

    Science.gov (United States)

    Terrien, Brian D; Espinoza, David; Stehman, Charles C; Rodriguez, Gabriel A; Connolly, Nicholas C

    2017-01-01

    A 24-year-old female with a history of ulcerative colitis underwent colectomy. The patient received an ineffective transversus abdominis plane (TAP) block with liposome bupivacaine (Exparel) intraoperatively and was started on a hydromorphone patient-controlled analgesia 5 hours after the TAP block, which did not relieve her pain. A continuous thoracic epidural (CTE) was then placed after blood levels of bupivacaine were drawn, and the patient immediately experienced significant pain relief. The combined use of liposome bupivacaine and bupivacaine CTE infusion in the postoperative management of this patient demonstrated no safety concerns, provided excellent analgesia and plasma concentrations of bupivacaine remained far below toxic levels. PMID:28144162

  20. 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

  1. A CLINICAL STUDY OF CAUDAL EPIDURAL ANAESTHESIA FOR TRANSURETHRAL RESECTION OF PROSTATE

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    Satyendra S

    2015-07-01

    Full Text Available In the Urological surgery, the most commonly performed procedure in Transurethral Resection of Prostate. Most of these patients are elderly above the age of 60 years with various systemic problems. The common problem includes cardiovascular disorder, chronic obstructive pulmonary diseases and various old age problems. These patients present as a challenge to anaesthesiologists because they are high risk patients for endoscopic surgeries. Various worker since many years tried different type of anesthesia procedure. The regional techniques have been proved to be safe and less risky. It includes spinal, lumbar epidural, combined spinal epidural and caudal epidural. The caudal epidural block have been used by many workers for TURP in elderly patients since so many years. The Present study includes 50 patients of ASA grade I, II, III including cardiovascular problem, COPD, and other spinal deformities, scheduled for TURP. After pre anesthetic checkup and through investigation, caudal epidural block were given by standard technique. Observation and results were recorded by observing the onset and duration of analgesia, level of block, any side effects. The changes in pulse rate, blood pressure, SPO 2 , ECG were closely monitored throughout the procedure. The observation showed that 60% of patients having co - existing diseases and most of them having chronic Hypertension (30%, onset of analgesia was 10 - 15 mins in 30 patients. Motor blockade by modified bromage scale was observed and found that 45 patients ( 90% has MBS - O. There were no significant changes observed in PR, BP, R/R, ECG and SPO 2 throughout the procedure in all patients. Response to total procedure was found excellent in 40 patients ( 80%. There were no significant complication observed in maximum number of patients. Only 5 patients had complained of nausea and vomiting, which was successfully treated by antiemetics

  2. 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

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    Esra Mercanoğlu; Zekeriyya Alanoğlu; Perihan Ekmekçi; Sacide Demiralp; Neslihan Alkış

    2013-01-01

    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 ...

  3. 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

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    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.

  4. 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.

  5. 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.

  6. Epidural injections for back pain

    Science.gov (United States)

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... be pregnant What medicines you are taking, including herbs, supplements, and other drugs you bought without a ...

  7. Post operatory analgesia in caesarean surgery.

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    Bárbara Lucía Cabezas Poblet

    2003-12-01

    Full Text Available 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. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment.

  8. Antibacterial activity of epidural infusions.

    Science.gov (United States)

    Coghlan, M W; Davies, M J; Hoyt, C; Joyce, L; Kilner, R; Waters, M J

    2009-01-01

    The incidence of epidural abscess following epidural catheterisation appears to be increasing, being recently reported as one in 1000 among surgical patients. This study was designed to investigate the antibacterial activity of various local anaesthetics and additives, used in epidural infusions, against a range of micro-organisms associated with epidural abscess. The aim was to determine which, if any, epidural infusion solution has the greatest antibacterial activity. Bupivacaine, ropivacaine and levobupivacaine crystals were dissolved and added to Mueller-Hinton Agar in concentrations of 0.06%, 0.125%, 0.2%, 0.25%, 0.5% and 1%. Fentanyl, adrenaline and clonidine were also mixed with agar in isolation and in combination with the local anaesthetics. Using a reference agar dilution method, the minimum inhibitory concentrations were determined for a range of bacteria. Bupivacaine showed antibacterial activity against Staphylococcus aureus, Enterococcus faecalis and Escherichia coli with minimum inhibitory concentrations between 0.125% and 0.25%. It did not inhibit the growth of Pseudomonas aeruginosa at any of the concentrations tested. Levobupivacaine and ropivacaine showed no activity against Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa, even at the highest concentrations tested, and minimal activity against Escherichia coli (minimum inhibitory concentrations 0.5% and 1% respectively). The presence of fentanyl, adrenaline and clonidine had no additional effect on the antibacterial activity of any of the local anaesthetic agents. The low concentrations of local anaesthetic usually used in epidural infusions have minimal antibacterial activity. While the clinical implications of this in vitro study are not known, consideration should be given to increasing the concentration of bupivacaine in an epidural infusion or to administering a daily bolus of 0.25% bupivacaine to reduce the risk of epidural bacterial growth.

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

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    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

  10. 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

  11. 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

  12. Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion

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    Hasanin, Ahmed M.; Mokhtar, Ali M.; Amin, Shereen M.; Sayed, Ahmed A.

    2017-01-01

    Background and Aims: Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However, the data about the use of ultrasound in thoracic epidural block are scanty. In this study, pre-insertion ultrasound scanning was compared to traditional manual palpation technique for insertion of the thoracic epidural catheter in abdominal operations. Subjects and Methods: Forty-eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study. Patients were divided into two groups with regard to technique of epidural catheter insertion; ultrasound group (done ultrasound screening to determine the needle insertion point, angle of insertion, and depth of epidural space) and manual palpation group (used the traditional manual palpation technique). Number of puncture attempts, number of puncture levels, and number of needle redirection attempts were reported. Time of catheter insertion and complications were also reported in both groups. Results: Ultrasound group showed lower number of puncture attempts (1 [1, 1.25] vs. 1.5 [1, 2.75], P = 0.008), puncture levels (1 (1, 1) vs. 1 [1, 2], P = 0.002), and needle redirection attempts (0 [0, 2.25] vs. 3.5 [2, 5], P = 0.00). Ultrasound-guided group showed shorter time for catheter insertion compared to manual palpation group (140 ± 24 s vs. 213 ± 71 s P = 0.00). Conclusion: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method. PMID:28217056

  13. Efeitos do bloqueio pudendo, peridural e subaracnóideo sobre a coagulação sangüínea de gestantes Efectos del bloqueo pudendo, peridural y subaracnoideo sobre la coagulación sanguínea de embarazadas Effects of pudendal nerve, epidural and subarachnoid block on coagulation of pregnant women

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    Alberto Vasconcelos

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Tem sido atribuída à anestesia regional diminuição significativa das complicações tromboembólicas no pós-operatório, provavelmente por sua ação atenuadora sobre a resposta neuroendócrino-metabólica. As gestantes, que apresentam aumento importante da coagulabilidade sangüínea, podem, teoricamente, beneficiar-se desse efeito por ocasião do parto. O objetivo deste estudo foi verificar o efeito da anestesia regional sobre a coagulação sangüínea em gestantes. MÉTODO: Foram estudadas 30 pacientes no terceiro trimestre de gestação, sendo dez submetidas à anestesia peridural para cesariana, com 150 mg de bupivacaína a 0,5% sem epinefrina e 2 mg de morfina (grupo PD; dez à anestesia subaracnóidea para cesariana com 15 mg de bupivacaína hiperbárica a 0,5% e 0,2 mg de morfina (grupo SA; e dez a bloqueio de pudendo para parto vaginal, com doses de até 100 mg de bupivacaína a 0,5% sem epinefrina (grupo BP. A coagulação sangüínea foi avaliada por meio de coagulograma (tempo de protrombina, tempo de trombina, tempo de tromboplastina parcial ativada e de tromboelastograma (tempo r, tempo k, tempo r + k, ângulo alfa e amplitude máxima nos seguintes momentos: antes e após a anestesia, após o nascimento do feto e 24 horas após a anestesia nos grupos PD e SA. No grupo BP a avaliação foi realizada antes da anestesia, após o nascimento do feto e 24 horas após a anestesia. RESULTADOS: Os resultados mostraram que nenhuma das técnicas anestésicas utilizadas teve influência na coagulação sangüínea das gestantes. Demonstraram, também, que durante o trabalho de parto tem início um processo de ativação da coagulação que é responsável pelas alterações encontradas nos três grupos estudados. CONCLUSÕES: Nas condições do presente estudo o bloqueio simpático e o anestésico local não influíram sobre a coagulação em gestantes de termo submetidas à anestesia peridural, subaracn

  14. 拉玛泽减痛分娩法联合可行走式腰硬麻醉在分娩镇痛中的临床观察%Clinical observation of Lamaze childbirth method of pain relief plus combined spinal and epidural ambulatory anesthesia in labor analgesia

    Institute of Scientific and Technical Information of China (English)

    李利波; 刘明; 梁丽芬

    2014-01-01

    目的:研究拉玛泽减痛分娩法联合可行走式腰硬联合麻醉的镇痛效果及其对母儿的影响。方法选择初产妇300例,随机分为实验组(拉玛泽联合可行走式腰硬联合麻醉组)、对照组(可行走式腰硬联合麻醉组)各150例,对两组产妇的疼痛程度、总产程时间、产后2h出血量、钳产率及新生儿窒息率等指标进行比较。结果实验组产妇分娩时的疼痛较对照组减轻,总产程时间缩短,产后2h出血量减少,钳产率和新生儿窒息率降低,差异有统计学意义(P<0.05)。结论拉玛泽减痛分娩法联合可行走式腰硬联合麻醉能够有效减轻分娩疼痛,缩短产程,减少产后出血,降低钳产率和新生儿窒息率,值得临床应用推广。%Objective To explore the analgesic effect of Lamaze childbirth method of pain relief plus combined spinal and epidural ambulatory anesthesia and its effect on mother and child. Methods 300 primiparas were selected and randomly allocated to an experimental group (Lamaze childbirth method plus combined spinal and epidural ambulatory anesthesia group) and a control group (combined spinal and epidural ambulatory anesthesia group), with 150 in each group. Indices such as pain degree, total stage of labor, amount of bleeding 2 hours after delivery, rate of forceps delivery and rate of neonatal asphyxia were compared between the two groups. Results Pain in the experimental group was milder than that in the control group during labor, total stage of labor was shorter, the amount of bleeding 2 hours after delivery was smaller, and rates of forceps delivery and neonatal asphyxia were lower than those in the control group. The differences were statistically significant (P<0.05). Conclusion Lamaze childbirth method of pain relief plus combined spinal and epidural ambulatory anesthesia helps effectively reduce labor pain, shorten the stage of labor, lower the amount of postpartum bleeding

  15. A comparative study of magnesium sulfate vs dexmedetomidine as an adjunct to epidural bupivacaine

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    Shahi, Vaibhav; Verma, Anil Kumar; Agarwal, Apurva; Singh, Chandra Shekhar

    2014-01-01

    Background and Aims: This prospective, randomized, double-blind study was undertaken to establish the effect of addition of magnesium or dexmedetomidine, as an adjuvant, to epidural bupivacaine in lower limb surgeries. Materials and Methods: One hundred and twenty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower limb surgeries were enrolled to receive either magnesium sulfate (Group M) or dexmedetomidine (Group D) along with epidural bupivacaine for surgical anesthesia. All the study subjects received an epidural anesthesia with 14 ml of 0.5% bupivacaine along with either MgSO4 50 mg (Group M) or dexmedetomidine 0.5 μg/kg (Group D) or saline (Group C). The onset of motor and sensory block, duration of block, hemodynamic parameters, and any adverse events were monitored. Results: Analgesia in the postoperative period was better in Group D, duration of sensory and motor blockade was significantly prolonged in Group D and incidence of sedation was more in Group D. Conclusion: Hence, addition of dexemedetomidine to epidural bupivacaine can be advantageous with respect to increased duration of motor and sensory blockade and arousable sedation. PMID:25425781

  16. 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.

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

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    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

  18. Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally.

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    Jarraya, Anouar; Elleuch, Sahar; Zouari, Jawhar; Smaoui, Mohamed; Laabidi, Sofiene; Kolsi, Kamel

    2016-01-01

    The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications. Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (Pbupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

  19. 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%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)

    吴晓岗

    2015-01-01

    目的:探讨自控腰硬联合分娩镇痛麻醉下,不同的停泵时机对初产妇的分娩过程和分娩结局的影响,以供临床参考。方法回顾性分析2012年01月至2014年01月在我院分娩的150例初产妇的临床资料,根据麻醉下停泵时机的不同将其分为三组( A组、B组、C组),每组各50例。其中A组宫口开全时停泵并且不再开泵;B组宫口开全停泵,待新生儿娩出后立即开泵;C组三个产程持续镇痛。三组均在第三产程结束后,将会阴缝合后结束镇痛并将硬外镇痛管拔除。对比分析三组产妇的镇痛效果(VAS)评分、三个产程的时间、缩宫素的使用、产后2h内出血量以及新生儿的Apgar评分。结果三组产妇的一、二、三产程的时间、产后2h出血量、新生儿Apgar评分比较差异无统计学意义(P>0.05),而C组的胎儿娩出痛较A组、B组有所减轻,VAS评分比较差异有统计学意义(P0. 05);ratios of labour pain for parturients in group A and B were higher than those in group C,use of oxytocin,rate of caesarean section in group C was higher than that in group A and B(P<0. 05). Conclusion Different time of stopping pumping does not prolong the second stage,does not affect Apgar scores or exacerbate postpartum haemorrhage. Applica-tion rate of oxytocin increases in the group which receives continued analgesia, yet improves parturients’satisfaction rate. So in self-control waist hard joint labor analgesia anesthesia,as long as careful observation and timely intervention can better influence on labor and birth outcomes,is a good way of labor analgesia.

  20. CENTRAL MECHANISMS OF ACUPUNCTURE ANALGESIA

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    Eman S. Mansour

    2015-12-01

    Full Text Available Background: Acupuncture is an component of traditional Chinese medicine (TCM that has been used for three thousand years to treat diseases and relieve pain. Pain is found to be the most common reason for people to use acupuncture. Due to recent scientific findings, acupuncture treatment has been accepted worldwide. Numerous trials have been conducted especially in analgesia. The mechanisms of acupuncture analgesia has been widely investigated, however, the underlying mechanism still not clear. This article summarizes the central mechanisms of acupuncture analgesia and reviews recent studies on the topic. Method: We have focused on examining the recent literature on acupuncture analgesia. The central mechanisms of acupuncture analgesia and reviews recent studies on the topic. We focused on the studies related to central mechanisms of acupuncture analgesia from these aspects: (neurophysiology, neurochemistry and neuroanatomy. Result: The result revealed that acupuncture act on various parts of the central nervous system, including the spinal cord, brain stem, cerebral ganglia and cerebral cortex to alleviate pain. The central mechanisms underlying the effects of acupuncture include neurohumors and neurotransmitters, which are involved in analgesia. At spinal level, Spinal opioids, glutamate, norepinephrine and serotonin are the key elements acupuncture-induced analgesia. At brain level, Endogenous opioid peptides, limbic system play essential roles in mediating the analgesia. Conclusion: Acupuncture is an effective approach to pain management. There is good evidence in both experimental and clinical research that supports acupuncture efficacy in management of chronic pain through central nervous system. Acupuncture should be strongly used as a part of pain management plans. This work helps in improving our understanding of the scientific basis underlying acupuncture analgesia.

  1. Epidural hematomas of posterior fossa

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    Radulović Danilo

    2004-01-01

    Full Text Available Background. Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. Methods. Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. Results. Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. Conclusion. Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.

  2. [Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster].

    Science.gov (United States)

    Miyamoto, Tatsuhito; Nakatani, Toshihiko; Narai, Yasuhiro; Sakakibara, Manabu; Hashimoto, Tatsuya; Saito, Youji

    2014-03-01

    A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. Fourteen days after epidural catheterization, spinal epidural abscess was pointed out on MRI. Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess.

  3. 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.

  4. 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

  5. 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

  6. 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.

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

    Science.gov (United States)

    de Souza Hobaika, Adriano Bechara

    2014-07-01

    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.

  8. [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.

  9. Prolongation of lidocaine-induced epidural anesthesia by medium molecular weight hyaluronic acid formulations: pharmacodynamic and pharmacokinetic studies in the rabbit.

    Science.gov (United States)

    Doherty, M M; Hughes, P J; Korszniak, N V; Charman, W N

    1995-04-01

    We evaluated the utility of medium molecular weight hyaluronic acid for prolonging the local anesthetic activity of lidocaine in a rabbit model of epidural analgesia. Equiviscous formulations were prepared as either a physical mixture of lidocaine hydrochloride and sodium hyaluronate (where drug release occurred via diffusion) or as a lidocaine-hyaluronate complex (where drug release occurred via diffusional and electrostatic processes). The novel hyaluronic acid formulations were functionally evaluated, relative to lidocaine solution, in an intact, conscious rabbit model. The hyaluronate formulations were well tolerated. The duration of sensory block and loss of weight-bearing was prolonged twofold by the lidocaine-hyaluronate complex relative to the solution (P lidocaine plasma concentration-time data indicated that the rate of drug absorption from the lidocaine-hyaluronate complex was decreased fourfold relative to the solution (P hyaluronic acid may offer advantages for the prolongation of epidural analgesia.

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

    DEFF Research Database (Denmark)

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

    1995-01-01

    OBJECTIVE: To evaluate the combined effects of pain relief by continuous epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection. DESIGN: Uncontrolled pilot investigation. SETTING: University hospital, Denmark. SUBJECTS: 17....../daily. No patient had a nasogastric tube, and oral feeding with normal food and protein enriched solutions (1000 Kcal (4180 KJ/day) was instituted 24 hours postoperatively together with intensive mobilisation. RESULTS: Median visual analogue pain scores were zero at rest and minimal during coughing and mobilisation...... weight loss. CONCLUSION: These results suggest that a combined approach of optimal pain relief with balanced analgesia, enforced early mobilisation, and oral feeding, may reduce the length of convalescence and hospital stay after colonic operations....

  11. Paraplegia After Thoracic Epidural Steroid Injection.

    Science.gov (United States)

    Loomba, Vivek; Kaveeshvar, Hirsh; Dwivedi, Samvid

    2016-09-01

    Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case.

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

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    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

  13. 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.

  14. Bacteriological Profile of Epidural Catheters

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    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.

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

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    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.

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

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    Carlos Alexandre Botelho do Amaral

    2015-02-01

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

  18. Combined spinal epidural anesthesia for cesarean section in a patient with left lung agenesis.

    Science.gov (United States)

    Babita, G; Rashmi, M; Deb, K

    2001-04-01

    Agenesis of the lung is a rare developmental defect characterized by complete absence of one lung, or hypoplasia of one or both lungs. The majority of reported cases have been associated with other congenital anomalies. It is usually detected in childhood as a result of either pulmonary symptoms or associated anomalies. Although pulmonary agenesis has been reported in adults, there is no report of the management of a pregnant patient for cesarean section in the anesthetic literature. We report the management of a 23-year-old pregnant female at 36 weeks' gestation with oligohydramnios and left lung agenesis for elective cesarean section. She presented with a history of repeated chest infection and was found to have restrictive lung function. She had no other congenital anomalies. Combined spinal epidural anesthesia was administered for cesarean section. The intraoperative course was uneventful except for bradyarrhythmias followed by tachyarrhythmias on manipulation of the uterus. She was given low dose epidural morphine with local anesthetic and intramuscular diclofenac for postoperative analgesia. We believe that normal pregnancy can safely be undertaken in the presence of left lung agenesis. In view of associated congenital anomalies in more than 50% of the cases, anesthetic management should include a particularly careful survey of other systems. The patient should otherwise be managed like any patient with limited pulmonary reserve. Combined spinal epidural anesthesia is safe and appropriate for such patients.

  19. Efficacy of epidural administration of morphine with bupivacaine for orthopaedic surgery in sheep

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    Durej M.

    2012-01-01

    Full Text Available The aim of the study was to test the hypothesis that epidural administration of morphine with bupivacaine provides more intense and sufficient perioperative analgesia compared with parenterally administrated butorphanol during orthopaedic surgery. Sheep were assigned to group C (control group, 6 sheep and group E (epidural, 5 sheep. Sheep from group C were pre-medicated with midazolam (0.3 mg/kg, i.m. and butorphanol (0.2 mg/kg, i.m.. Propofol was used for induction of general anesthesia in both groups. Sheep from group E were pre-medicated with midazolam, but without butorphanol. Sacrococcegeal epidural analgesia with morphine (0.1 mg/kg and bupivacaine (1 mg/kg was performed. We detected a significant increase in heart rate (19%, p=0.021 during surgery in group C. Two hours after surgery, the heart rate was 14.9% lower than prior to surgery in group E (p=0.017. In group E, throughout the surgery, we measured an insignificant increase in respiratory rate of 1.99%. In the same group, 120 minutes post surgery, we measured an increase in respiratory rate of 14.7%, while in group C there was a smaller increase of only 10.9%. The result from both groups was insignificant (p>0.05. The consumption of isoflurane in group C was higher than in group E by 27.3% (p=0.0043. The mean MAC was in group C higher by 27.6% as it was in group E (0.75% ± 0.25, 0.95 ± 0.3 in Group E and C, respectively. This distinction, according to the Mann-Whitney test, was not significant (p=0.329.

  20. 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.

  1. Idiopathic Spinal Epidural Abscess: A Case Report

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    Chaitali Biswas

    2011-11-01

    Full Text Available Epidural abscess is a potentially life-threatening disease which can lead to medical-surgical emergency. Idiopathic spinal epidural abscess (SEA with atypical manifestations is extremely rare. We describe such a case which led to severe neurological compromise and was not associated with any known risk factors.

  2. Idiopathic Spinal Epidural Abscess: A Case Report

    OpenAIRE

    Chaitali Biswas; Anirban Pal; Saswata Bharati; Nitesh Sinha

    2011-01-01

    Epidural abscess is a potentially life-threatening disease which can lead to medical-surgical emergency. Idiopathic spinal epidural abscess (SEA) with atypical manifestations is extremely rare. We describe such a case which led to severe neurological compromise and was not associated with any known risk factors.

  3. Prosthetic Valve Endocarditis: A Complication of Spinal Epidural Abscess

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    Armando Bedoya

    2010-01-01

    Full Text Available Epidural injections for chronic low back pain are controversial, and their effectiveness is debated. Although epidural injections are considered a minor procedure with low morbidity, catastrophic complications may occur. We describe a case of prosthetic valve endocarditis secondary to an epidural abscess after epidural injection to alert clinicians to this unusual association.

  4. Prosthetic Valve Endocarditis: A Complication of Spinal Epidural Abscess

    OpenAIRE

    Bedoya, Armando; Gentilesco, Bethany

    2010-01-01

    Epidural injections for chronic low back pain are controversial, and their effectiveness is debated. Although epidural injections are considered a minor procedure with low morbidity, catastrophic complications may occur. We describe a case of prosthetic valve endocarditis secondary to an epidural abscess after epidural injection to alert clinicians to this unusual association.

  5. Lumbar Epidural Varix Mimicking Perineural Cyst

    Science.gov (United States)

    Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent

    2013-01-01

    Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

  6. 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. PMID:27621865

  7. 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...

  8. Peripartum Isolated Cortical Vein Thrombosis in a Mother with Postdural Puncture Headache Treated with an Epidural Blood Patch

    Directory of Open Access Journals (Sweden)

    Etienne Laverse

    2013-01-01

    Full Text Available A 32-year-old woman presented with low pressure headache 3 days after delivery of her baby. An assessment of postdural puncture headache was made. This was initially treated with analgesia, caffeine, and fluids for the presumed cerebrospinal fluid (CSF leak. The woman was readmitted two days after her hospital discharge with generalised seizures. A brain scan showed features of intracranial hypotension, and she was treated for CSF leak using an epidural blood patch. Her symptoms worsened and three days later, she developed a left homonymous quadrantanopia. An MRI scan confirmed a right parietal haematoma with evidence of isolated cortical vein thrombosis (ICVT.

  9. 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

  10. 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.

  11. 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.

  12. 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...

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

    OpenAIRE

    2006-01-01

    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 com...

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

    Science.gov (United States)

    Bergström, M; Kieler, H; Waldenström, U

    2009-01-01

    Objective To examine the effects of antenatal education focussing on natural childbirth preparation with psychoprophylactic training versus standard antenatal education on the use of epidural analgesia, experience of childbirth and parental stress in first-time mothers and fathers. Design Randomised controlled multicentre trial. Setting Fifteen antenatal clinics in Sweden between January 2006 and May 2007. Sample A total of 1087 nulliparous women and 1064 of their partners. Methods Natural group: Antenatal education focussing on natural childbirth preparation with training in breathing and relaxation techniques (psychoprophylaxis). Standard care group: Standard antenatal education focussing on both childbirth and parenthood, without psychoprophylactic training. Both groups: Four 2-hour sessions in groups of 12 participants during third trimester of pregnancy and one follow-up after delivery. Main outcome measures Epidural analgesia during labour, experience of childbirth as measured by the Wijma Delivery Experience Questionnaire (B), and parental stress measured by the Swedish Parenthood Stress Questionnaire. Results The epidural rate was 52% in both groups. There were no statistically significant differences in the experience of childbirth or parental stress between the randomised groups, either in women or men. Seventy percent of the women in the Natural group reported having used psychoprophylaxis during labour. A minority in the Standard care group (37%) had also used this method, but subgroup analysis where these women were excluded did not change the principal findings. Conclusion Natural childbirth preparation including training in breathing and relaxation did not decrease the use of epidural analgesia during labour, nor did it improve the birth experience or affect parental stress in early parenthood in nulliparous women and men, compared with a standard form of antenatal education. PMID:19538406

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

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    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.

  16. Successful medical treatment of spinal epidural abscess.

    Science.gov (United States)

    Xiao, Bo-Ren; Wang, Chih-Wei; Lin, Jung-Chung; Chang, Feng-Yee

    2008-04-01

    Spinal epidural abscess is a rare but potentially fatal disease. A 67-year-old female suffered fever and painful swelling of the right knee and lower leg for one week. Both synovial fluid and blood cultures yielded methicillin-sensitive Staphylococcus aureus. Low back pain developed and fever was sustained despite the administration of intravenous oxacillin. Magnetic resonance imaging (MRI) of the thoracolumbar spine revealed spinal epidural abscess from T12 to S1. Because of severe hypoalbuminemia and general anasarca and followed by exploratory laparotomy for massive duodenal bleeding, she did not receive surgical intervention for the spinal epidural abscess. After intravenous administration of oxacillin 2 g 4-hourly for 12 weeks, she recovered and follow-up MRI confirmed the efficacy of the medical treatment. She remained well at 1-year follow-up. In a patient with minimal neurological deficit or surgical contraindication, spinal epidural abscess can be successfully treated with a medical regimen.

  17. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... 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 has not been...

  18. Placebo analgesia: understanding the mechanisms.

    Science.gov (United States)

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo analgesic effects. Distinct psychological traits can modulate expectations of analgesia, which facilitate brain pain control mechanisms involved in pain reduction. Many studies have highlighted the importance and clinical relevance of these responses. Gaining deeper understanding of these pain modulatory mechanisms has important implications for personalizing patient pain management.

  19. 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.

  20. Pharmacogenomic considerations in opioid analgesia

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    Vuilleumier PH

    2012-08-01

    Full Text Available Pascal H Vuilleumier,1 Ulrike M Stamer,1 Ruth Landau21Klinik für Anästhesiologie und Schmerztherapie, Inselspital Universität Bern, Switzerland; 2Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USAAbstract: Translating pharmacogenetics to clinical practice has been particularly challenging in the context of pain, due to the complexity of this multifaceted phenotype and the overall subjective nature of pain perception and response to analgesia. Overall, numerous genes involved with the pharmacokinetics and dynamics of opioids response are candidate genes in the context of opioid analgesia. The clinical relevance of CYP2D6 genotyping to predict analgesic outcomes is still relatively unknown; the two extremes in CYP2D6 genotype (ultrarapid and poor metabolism seem to predict pain response and/or adverse effects. Overall, the level of evidence linking genetic variability (CYP2D6 and CYP3A4 to oxycodone response and phenotype (altered biotransformation of oxycodone into oxymorphone and overall clearance of oxycodone and oxymorphone is strong; however, there has been no randomized clinical trial on the benefits of genetic testing prior to oxycodone therapy. On the other hand, predicting the analgesic response to morphine based on pharmacogenetic testing is more complex; though there was hope that simple genetic testing would allow tailoring morphine doses to provide optimal analgesia, this is unlikely to occur. A variety of polymorphisms clearly influence pain perception and behavior in response to pain. However, the response to analgesics also differs depending on the pain modality and the potential for repeated noxious stimuli, the opioid prescribed, and even its route of administration.Keywords: pain perception, opioid analgesia, genetic variation, pharmacogenetics

  1. Placebo analgesia: understanding the mechanisms

    OpenAIRE

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo a...

  2. Spinal epidural abscess in brucellosis.

    Science.gov (United States)

    Boyaci, Ahmet; Boyaci, Nurefsan; Tutoglu, Ahmet; Dokumaci, Dilek Sen

    2013-09-26

    Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 14 of treatment, decline was observed in the patient's symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined.

  3. Newborns from deliveries with epidural anaesthesia

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    Avramović Lidija

    2010-01-01

    Full Text Available Introduction. The use of epidural anaesthesia in delivery with the purpose to reduce pain and fear in a pregnant woman has the influence on the physiological status of the woman in childbirth and the course of delivery. From the epidural space of the pregnant woman, one part of free anaesthetic comes in the foetal circulation through the mother's circulation and placenta and connects with the foetal proteins. A lower value of albumins and serum proteins in the foetal circulation give bigger free fraction of anaesthetic which is accumulated in the foetal liver, brain and heart full of blood. Objective. The aim of the study was to examine the influence of epidural anaesthesia on the newborn. Methods. Retrospective study of 6,398 documents of newborns was performed in our Clinic of Gynaecology and Obstetrics 'Narodni front' during 2006. The first group was made of 455 newborns from deliveries with epidural anaesthesia and the second was the control group of 5,943 remaining newborns. In both groups we analysed the following: sex, week of gestation, weight, Apgar score, measure of care and resuscitation, perinatal morbidity and then the obtained results were compared. Results. Most of deliveries were vaginal without obstetric intervention (86.6%. The number of deliveries finished with vacuum extractor (4.6% was statistically significantly bigger in the group with epidural anaesthesia than in the control group. Most of the newborns in the first group were born on time (96.5% in 39.0±1.0 week of gestation and with foetal weight 3448±412 grammes. There was no statistical significance in Apgar score between both groups. Epidural anaesthesia does not increase the degree of the newborn's injury. Lower pH of blood was found in the newborns from deliveries with vacuum extractor or operated on (the Ceasarean section. Conclusion. Application of epidural anaesthesia decreases duration of delivery and has no adverse effects on the newborn and hypoxic

  4. Percepções e práticas sobre delirium, sedação e analgesia em pacientes críticos: uma revisão narrativa

    Directory of Open Access Journals (Sweden)

    Cassia Righy Shinotsuka

    2013-06-01

    Full Text Available Durante a última década, foi publicado um número significativo de estudos fundamentais que aumentaram o conhecimento atual sobre a sedação em pacientes criticamente enfermos. Desse modo, muitas das práticas até então consideradas como padrão de cuidado são hoje obsoletas. Foi demonstrado que a sedação excessiva é perigosa, e que protocolos com sedação leve ou sem sedação se associaram a melhores desfechos dos pacientes. O delirium vem sendo cada vez mais reconhecido como uma forma importante de disfunção cerebral associada com mortalidade mais alta, maior duração da ventilação mecânica e maior permanência na unidade de terapia intensiva e no hospital. Apesar de todas as evidências disponíveis, a tradução da pesquisa para o cuidado ao pé do leito é uma tarefa hercúlea. Foi demonstrado, por levantamentos internacionais, que práticas como interrupção e titulação da sedação só são realizadas em uma minoria dos casos. O estabelecimento das melhores práticas é um tremendo desafio que deve também ser contemplado nas novas diretrizes. Nesta revisão, resumimos os achados de estudos a respeito de sedação e delirium nos anos recentes e discutimos a distância entre a evidência e a prática clínica, assim como as formas de estabelecer as melhores práticas ao pé do leito.

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

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    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

  6. 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

  7. 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

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

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    Nilton Bezerra do Vale

    2006-10-01

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

  9. Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

    Directory of Open Access Journals (Sweden)

    Ushma D. Shah

    2017-01-01

    Full Text Available Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml and bupivacaine 0.5% (20ml for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries. Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects. Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief.

  10. 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

  11. 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

  12. Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability

    Science.gov (United States)

    Ruiz Picazo, David; Ramírez Villaescusa, José

    2016-01-01

    Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR). At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis. PMID:27069704

  13. Solitary Spinal Epidural Metastasis from Gastric Cancer

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    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.

  14. 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.

  15. 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

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

    OpenAIRE

    Mehta JH; Gibson ME; Amaro-Driedger D; Hussain MN

    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...

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

    DEFF Research Database (Denmark)

    Basse, L; Werner, M; Kehlet, H

    2000-01-01

    morning. Follow-up in the outpatient clinic was on days 8 and 30. RESULTS: Nine patients needed bladder recatheterization, 8 as a single procedure and 1 patient a second recatheterization with removal on day 7. This patient had urinary infection on day 10 and was readmitted for 5 days because of urosepsis...

  18. 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.

  19. Spinal epidural hematoma; Spinales epidurales Haematom

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2012-05-15

    Spinal epidural hematoma is an accumulation of blood in the potential space between the dura and bone. On unenhanced computed tomography epidural hemorrhage appears as a high-density spinal canal mass with variable cord compression. Magnetic resonance imaging is the modality of choice for evaluating spinal epidural hematoma and can demonstrate the extent of the hematoma and degree of cord compression. When treated surgically the outcome depends on the extent of preoperative neurological deficits and on the operative timing interval. (orig.) [German] Das spinale epidurale Haematom ist eine Blutansammlung zwischen Dura und Knochen. Die klinische Praesentation ist aehnlich dem akuten Bandscheibenvorfall, die Symptomatik ist allerdings in der Regel progredient. In der CT stellt sich ein frisches Haematom hyperdens dar. Die MRT ist die Methode der Wahl zur Diagnose spinaler epiduraler Haematome und kann die Ausdehnung sowie auch das Ausmass der Kompression darstellen. Die wichtigste Differenzialdiagnose vom epiduralen Haematom ist das epidurale Empyem. (orig.)

  20. Traumatic cervical epidural hematoma in an infant

    Directory of Open Access Journals (Sweden)

    Vithal Rangarajan

    2013-01-01

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

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  3. Rapidly Progressive Spontaneous Spinal Epidural Abscess

    Directory of Open Access Journals (Sweden)

    Abdurrahman Aycan

    2016-01-01

    Full Text Available Spinal epidural abscess (SEA is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

  4. Rapidly Progressive Spontaneous Spinal Epidural Abscess.

    Science.gov (United States)

    Aycan, Abdurrahman; Aktas, Ozgür Yusuf; Guzey, Feyza Karagoz; Tufan, Azmi; Isler, Cihan; Aycan, Nur; Gulsen, İsmail; Arslan, Harun

    2016-01-01

    Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

  5. 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.

  6. 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.

  7. Partial reinforcement, extinction, and placebo analgesia.

    Science.gov (United States)

    Au Yeung, Siu Tsin; Colagiuri, Ben; Lovibond, Peter F; Colloca, Luana

    2014-06-01

    Numerous studies indicate that placebo analgesia can be established via conditioning procedures. However, these studies have exclusively involved conditioning under continuous reinforcement. Thus, it is currently unknown whether placebo analgesia can be established under partial reinforcement and how durable any such effect would be. We tested this possibility using electrocutaneous pain in healthy volunteers. Sixty undergraduates received placebo treatment (activation of a sham electrode) under the guise of an analgesic trial. The participants were randomly allocated to different conditioning schedules, namely continuous reinforcement (CRF), partial reinforcement (PRF), or control (no conditioning). Conditioning was achieved by surreptitiously reducing pain intensity during training when the placebo was activated compared with when it was inactive. For the CRF group, the placebo was always followed by a surreptitious reduction in pain during training. For the PRF group, the placebo was followed by a reduction in pain stimulation on 62.5% of trials only. In the test phase, pain stimulation was equivalent across placebo and no placebo trials. Both CRF and PRF produced placebo analgesia, with the magnitude of initial analgesia being larger after CRF. However, although the placebo analgesia established under CRF extinguished during test phase, the placebo analgesia established under PRF did not. These findings indicate that PRF can induce placebo analgesia and that these effects are more resistant to extinction than those established via CRF. PRF may therefore reflect a novel way of enhancing clinical outcomes via the placebo effect.

  8. 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.

  9. 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.

  10. [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.

  11. Infektioner i forbindelse med epidural kateterisation

    DEFF Research Database (Denmark)

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

    1996-01-01

    coagulase- negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and other bacteria (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and propose...

  12. 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.

  13. MRI features of epidural extramedullary hematopoiesis

    Energy Technology Data Exchange (ETDEWEB)

    Alorainy, Ibrahim A. E-mail: alorainy@ksu.edu.sa; Al-Asmi, Abdullah R.; Carpio, Raquel del

    2000-07-01

    A case of {beta}-thalassemia intermedia with spinal cord compression due to extramedullary hematopoiesis, which was successfully treated by blood transfusion, is presented. Emphasis was made on the MRI appearance of extramedullary hematopoiesis on different pulse sequences. The theories that aimed to explain the involvement of the epidural space by extramedullary hematopoiesis are discussed.

  14. 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.)

  15. 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

  16. 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

    Directory of Open Access Journals (Sweden)

    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

  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

    Directory of Open Access Journals (Sweden)

    Castiñeiras Pérez, Eva:

    2007-04-01

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

  18. 不同镇痛方式应用于TURP患者的护理观察%Nursing observation of different analgesia methods used in TURP patients

    Institute of Scientific and Technical Information of China (English)

    魏莹; 郑庆国; 赵剑辉; 张春红

    2013-01-01

    目的:经尿道前列腺电切术(TURP)患者术后应用两种镇痛方式,观察镇痛及缓解膀胱痉挛的效果以及患者舒适度的差异,总结护理经验。方法 TURP(Transurethral resection of the prostate)术后患者,术后分别行硬膜外自控镇痛(PCEA patient-control ed epidural analgesia )和静脉自控镇痛(PCIA patient-control ed intravenous analgesia).随机分为两组,E组:0.2%罗哌卡因+0.5ug/ml舒芬太尼+阿扎司琼20mg,总量100ml,行PCEA。V组:喷他佐辛150mg+0.5ug/ml舒芬太尼+阿扎司琼20mg,总量100ml,行PCIA.。记录疼痛视觉模拟评分(visual analogue scale,VAS)、以及膀胱痉挛人数、膀胱持续冲洗时间、恶心呕吐等不良事件。结果两组患者年龄、体重、ASA分级、手术时间差异无统计学意义( P>0.05)。两组比较,镇痛开始后4,8,16,20,24,48hVAS 评分无明显不同(P>0.05),但膀胱痉挛人数和冲洗时间有明显差异(P<0.05),恶心呕吐项亦有所不同(P<0.05)。结论通过护理观察知,术后镇痛在缓解膀胱痉挛有明显效果,使病人更舒适,且并发症少。%Objective: two kinds of methods of analgesia in transurethral resection of prostate (TURP) patients, comfort difference observed analgesia and al eviate the effects of bladder spasm and patients, to sum up the nursing experience. Methods: TURP (Transurethral resection of the prostate) patients after surgery, respectively, patient-control ed epidural analgesia (PCEA patient-control ed epidural analgesia) and patient-control ed intravenous analgesia (PCIA patient-control ed intravenous analgesia) were divided into two groups, group E: 0.2%+0.5ug/ml ropivacaine with sufentanil + Azasetron 20mg, total 100ml, PCEA. Group V: pentazocine 150mg+0.5ug/ml sufentanil + Azasetron 20mg, total 100ml, PCIA. Record the pain visual analog scale (visual analogue scale, VAS), as wel as the number of bladder spasm, bladder flushing time. nausea and

  19. 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....

  20. Hypno-analgesia and acupuncture analgesia: a neurophysiological reality?

    Science.gov (United States)

    Saletu, B; Saletu, M; Brown, M; Stern, J; Sletten, I; Ulett, G

    1975-01-01

    The effects of hypnosis, acupuncture and analgesic drugs on the subjective experience of pain and on objective neurophysiological parameters were investigated. Pain was produced by brief electric stimuli on the wrist. Pain challengers were: hypnosis (induced by two different video tapes), acupuncture (at specific and unspecific loci, with and without electrical stimulation of the needles), morphine and ketamine. Evaluation of clinical parameters included the subjective experience of pain intensity, blood pressure, puls, temperature, psychosomatic symptoms and side effects. Neurophysiological parameters consisted of the quantitatively analyzed EEG and somatosensory evlked potential (SEP). Pain was significantly reduced by hypnosis, morphine and ketamine, but not during the control seesion. Of the four acupuncture techniques, only electro-acupuncture at specific loci significantly decreased pain. The EEG changes during hypnosis were dependent on the wording of the suggestion and were characterized by an increase of slow and a decrease of fast waves. Acupuncture induced just the opposite changes, which were most significant when needles were inserted at traditional specific sites and stimulated electrically. The evoked potential findings suggested that ketamine attenuates pain in the thalamo-cortical pathways, while hypnosis, acupuncture and morphine induce analgesia at the later CNS stage of stimulus processing. Finally some clinical-neurophysiological correlations were explored.

  1. Pathophysiological Substantiation of Epidural Administration of Tenoxicam in Dorsalgia Treatment

    OpenAIRE

    Yastrebov D.N.; Shpagin М.V.; Artifexov S.B.

    2012-01-01

    The aim of the investigation is to assess the efficiency of Tenoxicam epidural administration, and represent pathophysiological substantiation of new techniques of dorsalgias treatment. Materials and Methods. There have been examined 75 patients with intense lumbar pain syndrome who underwent epidural pharmacotherapy of pain syndrome. The 1st group (n=50) had epidural Tenoxicam introduction, by 20 mg in 10–20 ml of saline solution, the control group (n=25) was given the combination of cor...

  2. Serratia marcescens spinal epidural abscess formation following acupuncture.

    Science.gov (United States)

    Yang, Chih-Wei; Hsu, Shun-Neng; Liu, Jhih-Syuan; Hueng, Dueng-Yuan

    2014-01-01

    The formation of spinal epidural abscess following acupuncture is very rare. We herein report the case of a 54-year-old woman who presented with progressive low back pain and fever with a root sign. She underwent surgical decompression, with an immediate improvement of the low back pain. A culture of the epidural abscess grew Serratia marcescens. One year postoperatively, magnetic resonance imaging revealed the almost complete eradication of the abscess. This case is the first case of Serratia marcescens-associated spinal epidural abscess formation secondary to acupuncture. The characteristics of spinal epidural abscess that develop after acupuncture and how to prevent such complications are also discussed.

  3. 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.

  4. Resolving the Brainstem Contributions to Attentional Analgesia

    Science.gov (United States)

    Brooks, Jonathan C.W.; Davies, Wendy-Elizabeth

    2017-01-01

    Previous human imaging studies manipulating attention or expectancy have identified the periaqueductal gray (PAG) as a key brainstem structure implicated in endogenous analgesia. However, animal studies indicate that PAG analgesia is mediated largely via caudal brainstem structures, such as the rostral ventromedial medulla (RVM) and locus coeruleus (LC). To identify their involvement in endogenous analgesia, we used brainstem optimized, whole-brain imaging to record responses to concurrent thermal stimulation (left forearm) and visual attention tasks of titrated difficulty in 20 healthy subjects. The PAG, LC, and RVM were anatomically discriminated using a probabilistic atlas. Pain ratings disclosed the anticipated analgesic interaction between task difficulty and pain intensity (p pain intensity. Intersubject analgesia scores correlated to activity within a distinct region of the RVM alone. These results identify distinct roles for a brainstem triumvirate in attentional analgesia: with the PAG activated by attentional load; specific RVM regions showing pronociceptive and antinociceptive processes (in line with previous animal studies); and the LC showing lateralized activity during conflicting attentional demands. SIGNIFICANCE STATEMENT Attention modulates pain intensity, and human studies have identified roles for a network of forebrain structures plus the periaqueductal gray (PAG). Animal data indicate that the PAG acts via caudal brainstem structures to control nociception. We investigated this issue within an attentional analgesia paradigm with brainstem-optimized fMRI and analysis using a probabilistic brainstem atlas. We find pain intensity encoding in several forebrain structures, including the insula and attentional activation of the PAG. Discrete regions of the rostral ventromedial medulla bidirectionally influence pain perception, and locus coeruleus activity mirrors the interaction between attention and nociception. This approach has enabled the

  5. 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...

  6. CT in thrombosed dilated posterior epidural vein

    Energy Technology Data Exchange (ETDEWEB)

    Bammatter, S.; Schnyder, P.; Preux, J. de

    1987-05-01

    The authors report a case of thrombosis of the distal end of an enlarged right posterior epidural vein. The patient had a markedly narrow lumbar canal due to L5 spondylolisthesis. The dilated vein and the thrombosis were displayed by computed tomography but remained unrecognized until surgery. Pathogenesis of this condition is discussed. A review of the English, French and German literature revealed no prior radiological reports of a similar condition.

  7. 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 wi