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Sample records for bloqueo epidural con

  1. Anestesia peridural lombar ou bloqueio do plexo lombar combinados à anestesia geral: eficácia e efeitos hemodinâmicos na artroplastia total do quadril Anestesia epidural lumbar o bloqueo del plexo lumbar combinados con la anestesia general: eficacia y efectos hemodinámicos en la artroplastia total de la cadera Epidural lumbar block or lumbar plexus block combined with general anesthesia: efficacy and hemodynamic effects on total hip arthroplasty

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    Leonardo Teixeira Domingues Duarte

    2009-12-01

    avanzada y de las enfermedades asociadas a los pacientes. El objetivo del estudio, fue evaluar si el bloqueo del plexo lumbar combinado con la anestesia general, equivale a la anestesia epidural lumbar en cuanto a la eficacia del bloqueo nociceptivo, efectos hemodinámicos secundarios, dificultad en su ejecución e influencia en el sangramiento operatorio en pacientes sometidos a la ATC. MÉTODO: Pacientes estado físico ASA I a III que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. En el grupo Epidural, se realizó la anestesia epidural lumbar continua con la ropivacaína a 0,5% 10 a 15 mL. En el grupo Lumbar, fue realizado el bloqueo del plexo lumbar por la vía posterior con ropivacaína a 0,5% 0,4 mL.kg-1. Todos los pacientes fueron sometidos a la anestesia general. Se estudiaron: la dificultad en la ejecución de los bloqueos, su eficacia y los efectos hemodinámicos secundarios. RESULTADOS: Cuarenta y un pacientes fueron incluidos en el estudio. El tiempo para la ejecución del bloqueo epidural fue menor, pero el número de intentos en colocar la aguja fue similar en los dos grupos. El bloqueo epidural fue más eficaz. En el grupo Lumbar, se registró un aumento de la presión arterial diastólica y media (PAM y en el doble producto. Después de la incisión, el consumo anestésico durante la operación fue mayor. Posteriormente al bloqueo, la PAM fue menor en los 50, 60 y 70 minutos después de la realización del bloqueo epidural. El sangramiento fue parecido en los dos grupos. CONCLUSIONES: La técnica epidural promovió un bloqueo nociceptivo más eficaz sin asociarse a la inestabilidad hemodinámica, cuando se le combinó con la anestesia general. El bloqueo del plexo lumbar fue una técnica útil en combinación con la anestesia general cuando la anestesia epidural estuvo contraindicada.BACKGROUND AND OBJECTIVES: Anesthesia for total hip arthroplasty (THA is a challenge due to the advanced age and associated diseases of patients. The objective

  2. Bloqueo sesamoideo abaxial con ketamina en el caballo

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    Cruz Amaya, Jorge Mario

    2003-01-01

    En este trabajo se ha evaluado la posibilidad que tiene la Ketamina de actuar como analgésico local, utilizando el modelo experimental de la lampara de luz concentrada como estímulo doloroso supramaximo. En este modelo, el fármaco a evaluar se aplica sobre los nervios digitales palmares (bloqueo sesamoideo abaxial) y posteriormente, el estímulo nocivo, en la piel de la cuartilla. Antes de inducir el bloqueo se determinó el tiempo de retirada normal para un caballo sin analgesia al aplicarse e...

  3. Esclerosis sistémica complicada con síncope y bloqueo AV completo

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    Francisco Femenía

    2010-10-01

    Full Text Available La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémica, quien presenta episodio sincopal secundario a bloqueo auriculoventricular completo con necesidad de implante de marcapasos definitivo.

  4. Esclerosis sistémica complicada con síncope y bloqueo AV completo

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    Francisco Femenía; Mauricio Arce; Martín Arrieta

    2010-01-01

    La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémic...

  5. 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

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    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.

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

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

    2006-01-01

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

  7. Bloqueo auriculoventricular paroxístico desencadenado por estímulo vagal con síncope recurrente

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    Matías Calandrelli

    2008-01-01

    Full Text Available El bloqueo auriculoventricular completo (BAVC paroxístico con ECG de reposo normal es una entidad poco frecuente.Se presenta el caso de una paciente de 34 años que cursaba el segundo mes de embarazo y consultó por cuadros sincopales recurrentes.Luego de ser evaluada con ECG, eco-Doppler cardíaco, tilt test, estudio electroencefalográfico, TAC y RM de cerebro se descartó cardiopatía de base y se interpretó que se trataba de síncope neurocardiogénico.Por persistencia de los síntomas se realizó un Holter de 5 días hasta que presentó un nuevo síncope y se arribó al diagnóstico de BAVC paroxístico. Se indicó un marcapasos definitivo VDD y seis meses después persistía asintomática

  8. Esclerosis sistémica complicada con síncope y bloqueo AV completo Systemic sclerosis complicated with syncope and complete AV block

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    Francisco Femenía

    2010-10-01

    Full Text Available La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémica, quien presenta episodio sincopal secundario a bloqueo auriculoventricular completo con necesidad de implante de marcapasos definitivo.Systemic sclerosis is a complex disease that affects the connective tissue, the vascular system and the immune system. It typically produces skin and organ fibrosis. Cardiac bundle branch blocks and fascicular blocks occur in 25-75% of the cases and were found to be independent predictors of mortality. Second and third degree atrioventricular block are very rare. We present the case of a 47 year-old female with diagnosis of systemic sclerosis, presented with syncope secondary to complete atrioventricular block requiring permanent pacemaker implantation.

  9. Bloqueo auriculoventricular completo fetal

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    Bustos,Paola; Santiago,Claudia; Bahamondes,Francisco; Jaramillo,Luis

    2002-01-01

    Uno de los disturbios más graves del ritmo cardíaco fetal es el bloqueo aurículoventricular completo o de 3er grado (BAVC), condición de fácil detección clínica y ecocardiográfica, y muchas veces de altísima mortalidad fetal, que indica la necesidad de intervención terapéutica urgente. Se presenta el caso clínico de una paciente que teniendo el antecedente de un RN anterior con el mismo diagnóstico, se envía a nuestro servicio con bradiarritmia en el feto actual, para realizar estudio y trata...

  10. Bloqueo electrónico de la hebilla del cinturón de seguridad con detección del correcto abrochado

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    Prevosti Vives, Montserrat

    2011-01-01

    Impulsado por la problemática actual en el campo de la automoción, concretamente en el mal uso de los sistemas de retención de pasajeros, el presente proyecto consiste en el desarrollo de una idea, la investigación de su novedad, el análisis y estrategia de sus alternativas, el diseño de la solución, el cumplimiento de la normativa correspondiente y la redacción de una patente de la invención. La evolución de la idea nace con el concepto de un bloqueo electrónico de la hebilla ...

  11. Evaluación de la eficacia de tres técnicas analgésicas, analgesia epidural, bloqueo femoral continuo y doble bloqueo femoral y ciático continuos en la artroplastia total de rodilla.

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    Sánchez Contreras, María Dolores

    2015-01-01

    La artroplastia total de rodilla es una intervención quirúrgica que se realiza en pacientes afectos de gonartrosis avanzada que cursa con dolor e impotencia funcional significativa. La mayoría de pacientes tienen más 65 años y presentan frecuentemente patología asociada. El dolor postoperatorio que aparece como consecuencia de la agresión quirúrgica es de intensidad moderada-severa, se inicia en las 3-6 primeras horas, prolongándose hasta las 24h y es a partir de este momento cuando comienz...

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

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    Leonardo Teixeira Domingues Duarte

    2009-10-01

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

  13. Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico El bloqueo selectivo de los nervios supraescapular y axilar promueve una analgesia satisfactoria y un menor grado de bloqueo motor: comparación con el bloqueo interescalénico Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block: comparison with interscalene block

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    Patrícia Falcão Pitombo

    2013-02-01

    . El objetivo de este estudio fue comparar el bloqueo de los nervios supraescapular y axilar en las cirugías artroscópicas de hombro con el abordaje interescalénico del plexo braquial. MÉTODO: Sesenta y ocho pacientes fueron ubicados en dos grupos de 34, de acuerdo con la técnica utilizada: grupo Interescalénico (GI y grupo selectivo (GS, siendo ambos abordajes realizados con neuroestimulador. En el GI, y después de la respuesta motora adecuada, se inyectaron 30 mL de levopubivacaina en exceso enantiomérico de un 50% al 0,33% con adrenalina 1:200.000. En el GS, y después de la respuesta motora del nervio supraescapular y axilar, se inyectaron 15 mL de la misma sustancia en cada nervio. Enseguida se realizó la anestesia general. Las variables que se evaluaron fueron: tiempo para la realización de los bloqueos, analgesia, consumo de opioide, bloqueo motor, estabilidad cardiocirculatoria, satisfacción y aceptabilidad por parte del paciente. RESULTADOS: El tiempo para la ejecución del bloqueo interescalénico fue significativamente menor que para la realización del bloqueo selectivo. La analgesia fue significativamente mayor en el postoperatorio inmediato en el GI y en el postoperatorio tardío en el GS. El consumo de morfina fue significativamente mayor en la primera hora en el GS. El bloqueo motor fue significativamente menor en el GS. La estabilidad cardiocirculatoria, satisfacción y aceptabilidad de la técnica por el paciente no fueron diferentes entre los grupos. Ocurrió un fallo en el GI y dos en el GS. CONCLUSIONES: Ambas técnicas son seguras y eficaces con el mismo grado de satisfacción y de aceptabilidad. El bloqueo selectivo de ambos nervios presentó una analgesia satisfactoria, con la ventaja de proporcionar un bloqueo motor restringido al hombro.BACKGROUND AND OBJECTIVE: Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular

  14. Uso do bloqueio combinado raqui-peridural durante cirurgia de cólon em paciente de alto risco: relato de caso Uso del bloqueo combinado raquiepidural durante cirugía de colon en paciente de alto riesgo: relato de caso Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report

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    Luiz Eduardo Imbelloni

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado raqui-peridural (BCRP oferece vantagens sobre a anestesia peridural ou subaracnóidea com injeção única. O objetivo deste relato foi apresentar um caso onde a anestesia subaracnóidea segmentar pode ser técnica efetiva para intervenção cirúrgica gastrintestinal com respiração espontânea. RELATO DO CASO: Paciente estado físico ASA III, diabetes mellitus tipo II, com hipertensão arterial sistêmica e doença pulmonar obstrutiva crônica, foi escalada para ressecção de tumor de cólon direito. O BCRP foi realizado no interespaço T5 - T6 e foram injetados 8 mg de bupivacaína a 0,5% isobárica acrescida de 50 µg de morfina no espaço subaracnóideo. O cateter peridural (20G foi introduzido quatro centímetros em direção cefálica. Foi obtida sedação com doses fracionadas de 1 mg de midazolam (total de 6 mg. Bupivacaína a 0,5% foi administrada em bolus de 25 mg através do cateter duas horas após a anestesia subaracnóidea. Não houve necessidade de vasopressor nem atropina. CONCLUSÕES: Este caso proporciona evidências de que a raquianestesia segmentar pode ser uma técnica anestésica para operação gastrintestinal com respiração espontânea.JUSTIFICATIVA Y OBJETIVOS: El bloqueo combinado raquiepidural (BCRE, tiene ventajas sobre la anestesia epidural o subaracnoidea con inyección única. El objetivo de este relato, fue presentar un caso donde la anestesia subaracnoidea segmentaria, puede ser una técnica efectiva para la intervención quirúrgica gastrointestinal con respiración espontánea. RELATO DEL CASO: Paciente estado físico ASA III, diabetes mellitus tipo II, con hipertensión arterial sistémica y enfermedad pulmonar obstructiva crónica, que fue indicada para la resección del tumor de colon derecho. El BCRE se realizó en el interespacio T5 - T6, y se inyectaron 8 mg de bupivacaína a 0,5% isobárica con 50 µg más de morfina en el espacio subaracnoideo. El cat

  15. Bloqueo del sistema renina-angiotensina-aldosterona en pacientes con enfermedad renal diabética avanzada

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    Sheila Bermejo

    2018-03-01

    Conclusiones: El tratamiento con BSRAA es más frecuente en pacientes con FGe≥30 mL/min/1,73m2. No observamos diferencias en la evolución de la función renal entre los tres grupos. La mayor mortalidad observada en pacientes que no recibieron BSRAA se relacionó con la edad avanzada y peor función renal.

  16. Cardiomiopatía hipertrófica y síndrome de Wolff-Parkinson-White con bloqueo aurículo-ventricular completo. Una extraña asociación: Reporte de un caso Hypertrophic cardiomyopathy and Wolff-Parkinson-White Syndrome with complete auriculoventricular block. A strange association: Report of one case

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    Franco J Vallejo; Paula A Montaña; Carlos Vesga; Antonio Miranda; José E Citelli; Alberto Negrete; Efraín Gil

    2007-01-01

    Paciente masculino de 22 años quien ingresa por episodio de síncope. En el electrocardiograma se encuentra patrón de Wolff-Parkinson-White y signos de sobrecarga auricular e hipertrofia ventricular izquierda con bloqueo aurículo-ventricular completo. El ecocardiograma transtorácico es compatible con cardiomiopatía hipertrófica no obstructiva. Se lleva a estudio electrofisiológico donde se encuentra pre-excitación por vía accesoria y bloqueo aurículo-ventricular infrahisiano; se realiza ablaci...

  17. 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

    óidea ou bloqueio pudendo.JUSTIFICATIVA Y OBJETIVOS: La ha sido atribuida a la anestesia regional la disminución significativa de las complicaciones trombo embolicas en el postoperatorio, probablemente por su acción atenuante sobre la respuesta neuroendocrina-metabólica. Las embarazadas, que presentan aumento importante de la coagulabilidad sanguínea, pueden teóricamente, beneficiarse con ese efecto en ocasión del parto. El objetivo de este estudio fue verificar el efecto de la anestesia regional sobre la coagulación sanguínea en embarazadas. MÉTODO: Se estudiaron 30 pacientes en el 3° trimestre de embarazo, siendo diez sometidas a la anestesia peridural para cesárea, con 150 mg de bupivacaína a 0,5% sin epinefrina y 2 mg de morfina (grupo PD; diez a la anestesia subaracnoidea para cesárea con 15 mg de bupivacaína hiperbárica a 0,5% y 0,2 mg de morfina (grupo SA; y diez a Bloqueo de pudendo para parto vaginal, con dosis de hasta 100 mg de bupivacaína a 0,5% sin epinefrina (grupo BP. La coagulación sanguínea se evaluó a través del coagulograma (tiempo de protrombina, tiempo de trombina, tiempo de tromboplastina parcial activada y del tromboelastograma (tiempo r, tiempo k, tiempo r+k, ángulo alfa y amplitud máxima en los siguientes momentos: antes y después de la anestesia, después del nacimiento del feto y 24 horas después de la anestesia en los grupos PD y SA. En el grupo BP la evaluación fue realizada antes de la anestesia, después del nacimiento del feto y 24 horas después de la anestesia. RESULTADOS: Los resultados mostraron que ninguna de las técnicas anestésicas utilizadas tuvo influencia en la coagulación sanguínea de las embarazadas. También quedó demostrado que durante el trabajo de parto se inicia un proceso de activación de la coagulación, que es responsable por las alteraciones encontradas en los tres grupos estudiados. CONCLUSIONES: En las condiciones del presente estudio el Bloqueo simpático y el anestésico local no

  18. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol Postoperative analgesia for the management of chieloplasty in the breast-fed baby. Comparative study: bilateral intraoral blockade of the infraorbitary nerve with bupivacaine 0.25% plus adrenaline versus intravenous analgesia with tramadol

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    J. A. Delgado; A. Martínez-Tellería; M. E. Cano; J. Galera; R. Fernández-Valades; A. Ruiz-Montes

    2005-01-01

    Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con ed...

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

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    Luiz Eduardo Imbelloni

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Diversas questões envolvem os estudos, as análises e o tamanho da amostra para que sejam demonstrados os benefícios da anestesia regional. Análise de dados geralmente custa menos e requer menos tempo quando comparado com amplo estudo aleatório controlado. Esta análise retrospectiva compara a raquianestesia contínua, o bloqueio combinado raqui-peridural e a raquianestesia simples para cirurgias de quadril em pacientes idosos durante quatro anos, para determinar as possíveis vantagens e desvantagens das três técnicas. MÉTODO: Foram avaliados 300 prontuários sendo que: 100 pacientes receberam raquianestesia simples (Grupo 1, 100 receberam bloqueio combinado raqui-peridural (Grupo 2 e 100 receberam raquianestesia contínua (Grupo 3 nos últimos quatro anos. Todos os bloqueios foram realizados em decúbito lateral esquerdo. Foram avaliados: sucesso de punção, nível da analgesia, bloqueio motor de membros inferiores, qualidade da anestesia, necessidade de complementação, incidência de falhas, parestesias, cefaléia pós-punção, alterações cardiovasculares, confusão mental e delírio, transfusão sangüínea e mortalidade. RESULTADOS: Não existiu diferença significativa entre os grupos em relação a idade, peso e sexo. Os pacientes do grupo 2 foram menores do que os do grupo 1 e 3. As doses utilizadas foram de 15,30 mg de bupivacaína no grupo 1; 23,68 mg no grupo 2 e 10,10 mg no grupo 3. Não foi encontrada diferença significativa (p JUSTIFICATIVA Y OBJETIVOS: Diversas cuestiones envuelven los estudios, las análisis y el tamaño de la muestra para que sean demostrados los beneficios de la anestesia regional. Las análisis de datos generalmente cuestan menos y requieren menos tiempo, cuando comparado con un amplio estudio aleatorio controlado. Esta análisis retrospectiva compara la raquianestesia continua, el bloqueo combinado raqui-peridural y la raquianestesia simple para cirugías de cuadril en

  20. Hematoma epidural lombar pós-cirurgico em paciente com leucemia: relato de caso Hematoma epidural lumbar posquirúrgico en paciente con leucemia: relato de caso Postoperative lumbar epidural hematoma in a patient with leukemia: case report

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    Wagner Pasqualini

    2012-09-01

    Full Text Available A ocorrência de hematoma epidural como complicação pós-cirúrgica é relativamente baixa. O reconhecimento dessa patologia no diagnóstico diferencial nas paraplegias pós-cirúrgicas imediatas e o tratamento precoce por meio de intervenção cirúrgica com a descompressão do canal são fatores que estão diretamente relacionados à melhora do quadro neurológico. Este relato de caso é de um hematoma epidural no pós-operatório imediato de descompressão por estenose do canal vertebral lombar em paciente com leucemia.La ocurrencia de hematoma epidural, como complicación posquirúrgica, es relativamente baja. El reconocimiento de esa patología, en el diagnóstico diferencial en las paraplejías posquirúrgicas inmediatas y el tratamiento precoz por medio de intervención quirúrgica con la descompresión del canal, son factores que se relacionan directamente con la mejoría del cuadro neurológico. Este relato de caso es de un hematoma epidural en el posoperatorio inmediato, después de descompresión, por estenosis, del canal vertebral lumbar en paciente con leucemia.The occurrence of epidural hematoma as a postoperative complication is relatively low. The recognition of this condition in the differential diagnosis in the immediate postoperative paraplegia and the early surgical decompression are directly related with neurological improvement. We report a case of epidural hematoma in the early postoperative period of surgical decompression of the lumbar spinal canal, in a patient with leukemia.

  1. 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

    las repercusiones maternas y fetales con el uso de la bupivacaína (S75-R25 y de la ropivacaína cuando se usan para la analgesia de parto por bloqueo epidural. MÉTODOS: Realizamos un ensayo clínico prospectivo, encubierto y randomizado, con 49 pacientes gestantes a término, que presentaban bajo riesgo, con indicación de parto vaginal, y una edad entre los 15 y los 35 años, ASA I o II distribuidas en dos grupos: GI - bupivacaína (S75-R25 0,25%; GII - ropivacaína a 0,20%. RESULTADOS: Quedó evidenciada la diferencia estadísticamente significativa entre los dos grupos, 30 minutos después de la administración de la epidural, siendo que las puntuaciones de dolor fueron más elevadas en el grupo que utilizó la ropivacaína. No se encontraron diferencias estadísticas significativas en cuanto a la latencia de la analgesia, nivel sensorial del bloqueo, volumen del anestésico local, dosis de rescate, duración del parto y de la analgesia, frecuencia de parto instrumental, alteraciones hemodinámicas, puntuaciones de Apgar o pH del cordón umbilical e incidencia de eventos adversos. CONCLUSIONES: El uso de la bupivacaína (S75-R25 y la ropivacaína para la analgesia de parto, proporcionó buenas condiciones para la realización de la anestesia epidural con pequeñas incidencias de eventos adversosBACKGROUND AND OBJECTIVES: Spinal anesthesia is used for relief of pain during labor and it is associated with low indices of complications. Studies with levorotatory enantiomers of local anesthetics demonstrate higher safety due to the lower cardiotoxicity. The objective of this study was to evaluate the latency and duration of analgesia and maternal and fetal repercussions with bupivacaine (S75-R25 and ropivacaine in spinal anesthesia for labor analgesia. METHODS: A prospective, double-blind, randomized clinical assay was undertaken with 49 labouring parturients with low risk, with indication of vaginal delivery, ages 15 to 35 years, ASA I or II, divided into two groups

  2. Anestesia peridural para cesariana: estudo comparativo entre Bupivacaína Racêmica (S50-R50 e Bupivacaína com excesso enantiomérico de 50% (S75-R25 a 0,5% associadas ao Sufentanil Anestesia epidural para cesárea: estudio comparativo entre Bupivacaína Racémica (S50-R50 y Bupivacaína con exceso enantiomérico de 50% (S75-R25 a 0,5% asociadas al Sufentanil Epidural block for cesarean section: a comparative study between 0.5% racemic Bupivacaine (S50-R50 and 0.5% enantiomeric excess Bupivacaine (S75-R25 associated with Sufentanil

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    Angélica de Fátima de Assunção Braga

    2009-06-01

    bupivacaína racémica a 0,5% asociada a opioides por vía epidural constituye una técnica anestésica utilizada en cesárea, sin embargo su toxicidad se pone en tela de juicio. La bupivacaína con exceso enantiomérico de 50%, presenta un menor cardio y neurotoxicidad. Se evaluó la eficacia de la bupivacaína racémica y de la bupivacaína con exceso enantiomérico de 50% a 0,5%, asociadas al sufentanil, por vía epidural en embarazadas sometidas a la cesárea. MÉTODO: Cincuenta embarazadas a término, sometidas a la cesárea electiva bajo bloqueo epidural, distribuidas en dos grupos, de acuerdo con el anestésico local usado: Grupo I - bupivacaína racémica a 0,5% con vasoconstrictor; Grupo II - bupivacaína con exceso enantiomérico de 50% (S75-R25 a 0,5% con vasoconstrictor. En los dos grupos el anestésico local (100 mg estuvo asociado al sufentanil (20 µg y el volumen total usado de la solución fue de 24 mL. Se evaluaron: la latencia del bloqueo sensitivo; nivel máximo del bloqueo sensitivo; grado del bloqueo motor; tiempo para la regresión del bloqueo motor; duración de la analgesia; efectos colaterales maternos y repercusiones neonatales. RESULTADOS: La latencia, el nivel máximo del bloqueo sensitivo, el grado del bloqueo motor y la duración de la analgesia fueron similares en los dos grupos; el tiempo para la regresión del bloqueo motor fue significativamente menor en el Grupo II. Los efectos colaterales ocurrieron con frecuencia similar en los dos grupos. Hubo ausencia de alteraciones cardiocirculatorias maternas y repercusiones neonatales. CONCLUSIONES: La bupivacaína racémica y la bupivacaína con exceso enantiomérico de 50%, por vía epidural, proporcionan una anestesia adecuada para la realización de la cesárea. La bupivacaína con exceso enantiomérico de 50%, es una alternativa promisoria para ese tipo de procedimiento, por presentar un menor tiempo para la regresión del bloqueo motor, lo que mucho se desea en la paciente obst

  3. 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

  4. La inmunización con productos de excreción-secreción de Trichinella spiralis unido al bloqueo de CTLA-4 produce un elevado grado de protección ante un reto con el parásito

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    José Lino Zumaquero-Ríos

    2017-04-01

    Full Text Available En la búsqueda de una vacuna experimental efectiva contra Trichinella spiralis se han utilizado diferentes estrategias, pero el grado de protección alcanzado en la casi totalidad de los ensayos es insuficiente para lograr un adecuado control de la enfermedad. En la literatura hay evidencias de que moléculas inhibidoras de la activación de los linfocitos T están implicadas en la regulación de la respuesta inmune contra los helmintos. El bloqueo de estas moléculas puede ser un blanco potencial para el tratamiento de las infecciones causadas por estos parásitos. Por otra parte, se ha informado que la inmunización con productos de excreción-secreción de larvas musculares de T. spiralis proporciona una inmunidad protectora parcial. La infección con el parásito induce una elevada población de linfocitos T reguladores que modulan la respuesta inmune. En este trabajo encontramos que la inmunización con antígenos de excreción-secreción de larvas musculares, más el bloqueo de la molécula inhibidora CTLA-4 en los linfocitos T, causa una significativa reducción de las larvas del parásito en un modelo experimental murino. De esta forma, queda demostrado que la eliminación del efecto supresor inducido por el helminto da por resultado una respuesta Th2 protectora más potente.

  5. Tratamiento, mediante bloqueo de moléculas CD20 con Rituximab, en miopatías Inflamatorias Idiopáticas refractarias a tratamiento convencional

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    Chinchilla Palomares, Eduardo

    2012-01-01

    Las miopatías inflamatorias idiopáticas (MII) constituyen un grupo heterogéneo de enfermedades adquiridas, de probable mecanismo inflamatorio autoinmune, que se caracterizan por debilidad muscular e infiltrado inflamatorio local o difuso, junto con necrosis de las fibras musculares, en la biopsia muscular. Afectan preferentemente a la musculatura estriada. Dentro de este grupo se incluyen tres variantes principales: la dermatomiositis (DM), la polimiositis (PM) y la miositis con cuerpos de in...

  6. Generación de inclusiones no metálicas y su efecto sobre el bloqueo de boquillas de colada continua en aceros ultra bajo carbono estabilizados con titanio

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    Vega-Becerra, O.

    2005-12-01

    Full Text Available This work presents a thermodynamic and experimental analysis of the phases that precipitate in the non metallic inclusions depending on the contents of aluminium (Al, titanium (Ti and oxygen (O in the steel, and their influence on the nozzle clogging. For the thermodynamic analysis, the program FACT WIN (Facility For The Analysis of Chemical Thermodynamics subroutine Equilib. was used. The experimental tests were carried out in an TAMMANN furnace, in an argon atmosphere. The control of the content of dissolved oxygen was carried out by means of sensors of solid electrolyte bases zirconia. The characterization of the inclusions was carried out with SEM, EDS and by means of the technique of fractional reduction with carbon. A good agreement was observed between the thermodynamic predictions and the experimental results.

    En este trabajo se presenta un análisis termodinámico y experimental de las fases que precipitan en inclusiones no metálicas en función de los contenidos de aluminio (Al, titanio (Ti y oxígeno (O en el acero y su influencia sobre el bloqueo de boquillas de colada continua. Para el análisis termodinámico se utilizó el programa FACT-WIN (Facility For The Analysis of Chemical Thermodynamics subrutina Equilib. Las pruebas experimentales se realizaron en un horno TAMMANN, en atmósfera de argón. El control del contenido de oxígeno disuelto se llevó a cabo mediante sensores de electrólito sólido base zirconia. La caracterización de las inclusiones se realizó por SEM, EDS y mediante la técnica de reducción fraccionada con carbono. Se observó una buena concordancia entre las predicciones termodinámicas y los resultados experimentales.

  7. Correlación automatizada de parámetros geométricos mediante contornos de bloqueo en engranajes cilíndricos con contacto exterior//Automatic correlation of geometric parameters by means of blocking contours in spur and helical external gear

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    Robert Hernández-Ortega

    2012-12-01

    Full Text Available Este trabajo tuvo como objetivo obtener un procedimiento, que al implementarse en un software para el diseño de transmisiones por engranajes cilíndricos con contacto exterior, correlacione automáticamente los parámetros geométricos mediante los contornos de bloqueo y así facilitar el trabajo del diseñador deengranajes. Para ello, se transformaron las expresiones matemáticas que definen las limitaciones geométricas para que puedan ser utilizadas en un programa que construya el contorno de bloqueo sin la intervención del diseñador. Se estableció además la secuencia en que estas deben ser calculadas. El procedimiento obtenido se implementó en un programa de computación obteniéndose una velocidad deejecución de 1 segundo aproximadamente. De esta forma se logró la correlación automática de los parámetros geométricos y un contorno de bloqueo que muestra el conjunto de valores de los coeficientes de corrección de las ruedas que pueden ser utilizados, construidos sin interacción con el diseñador.Palabras claves: contorno de bloqueo, engranajes, parámetros geométricos._______________________________________________________________________________AbstractThe aim of this work was to obtain a procedure, that when being implemented in the design software of spur and helical external gears, correlate the geometric parameters automatically by means of the blocking contours making easier the designer's work. The mathematical expressions that define the geometriclimitations were transformed so that they can be used in a program that it builds the blocking contour without the designer's intervention. Besides that it was settled down the sequence they should be calculated. The procedure was implemented in a calculation program obtaining an execution speed about 1 second. This way it was achieved the automatic correlation of the geometric parameters and a blockingcontour construction without the designer's intervention that it shows the

  8. Cardiomiopatía hipertrófica y síndrome de Wolff-Parkinson-White con bloqueo aurículo-ventricular completo. Una extraña asociación: Reporte de un caso Hypertrophic cardiomyopathy and Wolff-Parkinson-White Syndrome with complete auriculoventricular block. A strange association: Report of one case

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    Franco J Vallejo

    2007-12-01

    Full Text Available Paciente masculino de 22 años quien ingresa por episodio de síncope. En el electrocardiograma se encuentra patrón de Wolff-Parkinson-White y signos de sobrecarga auricular e hipertrofia ventricular izquierda con bloqueo aurículo-ventricular completo. El ecocardiograma transtorácico es compatible con cardiomiopatía hipertrófica no obstructiva. Se lleva a estudio electrofisiológico donde se encuentra pre-excitación por vía accesoria y bloqueo aurículo-ventricular infrahisiano; se realiza ablación y se implanta marcapasos bicameral.A 22 years old male patient is admitted for a syncope episode. An electrocardiogram shows a Wolff-Parkinson-White pattern and signs of auricular overload with left ventricular hypertrophy and complete auriculoventricular block. The transthoracic echocardiogram is compatible with non-obstructive hypertrophic cardiomyopathy. An electrophysiological study is carried out, finding pre-excitation through an accessory way and infra-His auriculoventricular block. An ablation is performed and a bicameral pacemaker is implanted.

  9. Bloqueo aurículo-ventricular familiar progresivo tipo I: descripción clínica de una familia

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    Guillermo Mora, MD

    2011-08-01

    Full Text Available Se presenta el caso de una familia con bloqueo aurículo-ventricular, que compromete varias generaciones, con herencia mendeliana autosómica dominante, que afecta de manera progresiva el sistema de conducción cardiaco llevando a síncope y muerte súbita en edades tempranas. Esta entidad corresponde al bloqueo familiar cardiaco progresivo tipo I, descrito principalmente en Suráfrica. El tratamiento con marcapaso definitivo fue exitoso.

  10. Comentario sobre Ensayo clínico: Epidural con punción dural frente a epidural clásica en obstetricia. Rev electrón AnestesiaR 2009; Volumen 1(2)

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    Miró Murillo, Miguel

    2017-01-01

    1.- La incidencia de CPPD no aumenta con la CSE, este dato está avalado por dos revisiones sistemáticas de la cochrane (1).2.- Se han propuesto varias razones para que la punción dural de la CIE no suponga el esperado aumento de CPPD. El uso de la aguja epidural permite utilizar una aguja muy fina (26-29G) (2, 3). La presencia del catéter y de solución anestésica aumenta la presión en el espacio epidural, lo que disminuye el riesgo de pérdida de LCR a través del agujero dural, y los opiáceos ...

  11. Bloqueo neurolítico del tercer ganglio simpático dorsal en pacientes con síndrome de Raynaud: Una serie de casos Neurolytic blocking third dorsal simpathetic ganglion in patients with Raynaud´s syndrome: A number of cases

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    J. A. Flores Cantisani; M. G. Hinojosa Reyes; G. C. Palacios Saucedo; M. L. Prieto Duarte; O. Becerra Alcántara

    2013-01-01

    Introducción: El fenómeno de Raynaud es un trastorno vascular, frecuente en la población general, que consiste en la aparición paroxística de espasmo vascular distal, en pequeñas arterias y arteriolas cutáneas de las extremidades, con escasa repercusión sistémica. Existen bases anatómicas y fisiológicas para producir un bloqueo simpático selectivo utilizando agentes neurolíticos en los ganglios torácicos T2 y T3, considerados estaciones sinápticas que se distribuyen en el miembro superior. Ob...

  12. El lavado epidural con suero fisiológico puede acortar la recuperación postanestésica

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    Paz Martín, Daniel

    2009-01-01

    La reversión de la anestesia epidural depende de la redistribución de los anestésicos locales desde el tejido nervioso al compartimento central. Se puede aumentar la redistribución disminuyendo la concentración del anestésico local en el espacio epidural. Se han realizado estudios en los que la administración por vía epidural de 20-45ml de salino ha demostrado acelerar la recuperación hasta la deambulación. El objetivo del presente estudio es investigar cómo puede afectar la administración...

  13. Tratamiento con radiofrecuencia versus bloqueo analgésico con corticoide de los nervios geniculares en la prótesis total de rodilla dolorosa, estudio clínico aleatorizado doble ciego.

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    Qudsi Sinclair, Salima

    2018-01-01

    La artrosis de rodilla es una enfermedad que afecta a un tercio de la población mayor de 65 años, y se está convirtiendo en un motivo de consulta cada vez más frecuente debido al dolor y la discapacidad que produce. El tratamiento gold standard es la prótesis total de rodilla (PTR); sin embargo entre un 15%-30% de los pacientes intervenidos de prótesis total de rodilla continúan con dolor y limitación. Objetivo Queremos valorar, analizar y comparar el resultado que obtenemos en términ...

  14. Anestesia peridural contínua para cesariana em paciente com arterite de Takayasu: relato de caso Anestesia peridural continua para cesárea en paciente con arteritis de Takayasu: relato de caso Continuous epidural anesthesia for cesarean section in a patient with Takayasu’s arteritis: case report

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    Aloísio Cerqueira Buettel

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anestesia peridural contínua com titulação das doses de anestésico local proporciona eficácia e segurança em pacientes que não toleram flutuações da pressão arterial. O objetivo deste relato é apresentar um caso em que foi utilizada com sucesso anestesia peridural contínua para cesariana em paciente com arterite de Takayasu. RELATO DO CASO: Paciente primigesta, 25 anos, 63 kg, portadora de arterite de Takayasu, com 34-35 semanas de gestação, apresentando sofrimento fetal agudo, PA de 155/85 mmHg, FC de 92 bpm, com ausência de pulsos carotídeos, assim como nos membros superiores e do membro inferior direito. Apresentava apenas pulso poplíteo esquerdo palpável. Foi realizado bloqueio peridural contínuo com doses fracionadas de 25 mg de bupivacaína a 0,5% com epinefrina (1:200.000, a intervalos de 5 em 5 minutos até um total de 100 mg, associando-se 2 mg de morfina e 100 µg de fentanil. CONCLUSÕES: A anestesia peridural contínua com doses tituladas de bupivacaína a 0,5% com epinefrina pode ser utilizada em pacientes com Arterite de Takayasu, tomando-se as medidas de precaução com portadoras dessa doença.JUSTIFICATIVA Y OBJETIVOS: Anestesia peridural continua con titulación de las dosis de anestésico local proporciona eficacia y seguridad en pacientes que no toleran flutuaciones de la presión arterial. El objetivo de este relato es presentar un caso en que fue utilizado con suceso anestesia peridural continua para cesárea en paciente con arteritis de Takayasu. RELATO DEL CASO: Paciente primigesta, 25 años, 63 kg, portadora de Arteritis de Takayasu, con 34-35 semanas de gestación, presentando sufrimiento fetal agudo, PA de 155/85 mmHg, FC de 92 bpm, con ausencia de pulsos carotídeos, así como en los miembros superiores y del miembro inferior derecho. Presentaba apenas pulso poplíteo izquierdo palpable. Fue realizado bloqueo peridural continuo con dosis fraccionadas de 25 mg de bupivaca

  15. La inmunización con productos de excreción-secreción de Trichinella spiralis unido al bloqueo de CTLA-4 produce un elevado grado de protección ante un reto con el parásito

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    José Lino Zumaquero-Ríos; Martín Pérez-Santos; Abel Villa-Mancera; Jorge Sarracent-Pérez

    2017-01-01

    En la búsqueda de una vacuna experimental efectiva contra Trichinella spiralis se han utilizado diferentes estrategias, pero el grado de protección alcanzado en la casi totalidad de los ensayos es insuficiente para lograr un adecuado control de la enfermedad. En la literatura hay evidencias de que moléculas inhibidoras de la activación de los linfocitos T están implicadas en la regulación de la respuesta inmune contra los helmintos. El bloqueo de estas moléculas puede ser un blanco potencial ...

  16. Hematoma epidural subagudo Subacute epidural hematoma

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    Yvei González Orlandi

    2011-03-01

    Full Text Available Se presenta el caso de un paciente con hematoma epidural subagudo, temporoparietal derecho, secundario a una agresión física. En el cuadro clínico, a las 24 h, predominó la cefalea de intensidad moderada, con somnolencia y agitación psicomotora ligera. Las radiografías simples de cráneo no mostraron alteraciones. Los síntomas se mantuvieron a pesar del tratamiento médico, por lo que se realizó una tomografía axial simple de cráneo que mostró la presencia de un hematoma epidural subagudo temporoparietal derecho, con desplazamiento de estructuras de la línea media. Se realizó una craneotomía temporoparietal derecha para la evacuación del hematoma posterior. El paciente evolucionó satisfactoriamente y se recuperó por completo, tanto clínica como imaginológicamente.This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographies didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging.

  17. 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.

  18. Influencia del bloqueo directo y el uno contra uno en el éxito del lanzamiento en baloncesto

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    Verónica Muñoz Arroyave

    2015-03-01

    Full Text Available El presente estudio tiene como objetivo analizar el impacto del uno contra uno y el bloqueo directo sobre la eficacia en los lanzamientos. Se desarrolló un instrumento ad hoc denominado sistema de observación de conceptos fundamentales en baloncesto (SOCFB para estudiar las acciones ofensivas del Fútbol Club Barcelona Regal en la Copa del Rey en la temporada 2013-2014. Se analizaron un total de 643 acciones ofensivas donde se destacan los siguientes hallazgos: a el 34 % de las acciones del jugador con balón finalizaron en lanzamiento mientras que el 66 % terminaron en pases; b la principal consecuencia del uno contra uno interior fueron los lanzamientos (z = 6,2, p < 0,001; c en el uno contra uno exterior se encontraron relaciones estadísticamente significativas con el espacio exterior de la zona (z = 3,3, p < 0,001 y la lateralidad del espacio lateral izquierdo (z = 2, p <0,05; d en el bloqueo directo se observaron relaciones estadísticamente significativas con las acciones que no finalizaron. De estos resultados podemos extraer las siguientes conclusiones: a el bloqueo directo es el concepto más utilizado y fue utilizado como medio para la generación de ventajas; b el uno contra uno interior genera más lanzamientos y de mayor efectividad.

  19. Vitrectomía y facovitrectomía con anestesia tópica/intracameral

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    Jesús Oscar Moya Romero

    2015-01-01

    Conclusiones: El uso de anestesia tópica/intracameral en vitrectomía pars plana y facovitrectomía para casos seleccionados es seguro y efectivo como alternativa al bloqueo retrobulbar y peribulbar, evitando complicaciones relativas al bloqueo, con una incidencia de complicaciones similar a lo reportado, y adecuada tolerancia, para el paciente.

  20. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1 com ropivacaína e a analgesia subaracnóidea com morfina Analgesia pós-operatoria en cirugía ortopédica: estudio comparativo entre el bloqueo del plexo lombar por vía perivascular inguinal (3 en 1 con ropivacaína y la analgesia subaracnóidea con morfina Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1 and spinal anesthesia with morphine

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    Neuber Martins Fonseca

    2003-04-01

    perivascular inguinal, llamado de bloqueo 3 en 1, ha sido utilizado para analgesia pós-operatoria. El objetivo de este estudio fue comparar la analgesia pós-operatoria del bloqueo 3 en 1 a la de la morfina subaracnóidea en pacientes sometidos a cirugías ortopédicas en miembro inferior (MI. MÉTODO: Fueron estudiados 40 pacientes escalados para cirugía ortopédica de MI, de ambos sexos, estado físico ASA I y II, con edades entre 15 y 75 años, distribuidos en 2 grupos (M y BPL. Fue realizada anestesia subaracnóidea en todos los pacientes, en L3-L4 ó L4-L5, con 20 mg de bupivacaína isobárica a 0,5%. En el grupo M (n = 20 fue asociado 50 µg de morfina al anestésico local. En el grupo BPL (n = 20 fue realizado el bloqueo 3 en 1 al término de la cirugía, utilizando 200 mg de ropivacaína a 0,5%. Se evaluó la analgesia y la intensidad del dolor a las 4, 8, 12, 14, 16, 20 y 24 horas después del término de la cirugía, el nivel del bloqueo subaracnóideo, el tiempo quirúrgico y las complicaciones. RESULTADOS: La duración de la analgesia en el grupo BPL fue de 13,1 ± 2,47, en cuanto en el grupo M todos los pacientes referían dolor y ausencia de bloqueo motor en el primero instante evaluado (4 horas. Hubo falla del bloqueo de uno de los 3 nervios en 3 pacientes. La incidencia de náusea y prurito fue significativamente mayor en el grupo M. Cuanto a la retención urinaria, no hubo diferencia significante entre los grupos. No hubo depresión respiratoria, hipotensión arterial o bradicardia. La analgesia pós-operatoria fue mas efectiva en el grupo BPL, comparada al grupo M a las 4, 8, 12,14 y 16 horas. A las 20 y 24 horas no hubo diferencia significante entre los grupos.BACKGROUND AND OBJECTIVES: Perivascular Lumbar plexus inguinal block, (3-in-1 block has been used for postoperative analgesia. This study aimed at comparing postoperative analgesia of 3-in-1 block and spinal morphine in patients submitted to lower limb orthopedic surgeries (LL. METHODS: Forty ASA I

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

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    Derya Arslan Yurtlu

    2013-02-01

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

  2. Comparação das técnicas transarterial e de estimulação de múltiplos nervos para bloqueio do plexo braquial por via axilar usando lidocaína com epinefrina Comparación de las técnicas transarterial y de estimulación de múltiples nervios para bloqueo del plexo braquial por vía axilar usando lidocaína con epinefrina Comparison of transarterial and multiple nerve stimulation techniques for axillary block using lidocaine with epinephrine

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    Luiz Eduardo Imbelloni

    2005-02-01

    resulta en alta efectividad para el bloqueo axilar del plexo braquial. La técnica de utilizar múltiples estímulos exige más tiempo y mayor experiencia. Este estudio prospectivo compara la latencia y el índice de éxito del bloqueo del plexo braquial usando dos técnicas de localización: transarterial o múltipla estimulación de los nervios. MÉTODO: La lidocaína con epinefrina, 800 mg, fue usada inicialmente para el bloqueo axilar. En el grupo transarterial, 30 mL de lidocaína a 1,6% con epinefrina fueron inyectados profundamente y 20 mL superficialmente a la arteria axilar. En el grupo de múltipla estimulación, tres nervios fueron localizados eléctricamente y bloqueados con volúmenes 20 mL, 20 mL y 10 mL de la solución. El bloqueo fue considerado efectivo cuando la analgesia estaba presente en todos los nervios en la área distal al codo. RESULTADOS: El tiempo de latencia (8,8 ± 2,3 min versus 10,2 ± 2,4 min; p-valor = 0,010 fue significativamente menor en el grupo transarterial. Bloqueos sensitivos completos en los cuatro nervios (mediano, ulnar, radial y musculocutáneo fueron logrados en un 92,5% versus 83,3% en el grupo de múltipla estimulación y acceso transarterial, respectivamente sin diferencia significativa (p-valor = 0,68. El nervio musculocutáneo fue significativamente más fácil de bloquear con el estimulador de nervio periférico (p = 0,034. CONCLUSIONES: La técnica de múltipla estimulación para el bloqueo axilar usando estimulador de nervios (3 inyecciones y la técnica transarterial (2 inyecciones producen resultados semejantes en la calidad del bloqueo. El nervio musculocutáneo es más facilmente bloqueado con el uso del estimulador del nervio periférico. La técnica de múltipla estimulación necesitó menor suplementación del bloqueo y aumentó el tiempo para el inicio de la cirugía.BACKGROUND AND OBJECTIVES: High-dose transarterial technique results in highly effective axillary block. The multiple nerve stimulation technique

  3. Analgesia pós-operatória com bloqueio bilateral do nervo pudendo com bupivacaína S75:R25 a 0,25%: estudo piloto em hemorroidectomia sob regime ambulatorial Analgesia pos-operatoria con bloqueo bilateral del nervio pudendo con bupivacaína S75:R25 a 0,25%: estudio piloto en hemorroidectomia bajo régimen ambulatorial Bilateral pudendal nerves block for postoperative analgesia with 0.25% S75:R25 bupivacaine: pilot study on outpatient hemorrhoidectomy

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    Luiz Eduardo Imbelloni

    2005-12-01

    permitirão demonstrar se esta técnica deve ser a primeira opção para analgesia em hemorroidectomias. A permanência de anestesia perineal por 20,21 horas deverá induzir novos trabalhos com o bloqueio dos nervos pudendos orientado por estimulador para o ato cirúrgico.JUSTIFICATIVA Y OBJETIVOS: La hemorroidectomia puede ser realizada bajo varias técnicas anestésicas y en régimen ambulatorial. El dolor pos-operatorio es intenso y puede atrasar el retorno para el hogar. El objetivo de este estudio fue evaluar las ventajas y la realización del bloqueo bilateral de los nervios pudendos para analgesia pos-operatoria en hemorroidectomias. MÉTODO: El bloqueo bilateral de los nervios pudendos con bupivacaína S75:R25 a 0,25% fue realizado con estimulador de nervios en 35 pacientes sometidos a la hemorroidectomia bajo raquianestesia. Fueron evaluadas intensidad del dolor, duración de la analgesia, analgesia de demanda y eventuales complicaciones relacionadas a la técnica. Los datos fueron evaluados a las 6, 12, 18, 24 y 30 horas después del término de la intervención quirúrgica. RESULTADOS: En todos los pacientes, fue logrado éxito con la estimulación de ambos los nervios pudendos. En ningún momento de la evaluación ocurrió dolor intenso. Hasta 12 horas después del bloqueo, todos los pacientes presentaron anestesia en la región perineal; con 18 horas, 17 pacientes y 24 horas, 10 pacientes A analgesia pos-operatoria fue óptima en 18 pacientes; satisfactoria, en cinco pacientes; e insatisfactoria, en siete pacientes. La duración media de la analgesia fue de 23,77 horas. No ocurrieron alteraciones de la presión arterial, de la frecuencia cardiaca, ni fueron observados náuseas o vómitos. Todos los pacientes tuvieron micción espontánea. Ninguna complicación local o sistémica fue relacionada al anestésico local. Veintisiete pacientes clasificaron de excelente la técnica de analgesia y apenas tres pacientes del sexo masculino quedaron satisfechos

  4. Avaliação da profundidade do espaço peridural com o uso do ultrassom Evaluación de la profundidad del espacio epidural con el uso del ultrasonido Evaluating the depth of the epidural space with the use of ultrasound

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    Pablo Escovedo Helayel

    2010-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi avaliar o uso do ultrassom na determinação da profundidade do espaço peridural. MÉTODO: Sessenta pacientes foram alocados prospectivamente tendo a identificação do espaço intervertebral L3-L4 inicialmente feita pelo método palpatório. Posteriormente, utilizou-se o método ultrassonográfico, realizando-se a medida da profundidade do espaço peridural (PU. Após a punção peridural, foram anotadas as medidas da profundidade (PA. Realizaram-se estatísticas descritivas dos dados e calculou-se o coeficiente de correlação de concordância e análise de Bland-Altman, com intervalo de 95% de confiança para as medidas de profundidade. RESULTADOS: A análise de concordância entre o método palpatório e ultrassonográfico foi de 86,6%. Foram obtidos valores médios de PU 4,97 ± 0,51 cm e PA 4,97 ± 0,71 cm e coeficiente de correlação de Pearson de 0,66, enquanto a análise Bland-Altman revelou diferença média de 0,0035 ± 0,53 cm, com limite de 95% de confiança entre -0,228 a 0,221. CONCLUSÕES: A ultrassonografia é uma ferramenta precisa para a determinação da profundidade do espaço peridural.JUSTIFICATIVA Y OBJETIVOS: El objetivo de este estudio fue evaluar el uso del ultrasonido para la determinación de la profundidad del espacio epidural. MÉTODO: Sesenta pacientes fueron ubicados, prospectivamente teniendo la identificación del espacio intervertebral L3-L4 inicialmente realizada por el método de palpación. Posteriormente se usó el método de ultrasonido, y se realizó la medida de la profundidad del espacio epidural (PU. Después de la punción epidural, se anotaron las medidas de la profundidad (PA. Se midieron las estadísticas descriptivas de los datos y se calculó el coeficiente de correlación de concordancia y análisis de Bland-Altman, con un intervalo de un 95% de confianza para las medidas de profundidad. RESULTADOS: El análisis de concordancia entre el m

  5. Estudo comparativo de midazolam com cetamina S(+ versus midazolam com bloqueio paracervical uterino para aspiração manual intra-uterina Estudio comparativo de midazolam con cetamina S(+ versus midazolam con bloqueo paracervical uterino para aspiración manual intrauterina Comparative study of midazolam with ketamine S(+ versus midazolam with uterine paracervical block for manual intrauterine aspiration

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    Vonaldo Torres de Almeida

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Avaliar a efetividade, a analgesia pós-operatória e o grau de satisfação e recomendação das pacientes submetidas à aspiração manual intra-uterina por meio da comparação de duas técnicas anestésicas. MÉTODO: Foram estudadas, prospectivamente, 80 pacientes distribuídas aleatoriamente em dois grupos. Todas receberam midazolam, por via venosa. Em seguida, o Grupo MC recebeu cetamina S(+ por via venosa e o Grupo MP, bloqueio paracervical uterino. Na sala de cirurgia a eficácia da técnica foi avaliada por três observadores (o pesquisador, o obstetra e o residente de obstetrícia e, após uma hora, foi avaliada por um observador que desconhecia a técnica realizada, a analgesia pós-operatória, os graus de satisfação de recomendação da paciente mediante escala verbal. RESULTADOS: As técnicas mostraram-se eficientes em 95% das pacientes do Grupo MC e 76,7% das pacientes do Grupo MP (p = 0,04. Entre as pacientes do Grupo MC, 67% não apresentaram dor após uma hora, enquanto no grupo MP a porcentagem de pacientes sem dor foi de 33,3% (p JUSTIFICATIVA Y OBJETIVOS: Evaluar la efectividad, la analgesia postoperatoria y el grado de satisfacción y recomendación de las pacientes sometidas a la aspiración manual intrauterina a través de la comparación de las técnicas anestésicas. MÉTODO: Formando parte de un estudio de prospección, se estudiaron 80 pacientes distribuidas aleatoriamente en 2 grupos. Todas recibieron midazolam por vía venosa. En seguida, el Grupo MC, recibió cetamina S(+ por vía venosa y el Grupo MP bloqueo paracervical uterino. En la sala de cirugía la eficacia de la técnica fue evaluada por tres observadores (el investigador, el obstetra y el residente de obstetricia y después de una hora, fue evaluada por un observador que desconocía la técnica realizada, la analgesia postoperatoria y los grados de satisfacción de recomendación de la paciente mediante escala verbal

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

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    Leonardo Teixeira Domingues Duarte

    2009-06-01

    diferentes bloqueos de nervios periféricos. El objetivo de este estudio, fue comparar la eficacia de la analgesia postoperatoria, resultante de la administración en dosis única de la bupivacaína a 0,5% o de la ropivacaína a 0,5% en el bloqueo del plexo lumbar por la vía posterior en la artroplastia total de la cadera. MÉTODO: Treinta y siete pacientes fueron ubicados aleatoriamente en dos grupos según el anestésico local utilizado en el bloqueo: Grupo B - bupivacaína a 0,5% con epinefrina 1:200.000 o Grupo R - ropivacaína a 0,5%. Durante el período postoperatorio, los puntajes de dolor y el consumo de morfina en la analgesia controlada por el paciente, fueron comparados entre los grupos. El sangramiento durante la operación y la incidencia de efectos adversos y de complicaciones también fueron comparados. RESULTADOS: Pese a que los puntajes de dolor hayan sido menores en el Grupo R 8 horas, 12 horas y 24 horas después del bloqueo, esas diferencias no fueron clínicamente significativas. La regresión lineal múltiple no identificó el anestésico local como una variable independiente. No hubo diferencia en el consumo de morfina, en el sangramiento intraoperatorio y en la incidencia de complicaciones y efectos adversos entre los dos grupos. CONCLUSIONES: La bupivacaína a 0,5% y la ropivacaína a 0,5%, ofrecieron un alivio eficaz y prolongado del dolor postoperatorio después de la artroplastia total de la cadera, sin diferencia clínica, cuando dosis equivalentes fueron administradas en el bloqueo del plexo lumbar por la vía posteriorBACKGROUND AND OBJECTIVES: Posterior lumbar plexus block promotes effective postoperative analgesia in total knee arthroplasty. Ropivacaine and bupivacaine do not show differences in analgesic efficacy when used in different peripheral nerve blocks. The objective of this study was to compare the efficacy of postoperative analgesia resulting from the administration of a single dose of 0.5% bupivacaine or 0.5% ropivacaine in

  7. Bloqueo aurículo-ventricular familiar progresivo tipo I: descripción clínica de una familia Progressive familial atrio-ventricular block type I: clinical description of a family

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    Guillermo Mora

    2011-10-01

    Full Text Available Se presenta el caso de una familia con bloqueo aurículo-ventricular, que compromete varias generaciones, con herencia mendeliana autosómica dominante, que afecta de manera progresiva el sistema de conducción cardiaco llevando a síncope y muerte súbita en edades tempranas. Esta entidad corresponde al bloqueo familiar cardiaco progresivo tipo I, descrito principalmente en Suráfrica. El tratamiento con marcapaso definitivo fue exitoso.We present the case of a family with atrio-ventricular block that involves several generations, with dominant autosomal mendelian inheritance that progressively affects the cardiac conduction system leading to syncope and sudden death in early life. This entity corresponds to progressive familial atrio-ventricular block type I, described mainly in South Africa . Treatment with permanent pacemaker therapy was successful.

  8. 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

  9. Transforaminal epidural blood patch.

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    Weil, Lawrence; Gracer, Richard I; Frauwirth, Neal

    2007-07-01

    Spinal headache is an occasional, but painful complication of epidural injection procedures due to dural puncture that allows leakage of CSF from the thecal sac, thereby reducing intracranial pressure. In the event of failure of conservative management, (e.g. abdominal binder, fluids, acetaminophen), an epidural blood patch is often used. This case report describes a patient with spinal headache after a transforaminal selective epidural injection in a post laminectomy patient that was treated with a transforaminal epidural blood patch after the failure of conservative management. The patient underwent left transforaminal epidural injections at L5 and S1 for management of chronic low back pain secondary to post laminectomy syndrome. Three days later, the patient presented with a severe post lumbar puncture headache and failed to respond to conservative management. Interlaminar epidural approach for blood patch was not feasible secondary to prior laminectomy. Transforaminal epidural blood patch was performed utilizing 2 mL of autologous blood at each of the two sites. The patient recovered well without headache. In cases, with inability to perform interlaminar blood patch, a transforaminal approach may be considered.

  10. Peridural torácica alta associada ou não à peridural torácica baixa em pacientes ambulatoriais: implicações clínicas Peridural torácica alta asociada o no a la peridural torácica baja en pacientes ambulatoriales: implicaciones clínicas High thoracic epidural anesthesia associated or not to low thoracic epidural anesthesia in outpatient procedures: clinical implications

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    Djalma Sperhacke

    2004-08-01

    así como en los miembros superiores e inferiores. MÉTODO: Treinta y dos pacientes, estado físico ASA I y II, sin molestia pulmonar broncoespástica, en actividad y peso corporal igual o superior a 50 kg, fueron sometidos a 21 bloqueos peridurales torácicos aislados en T2-T3 y las 11 restantes, a bloqueos peridurales torácicos en T11-T12, con ropivacaína a 7,5% (45 a 90 mg asociada al sufentanil (10 a 20 µg. Repercusiones hemodinámicas, respiratorias y motoras en los miembros superiores e inferiores fueron evaluadas respectivamente, sobre monitorización no invasiva, espirometria, fuerza de preensión de la mano y escala de Bromage. RESULTADOS: La media de duración de las cirugías mamarias fue de 105 min con depresión motora de los miembros superiores (p BACKGROUND AND OBJECTIVES: Hemodynamic changes are easily controlled under low or median thoracic epidural block. Since high thoracic epidural block (T2-T3 often affects brachial plexus roots (C4 C5-T1(T2, some of them responsible for phrenic nerve formation (C3-C4-C5, potential motor repercussions on this nerve are to be expected. Our study performed during cosmetic surgeries under isolated segmental epidural block in T2-T3 or associated to segmental epidural block in T11-T12, has evaluated motor repercussions on respiratory dynamics, upper and lower limbs. METHODS: Participated in this study 32 patients physical status ASA I and II, without active bronchospastic pulmonary disease and body weight equal to or above 50 kg, 21 of whom were submitted to isolated thoracic epidural blocks in T2-T3 and the remaining patients (11 were submitted to a combined thoracic epidural blocks in T11-T12 with 7.5% ropivacaine (45 to 90 mg associated to sufentanil (10 to 20 µg. Hemodynamic, respiratory and upper and lower limbs motor repercussions were evaluated by noninvasive monitoring, spirometry hand grasping strength and Bromage score, respectively. RESULTS: Mean mammary surgeries duration was 105 minutes with upper

  11. ¿Está viva la OMC? Bloqueos y consensos en las negociaciones de las Conferencias Ministeriales de Bali

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    Julieta Zelicovich

    2017-05-01

    Full Text Available Tras más de una década de bloqueos en las negociaciones comerciales multilaterales, tanto en la Conferencia Ministerial de Bali, en 2013, como en la Conferencia Ministerial de Nairobi, en 2015, los miembros de la OMC lograron destrabar acuerdos multilaterales. El artículo propone indagar acerca de los factores que explican ese cambio en la dinámica de negociación, tratando de vislumbrar si se trata de un vuelco estructural o de resultados coyunturales. Para ello se recurre a la metodología de estudio de caso con process tracing, analizando la incidencia de variables del contexto internacional y variables internas a la dinámica de las negociaciones en los resultados mencionados

  12. Coma profundo consecutivo a bloqueo del plexo braquial: A propósito de 1 caso

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    Domingo Ángel Labrada Tapia

    2002-04-01

    Full Text Available Se presenta el caso clínico infrecuente de un paciente masculino de 17 años de edad, que sufrió un accidente de tránsito y por el cual mostraba herida avulsiva del miembro superior izquierdo. Se le practicó bloqueo del plexo braquial por la técnica perivascular interescalénica, donde se utilizó como agente anestésico la mepivacaína al 2 %. Minutos después, el paciente cae en coma profundo con resolución muscular total, pupilas midriáticas y arreactivas, reflejo fotomotor, corneal y parpabral ausentes. Se intuba y acopla al respirador mecánico Mark-8, y la hemodinamia se mantuvo sin presentar convulsiones. Posteriormente, de forma paulatina, se recupera totalmente sin dejar secuelasThe clinical unfrequent case of a 17-year-old male patient that had an avulsive wound of the left upper limb as a result of a traffic accident is presented. Block of the brachial plexus was performed by the interscalene perivascular technique. Mepivacaine 2 % was used as an anesthetic. Some minutes later, the patient had a deep coma with total muscular resolution, mydriatic and non-reactive pupils. The photomotor, corneal and eyelid reflexes were absent. He was intubated and coupled to the Mark-8 mechanical respirator. The hemodynamics was maintained without presenting convulsions. Later on, he recovered himself gradually and had no sequelae

  13. 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.

  14. Raquianestesia total após bloqueio do plexo lombar por via posterior: relato de caso Raquianestesia total después del bloqueo del plexo lumbar por vía posterior: relato de caso Total spinal block after posterior lumbar plexus blockade: case report

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2006-10-01

    anestesiologista conhecimento minucioso da anatomia, treinamento na técnica e vigilância constante.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar puede ser bastante útil en procedimientos quirúrgicos de la cadera, del muslo y de la rodilla, pero exige práctica del anestesiólogo teniendo en cuenta sus potenciales complicaciones. El presente relato tiene como objetivos presentar un caso de raquianestesia total después del bloqueo del plexo lumbar por la vía posterior y discutir el probable mecanismo fisiopatológico. RELATO DEL CASO: Paciente del sexo masculino, 34 años, 97 kg, estado físico ASA I, programado para artroplastia total de la cadera. Fue realizada anestesia general seguida de bloqueo del plexo lumbar derecho por la vía posterior con auxilio de estimulador de nervio periférico. La aguja fue introducida hasta una profundidad de 8 cm, perpendicular a la piel, y a una distancia de 4 cm de la línea media sobre una línea perpendicular al proceso espinoso de L4. Después de la identificación de respuesta motora en el cuadriceps, la intensidad de la corriente de estimulación se redujo hasta 0,35 mA, siendo entonces administrada ropivacaína a 0,5% (39 mL. Durante la inyección, fueron verificadas contracciones intermitentes del cuadriceps. Después del bloqueo, el paciente evolucionó con apnea, hipotensión arterial y midriasis bilateral. Al final de la cirugía, presentaba bloqueo motor en los dos miembros inferiores que solo mejoró nueve horas después de la realización del bloqueo. En el postoperatorio, el paciente se quejó de dolor intenso, recibiendo alta hospitalaria 12 días después de la cirugía sin anormalidades motora o sensitiva. CONCLUSIONES: La identificación del compartimento del psoas, donde está el plexo lumbar, exige la utilización de intensidad de corriente entre 0,5 e 1 mA. La incidencia de respuesta motora con bajas corrientes puede indicar posicionamiento de la aguja dentro del recubrimiento que envuelve la raíz nerviosa y

  15. Cervical epidural hematoma: Following interlaminar cervical epidural steroid injection

    Directory of Open Access Journals (Sweden)

    Dwarkadas Kanhayalal Baheti

    2015-01-01

    Full Text Available Cervical epidural steroid injection is a common procedure performed for patients with cervical radiculopathy. Cervical epidural hematoma is a rare but known complication of Intervention Pain Treatment Procedure (IPTP in healthy patients without coagulopathy. We report a case of cervical epidural hematoma as a complication of cervical epidural steroid injection in an elderly patient with cervical radiculopathy; resulting in right upper limb motor sensory deficit. Patient responded to conservative management and surgery was not performed since symptoms progressively improved.

  16. 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

  17. Bloqueio peribulbar com a associação da mistura enantiomérica de bupivacaína (S75-R25 a 0,5% e lidocaína a 2%: efeitos da adição de hialuronidase Bloqueo peribulbar con la asociación de la mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2%: efectos de la adición de hialuronidasa Peribulbar block with the association of 0.5% enantiomeric mixture of bupivacaine (S75-R25 and 2% lidocaine: effects of hyaluronidase addition

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Soares

    2002-07-01

    realización de bloqueo peribulbar con la asociación de la mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2%. MÉTODO: Fueron estudiados 35 pacientes divididos en grupo 1, que recibió una combinación de iguales volúmenes de mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2% con adrenalina 5 µg.ml-1 y grupo 2, que recibió la misma solución anestésica adicionada de hialuronidasa 50 UI.ml-1. La motilidad de los músculos rectos, orbicular del ojo y elevador de la pálpebra fue evaluada 1, 5, 10 y 15 minutos después del bloqueo. RESULTADOS: Los escores de motilidad de los músculos extra-oculares diminuyeron significativamente durante el período de observación, sin diferencias entre los grupos. Los porcentuales de pacientes que presentaron acinesia del globo ocular en cada momento del estudio no diferiran significativamente entre los grupos. Los escores de dolor a la inyección del anestésico local no diferiran entre los grupos. La anestesia quirúrgica fue satisfactoria en todos los pacientes. CONCLUSIONES: Este estudio no demostró ningún efecto de la adición de hialuronidasa en la concentración de 50 UI.ml-1 sobre la acinesia de los músculos rectos, elevador de la pálpebra y orbicular del ojo durante la instalación de bloqueo peribulbar realizado con la asociación de la mistura enantiomérica de bupivacaína (S75-R25 a 0,5% y lidocaína a 2% con adrenalina 5 µg.ml-1.BACKGROUND AND OBJECTIVES: The benefits of adding hyaluronidase to local anesthetics for peribulbar blockade remain controversial. This study aimed at comparing the effects of hyaluronidase on the akinesia of rectis muscles, elevator muscle of upper eyelid and orbicular muscle of the eye after peribulbar blockade with 0.5% enantiomeric mixture of bupivacaine (S75-R25 and 2% lidocaine. METHODS: Participated in this study 35 adult patients, who were distributed in group 1, receiving a 1:1 association of 0.5% enantiomeric mixture of bupivacaine (S75-R25

  18. Evaluación del efecto de bloqueo en el condicionamiento clásico de preferencias

    Directory of Open Access Journals (Sweden)

    César A. Contreras-Bejarano

    2011-02-01

    Full Text Available Esta investigación experimental tuvo como objetivo poner a prueba el efecto de bloqueode Kamin en el condicionamiento clásico de preferencias. Se diseñaron tres partes: Estudio1, Experimento 1 y Experimento 2. El Estudio preliminar (n = 54 consistió en laelección de los estímulos condicionados (marcas publicitarias ficticias y del estímulo incondicionado(figura femenina con una proporción controlada de la medida de cintura/cadera. En el Experimento 1 (n = 60 se efectuó el entrenamiento en condicionamientoclásico de preferencias. Finalmente, en el Experimento 2 (n = 40, se examinó el efecto debloqueo en el condicionamiento clásico de preferencias con pruebas de tipo cognoscitivoy afectivo. Participaron estudiantes universitarios de diferentes carreras entre 17 y 25años. Los resultados indican que se manifestó un efecto de bloqueo en tres de las cuatropruebas utilizadas para evaluar dicho fenómeno. Se plantea, a manera de conclusión,que este efecto potencialmente explica diferentes fenómenos en los campos de la publicidady el mercadeo, especialmente en lo que concierne a competencia de marcas.

  19. 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

  20. Posterior fossa epidural hematoma

    International Nuclear Information System (INIS)

    Kushner, M.J.; Luken, M.G. III

    1983-01-01

    CT demonstrated posterior fossa epidural hematoma in three patients with head trauma in whom this diagnosis was not clinically apparent. No patient was in stupor or coma and no patient experienced a lucid interval. Only one patient had signs referable to the posterior fossa. Two patients had occipital skull fracture disclosed by plain radiographs. CT revealed a unilateral biconvex hematoma in two cases, and a bilateral hematoma with supratentorial extension in the third. All patients underwent suboccipital craniectomy and recovered. Therapeutic success in these cases was facilitated by early CT and the rapid disclosure of the unsuspected posterior fossa lesions. CT showing contiguous hematoma below and above the tentorium cerebelli after posterior head trauma is highly suggestive of epidural hematoma arising from the posterior fossa. (orig.)

  1. Epidural abscess: diagnosis and management

    African Journals Online (AJOL)

    Adele

    Delayed diagnosis of an epidural abscess may cause the death of a patient. Important clinical manifestations include a high fever, back pain and leucocytosis. Due to its rare ... departments with dedicated and specialised nursing. Epidural abscess is both ... removed and sent for bacteriological examination. Neurologi-.

  2. Bloqueo Interfascial Pecto-Intercostal continuo para fractura esternal

    OpenAIRE

    Agrelo Lousame, Ana; Fernández Gacio, Mercedes

    2015-01-01

    Presentamos el caso de un paciente con fractura esternal secundaria a mieloma múltiple con cuadro de infección respiratoria alta concomitante. El dolor en la zona de fractura que el paciente presentaba limitaba su capacidad para toser y respirar profundamente. El método ideal para el manejo del dolor en esta situación es aquel, que de una forma simple, nos permita una completa analgesia, respiración profunda y tos eficaz así como la colaboración del paciente con los ejercicios de fisioterapia...

  3. Estudo comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25 a 0,5% em anestesia peridural Estudio comparativo entre bupivacaína a 0,5% y mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% en anestesia peridural Comparative study between 0.5% bupivacaine and 0.5% enantiomeric mixture of bupivacaine (S75-R25 in epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Rosane Fossatti Gonçalves

    2003-04-01

    analgésico en el período pós-operatorio fue superior para el grupo S75-R25, comparado al grupo Bupivacaína (596 ± 436 minutos versus 463 ± 270 minutos, respectivamente; p = 0,04572. La incidencia de efectos adversos fue semejante entre los grupos. CONCLUSIONES: La mezcla enantiomérica de bupivacaína (S75-R25 presentó mayor tiempo analgésico y menor grado de bloqueo motor, comparada con la solución de bupivacaína racémicaBACKGROUND AND OBJECTIVES: A bupivacaine formulation containing 25% of R(+ and 75% of S(- isomer has been used because its anesthetic properties with less toxicity than the racemic bupivacaine. This study aimed at evaluating the racemic bupivacaine as compared to B25/75 in epidural anesthesia. METHODS: Participated in this study 44 patients who were distributed in two groups (n = 22, namely Bupivacaine and S75-R25. Patients were premedicated with intravenous midazolam. Epidural anesthesia was induced at L3-L4 or L2-L3 interspace with 16 to 24 ml of the anesthetic solution. Group Bupivacaine received 0.5% bupivacaine with vasoconstrictor. Group S75-R25 received the enantiomeric mixture of 0.5% bupivacaine with vasoconstrictor. The following parameters were evaluated: lower limb temperature before and after epidural block, blockade onset, type of sensation referred by the patient, possible sensory failures, metameric sensory level and motor block level. Time for first analgesic request in the PACU was also recorded. RESULTS: Forty-one patients completed the study. Groups were demographically similar. Perioperative midazolam dose, epidural anesthetic volume, blockade onset, sensory failures at pinprick, lower limb temperature in different moments, type of paresthesia sensation and anesthetic depth in dermatomes were similar between groups. Motor block was less intense in group S75-R25 (p = 0.0117 as compared to group Bupivacaine. Time to first postoperative analgesic dose was longer for group S75-R25 as compared to group Bupivacaine (596 ± 436

  4. Sistemas de liberação controlada com bupivacaína racêmica (S50-R50 e mistura enantiomérica de bupivacaína (S75-R25: efeitos da complexação com ciclodextrinas no bloqueio do nervo ciático em camundongos Sistemas de liberación controlada con bupivacaína racémica (S50-R50 y mescla enantiomérica de bupivacaína (S75-R25: efectos de la complexación con ciclodextrinas en el bloqueo del nervio ciático en ratones Drug-delivery systems for racemic bupivacaine (S50-R50 and bupivacaine enantiomeric mixture (S75-R25: cyclodextrins complexation effects on sciatic nerve blockade in mice

    Directory of Open Access Journals (Sweden)

    Daniele Ribeiro de Araújo

    2005-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os efeitos adversos associados ao uso de bupivacaína levaram à procura por novos anestésicos locais (AL com perfil de bloqueio semelhante e menos tóxicos, surgindo novas preparações como a mistura enantiomérica de bupivacaína (S75-R25. Os sistemas de liberação controlada, contendo AL em carreadores como ciclodextrinas (CD, têm como objetivo melhorar a eficácia anestésica e o índice terapêutico dessas drogas. Este estudo visou a preparação, a caracterização e a avaliação da eficácia anestésica dos complexos de inclusão da mistura enantiomérica da bupivacaína (S75-R25 e da bupivacaína racêmica (S50-R50 com hidroxipropilb-ciclodextrina (HPb-CD comparando-os com as preparações atualmente utilizadas na clínica. MÉTODO: Os complexos de inclusão foram preparados misturando-se quantidades apropriadas de HPb-CD e S50-R50 ou S75-R25 nas razões molares (1:1 e 1:2 e caracterizados por estudos de solubilidade de fases. Determinaram-se as constantes de afinidade (K de cada AL pela HPb-CD. Os bloqueios motor e sensorial induzidos pelas drogas livres e complexadas foram avaliados, em camundongos, através do bloqueio do nervo ciático. Para a realização dos experimentos, utilizaram-se três concentrações de AL: 0,125%; 0,25% e 0,5%. RESULTADOS: Os estudos de solubilidade indicaram a formação de complexos de inclusão de S50-R50 e S75-R25 com HPb-CD, com valores de constante de afinidade (K similares para os dois anestésicos: 14,7 M-1 (S50-R50:HP-bCD e 14,3 M-1 (S75-R25:HP-bCD. Os testes em animais mostraram que a complexação potencializou o bloqueio nervoso diferencial induzido pelos AL: i a duração do bloqueio motor induzido por S75-R25 foi similar à do S50-R50, mas menos intenso (p JUSTIFICATIVA Y OBJETIVOS: Los efectos adversos asociados al uso de bupivacaína llevaron a la búsqueda por nuevos anestésicos locales (AL con perfil de bloqueo semejante y menos tóxicos, surgiendo nuevas

  5. Utilización de memorias cache con bloqueo en sistemas de tiempo real.

    OpenAIRE

    Martí Campoy, Antonio

    2015-01-01

    Los procesadores actuales ofrecen una relación precio prestaciones muy interesante, además de otras cualidades como la garantía de funcionamiento o la gran disponibilidad de herramientas de desarrollo. Este conjunto de virtudes los hace muy atractivos para el desarrollo de cualquier sistema informático, incluidos los sistemas de tiempo real (STR). Sin embargo, los sistemas de tiempo real necesitan verificar no sólo la corrección de los cálculos y operaciones que realizan, sino que también ...

  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 ... pillow under your stomach. If this position causes pain, you either sit up or lie on your ...

  7. Volumes anestésicos efetivos no bloqueio do nervo isquiático: comparação entre as abordagens parassacral e infraglútea-arabiceptal com bupivacaína a 0,5% com adrenalina e ropivacaína a 0,5% Volúmenes anestésicos efectivos en el bloqueo del nervio isquiático: comparación entre los abordajes parasacral e infraglúteo-parabicipital con bupivacaína a 0,5% con adrenalina y ropivacaína a 0,5% Effective anesthetic volumes in sciatic nerve block: comparison between the parasacral and infragluteal-parabiceps approaches with 0.5% bupivacaine with adrenaline and 0.5% ropivacaine

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2009-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O volume e a massa das soluções de anestésico local (AL influenciam a taxa de sucesso dos bloqueios periféricos. Desta forma, o objetivo principal do estudo foi determinar os volumes de anestésico local para o bloqueio do nervo isquiático (BNI nas abordagens parassacral e infraglútea-parabiceptal. MÉTODO: Cento e um pacientes foram alocados aleatoriamente em 4 grupos e submetidos ao BNI nas abordagens infraglútea-parabiceptal ou parassacral, utilizando ropivacaína a 0,5% ou bupivacaína a 0,5% com adrenalina 5 µg.mL-1. Sucesso foi definido como bloqueio sensitivo e motor completo do nervo isquiático 30 minutos após a injeção do AL. Os volumes foram calculados pelo método up-and-down. RESULTADOS: Na abordagem parassacral o volume efetivo médio da ropivacaína foi 17,6 mL (IC 95%: 14,9 - 20,8 e da bupivacaína 16,4 mL (IC 95%: 12,3 - 21,9. Na abordagem infraglútea-parabiceptal o volume efetivo médio da ropivacaína foi 21,8 mL (IC 95%: 18,7 - 25,5 e bupivacaína 20,4 mL (IC 95%: 18,6 - 22,5. Volumes foram significativamente menores (p JUSTIFICATIVA Y OBJETIVOS: El volumen y la masa de las soluciones de anestésico local (AL, influyen en la tasa de éxito de los bloqueos periféricos. Así, el objetivo principal del estudio fue determinar los volúmenes de anestésico local para el bloqueo del nervio isquiático (BNI en los abordajes parasacral e infraglúteoparabicipital. MÉTODO: Ciento y un pacientes se ubicaron aleatoriamente en 4 grupos y fueron sometidos al BNI para los abordajes infraglúteoparabicipital o parasacral, utilizando ropivacaína a 0,5% o bupivacaína a 0,5% con adrenalina 5 µg.mL-1. El éxito se definió como bloqueo sensitivo y motor completo del nervio isquiático 30 minutos después de la inyección del AL. Los volúmenes se calcularon a través del método up-and-down. RESULTADOS: En el abordaje parasacral, el volumen efectivo promedio de la ropivacaína fue de 17,6 mL (IC 95

  8. Bloqueo aurículo-ventricular de primer grado en tirotoxicosis aguda First degree atrio-ventricular block in acute thyrotoxicosis

    Directory of Open Access Journals (Sweden)

    Antonio R. Vilches

    2004-02-01

    Full Text Available El cuadro clínico de la tirotoxicosis incluye síntomas cardiovasculares variados. La taquicardia sinusal es el trastorno electrocardiográfico más frecuente y los trastornos de conducción son extremadamente raros como modo de presentación. Comunicamos un caso de bloqueo aurículo-ventricular de primer grado en una paciente con hipertiroidismo recién diagnosticado y que comenzó días antes de la consulta con un cuadro general inespecífico. Su evaluación ulterior demostró que se trataba de una tirotoxicosis aguda autoinmune, y su tratamiento con metimazol corrigió el trastorno totalmente. Se discuten los mecanismos fisiopatológicos involucrados y las implicancias clínicas desde el punto de vista del internista.Thyrotoxicosis may present with a variety of cardiovascular symptoms. Sinus tachycardia is the most frequently encountered electrocardiographic abnormality and conduction disturbances are extremely uncommon. We present a case of first degree atrio-ventricular block in a patient with newly diagnosed hyperthyroidism and discuss the underlying pathophysiological mechanisms and the clinical implications from the internist’s standpoint.

  9. 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...

  10. PAPEL DEL FACTOR DE BLOQUEO INDUCIDO POR PROGESTERONA (PIBF) EN EMBARAZO Y CÁNCER

    OpenAIRE

    Gutiérrez-Rodríguez, Araceli; Camacho-Arroyo, Ignacio

    2016-01-01

    El factor de bloqueo inducido por progesterona (PIBF) es una proteína inmunomoduladora por medio de la cual la progesterona ejerce varios de sus efectos inmunológicos en diferentes células de alta proliferación, que incluyen desde células embrionarias hasta células tumorales. El PIBF ocasiona un incremento en la síntesis de anticuerpos asimétricos y de citocinas tipo Th2 como las interleucinas (IL) 4, 6 y 10, así como una disminución en la actividad citotóxica de las células NK...

  11. Bloqueio "3 em 1" por via anterior: bloqueio parcial, completo ou superdimensionado? Correlação entre anatomia, clínica e radio imagens Bloqueo "3 en 1" por vía anterior: bloqueo parcial, completo o superdimensionado? Correlación entre anatomía, clínica y radio imágenes Anterior "3-in-1" blockade: partial, total or overdimensioned block? Correlation between anatomy, clinic and radio images

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2004-08-01

    em 1" ou "2,5 em 1", sem a participação do nervo obturador. Com cateter curto (G2, o bloqueio "3 em 1" foi classificado como completo em 6,6% dos casos (um paciente. Porém, com cateter longo (G3, o resultado tende a ser mais previsível em relação aos outros grupos, especialmente quando o cateter alcança o espaço paravertebral lombossacral, resultando num bloqueio "3 em 1" completo em 20% dos casos (três pacientes ou, raramente, num bloqueio "3 em 1" superdimensionado em 13,2% dos casos (dois pacientes.JUSTIFICATIVA Y OBJETIVOS: El clásico bloqueo "3 en 1" por vía anterior ha suscitado divergencias cuanto al envolvimiento anestésico de sus tres participantes, el nervio femoral, el nervio cutáneo lateral del muslo y el nervio obturador. El objetivo de este estudio es verificar el resultado del bloqueo "3 en 1" por vía anterior, a través de las técnicas: inyección única (G1, catéteres cortos (G2 y catéteres largos (G3. Los bloqueos "3 en 1", clínicamente identificados como completos o superdimensionados fueron, adicionalmente, investigados por medio de radio imagen. MÉTODO: La identificación del espacio subfascial ilíaco en los bloqueos "3 en 1" con inyección única o con catéteres fue hecha por la pérdida de resistencia al aire. En varios eventos dolorosos, el volumen anestésico administrado varió entre 30 y 40 ml y la introducción cranial de los catéteres fue hasta 18 cm en el espacio subfascial ilíaco. Cuando la pesquisa clínica apuntaba envolvimiento del nervio obturador o de otro nervio adicional al bloqueo "3 en 1", se complementava la investigación con estudio radiográfico y tomodensiométrico con el propósito de establecer correspondencia con la anatomía pélvica. RESULTADOS: El envolvimiento de los nervios femoro cutáneo lateral y obturador no fueron constantes, al contrario del nervio femoral. En el estudio, ningún bloqueo "3 en 1" completo con inyección única (G1 se manifestó, y si un bloqueo "2 en 1", con la

  12. Epidural Naloxone to Prevent Buprenorphine Induced PONV

    Directory of Open Access Journals (Sweden)

    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.

  13. Epidural hematomas of posterior fossa

    Directory of Open Access Journals (Sweden)

    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.

  14. Epidural extramedullary haemopoiesis in thalassaemia

    International Nuclear Information System (INIS)

    Boyacigil, S.; Ali, A.; Ardic, S.; Yuksel, E.

    2002-01-01

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

  15. Bloqueo mediático, redes sociales y malestar ciudadano. Para entender el movimiento español del 15-M

    Directory of Open Access Journals (Sweden)

    Xosé Ramón Rodríguez-Polo

    2013-01-01

    Full Text Available El movimiento del 15-M ha sido la movilización más importante que ha vivido España en los últimos años. En este trabajo proponemos analizar este fenómeno mediante el estudio de cuatro elementos que consideramos que presentan las claves para entender algunas de sus causas y el enorme respaldo social que alcanzó. Empleando el análisis secundario de datos abordamos el estudio de la situación de bloqueo del debate público, la incidencia política que facilitan los medios sociales, los colectivos activistas y el descontento de la ciudadanía española. Del análisis de la opinión pública se colige que el problema económico de la crisis derivó, por causa de su gestión, en un problema social, para transformarse finalmente en un problema político, manifestado en un clima de enorme descontento con la situación política y con el gobierno. La irrupción del 15-M hizo aflorar todo el malestar acumulado, convirtiendo un acto organizado por colectivos minoritarios en toda una marea ciudadana de repulsa.

  16. Valoración a largo plazo de los resultados de tratamiento mediante osteosíntesis con miniplacas en sus diferentes usos en cirugía craneomaxilofacial

    OpenAIRE

    Marí Roig, Antonio

    2003-01-01

    Después de la introducción de la osteosíntesis con miniplacas hace más de 25 años, siguen existiendo controversias en su aplicación en determinadas situaciones de la cirugía craneomaxilofacial. En las fracturas mandibulares se utilizan diferentes tipos de placas asociadas o no a bloqueo intermaxilar con un indice de complicaciones muy variable (James y col, 1981; Limchayseng 1988); el tratamiento más adecuado cuando existen dientes en el foco de fractura. La utilización del bloqueo intermaxi...

  17. Atitudes de anestesiologistas e médicos em especialização em anestesiologia dos CET/SBA em relação aos bloqueios nervosos dos membros superior e inferior Actitudes de anestesiólogos y médicos en especialización en anestesiología de los CET/SBA con relación a los bloqueos nerviosos de los miembros superior e inferior The attitude of anesthesiologists and anesthesiology residents of the CET/SBA regarding upper and lower limb nerve blocks

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2009-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O emprego da anestesia regional, em especial dos bloqueios nervosos periféricos (BNP tem aumentado na prática anestesiológica devido à menor necessidade de instrumentação de vias aéreas, menor custo e excelente analgesia pós-operatória. Entretanto, sua utilização sofre restrições causadas pela falta de treinamento, maior tempo de realização, temor de complicações neurológicas e toxicidade sistêmica. O objetivo desse estudo foi medir as atitudes de anestesiologistas e médicos em especialização nos Centros de Ensino e Treinamento (CET/SBA em relação aos BNP. MÉTODO: Foi construído um questionário com 25 itens sendo disponibilizado eletronicamente e por correio aos responsáveis de 80 CET, seus instrutores e médicos em especialização. RESULTADOS: Quarenta e dois CET (52,5% devolveram 188 questionários, sendo 62 (32% médicos em especialização (ME e 126 (68% anestesiologistas. O coeficiente de confiabilidade de Cronbach do questionário foi 0,79. A análise fatorial revelou seis fatores, que explicaram 53% da variância dos escores: fator 1 - atitudes positivas, responsável por 18,34 % da variância; fator 2 - treinamento/aplicação, responsável por 11,73 % da variância; fator 3 - aspectos negativos, responsável por 7,11 % da variância; fator 4 - fatores limitantes, responsável por 6,39 % da variância; fator 5 - anestesia regional como diferencial de competência, responsável por 5,79% da variância; e fator 6 - respeito pelo paciente, responsável por 5,4 % da variância. CONCLUSÕES: O questionário mostrou-se uma ferramenta fidedigna para medida de atitudes com relação à anestesia regional. Os anestesiologistas demonstraram maior interesse nos aspectos relacionados aos pacientes enquanto os ME tiveram como foco principal a aquisição de habilidades técnicas.JUSTIFICATIVA Y OBJETIVOS: El uso de la anestesia regional, en especial de los bloqueos nerviosos periféricos (BNP ha

  18. MR imaging of spinal epidural sepsis

    International Nuclear Information System (INIS)

    Angtuaco, E.; McConnell, J.; Chadduck, W.; Flanigan, S.; Binet, E.

    1987-01-01

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

  19. Simulação de bloqueios periféricos guiados por ultra-som: curva de aprendizado dos residentes de anestesiologia do CET-SMA/HSL Simulacro de bloqueos periféricos guiados por ultrasonido: curva de aprendizaje de los residentes de anestesiología del CET-SMA/HSL Simulation of ultrasound-guided peripheral nerve block: learning curve of CET-SMA/HSL anesthesiology residents

    Directory of Open Access Journals (Sweden)

    Marilia Bonifácio Baranauskas

    2008-04-01

    por ultrasonido a través de modelo experimental de gelatina. MÉTODO: Fue desarrollado un modelo experimental con un recipiente lleno de gelatina y aceituna sumergida. Nueve residentes se distribuyeron aleatoriamente en tres grupos (G1, G2, G3 compuestos cada uno, por un R1, un R2 y un R3. Los tres grupos recibieron una explicación teórica. El G1 recibió dos horas de entrenamiento práctico, el G2 una hora y el G3 no fue entrenado. Acto seguido, se les solicitó a los participantes que pusiesen la aguja en el punto medio de la pared de la aceituna, cerca del transductor y reposicionar la aguja entre la aceituna y el fondo del recipiente, simulando la inyección perineural del anestésico. Se evaluaron la velocidad y la eficacia de las tareas, además de las fallas técnicas. RESULTADOS: El G1 presentó un promedio de tiempo para la realización de las tareas de 37,63 segundos, sin fallas técnicas; en el G2 se observó un promedio de 64,40 segundos, ocurriendo dos fallas técnicas y el G3 presentó un promedio de 93,83 segundos, con doce fallas técnicas. CONCLUSIONES: El estudio permite concluir que el mayor tiempo de entrenamiento en un modelo experimental de bloqueos periféricos guiados por ultrasonido mejoró la curva de aprendizaje en el simulacro de la técnica.BACKGROUND AND OBJECTIVES: The use of ultrasound imaging in peripheral nerve block has been increasing. However, there are few reports in the literature on the learning curve of the ultrasound technique. The objective of this report was to evaluate the learning curve of CET-SMA/HSL Anesthesiology residents of ultrasound-guided peripheral block using an experimental agar model. METHODS: An experimental model was developed by filling a bowl with agar and olives. Nine residents were randomly divided in three groups (G1, G2, and G3, each one with a R1, a R2, and a R3. All three groups received theoretical explanation. G1 also had two hours of practical training, G2 had one hour, and G3 had no training

  20. Unusual cervical spine epidural abscess.

    Science.gov (United States)

    Liou, Jr-Han; Su, Yu-Jang

    2015-10-01

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

  1. Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral? Control del dolor postoperatorio de la artroplastia total de la rodilla: ¿es necesario asociar el bloqueo del nervio isquiático al bloqueo del nervio femoral? Control of postoperative pain following total knee arthroplasty: is it necessary to associate sciatic nerve block to femoral nerve block?

    Directory of Open Access Journals (Sweden)

    Affonso H. Zugliani

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A artroplastia total do joelho (ATJ promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO: Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9 foi realizado bloqueio do nervo femoral e no Grupo B (n = 8, bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1. RESULTADOS: A mediana do tempo de analgesia (M1 no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001. Não foram observadas complicações atribuíveis às técnicas utilizadas. CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ.JUSTIFICATIVA Y OBJETIVOS: La artroplastia total de la rodilla (ATR promueve gran trauma del tejido produciendo un intenso dolor en el postoperatorio. La analgesia de postoperatorio de buena calidad es fundamental, debiendo considerar que la movilización articular precoz es un importante aspecto para la obtención de buenos resultados. Existen controversias en la literatura sobre la eficacia del bloqueo aislado del nervio femoral. El objetivo de este estudio fue evaluar la analgesia en postoperatorio con la asociaci

  2. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

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    Pritam Yadav

    2018-01-01

    Full Text Available >Background: Dural puncture epidural (DPE is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique.Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural. In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2% with 20 mcg of Fentanyl (2 mcg/ml in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS, sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome.Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05.Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

  3. 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

    Directory of Open Access Journals (Sweden)

    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.

  4. Epidural and intramuscular pethidine - a pharmacokinetic study ...

    African Journals Online (AJOL)

    Epidural preservative-free pethidine hydrochloride 0,75 mg/kg is rapidly absorbed into the blood. At 1,5 mg/kg the plasma levels reached are similar to those achieved by intramuscular preservative-free pethidine hydrochloride, as is the time course. Plasma levels fall more rapidly after epidural pethidine, Since the plasma ...

  5. pethidine study Epidural and intramuscular a pharmacokinetic

    African Journals Online (AJOL)

    1983-02-05

    Feb 5, 1983 ... Eleven patients received intramuscular and 10 epidural pethidine. Premedication was with oral diazepam 10 mg 2 hours pre- operatively. Two patients in the epidural group received meto- clopramide 10 mg intravenously for nausea during the trial. Bupi\\·acaine 0,5% (plain) was used for all skin infiltration.

  6. 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...

  7. Labor epidural analgesia: Past, present and future

    Directory of Open Access Journals (Sweden)

    Reena

    2014-01-01

    Full Text Available One of the most severe pains experienced by a woman is that of childbirth. Providing analgesia for labor has always been a challenge more so because of the myths and controversies surrounding labor. It is imperative to understand the pain transmission during various stages of labor in order to select a proper technique for providing labor analgesia. The adverse effects of labor pain are numerous and affect both the mother as well as the fetus. Currently lumbar epidural is considered to be the gold standard technique for labor analgesia. Local anaesthetics like bupivacaine and ropivacaine are commonly used and adjuvants like clonidine, fentanyl and neostigmine have been extensively studied. However, despite being so popular, epidural analgesia is not without complications, with hypotension being the most common. Other complications include accidental dural puncture, infection, intravascular placement, high block and epidural hematoma. Other neuraxial techniques include continuous caudal analgesia, and combined spinal epidural analgesia. The numerous studies investigating the various aspects of this method have also served to dispel various myths surrounding epidural analgesia like increased incidence of cesarean section and instrumental delivery, prolongation of labor and future back pain. The future of labor analgesia lies in the incorporation of ultrasound in identifying the epidural space helping in proper catheter placement. The keywords "labor epidural" in the PUBMED revealed a total of 5018 articles with 574 review articles and 969 clinical trials. The relevant articles along with their references were extensively studied.

  8. Riscos cardiovasculares do bloqueio androgênico Riesgos cardiovasculares del bloqueo androgénico Cardiovascular risks of androgen deprivation therapy

    Directory of Open Access Journals (Sweden)

    Adriano Freitas Ribeiro

    2010-09-01

    Full Text Available O adenocarcinoma de próstata é o câncer mais comum no sexo masculino após o câncer de pele. Entre as várias formas de tratamento do câncer de próstata, a terapia de bloqueio androgênico é uma modalidade consagrada nos pacientes com doença metastática ou localmente avançada, que provavelmente resulta em aumento de sobrevida. No entanto, o bloqueio androgênico é causador de uma série de consequências adversas. Complicações como osteoporose, disfunção sexual, ginecomastia, anemia e alterações na composição corporal são bem conhecidas. Recentemente, uma série de complicações metabólicas foi descrita como aumento da circunferência abdominal, resistência à insulina, hiperglicemia, diabete, dislipidemia e síndrome metabólica com consequente aumento do risco de eventos coronarianos e mortalidade cardiovascular nessa população específica. Este artigo de atualização apresenta uma revisão bibliográfica realizada no MEDLINE de toda literatura publicada em inglês no período de 1966 até junho de 2009, com as seguintes palavras-chave: androgen deprivation therapy, androgen supression therapy, hormone treatment, prostate cancer, metabolic syndrome e cardiovascular disease, no intuito de analisar quais seriam os reais riscos cardiovasculares da terapia de deprivação androgênica, também chamada bloqueio androgênico, nos pacientes com câncer de próstata.El adenocarcinoma de próstata es el cáncer más común en el sexo masculino después del cáncer de piel. Entre las varias formas de tratamiento del cáncer de próstata, la terapia de bloqueo androgénico es una modalidad consagrada en los pacientes con enfermedad metastásica o localmente avanzada, que probablemente resulta en aumento de sobrevida. Mientras tanto, el bloqueo androgénico es causante de una serie de consecuencias adversas. Complicaciones como osteoporosis, disfunción sexual, ginecomastia, anemia y alteraciones en la composición corporal son

  9. El blocao (y el bloqueo de José Díaz Fernández

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    Luis Fernando Bueno Morillas

    2015-06-01

    Full Text Available El blocao (1928 fue la primera novela de José Díaz Fernández. Supuso un éxito editorial insólito hasta entonces porque reunía tres características novedosas: una actitud crítica ante la guerra de Marruecos, una integración de las novedades vanguardistas en la que su autor llamó literatura de avanzada y un posicionamiento del intelectual al lado de las reivindicaciones del pueblo. Sin embargo, aunque publicó otra novela un año después (La Venus mecánica, un libro teórico en el que definía la literatura que él propugnaba y practicaba (El nuevo romanticismo y algunas narraciones breves, Díaz Fernández se bloqueó y dejó la literatura narrativa que tan buenas expectativas levantó. Analizaremos las posibles causas de ese bloqueo.

  10. Papel del factor de bloqueo inducido por Progesterona (PIBF en embarazo y cáncer

    Directory of Open Access Journals (Sweden)

    Araceli Gutiérrez-Rodríguez

    2016-01-01

    Full Text Available El factor de bloqueo inducido por progesterona (PIBF es una proteína inmunomoduladora por medio de la cual la progesterona ejerce varios de sus efectos inmunológicos en diferentes células de alta proliferación, que incluyen desde células embrionarias hasta células tumorales. El PIBF ocasiona un incremento en la síntesis de anticuerpos asimétricos y de citocinas tipo Th2 como las interleucinas (IL 4, 6 y 10, así como una disminución en la actividad citotóxica de las células NK y en la producción de citocinas tipo Th1, como el factor de necrosis tumoral alfa (TNFα e IL-12. Lo anterior provoca una reducción en la relación Th1/Th2 que es característica del embarazo sano, lo que tiene como consecuencia un aumento en la inmunidad humoral y una disminución en la inmunidad celular. Estos mecanismos inmunomoduladores tienen como resultado una evasión del sistema inmune de la madre por parte del feto para que el embarazo llegue a término. De manera interesante, diversos estudios sugieren que estos mismos mecanismos son utilizados por las células cancerosas para facilitar la progresión de tumores que presentan sobre-expresión del PIBF.

  11. Spinal epidural hematomas examined on MRI

    International Nuclear Information System (INIS)

    Rejnowski, G.; Poniatowska, R.; Kozlowski, P.

    1995-01-01

    Spinal epidural hematomas are rare pathology, caused by trauma or spontaneous. In clinical examination acute spinal cord compression is observed. MRI designations appear entirely particular. In sagittal projection, biconvex mass in the dorsal, or sometimes ventral part of the spinal canal is clearly visible. This is well delineated by the thecal sac from the cord and cauda equina. MRI investigations in 3 patients revealed corresponding with spinal bone injuries and cord edema epidural hematomas. Differential diagnosis must contain subdural hematoma and epidural neoplasms or abscess. (author)

  12. Anestesia combinada raqui-peridural em paciente portadora de esclerose lateral amiotrófica: relato de caso Anestesia combinada raquiepidural en paciente portadora de esclerosis lateral amiotrófica: relato de caso Combined spinal-epidural block in a patient with amyotrophic lateral sclerosis: case report

    Directory of Open Access Journals (Sweden)

    Adriano Bechara de Souza Hobaika

    2009-04-01

    transtrocantérica de fémur. Cuadro de debilidad en los miembros superiores e inferiores, disartria, consciente y orientada. Aparato respiratorio: tos ineficaz, reducción de la fuerza de los músculos intercostales y diafragma y reducción del murmurio vesicular en bases pulmonares. Primeramente, la punción epidural fue realizada en L3/L4, donde un catéter de silicona fue introducido 5 cm. A continuación, la punción raquídea se hizo en L4/L5 con administración de 7.5 mg de bupivacaína hiperbárica. Más 37 mg de ropivacaína a 0,37% se administraron por el catéter epidural para que el bloqueo sensitivo llegase al dermatomo T10. El procedimiento transcurrió sin complicaciones y la paciente recibió alta tres días después. CONCLUSIONES: Las evidencias han demostrado que la administración de bloqueos de neuro eje, parece ser segura en pacientes con esclerosis lateral amiotrófica, pues evita la manipulación de las vías aéreas y las complicaciones ventilatorias.BACKGROUND AND OBJECTIVES: Amyotrophic lateral sclerosis starts between the fifth and sixth decades of life, causing degeneration and death of upper and lower motor neurons. When the muscles responsible for ventilation are affected, the patient dies of respiratory failure within a few years. CASE REPORT: This is a 63 years old female with amyotrophic lateral sclerosis who underwent surgical treatment of a transtrochanteric fracture of the femur. The patient presented weakness of upper and lower limbs and dysarthria, and she was awake and oriented. Respiratory function: ineffective cough, decreased strength of the intercostal muscles and diaphragm, and reduction of the breath sounds in both lung bases. Initially, the L3/L4 epidural space was punctured and a silicon catheter was introduced to 5 cm. This was followed by a spinal puncture in the L4/L5 space and the administration of 7.5 mg of hyperbaric bupivacaine. This was followed by the administration of 37 mg of 0.37% ropivacaine through the epidural

  13. [Spontaneous epidural hematoma in panarteritis nodosa].

    Science.gov (United States)

    Leys, D; Viader, F; Rivrain, Y; Masson, M; Cambier, J

    1984-01-01

    Four years after the first sign of panarteritis nodosa, a 60 years old woman presented severe pain in the lower thoracic spine followed by motor, sensory and sphincter paralysis. With corticosteroid therapy, condition improved 24 hours later, but myelography revealed an incomplete block from T9 to L1, by an epidural hemorrhage. In the course of panarteritis nodosa, one case of epidural hemorrhage, and a few cases of subarachnoid hemorrhage of the spinal canal have been described.

  14. Spontaneous intracranial epidural hematoma during rivaroxaban treatment

    Energy Technology Data Exchange (ETDEWEB)

    Ruschel, Leonardo Gilmone; Rego, Felipe Marques Monteiro do; Milano, Jeronimo Buzetti; Jung, Gustavo Simiano; Silva Junior, Luis Fernando; Ramina, Ricardo, E-mail: leonardoruschel@yahoo.com.br [Instituto de Neurologia de Curitiba (INC), Curitiba, PR (Brazil)

    2016-11-15

    According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xarelto®. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban. (author)

  15. Epidural Hematoma Following Cervical Spine Surgery.

    Science.gov (United States)

    Schroeder, Gregory D; Hilibrand, Alan S; Arnold, Paul M; Fish, David E; Wang, Jeffrey C; Gum, Jeffrey L; Smith, Zachary A; Hsu, Wellington K; Gokaslan, Ziya L; Isaacs, Robert E; Kanter, Adam S; Mroz, Thomas E; Nassr, Ahmad; Sasso, Rick C; Fehlings, Michael G; Buser, Zorica; Bydon, Mohamad; Cha, Peter I; Chatterjee, Dhananjay; Gee, Erica L; Lord, Elizabeth L; Mayer, Erik N; McBride, Owen J; Nguyen, Emily C; Roe, Allison K; Tortolani, P Justin; Stroh, D Alex; Yanez, Marisa Y; Riew, K Daniel

    2017-04-01

    A multicentered retrospective case series. To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment ( P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

  16. Spontaneous intracranial epidural hematoma during rivaroxaban treatment.

    Science.gov (United States)

    Ruschel, Leonardo Gilmone; Rego, Felipe Marques Monteiro do; Milano, Jerônimo Buzetti; Jung, Gustavo Simiano; Silva, Luis Fernando; Ramina, Ricardo

    2016-11-01

    According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.

  17. Utilidad de la ecografía en el bloqueo anestésico de la extremidad pelviana en el perro

    OpenAIRE

    Echeverry Bonilla, Diego Fernando

    2012-01-01

    La presente Tesis Doctoral evaluó la utilidad de la ecografía en el bloqueo anestésico de los nervios ciático, femoral y plexo lumbar en el perro. Las características anatómicas de estas estructuras nerviosas fueron evaluadas en 12 cadáveres. La utilidad de la ecografía para el bloqueo anestésico de estas estructuras fue evaluada en in vitro 27 cadáveres caninos mediante la inyección guiada por ecografía de una tinción alrededor de los nervios estudiados y la posterior...

  18. Intermittent epidural TOP-UPS vs. patient control epidural analgesia during labor.

    Science.gov (United States)

    Marijic, Vlatka; Bukovic, Damir; Mihaljevic, Slobodan; Oreskovic, Slavko; Persec, Jasminka; Zupic, Tomislav; Juras, Josip; Milinovic, Darko

    2013-12-01

    Pain during labor and delivery is often very unpleasant and stressful for the parturients. Patient controlled epidural analgesia (PCEA) has been found to be both safe and effective, providing optimal pain relief and allowing women to participate in their own analgesia). Compared to other epidural techniques, intermittent epidural top-ups and continuous epidural analgesia (CEA), PCEA uses diluted local anesthetic solutions with less motor block and less unscheduled clinician interventions. The purpose of our study was to compare intermittent bolus epidural top-ups and PCEA in labor. Sixty ASA I patients who requested epidural analgesia for labor and had written consent were included in the study. 30 patients in the first group received intermittent bolus epidural top-ups, while patients in the second group received PCEA. We evaluated duration of labor, maternal sense of pain using VAS scale and maternal satisfaction during fetal descent in both groups. We found that the duration of labor was significantly shorter and maternal sense of pain was lower in the PCEA group than in the group receiving epidural bolus top-ups. There were no differences between groups in maternal satisfaction during fetal descent.

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

    International Nuclear Information System (INIS)

    Tok, Chung Hong; Kaur, Shaleen; Gangi, Afshin

    2011-01-01

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

  20. Fluoroscopically guided tunneled trans-caudal epidural catheter technique for opioid-free neonatal epidural analgesia.

    Science.gov (United States)

    Franklin, Andrew D; Hughes, Elisabeth M

    2016-06-01

    Epidural analgesia confers significant perioperative advantages to neonates undergoing surgical procedures but may be very technically challenging to place using a standard interlaminar loss-of-resistance to saline technique given the shallow depth of the epidural space. Thoracic epidural catheters placed via the caudal route may reduce the risk of direct neural injury from needle placement, but often pose higher risks of infection and/or improper positioning if placed without radiographic guidance. We present a detailed method of placing a fluoroscopically guided, tunneled transcaudal epidural catheter, which may reduce both of these risks. The accuracy and precision of this technique often provides adequate analgesia to allow for opioid-free epidural infusions as well as significant reductions in systemic opioids through the perioperative period. Opioid-free analgesia using a regional anesthetic technique allows for earlier extubation and reduced perioperative sedation, which may have a less deleterious neurocognitive effect on the developing brain of the neonate.

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

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2006-12-01

    dos cinco nervos do plexo lombar.JUSTIFICATIVA Y OBJETIVOS: Este estudio evaluó la eficacia de la inyección única de bupivacaína a 0,25% en el compartimiento del psoas o perivascular inguinal a través del estimulador de nervios periféricos para analgesia postoperatoria en pacientes sometidos a intervenciones quirúrgicas ortopédicas. MÉTODO: Cien pacientes recibieron bloqueo del plexo lumbar a través del compartimiento del psoas y fueron comparados con 100 pacientes que recibieron bloqueo del plexo lumbar vía perivascular inguinal, identificados por el estimulador de nervios periféricos con la inyección de 40 mL bupivacaína a 0,25% sin epinefrina. La analgesia en los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fue evaluada a las 4, 8, 12, 16, 20 y 24 horas después del final de la intervención quirúrgica. La intensidad del dolor también fue medida en el mismo período. La cantidad de opioides administrada en el postoperatorio fue anotada. En cinco pacientes de cada grupo, un estudio radiográfico con contraste no iónico se realizó para medir la dispersión de la solución anestésica. RESULTADOS: Los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fueron bloqueados en 92% de los pacientes en el compartimiento del psoas versus 62% en el bloqueo perivascular inguinal. El bloqueo del plexo lumbar redujo la necesidad de opioides y 42% de los pacientes sometidos al bloqueo del compartimiento del psoas y 36% de los pacientes en el bloqueo inguinal no necesitaron analgésico adicional en el postoperatorio. La duración de la analgesia fue de aproximadamente 21 horas con el bloqueo del compartimiento del psoas y 15 horas en el bloqueo perivascular inguinal. CONCLUSIONES: El bloqueo del compartimiento del psoas y perivascular inguinal es una excelente técnica para la analgesia postoperatoria en intervenciones quirúrgicas ortopédicas reduciendo la necesidad de opioides. Ese

  2. 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...

  3. Subarachnoid pneumocephalus: a rare complication of epidural catheter placement.

    Science.gov (United States)

    McMurtrie, Robert; Jan, Rehana

    2002-11-01

    Several potential complications may occur during identification of the epidural space. We present a case of subarachnoid pneumocephalus as a rare complication of epidural catheter placement. Copyright 2002 by Elsevier Science Inc.

  4. Geographic Variation in Epidural Steroid Injection Use in Medicare Patients

    OpenAIRE

    Friedly, Janna; Chan, Leighton; Deyo, Richard

    2008-01-01

    Background: The rates of epidural steroid injections have increased dramatically over time, with conflicting evidence regarding the efficacy of epidural steroid injections for the treatment of various low-back pain disorders. Given the uncertainty about their role, we sought to evaluate the geographic variation in the use of epidural steroid injections for low back pain within the United States. We also sought to determine whether greater rates of epidural steroid injections are associated wi...

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

    Directory of Open Access Journals (Sweden)

    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

  6. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso Phrenic nerve block after interscalene brachial plexus block: case report

    Directory of Open Access Journals (Sweden)

    Luis Henrique Cangiani

    2008-04-01

    embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilatorio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos.BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective

  7. Accidental Breakage of Lumbar Epidural Catheter - Case report ...

    African Journals Online (AJOL)

    Breakage of epidural catheter is a rare occurrence with only isolated reports. Though insertion of epidural catheter is generally considered a safe procedure, breakage during removal leaving a segment in the patient's back can occur. There are many factors associated with breakage of an epidural catheter, such as the ...

  8. Primary thoracic epidural lymphoma: A rare cause of spinal cord ...

    African Journals Online (AJOL)

    Spinal epidural lymphoma is a rare entity that is not often considered in the differential diagnosis of an epidural mass in a previously healthy individual. Pfatients with Primary Spinal Epidural Lymphomas (PSELs) have negative diagnostic work up for systemic lymphoma and unlike disseminated lymphoma, they achieve ...

  9. An experience with epidural morphine in lumbar surgery patients.

    Science.gov (United States)

    Ozuna, J; Snyder, G

    1987-10-01

    A chart review of the patients who received epidural morphine for lumbar surgery during the first year of implementation of the procedure was conducted. This article reviews the pharmacology and side effects of epidural morphine, describes the procedure of administering epidural morphine, discusses side effects and technical problems encountered, and presents implications for nursing practice.

  10. Neonatal respiratory depression associated with epidural analgesia

    Directory of Open Access Journals (Sweden)

    Alberto Gálvez Toro

    2013-06-01

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

  11. Epidural steroid injection for lumbosacral radiculopathy

    International Nuclear Information System (INIS)

    Sung, Mi Sook

    2006-01-01

    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

  12. 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.

  13. Estudo comparativo entre soluções a 0,5% de levobupivacaína, bupivacaína em excesso enantiomérico de 50% e bupivacaína racêmica em anestesia peridural para cirurgia de abdômen inferior Estudio comparativo entre soluciones a 0,5% de levobupivacaína, bupivacaína en exceso enantiomérico del 50% y bupivacaína racémica en anestesia peridural para cirugía de abdomen inferior Levobupivacaine 0.5%, 50% enantiomeric excess bupivacaine and racemic bupivacaine in epidural anesthesia for lower abdominal procedures. Comparative study

    Directory of Open Access Journals (Sweden)

    Pedro Paulo Tanaka

    2005-12-01

    la edad en el grupo I. Los parámetros hemodinámicos fueron semejantes entre los grupos. Hubo una diferencia significativa con relación a la intensidad del bloqueo motor relatado entre los grupos estudiados (menor intensidad en el grupo I comparada a los grupos II y III. CONCLUSIONES: Fue observado un adecuado bloqueo motor y sensitivo para la realización de la cirugía en los grupos estudiados con pocos efectos colaterales, sugiriendo que las soluciones son eficaces en la anestesia peridural para cirugía de abdomen inferior. La levobupivacaína presentó menor bloqueo motor que los otros dos grupos.BACKGROUND AND OBJECTIVES: With the purpose of finding a local anesthetic agent safer than racemic bupivacaine, several animal studies have been performed with its isomers. This study aimed at evaluating, for one hour after injection, the efficacy of 50% enantiomeric excess bupivacaine as compared to levobupivacaine and racemic bupivacaine for epidural anesthesia in patients submitted to lower abdominal procedures. METHODS: After the Research Ethics Committee approval, 87 patients aged 18 to 65 years, physical status ASA I and II, undergoing lower abdominal procedures were included in this randomized double-blind study. Patients were distributed in three groups which received 27 mL (including test dose of local anesthetics with epinephrine (1:200,000 and fentanyl (100 µg solutions. Group I was given 0.5% levobupivacaine, group II received 50% enantiomeric excess 0.5% bupivacaine, and group III received 0.5% bupivacaine. Monitoring consisted of pulse oximetry, cardioscopy and noninvasive blood pressure. Motor and sensory block profiles were evaluated, in addition to the incidence of side effects. Unidentified local anesthetic vials were numbered, and the randomized distribution list was opened only at the end of the experiment. RESULTS: There were no significant differences regarding height and physical status between groups. There was a significant age difference in

  14. Delayed epidural hematoma after mild head injury

    Directory of Open Access Journals (Sweden)

    Radulović Danilo

    2005-01-01

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

  15. Retrograde epidural catheter relieves intractable sacral pain

    Directory of Open Access Journals (Sweden)

    Ruchir Gupta

    2016-01-01

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

  16. 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.

  17. Sciatica caused by lumbar epidural gas.

    Science.gov (United States)

    Belfquih, Hatim; El Mostarchid, Brahim; Akhaddar, Ali; gazzaz, Miloudi; Boucetta, Mohammed

    2014-01-01

    Gas production as a part of disc degeneration can occur but rarely causes nerve compression syndromes. The clinical features are similar to those of common sciatica. CT is very useful in the detection of epidural gas accumulation and nerve root compression. We report a case of symptomatic epidural gas accumulation originating from vacuum phenomenon in the intervertebral disc, causing lumbo-sacral radiculopathy. A 45-year-old woman suffered from sciatica for 9 months. The condition worsened in recent days. Computed tomography (CT) demonstrated intradiscal vacuum phenomenon, and accumulation of gas in the lumbar epidural space compressing the dural sac and S1 nerve root. After evacuation of the gas, her pain resolved without recurrence.

  18. Correlación clinicorradiográfica de la fibrosis epidural en el síndrome poslaminectomía mediante epidurografía Clinical/radiography correlation of epidural fibrosis in postlaminectomy syndrome by epidurography

    OpenAIRE

    G. Cardona; J.R. Hernández-Santos; S. Tenopala; A. Jiménez-Ramos; I.M. Narváez; J.C. Torres

    2010-01-01

    Introducción: La epidurografía es un recurso invasivo que evalúa deformidades y eventual ocupación del espacio epidural, además de ser un estudio fácilmente realizable, confiable, económico y que forma parte del algoritmo de manejo del síndrome poslaminectomía. Objetivo: Verificar si la localización y la extensión de la fibrosis epidural se correlacionan con el cuadro clínico presente en los pacientes con síndrome poslaminectomía. Material y métodos: Se incluyó a 30 pacientes con diagnóstico ...

  19. Bloqueios nervosos guiados por ultra-som Bloqueos nerviosos guiados por ultrasonido Ultrasound-guided nerve blocks

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2007-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As técnicas de bloqueios nervosos guiados por ultra-som são baseadas na visualização direta das estruturas nervosas, da agulha de bloqueio e das estruturas anatômicas adjacentes. Desta maneira, é possível depositar a solução de anestésico local precisamente em torno dos nervos e acompanhar a sua dispersão em tempo real, obtendo-se, assim, um bloqueio mais eficaz, de menor latência, menor dependência de referências anatômicas, menor volume de solução anestésica e maior segurança. CONTEÚDO: O artigo revisa os aspectos relativos aos mecanismos físicos para formação de imagens, a anatomia ultra-sonográfica do neuroeixo e dos plexos braquial e lombossacral, os equipamentos e materiais empregados nos bloqueios, os ajustes do aparelho de ultra-som para melhorar as imagens, os planos de visualização das agulhas de bloqueio e as técnicas e o treinamento em bloqueios guiados por ultra-som. CONCLUSÕES: Os passos para se obter sucesso em anestesia regional incluem a identificação exata da posição dos nervos, a localização precisa da agulha, sem lesões nas estruturas adjacentes e, finalmente, a injeção cuidadosa de anestésico local junto aos nervos. Embora a neuroestimulação forneça grande auxílio na identificação dos nervos, esta não consegue, isoladamente, preencher todas essas exigências. Por isso, acredita-se que os bloqueios guiados por ultra-som serão a técnica de eleição para anestesia regional num futuro não muito distante.JUSTIFICATIVA Y OBJETIVOS: Las técnicas de bloqueos nerviosos guiados por ultrasonido se basan en la visualización directa de las estructuras nerviosas, de la aguja de bloqueo y de las estructuras anatómicas adyacentes. De esa manera, se puede depositar la solución de anestésico local precisamente en torno de los nervios y acompañar su dispersión en tiempo real, obteniéndose así, un bloqueo más eficaz, de menor latencia, menor dependencia de

  20. Nocardia brasiliensis vertebral osteomyelitis and epidural abscess.

    Science.gov (United States)

    Johnson, Philip; Ammar, Hussam

    2013-04-11

    Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature.

  1. SEGMENTAL EPIDURAL ANAESTHESIA FOR INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Sachidanand

    2015-09-01

    Full Text Available BACKGROUND: Epidural anaesthesia is suitable as a sole agent for lower abdominal surgery and surgery on lower limbs. It has some definite advantages over spinal anaesthesia like avoidance of post spinal headache, minimal chances of meningitis, and minimal chances of nausea and vomiting in postoperative period. But administration of conventional dosage of local epidural anaesthetics (15ml and above for surgical anaesthesia frequently results in multiple hemodynamic changes, including decreases in chronotropism, inotro pism, dromotropism, systemic vascular resistance, cardiac output, and myocardial oxygen consumption. The segmental epidural block denotes the use of a small volume enough to block only the segments involved in the field of surgery. AIM: To study the effect iveness of segmental epidural anaesthesia for inguinal hernia repair. DESIGN: R andomized control study. METHODS: 100 pts belonging to ASA PS I & II posted for inguinal hernia repair given 5ml of 0.5% bupivacaine through epidural route at L1 - L2 level and a fter conforming the adequacy and level of analgesia, the surgery was commenced. If the patient complained of pain during needle prick, then injected local anaesthetic (0.5% Bupivacaine with an incremental dosage of 1ml at a time, till the complete onset o f analgesia Pulse Rate and Blood Pressure were recorded at an interval of 1 minute for first 5 minutes and then every 5 minutes till the end of the surgery. Oxygen saturation and ECG monitoring was done continuously. Onset of analgesia, level of analgesia ( P re & post operatively, duration of analgesia, total dosage of local anaesthetic used were recorded. Complications like bradycardia, hypotension, respiratory depression, shivering, nausea and vomiting, sweating and inadvertent dural puncture were recorde d. RESULTS: 53% of patients had excellent quality of analgesia and relaxation. 34% patients had good quality analgesia and relaxation, mild discomfort while handling sac

  2. 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.

  3. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study.

    Science.gov (United States)

    Patel, N P; El-Wahab, N; Fernando, R; Wilson, S; Robson, S C; Columb, M O; Lyons, G R

    2014-05-01

    We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  4. 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. 2015 BMJ Publishing Group Ltd.

  5. 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...

  6. 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

    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......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...

  7. 98. Leiomiomatosis con diseminación intravascular: Desde el útero a cavidades cardíacas y pulmón

    Directory of Open Access Journals (Sweden)

    M.aE. Arnaiz García

    2010-01-01

    Conclusiones: La leiomiomatosis uterina es una tumoración benigna con enorme tendencia a la extensión intravascular y cardíaca. Su tratamiento incluye resección tumoral y bloqueo hormonal de por vida, en mujeres jóvenes, generalmente. El tratamiento quirúrgico para resección tumoral exige control eco-cardiográfico para comprobar la completa resección del mismo.

  8. Thoracic epidural anaesthesia for major abdominal surgeries ...

    African Journals Online (AJOL)

    The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Data were obtained from the ... In a previous study, Consani et al.3 documented the feasibility of thoracic epidural ... thoracostomy and mastectomy in high-risk patients.2,6 Since TEA places less demand on drugs, ...

  9. 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.

  10. Vasovagal Syncope during Epidural Catheterization before ...

    African Journals Online (AJOL)

    The risk factors can be patient related (young, athletics, hypertensive, history of syncope, inferior myocardial infarction and others), anaesthesia related (light anaesthesia, spinal, epidural anaesthesia, airway manipulation, hypercapnia, hypoxia and others) and surgical related (strabismus, anal dilatation, abdominal and ...

  11. 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...

  12. Perioperative effect of epidural dexmedetomidine with intrathecal ...

    African Journals Online (AJOL)

    2011-06-10

    Jun 10, 2011 ... and a thorough preanaesthetic check-up carried out, the patients were randomly divided into two groups using the manual envelope randomisation technique. ... commands or light tactile stimulus (sedation scale 3-4) 10 ± 5 minutes following administration of dexmedetomidine in the epidural space.

  13. Cerebellar herniation after cervical transforaminal epidural injection.

    Science.gov (United States)

    Beckman, William A; Mendez, Robert J; Paine, Gregory F; Mazzilli, Michael A

    2006-01-01

    The purpose of this study is to inform readers of potential catastrophic complications associated with performing cervical transforaminal epidural steroid injections. A 31-year-old man presented to the pain clinic with a history of cervical radicular pain and right upper-extremity radicular symptoms. He was referred from the orthopedic spine clinic for evaluation for epidural steroid injection, having failed conservative treatment consisting of nonsteroidal anti-inflammatory drugs, muscle relaxants, oral steroids, and physical therapy. After undergoing a transforaminal epidural steroid injection at the right C8 nerve root, he developed a cerebellar infarct and brainstem herniation. He survived but has residual deficits of persistent diplopia on right lateral gaze and difficulties with short-term memory loss and concentration. Although transforaminal epidural steroid injections are an efficacious treatment for radicular syndromes, there can be catastrophic complications. In light of the growing body of similar case reports, further investigation is warranted to establish a safe protocol for the use of this modality.

  14. Spontaneous extracranial decompression of epidural hematoma

    International Nuclear Information System (INIS)

    Neely, John C.; Jones, Blaise V.; Crone, Kerry R.

    2008-01-01

    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. 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.)

  16. Epidural analgesia, neonatal care and breastfeeding.

    Science.gov (United States)

    Zuppa, Antonio Alberto; Alighieri, Giovanni; Riccardi, Riccardo; Cavani, Maria; Iafisco, Alma; Cota, Francesco; Romagnoli, Costantino

    2014-11-29

    The objective of our study is to evaluate the correlation between epidural analgesia during labor, start of breastfeeding and type of maternal-neonatal care.Two different assistance models were considered: Partial and Full Rooming-in.In this cohort study, 2480 healthy infants were enrolled, 1519 in the Partial Rooming-in group and 1321 in the Full Rooming-in group; 1223 were born to women subjected to epidural analgesia in labor.In case of Partial Rooming-in the rate of exclusive or prevailing breastfeeding is significant more frequent in newborns born to mothers who didn't receive analgesia. Instead, in case of Full Rooming-in the rate of exclusive or prevailing breastfeeding is almost the same and there's no correlation between the use or not of epidural analgesia.The good start of lactation and the success of breastfeeding seems to be guaranteed by the type of care offered to the couple mother-infant, that reverses any possible adverse effects of the use of epidural analgesia in labor.

  17. Bloqueo aurículo-ventricular congénito completo: Reporte de un caso y revisión de la literatura Congenital complete atrioventricular block: eport of one case and literature review

    Directory of Open Access Journals (Sweden)

    Alejandro Díaz D

    2008-02-01

    Full Text Available El bloqueo aurículo-ventricular completo congénito, es una entidad poco común, que presenta alta morbilidad y mortalidad con incidencia real que permanece desconocida y requiere alto índice de sospecha para su diagnóstico y, por ende, su temprana intervención. Se observa en hijos de madres con enfermedades autoinmunes del tejido conectivo, en especial, lupus eritematoso sistémico cuando su aparición es congénita. A nivel postnatal, es más frecuente que ocurra por cardiopatías congénitas. También puede manifestarse en corazones normales desde el punto de vista estructural. El hallazgo clínico característico es bradicardia persistente que se manifiesta desde la vida intrauterina y repercute en la estabilidad circulatoria del feto llegando a producir hidrops, complicación seria y letal. Después del nacimiento aparece igualmente con bradicardia que puede o no descompensar la parte hemodinámica del paciente. El diagnóstico se hace por sospecha clínica, con ecocardiografía fetal y postnatal, electrocardiograma y detección de anticuerpos maternos tipo antiRo y antiLa. La implantación de un marcapasos es el tratamiento definitivo que contribuye a mejorar la sobrevida y el pronóstico de estos pacientes. Se presenta el caso de una paciente prematura, de 31 semanas, debido a hidrops no inmune, en quien se diagnosticó bloqueo aurículo-ventricular completo congénito secundario a lupus materno confirmado por anticuerpos anti-nucleares francamente positivos y anticuerpos antiRo y antiLa positivos, quien recibió manejo con soporte inotrópico y posterior implantación de marcapasos. Presentó mejoría completa de la falla cardiaca y se remitió hacia otra institución para manejo convencional del prematuro.Complete congenital atrioventricular block is a rare entity that has a high morbidity and mortality. Its real incidence remains unknown and a high suspicion index is needed for its diagnosis and consequently for its early

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-06-15

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  19. 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 analyses are also judged to be reliable. The women in the study are not representative of all women who use epidurals, but it was possible to draw out several common experiences. The possibility of generalizing the results is depending on the context, including the contents of the medication and how...... midwives handle the epidurals. Conclusion: In particular, the use of an epidural does not diminish the need for an individual approach. The woman’s level of consciousness and the entire situation makes her very sensitive to the midwives care....

  20. 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...... 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...... 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...

  1. 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.

  2. Bloqueio dos nervos femoral e isquiático guiados por ultrassom em paciente anticoagulado: case reports Bloqueo de los nervios femoral e isquiático guiados por ultrasonido en paciente anticoagulado Ultrasound-guided femoral and sciatic nerve blocks in an anticoagulated patient: relato de casos

    Directory of Open Access Journals (Sweden)

    Leonardo Henrique Cunha Ferraro

    2010-08-01

    cada vez más en una práctica frecuente. Con la menor probabilidad de promover lesiones vasculares, el ultrasonido se convierte en un instrumento interesante en la realización de bloqueos periféricos, especialmente en los pacientes que usan anticoagulantes o con disturbios de la coagulación. El objetivo de este estudio fue relatar dos casos en que se realizaron los bloqueos isquiático y femoral guiados por ultrasonido en pacientes anticoagulados. RELATO DE LOS CASOS: En el primer caso, la cirugía realizada consistió en la amputación del pie anterior izquierdo en función de una necrosis y de señales de infección. El segundo caso, fue una limpieza quirúrgica de la rodilla izquierda. Los pacientes presentaron disturbios de coagulación con una actividad de protrombina y tiempo de tromboplastina activado por encima de los valores normales. Los dos pacientes se sometieron al bloqueo femoral e isquiático guiado por ultrasonido, evolucionando sin alteración motora o sensitiva en los territorios de esos nervios y sin hematoma en la región local de la punción. CONCLUSIONES: La anticoagulación impone ciertas restricciones a la aplicación de las técnicas anestésicas regionales clásicas. Con el avance de los equipos y métodos de ultrasonido, hoy por hoy se puede identificar con alta precisión las estructuras vasculares y neurales. Eso posibilita que la punción guiada por ultrasonido sea más exacta, tanto para alcanzar el área de interés como para minimizar los riesgos de lesión vascular accidental. Hasta el presente momento, no se recomienda la realización de bloqueo periférico en pacientes anticoagulados o portadores de coagulopatías. Sin embargo, considerando que existen pocos relatos sobre bloqueos regionales con ultrasonido en situaciones de coagulopatías, la seguridad de tal técnica en esas condiciones todavía no se ha establecido.BACKGROUND AND OBJECTIVES: The use of the ultrasound to guide the puncture in peripheral nerve blocks has become

  3. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    International Nuclear Information System (INIS)

    Lee, K.-W.; McLeary, M.S.; Zuppan, C.W.; Won, D.J.

    2000-01-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  4. 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...

  5. Presumed Group B Streptococcal Meningitis After Epidural Blood Patch.

    Science.gov (United States)

    Beilin, Yaakov; Spitzer, Yelena

    2015-06-15

    Bacterial meningitis after epidural catheter placement is rare. We describe a case in which a parturient received labor epidural analgesia for vaginal delivery complicated by dural puncture. The patient developed postdural puncture headache and underwent 2 separate epidural blood patch procedures. She subsequently developed a headache with fever and focal neurologic deficits. She was treated with broad spectrum antibiotics for presumed meningitis, and she made a full recovery. Blood cultures subsequently grew group B streptococcus.

  6. Salmonella Typhi Vertebral Osteomyelitis and Epidural Abscess

    Directory of Open Access Journals (Sweden)

    Hau Wei Khoo

    2016-01-01

    Full Text Available Salmonella vertebral osteomyelitis is an uncommon complication of Salmonella infection. We report a case of a 57-year-old transgender male who presented with lower back pain for a period of one month following a fall. Physical examination only revealed tenderness over the lower back with no neurological deficits. MRI of the thoracic and lumbar spine revealed a spondylodiscitis at T10-T11 and T12-L1 and right posterior epidural collection at the T9-T10 level. He underwent decompression laminectomy with segmental instrumentation and fusion of T8 to L3 vertebrae. Intraoperatively, he was found to have acute-on-chronic osteomyelitis in T10 and T11, epidural abscess, and discitis in T12-L1. Tissue and wound culture grew Salmonella Typhi and with antibiotics susceptibility guidance he was treated with intravenous ceftriaxone for a period of six weeks. He recovered well with no neurological deficits.

  7. Epidural Analgesia and Fever at Labor

    Directory of Open Access Journals (Sweden)

    Ye. M. Shifman

    2008-01-01

    Full Text Available Objective: to study the incidence of labor fever under epidural analgesia (EA and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vásquez

    2002-06-01

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

  10. Síndrome de Tako-Tsubo em decorrência de bloqueio neuromuscular residual: relato de caso Síndrome de Tako-Tsubo como consecuencia de bloqueo neuromuscular residual: relato de caso Tako-Tsubo syndrome secondary to residual neuromuscular blockade: case report

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Tako-Tsubo é uma complicação pós-operatória rara, com mortalidade em torno de 5%. O objetivo deste relato é apresentar o bloqueio neuromuscular residual como fator desencadeante da referida síndrome, discutir sobre a mesma e alertar sobre o bloqueio neuromuscular residual. RELATO DO CASO: Paciente do sexo feminino, 61 anos, estado físico ASA I, submetida à anestesia geral associada a bloqueio paravertebral cervical para reparo artroscópico de lesão de manguito rotator. Após extubação foi evidenciado bloqueio neuromuscular residual por meio do exame clínico. Na sala de recuperação pós-anestésica evoluiu com sonolência, taquicardia, hipertensão arterial e acidose respiratória grave. Após a reintubação, evoluiu com parada cardíaca em atividade elétrica sem pulso, revertida com adrenalina e massagem cardíaca externa. Apresentou no pós-operatório elevação de segmento ST, aumento de troponina e acinesia de segmento médio-apical de ventrículo esquerdo com fração de ejeção estimada em 30%. A cineangiocoronariografia mostrou coronárias isentas de ateromatose significativa e grave comprometimento da função sistólica com acinesia inferior e ântero-septo-apical com hipercontratilidade compensatória de suas porções basais. Com o tratamento instituído houve recuperação funcional completa. CONCLUSÕES: O bloqueio neuromuscular residual associado à paralisia diafragmática e possível atelectasia pulmonar levando a insuficiência respiratória, hipercapnia e descarga adrenérgica foram os fatores desencadeantes da síndrome de Tako-Tsubo com sua grave repercussão clínica.JUSTIFICATIVA Y OBJETIVOS: El Síndrome de Tako-Tsubo es una complicación postoperatoria rara con una mortalidad en torno de un 5%. El objetivo de este relato es presentar el bloqueo neuromuscular residual como factor desencadenante del referido síndrome, discutir sobre él y alertar sobre el bloqueo

  11. Effect of epidural analgesia on labor and its outcomes

    International Nuclear Information System (INIS)

    Fawad, A.; Naz, H.; Nelofar, T.; Abbasi, A.U.N.

    2015-01-01

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

  12. EFFECT OF EPIDURAL ANALGESIA ON LABOR AND ITS OUTCOMES.

    Science.gov (United States)

    Anwar, Sadia; Anwar, Muhannad Waseem; Ahmad, Sajjad

    2015-01-01

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

  13. Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas Bloqueo pleural bilateral: analgesia y funciones pulmonares en pós-operatorio de laparotomias medianas Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Não obstante o bloqueio pleural ter sido convertido quase numa panacéia analgésica, resultados contraditórios foram publicados. O objetivo deste estudo foi observar o desempenho analgésico e espirométrico das funções pulmonares no pós-operatório imediato de 21 pacientes com o bloqueio pleural bilateral em laparotomias medianas de urgência. MÉTODO: Bloqueio pleural bilateral foi realizado em decúbito dorsal horizontal em 21 pacientes com 20 ml de bupivacaína a 0,375% com adrenalina a 1:400.000 administrados por cateter em cada hemitórax durante o pós-operatório imediato. Soluções aleatórias de bupivacaína e de solução fisiológica foram administradas por residentes ou enfermeiras que desconheciam o conteúdo das seringas, e seus desfechos analgésicos avaliados de acordo com a escala de dor Prince Henry ao comparar os valores pré e pós-bloqueio pleural bilateral. Em função da dor pós-operatória, testes espirométricos das funções pulmonares também foram determinados mediante espirômetro portátil. RESULTADOS: Analgesia pós-operatória, com duração média de 247,75 ± 75 minutos foi constatada em todos os pacientes com a bupivacaína, embora tenha persistido dor residual de menor intensidade na região suprapúbica em cinco pacientes (8% e em dois pacientes na apófise xifóide (3,2%. Nenhum efeito analgésico foi obtido com solução fisiológica. Face à dor pós-operatória, as funções pulmonares, avaliadas antes e após os bloqueios, registraram melhora com a bupivacaína na CVF (p JUSTIFICATIVA Y OBJETIVOS: No obstante el bloqueo pleural haber sido convertido casi en una panacea analgésica, fueron publicados resultados contradictorios. El objetivo de este estudio fue observar el desempeño analgésico y espirométrico de las funciones pulmonares en el pós-operatorio inmediato de 21 pacientes con el bloqueo pleural bilateral en laparotomias medianas de urgencia. M

  14. Perirectal block for out-patient anorectal surgery: A new technique Bloqueo perirrectal para cirugía anorrectal ambulatoria: una nueva técnica

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    Javier H. Eslava-Schmalbach

    2011-03-01

    la anestesia y la analgesia posoperatoria cuando se utiliza una nueva técnica de dos punciones.
    Materiales y métodos. Se incluyeron, consecutivamente, los pacientes programados para cirugía rectal ambulatoria entre enero de 2003 y diciembre de 2007. Se utilizó la nueva técnica anestésica de dos punciones. Se registraron las necesidades de manejo anestésico alternativo y el nivel de dolor posoperatorio por medio de una escala visual análoga graduada. El seguimiento fue telefónico (1 a 10 días posoperatorios para evaluar complicaciones, dolor (sí/no y nivel de satisfacción (escala, 1 a 5.
    Resultados. Se incluyeron 409 sujetos. El 50,61 % eran mujeres. La edad promedio fue de 43 años, (rango, 17 a 85. El 12,7 % eran mayores de 60 años. De acuerdo con la clasificación de la American Society of Anesthesiology (ASA, el 72,6 % fueron ASA1 y 26,1 % ASA2. Se practicó hemorroidectomía externa e interna en 31 % de los pacientes; 61,6 % tuvo más de dos procedimientos. Se utilizó lidocaína en 406 sujetos. Se adicionó ropivacaína en 9,2 % y levobupivacaína en 89,4 %. La mediana de seguimiento fue de cuatro días. Se obtuvo respuesta de 346 sujetos (84,6 %; 105 (30,3 % refirieron haber sufrido dolor durante el posoperatorio, lo que fue más frecuente en el grupo de lidocaína más ropivacaína (17/39, 43,5 % que en el de lidocaína más bupivacaína (88/307, 28,6 %. La satisfacción se evaluó en 336 sujetos (82,1 %: 332 (98,8 % la calificaron en 5, 2 sujetos (0,6 % la calificaron en 2 y en 1. No hubo complicaciones.
    Conclusiones. El bloqueo perirrectal de dos punciones es una técnica fácil que, además, provee analgesia y un alto grado de satisfacción.

  15. Clinical audit of knowledge and practice of epidural labour ...

    African Journals Online (AJOL)

    Epidural analgesia (EA) is the most ideal method for pain relief during labour. We sought to highlight the current knowledge and practice of the obstetricians regarding epidural labour analgesia (ELA). An audit was conducted amongst obstetricians in two teaching hospitals in the south west of Nigeria. Most of our ...

  16. Epidural steroid injections for radicular lumbosacral pain: a systematic review

    NARCIS (Netherlands)

    Shamliyan, T.A.; Staal, J.B.; Goldmann, D.; Sands-Lincoln, M.

    2014-01-01

    Most clinical guidelines do not recommend routine use of epidural steroid injections for the management of chronic low back pain. However, many clinicians do not adhere to these guidelines. This comprehensive evidence overview concluded that off-label epidural steroid injections provide small

  17. The spontaneous spinal epidural hematoma : a study of the etiology

    NARCIS (Netherlands)

    Groen, R J; Ponssen, H

    From the literature 199 cases of spontaneous spinal epidural hematoma (SSEH) are analyzed. With these data and the vascular anatomical characteristics of the spinal epidural space, the theories on the etiology of the SSEH are discussed. There seems to be no relationship between the SSEH and arterial

  18. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer

    2004-01-01

    BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase wh...

  19. Vertex epidural haematoma manifesting with bilateral upper limb ...

    African Journals Online (AJOL)

    Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and ...

  20. Ascending back pain and headache during attempted epidural placement.

    Science.gov (United States)

    Kreitzer, J M; Reed, A P; Dauro, A T; Brodman, M L; Bronster, D J

    1991-01-01

    A 30-year-old parturient requested epidural analgesia during labor. Immediately after the epidural space was presumably identified using the loss-of-resistance-to-air technique, she reported severe back pain, followed by neck pain, which progressed to severe unrelenting headache. An emergency computerized tomographic (CT) scan performed during labor showed air in the intracranial subarachnoid space.

  1. Tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção acidental da duramáter em paciente HIV positivo: relato de caso Tampón peridural con dextran 40 en la profilaxia de la cefalea pós-punción accidental de la duramáter en paciente SIDA positivo: relato de caso Epidural patch with dextran 40 to prevent postdural puncture headache in an HIV patient: case report

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2002-11-01

    han sido relatadas. El objetivo de este articulo es presentar un caso del uso del tampón peridural con dextran 40 en la profilaxia de la cefalea pós-punción de duramáter en paciente portador del virus de la imunodeficiencia humana (HIV, con historia de cefalea en anestesia subaracnóidea anterior. Relato do caso: Paciente masculino, 31 años, 70 kg, estado físico ASA II, portador de SIDA, para tratamiento de condilomatosis anal recidivada, con relato de cefalea intensa y limitante durante dos semanas después de anestesia subaracnóidea (aguja Quincke 25G. Durante la tentativa de anestesia peridural con aguja de Tuohy 18G en L3-L4, hubo perforación accidental de la duramáter. Fueron inyectados, por dos veces, 20 ml de dextran 40 a 10% por catéter peridural; la primera, 150 minutos después de la administración de los anestésicos y la segunda en la mañana siguiente a la cirugía. El paciente evoluyó asintomático y recibió alta al día siguiente a su internación. CONCLUSIONES: El uso del tampón con soluciones coloides como el dextran 40 no está bien establecido, sin embargo existen algunos relatos de su uso con suceso y entendemos que su potencial debe ser mejor explorado.BACKGROUND AND OBJECTIVES: Postdural puncture headache is a well-known complication of spinal and epidural anesthesia and, so far, its most effective treatment is the epidural blood patch. Nevertheless this is an invasive procedure subject to severe complications. Its use in special patient populations (HIV positive patients and leukemias is controversial. Several alternatives have been reported. This study aimed at showing a case of prophylactic epidural dextran 40 patch in an HIV patient with previous history of headache following spinal anesthesia. CASE REPORT: Male patient, 31 years old, 70 kg, physical status ASA II, HIV positive, presented for recurrent anal condylomatosis treatment, with a history of severe and limiting headache for two weeks following spinal anesthesia. (25G

  2. Spontaneous methicillin-resistant Staphylococcus aureus epidural abscess in pregnancy.

    Science.gov (United States)

    Connealy, Brendan D; Lovgren, Todd R; Tomich, Paul G; Smith, Carl V; Berg, Teresa G

    2010-08-01

    Epidural abscess is a rare complication of regional anesthesia, and spontaneous formation is even more uncommon. Diabetes mellitus, concomitant infection, intravenous drug use, and immune suppression are risk factors for spontaneous epidural abscess. A 29-year-old white woman presented at 28 weeks of estimated gestational age reporting an intermittent headache. She had Horner syndrome and was hospitalized. A cervicothoracic epidural abscess was diagnosed. Surgical decompression and parenteral antibiotics resulted in complete resolution of neurologic symptoms. Cultures were positive for methicillin-resistant Staphylococcus aureous. Spontaneous epidural abscess is a rare condition and diagnosis is often delayed. The finding of Horner syndrome led to imaging of the cervical spine and diagnosis of epidural abscess. Early intervention resulted in resolution of neurologic symptoms and a successful pregnancy outcome.

  3. Epidural Fluid Collection After Percutaneous Endoscopic Lumbar Discectomy.

    Science.gov (United States)

    Liu, Wei-Chiang; Choi, Gun; Lee, Sang-Ho; Kwon, Amy M; Kim, K Hwan; Park, Jeeyoung; Park, Hyeon Seon

    2018-03-01

    The frequency and extent of epidural fluid collection after percutaneous endoscopic lumbar discectomy (PELD) have not been previously described. The purpose of this study was to evaluate the significance of epidural fluid collection after PELD. From March 2008 to November 2015, immediate postoperative magnetic resonance imaging (MRI) of 464 consecutive patients, comprising 284 men and 180 women, were obtained after PELD. The mean age of the patients at the time of admission was 43.1 years (range, 18-81 years). We also performed 24-hour follow-up MRIs after PELD in 35 patients to evaluate the morphologic changes on epidural fluid collection and to identify whether the collection was due to saline accumulation or cerebrospinal fluid leak. The level of disc herniation was at L4-5, L5-S1, L3-4, and L2-3 in 245 (52.8%), 173 (37.3%), 37 (8.0%), and 9 (1.9%) patients, respectively. Of 464 patients, 418 (90.1%) had abnormal epidural fluid collection, 404 (87.1%) patients had ventral epidural fluid collection, 393 (84.7%) patients had dorsal epidural fluid collection, and 10 patients had epidural hematoma as per immediate postoperative MRI. According to the 24-hour follow-up MRI findings, 30 patients had epidural fluid collection; the epidural fluid collection in 28 patients (93.3%) resolved with time, and a minimal amount of fluid remained in 2 patients, but the lesion size decreased compared with that on the previous day. Epidural fluid collection usually occurs after percutaneous endoscopic discectomy, which is mainly due to saline accumulation and typically resolves with time, without treatment or complications. Copyright © 2018 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2012-01-01

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

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

    Science.gov (United States)

    Mousa, Wesam Farid; Al-Metwalli, Roshdi; Mostafa, Manal

    2012-01-01

    Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration. PMID:22412775

  6. 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

    ão necessários para avaliar diferença na incidência de cesarianas.JUSTIFICATIVA Y OBJETIVOS: El alivio del dolor en el trabajo de parto ha recibido una atención constante objetivando el bienestar materno, disminuyendo el estrés causado por el dolor y reduciendo las consecuencias de éste sobre el concepto. Innumerables técnicas pueden ser utilizadas para la analgesia de parto. Este trabajo tuvo como objetivo comparar la técnica peridural continua con la combinada, ambas con el uso de bupivacaína a 0,25% en exceso enantiomérico 50% y fentanil como agentes. MÉTODO: Participaron del estudio 40 parturientes en trabajo de parto con dilatación cervical entre 4 y 5 cm que se repartieron en de los grupos iguales de forma aleatoria. El Grupo I recibió anestesia peridural continua. El Grupo II recibió anestesia combinada. Se evaluaron: medidas antropométricas, edad de embarazo, dilatación cervical, tiempo entre el bloqueo y la ausencia de dolor a través de la escala analógica visual, posibilidad de deambulación, tiempo entre el inicio de la analgesia y la dilatación cervical completa, duración del período expulsivo, parámetros hemodinámicos maternos y vital edad del recién nacido. Posibles complicaciones como depresión respiratoria, hipotensión arterial materna, prurito, náuseas y vómitos también fueron observados. Para la comparación de los promedios se utilizó el teste t de Student y para la paridad y tipo de parto se utilizó el teste del Qui-cuadrado. RESULTADOS: No hubo diferencia estadística significativa entre los de los grupos con relación al tiempo entre el inicio de la analgesia y la dilatación cervical completa, como también con relación al tiempo de la duración del período expulsivo, incidencia de cesárea relacionada con la analgesia, parámetros hemodinámicos maternos y vital edad del recién nacido. CONCLUSIONES: Las dos técnicas fueron eficaces y seguras para la analgesia del trabajo de parto, aunque la técnica combinada haya

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

    Directory of Open Access Journals (Sweden)

    Héctor Iván García García

    1998-03-01

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

  8. Collateral pathways in lumbar epidural venography

    International Nuclear Information System (INIS)

    Thijssen, H.O.M.; Ike, B.W.; Chevrot, A.; Bijlsma, R.

    1982-01-01

    Opacification of collateral pathways other than the central channels is very rare in lumbar epidural venography. Two cases of opacification of the inferior mesenteric vein following extravasation of contrast medium at the tip of the lateral sacral vein catheter are reported. One case is presented in which filling of normal parametrial venous plexuses and the left ovarian vein occurred as a consequence of incompetent or absent valves in the internal iliac vein. The literature containing comparable collateral flow patterns in disease is reviewed. The significance of the phlebographic features in our cases is discussed. (orig.)

  9. Extensive spinal epidural abscess complicated with hydrocephalus

    Directory of Open Access Journals (Sweden)

    Balan Corneliu

    2015-12-01

    Full Text Available Spinal epidural abscess is a rare but severe infection requiring prompt recognition in order to have a favorable outcome and appropriate treatment, mainly surgical. We present one of the largest extensions of such abscess in literature, involving the whole spine. No surgical treatment was tempted due to the involvement of 19 levels but antibiotics. The evolution of the lesion was complicated with hydrocephalus, by mechanism of cervical block of CSF flow, and needed first external derivation and later ventriculo-peritoneal drainage.

  10. Epidural Labor Analgesia and Maternal Fever.

    Science.gov (United States)

    Sharpe, Emily E; Arendt, Katherine W

    2017-06-01

    Women receiving an epidural for labor analgesia are at increased risk for intrapartum fever. This relationship has been supported by observational, before and after, and randomized controlled trials. The etiology is not well understood but is likely a result of noninfectious inflammation as studies have found women with fever have higher levels of inflammatory markers. Maternal pyrexia may change obstetric management and women are more likely to receive antibiotics or undergo cesarean delivery. Maternal pyrexia is associated with adverse neonatal outcomes. With these consequences, understanding and preventing maternal fever is imperative.

  11. Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome Migración epidural posterior de fragmento de disco lumbar secuestrado que causa síndrome de cauda equina Migração epidural posterior de fragmento de disco lombar sequestrado que causa síndrome da cauda equina

    Directory of Open Access Journals (Sweden)

    Abolfazl Rahimizadeh

    2013-01-01

    Full Text Available Posterior epidural migration (PEM of a sequestered free lumbar disc fragment is rare. The rarity is due to presence of several anatomical restraints which restrict a free fragment to move to the posterior compartment. This unusual presentation of disc herniation appeared in the literature either as a single case report or in small series from two to six cases. Herein two new demonstrative cases will be presented with a brief review of the literature.La migración epidural (PEM posterior Epidural Migration de fragmento de disco lumbar libre secuestrado es rara. La rareza se debe a la existencia de varias restricciones anatómicas impidiendo que el fragmento libre se mueva hacia el compartimento posterior. Esa presentación no común de hernia de disco apareció en la literatura como un relato de caso único o en pequeñas series de dos a seis casos. En este artículo, se presentan dos casos nuevos demostrativos, conjuntamente con una revisión breve de la literatura.A migração epidural posterior (PEM posterior epidural migration de fragmento de disco lombar livre sequestrado é rara. A raridade deve-se à presença de várias restrições anatômicas que impedem que o fragmento livre se mova para o compartimento posterior. Essa apresentação incomum de hérnia de disco apareceu na literatura como relato de caso único ou em pequenas séries de dois a seis casos. Neste artigo, são apresentados dois novos casos demonstrativos, com uma breve revisão da literatura.

  12. O Bloqueio do plexo hipogástrico superior é eficaz no tratamento de dor pélvica crônica? ¿El bloqueo del plexo hipogástrico superior es eficaz en el tratamiento del dolor pélvico crónico? Is superior hypogastric plexus block effective for treatment of chronic pelvic pain?

    Directory of Open Access Journals (Sweden)

    André P Schmidt

    2005-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo hipogástrico tem sido apresentado como uma alternativa segura e eficaz no tratamento de pacientes portadores de dor pélvica crônica. Os estudos publicados e disponíveis no MedLine, abordando este tema, foram incluídos e analisados nesta revisão. CONTEÚDO: Alguns estudos documentaram a eficácia do bloqueio do plexo hipogástrico superior em reduzir a intensidade da dor e o consumo de opióides, principalmente em pacientes com câncer. No entanto, os estudos apresentam falhas em seus métodos ou desenhos. CONCLUSÕES: Novos estudos prospectivos melhor conduzidos ainda são necessários para ratificar a efetividade do bloqueio do plexo hipogástrico no alívio de condições dolorosas pélvicas. Esses estudos devem possuir critérios de inclusão mais rigorosos, seguimento mais prolongado, avaliação de outros sintomas e da qualidade de vida antes e após o procedimento. O bloqueio do plexo hipogástrico superior deve ser recomendado como uma alternativa e não como terapêutica principal.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo hipogástrico ha sido presentado como una alternativa segura y eficaz en el tratamiento de pacientes portadores de dolor pélvico crónico. Los estudios publicados y disponibles en el MedLine, abordando este tema, fueron incluidos y analizados en esta revisión. CONTENIDO: Algunos estudios documentaron la eficacia del bloqueo del plexo hipogástrico superior en reducir la intensidad del dolor y el consumo de opioides, principalmente en pacientes con cáncer. Sin embargo, los estudios presentan fallas en sus métodos o dibujos. CONCLUSIONES: Aún son necesarios nuevos estudios prospectivos y mejor conducidos, para poder ratificar la efectividad del bloqueo del plexo hipogástrico en el alivio de condiciones dolorosas pélvicas. Esos estudios deben poseer criterios de inclusión más rigurosos, seguimiento más prolongado, evaluación de otros síntomas y de la

  13. Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome.

    Science.gov (United States)

    Rocco, A G; Frank, E; Kaul, A F; Lipson, S J; Gallo, J P

    1989-03-01

    Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. The spinal interspace identified with the patients' pain complaint was the site of injection. For each treatment, patients were admitted to the Clinical Research Center for 24 h and their condition continuously monitored with a pulse oximeter and apnea monitor. Five to 7 patients in each group had pain relief for less than 1 month. No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.

  14. Intoxicación con glicósidos cardíacos en un perro debido a la ingestión de Cotyledon orbiculata

    OpenAIRE

    Planellas, Marta

    2010-01-01

    Las intoxicaciones por plantas son comunes en animales. En este articulo exponemos un caso de intoxicación en un perro debido a la ingestión de una planta cardiotóxica, Cotyledon orbiculata.. El paciente se presentó con un cuadro agudo gastrointestinal (vómitos y diarreas) y cardíaco (bradicardia severa de 20-40 ppm, con bloqueos atrioventriculares). En la historia clínica destacó la presencia de fragmentos de una planta de jardín en los vómitos del paciente. Después de seis días de hospitali...

  15. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Isoyama-Shirakawa, Yuko; Abe, Madoka; Nakamura, Katsumasa

    2015-01-01

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  16. Sonographic evaluation of epidural and intrathecal injections in cats.

    Science.gov (United States)

    Otero, Pablo E; Verdier, Natali; Zaccagnini, Andrea S; Fuensalida, Santiago E; Sclocco, Matias; Portela, Diego A; Waxman, Samanta

    2016-11-01

    To describe the ultrasonographic anatomy of the caudal lumbar spine in cats and to detect ultrasound (US) signs associated with epidural or intrathecal injection. Prospective, clinical study. Twenty-six client-owned cats. Transverse (position 1) and parasagittal (position 2) two-dimensional US scanning was performed over the caudal lumbar spine in all cats. Midline distances between the identified structures were measured. Cats assigned to epidural injection (group E, n = 16) were administered a bupivacaine-morphine combination confirmed by electrical stimulation. Cats assigned to intrathecal injection (group I, n = 10) were administered a morphine-iohexol combination injected at the lumbosacral level and confirmed by lateral radiography. The total volume injected (0.3 mL kg -1 ) was divided into two equal aliquots that were injected without needle repositioning, with the US probe in positions 1 and 2, respectively. The presence or absence of a burst of color [color flow Doppler test (CFDT)], dural sac collapse and epidural space enlargement were registered during and after both injections. US scanning allowed measurement of the distances between the highly visible structures inside the spinal canal. CFDT was positive for all animals in group E. In group I, intrathecal injection was confirmed in only two animals, for which the CFDT was negative; seven cats inadvertently and simultaneously were administered an epidural injection and showed a positive CFDT during the second aliquot injection, and the remaining animal was administered epidural anesthesia and was excluded from the CFDT data analysis. Dural sac collapse and epidural space enlargement were present in all animals in which an epidural injection was confirmed. US examination allowed an anatomical description of the caudal lumbar spine and real-time confirmation of epidural injection by observation of a positive CFDT, dural sac collapse and epidural space enlargement. © 2016 Association of Veterinary

  17. Intracranial epidural hemorrhage during lumbar spinal surgery.

    Science.gov (United States)

    Imajo, Yasuaki; Kanchiku, Tsukasa; Suzuki, Hidenori; Yoshida, Yuichiro; Nishida, Norihiro; Goto, Hisaharu; Suzuki, Michiyasu; Taguchi, Toshihiko

    2016-01-01

    The authors report a case of intracranial epidural hemorrhage (ICEH) during spinal surgery. We could not find ICEH, though we recorded transcranial electrical stimulation motor evoked potentials (TcMEPs). A 35-year-old man was referred for left anterior thigh pain and low back pain that hindered sleep. Sagittal T2-weighted magnetic resonance imaging revealed an intradural tumor at L3-L4 vertebral level. We performed osteoplastic laminectomy and en bloc tumor resection. TcMEPs were intraoperatively recorded at the bilateral abductor digiti minimi (ADM), quadriceps, tibialis anterior and abductor hallucis. When we closed a surgical incision, we were able to record normal TcMEPs in all muscles. The patient did not fully wake up from the anesthesia. He had right-sided unilateral positive ankle clonus 15 min after surgery in spite of bilateral negative of ankle clonus preoperatively. Emergent brain computed tomography scans revealed left epidural hemorrhage. The hematoma was evacuated immediately via a partial craniotomy. There was no restriction of the patient's daily activities 22 months postoperatively. We should pay attention to clinical signs such as headache and neurological findgings such as DTR and ankle clonus for patients with durotomy and cerebrospinal fluid (CSF) leakage. Spine surgeons should know that it was difficult to detect ICEH by monitoring with TcMEPs.

  18. Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

    Directory of Open Access Journals (Sweden)

    Ozlem Bilir

    2014-01-01

    Full Text Available Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

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

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2003-04-01

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

  20. Comunicación y bloqueo institucional.- El caso de Canal 13 [de Costa Rica

    Directory of Open Access Journals (Sweden)

    Lic. William Ortiz A.

    1999-01-01

    Full Text Available institución especializada en la comunicación social puede ser estudiada de muchas maneras. El abordaje que procuramos asume una perspectiva crítica y considera la institución desde el punto de vista de la relación entre un mensaje y un sujeto receptor, es decir, se trata de la relación que vincula un conjunto de programas emitidos con un público, el cual los consume en su calidad de espectador. Pero como esta relación no se materializa si no es al interior de una sociedad, interesa situar constantemente a la institución dentro de la colectividad humana de la que forma parte y, más concretamente, dentro del estado y no dentro de la sociedad civil.

  1. Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

    Directory of Open Access Journals (Sweden)

    Nathaniel H. Greene

    2015-01-01

    Full Text Available Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter. Methods. This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD on computed tomography (CT to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging. Results. There was a strong association between CT measurement and loss of resistance depth (P35 changed this relationship (P=0.007. The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individual ICCs>0.9. Conclusions. Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.

  2. Effect of intravenous versus epidural fentanyl on the minimum local analgesic concentration of epidural bupivacaine in labor.

    Science.gov (United States)

    Polley, L S; Columb, M O; Naughton, N N; Wagner, D S; Dorantes, D M; van de Ven, C J

    2000-07-01

    The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration (EC50) in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the relative local anesthetic sparing efficacies of intravenous and epidural fentanyl by comparison of their effects on the MLAC of bupivacaine. In this double-blind, randomized, prospective study, 84 parturients at < or = 7-cm cervical dilation who requested epidural analgesia were allocated to one of two groups. After lumbar epidural catheter placement, 20 ml bupivacaine (n = 44) or bupivacaine with 3 microg/ml (60 microg) fentanyl (n = 40) was administered. The plain bupivacaine group then received 60 microg intravenous fentanyl. The bupivacaine-fentanyl group received intravenous saline. The concentration of bupivacaine was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores, with < or = 10 mm within 30 min define as effective. The MLAC of bupivacaine-intravenous fentanyl was 0.064% wt/vol (95% confidence interval, 0.049-0.080), and the MLAC of bupivacaine-epidural fentanyl was 0.034% wt/vol (95% confidence interval, 0.017-0.050). Epidural fentanyl significantly increased the analgesic potency of bupivacaine by a factor of 1.88 (95% confidence interval, 1.09-3.67) compared with intravenous fentanyl. The epidural fentanyl group demonstrated significantly higher dermatomal spread (P = 0.0064) and increased pruritus (P = 0. 01). Epidural fentanyl significantly reduced the MLAC of bupivacaine when compared with intravenous fentanyl for the parturients in this study. The significantly enhanced local anesthetic sparing, dermatomal level, and pruritus with epidural fentanyl suggest a primarily spinal site of action.

  3. Continuous positive airway pressure breathing increases the spread of sensory blockade after low-thoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Gielen, M.J.M.; Giele, J.L.P.

    2006-01-01

    Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the

  4. An epidural hematoma in an adolescent patient after cardiac surgery.

    Science.gov (United States)

    Rosen, David A; Hawkinberry, Denzil W; Rosen, Kathleen R; Gustafson, Robert A; Hogg, Jeffery P; Broadman, Lynn M

    2004-04-01

    An 18-yr-old patient had a thoracic epidural placed under general anesthesia preceding an uneventful aortic valve replacement with a bioprosthetic valve. On the second postoperative day, he was anticoagulated and also received an antithrombotic medication. While ambulating, he experienced pain in his back, and there was blood in his epidural catheter. The catheter was removed, and he developed motor and sensory loss. Rapid surgical decompression resulted in recovery of his lost neurological function. Management and strategies for preventing this problem are discussed. Epidural hematoma is a rare complication of epidural anesthesia and has not been reported in pediatric patients undergoing cardiac surgery. The successful treatment of this complication requires swift recognition, diagnosis, and surgical intervention.

  5. Lower Back Tattoo: OK to Have an Epidural?

    Science.gov (United States)

    ... and delivery, postpartum care Could a lower back tattoo keep me from having an epidural during labor? ... Yvonne Butler Tobah, M.D. A lower back tattoo won't necessarily prevent you from having an ...

  6. 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.

  7. Epidural haematoma: pathophysiological significance of extravasation and arteriovenous shunting

    International Nuclear Information System (INIS)

    Habash, A.H.; Sortland, O.; Zwetnow, N.N.

    1982-01-01

    35 patients with epidural bleeding operated on at Rikshospitalet, Oslo, during the period 1965 - 1980 had preoperative angiography with visualization of the external carotid artery. Twenty-one patients had extravasation of contrast medium from meningeal arteries. Seventeen of the 21 had also shunting of contrast medium from meningeal arteries to meningeal or diploic veins, while 20 of the 21 also had bled from a ruptured meningeal artery at operation. It was further found that of 20 patients who deteriorated after trauma 18 had an epidural arteriovenous shunt or extravasation. Conversely, of 15 patients who improved after trauma 12 had no evidence of a shunt. The strong correlation between the clinical course and the occurrence of extravasation supports previous experimental and clinical data, indicating the epidural arteriovenous shunt to be a major factor in the pathophysiology and the outcome of epidural bleeding. (author)

  8. Metastatic thymoma presenting as spontaneous epidural lumbar haematoma.

    Science.gov (United States)

    Shivapathasundram, Ganeshwaran; Sammons, Vanessa; Bazina, Renata

    2016-05-01

    We report the case of a 44-year-old man who was found to have metastatic thymoma to his lumbar spine presenting as a spontaneous epidural haematoma. The man presented with back pain and cauda equina like symptoms in the absence of trauma, antiplatelet or anticoagulant agents. Following a laminectomy and excision of the epidural collection he made a full neurological recovery. Histopathology of the haematoma demonstrated metastatic thymoma. To the best of our knowledge, this is the first such case of metastatic thymoma to the lumbar spine presenting as a spontaneous epidural collection. We believe, in all patients with spontaneous spinal epidural haematoma and a background of malignancy, histopathological analysis should be sought.

  9. Systemic and neurotoxic effects of epidural meloxicam in rabbits

    Directory of Open Access Journals (Sweden)

    Gracineide da Costa Felipe

    Full Text Available ABSTRACT: The aim of this study was to assess systemic and neurotoxic changes following an epidural administration of meloxicamin to rabbits. Twelve adult rabbits four males and eight females; average mass, 1.9 ± 0.1kg were randomly divided into two groups: a control group (GC, which received a single dose of 0.9% NaCl epidurally in a volume of 0.3mL kg-1and a meloxicam group (GM, which received 0.2mg kg-1 meloxicam epidurally along with 0.9% NaCl in a total volume of 0.3mL kg-1. Heart rate, respiratory rate, body temperature, and neurological abnormalities were assessed prior to administration of anesthesia (H0, 1, 2, 3, 6, 12, and 24h following epidural puncture (H1, H2, H3, H6, H12, and H24, respectively, and every 24h afterward for 10 days after epidural puncture (D2, D3, D4, D5, D6, D7, D8, D9, and D10. The surface temperature of lumbosacral region was also measured at H0, H1, H6, H12, H24, D5 and D10. Three animals from each group were euthanized on days 15 and 30 after epidural puncture to assess possible spinal injuries. Variances observed in physiological parameters were not suggestive of adverse effects of meloxicam, as all were within the reference standards, and there were no physical or behavioral changes observed. Neurological function was similar between groups, with only difference between baseline values and values 1h after epidural administration in both groups. There were no histopathological changes in the GM group, and only one animal showed discrete lymphocytic infiltrate. Epidural lumbosacral administration of meloxicam at a dose of 0.2mg kg-1 caused no significant systemic or neurotoxic effects in rabbits.

  10. Sciatica caused by a dilated epidural vein: MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P.; Petre, C.; Wilms, G. [Dept. of Radiology, Catholic University of Leuven (Belgium); Plets, C. [Dept. of Neurosurgery, Catholic University of Leuven (Belgium)

    1999-02-01

    We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now. (orig.) (orig.) With 1 fig., 4 refs.

  11. Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Christine Vien

    2016-01-01

    Full Text Available Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

  12. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases : a review of the literature and a comparison with operative cases

    NARCIS (Netherlands)

    Groen, R J M

    OBJECTIVE: To identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH). METHODS: The literature was reviewed regarding non-operative cases of SSEH (SSEH(cons)). Sixty-two cases from the literature and 2 of our own cases were collected,

  13. 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.

  14. 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.

  15. Primary epidural lymphoma without vertebral involvement in a HIV-positive patient; Linfoma epidural primario sin afectacion vertebral en un paciente VIH positivo

    Energy Technology Data Exchange (ETDEWEB)

    Perez, M. O.; Grive, E.; Quiroga, S.; Rovira, A. [Hospital General Universitari Vall d`Hebron. Barcelona. (Spain)

    1999-05-01

    Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin`s lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs.

  16. A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

    Directory of Open Access Journals (Sweden)

    Joana Nunes

    Full Text Available Abstract Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB compared to continuous epidural infusion (CEI leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 µg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2 µg/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus; B - Ropivacaine 0.1% plus Sufentanil 0.2 µg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37. The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83. We found a higher caesarean delivery rate in group A (56.7%; p = 0.02. No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes.

  17. A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia.

    Science.gov (United States)

    Nunes, Joana; Nunes, Sara; Veiga, Mariano; Cortez, Mara; Seifert, Isabel

    2016-01-01

    There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10mL with Ropivacaine 0.16% plus Sufentanil 10μg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2μg/mL solution as continuous epidural infusion (5mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2μg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10mL/h starting 60min after the initial bolus. Rescue boluses of 5mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. We analyzed 130 pregnants (A=60; B=33; C=37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p=0.83). We found a higher caesarean delivery rate in group A (56.7%; p=0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  18. 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

  19. Relación entre daño mitocondrial y producción de H2O2 en embriones bovinos producidos in vitro con alto y bajo potencial de desarrollo

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    Marlene Jiménez

    2001-04-01

    Full Text Available

    Los embriones producidos in vitro (EPIV presentan bloqueo en el
    desarrollo en el momento de la activación del genoma (8-16 células en bovinos, limitando la producción de blastocitos (35%. Este fenómeno ha sido relacionado con la producción de Especies Reactivas de Oxígeno (ERO. Entre las fuentes de ERO se han descrito altas tensiones de oxígeno, exposición a la luz y alteración del metabolismo oxidativo (1. Los EPIV con baja competencia para superar el bloqueo presentan fallas en la funcionalidad mitocondrial (1 y nucleolar, exhibiendo un retardo en su tasa de clivaje (2. Algunos autores han relacionado el tiempo al primer clivaje con la cantidad relativa de ciertos
    transcriptos, como Glutatión (2, un limpiador de ERO, sugiriendo que los embriones incompetentes presentan fallas  transcripcionales que les impiden defenderse contra las ERO producidas en cultivo, quizás manteniendo niveles elevados de H2O2 lo que los hace más susceptibles al daño celular.
    Hasta el presente no se ha efectuado un estudio de cinética de producción de ERO, en EPIV bovinos con alta y baja competencia durante el desarrollo temprano, ni se ha logrado esclarecer el papel de la mitocondria en la generación de ERO (como fuente o como blanco.
    Los objetivos de este estudio son determinar la cinética de producción de H2O2 en embriones con alta y baja competencia para superar el bloqueo y la relación de éstos con procesos de daño mitocondrial y mortalidad embrionaria.

     

     

  20. Operative treatment of spontaneous spinal epidural hematomas : a study of the factors determining postoperative outcome

    NARCIS (Netherlands)

    Groen, R J; van Alphen, H A

    OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was

  1. [Epidural obstetric analgesia, maternal fever and neonatal wellness parameters].

    Science.gov (United States)

    Fernández-Guisasola, J; Delgado Arnáiz, C; Rodríguez Caravaca, G; Serrano Rodríguez, M L; García del Valle, S; Gómez-Arnau, J I

    2005-04-01

    To study the relation between epidural analgesia and the development of maternal fever during labor and childbirth, and to determine the possible relation between that association and neonatal welfare and in the performance of tests to rule out sepsis in newborns. Prospective study of all women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered epidural analgesia based on infusion of 0.0625% bupivacaine and 2 microg x mL(-1). Data collected were age, nulliparity, epidural analgesia infusion, induction of labor, uterine stimulation with oxytocin, type of birth, fetal weight, duration of dilation and expulsion, Apgar score (at 1 and 5 minutes), umbilical artery pH, and maternal temperature. Data for 4364 women were analyzed. Fever developed during labor in 5.7%; 93.7% of the fevers occurred in women receiving epidural analgesia (P<0.05). Logistic regression analysis revealed that independent risk factors for the development of fever were epidural analgesia (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.05-3.04), nulliparity (OR, 2,929; 95% CI, 2.005-4.279), fetal weight (OR, 1.484; 95% CI, 1.102-2.001), and duration of labor (OR, 1.003; 95% CI, 1.003-1.004). No significant differences in Apgar score at 5 minutes or umbilical artery pH were found between the women with and without fever. Tests to rule out sepsis were ordered for 85.1% of the infants of mothers with fever after epidural analgesia. Epidural analgesia was associated with greater risk of developing fever in mothers giving birth, but that association had no repercussion on the neonatal wellness parameters studied.

  2. Acute cervical epidural hematoma: case report Hematoma epidural cervical agudo: relato de caso

    Directory of Open Access Journals (Sweden)

    GUILHERME BORGES

    2000-09-01

    Full Text Available A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.Paciente de 74 anos acordou à noite sentindo fortes dores na região da nuca acompanhadas de ansiedade e desconforto torácico e respiratório. A internação emergencial em clinica cardiológica não demonstrou problemas cardíacos. Com a progressão do quadro neurológico traduzida por quadriplegia severa foi realizada uma punção lombar para afastar hipótese de meningite, sendo retirados cerca de 20 ml de liquor. Trinta minutos imediatamente após a punção lombar foi observada completa remissão do déficit neurológico. Transferido para um hospital geral a tomografia computadorizada demonstrou extenso hematoma epidural espinal em nivel C4/C5 com extensão a C7/Th1, bem como hemangioma do sexto corpo vertebral (C6. A ressonância magnética demonstrou as mesmas lesões. Observando

  3. Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model

    OpenAIRE

    Sae-Jung, Surachai; Jirarattanaphochai, Kitti; Sumananont, Chat; Wittayapairoj, Kriangkrai; Sukhonthamarn, Kamolsak

    2015-01-01

    Study Design Agreement study. Purpose To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model. Overview of Literature Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validate...

  4. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    International Nuclear Information System (INIS)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C.; Pifferi, M.; Baldini, G.

    1997-01-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.)

  5. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    Energy Technology Data Exchange (ETDEWEB)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C. [Department of Radiology, University of Pisa, Via Roma 67, I-56 100 Pisa (Italy); Pifferi, M.; Baldini, G. [Department of Pediatrics, University of Pisa, Pisa (Italy)

    1997-12-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.) With 2 figs., 9 refs.

  6. [Reaction of spinal epidural venous plexuses of the spinal canal in low back spinal discopathy].

    Science.gov (United States)

    Gongal'skiĭ, V V; Prokopovich, E V

    2002-01-01

    Clinical ultrasonic investigations have shown dependence of blood-stream in spinal epidural venous plexuses on the character of low back spinal diskopathy. The leading starting factor of epiduritis is a disk protrusion or large size hernia. Epiduritis in disscopathy can run a chronic course, become a cause of (or complicate) development of vertebral neurological reflex or compression syndromes. One of acceptable diagnostic methods for local epiduritis is an ultrasonic technique which is a valuable adjunct to clinical studies.

  7. Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína Comparación entre tres técnicas regionales de analgesia postoperatoria en niños con ropivacaina Comparison among three techniques of postoperative regional analgesia with ropivacaine in children

    Directory of Open Access Journals (Sweden)

    Ana Maria Menezes Caetano

    2006-12-01

    ropivacaína para la analgesia postoperatoria en niños. MÉTODO: Se estudiaron 87 niños del sexo masculino, con edad entre 1 y 5 años, sometidos a herniorrafias inguinales electivas unilaterales. Los niños recibieron aleatoriamente la PS, el BIHII o la IFO. Se investigó la necesidad de analgésico en el postoperatorio, el tiempo necesario para su primera dosis, la intensidad de dolor y el grado de bloqueo motor. RESULTADOS: En el grupo de la IFO se observó una mayor necesidad de analgésicos, y una mayor intensidad de dolor en las 1ª y 2ª horas, cuando se comparó con la PS y el BIHII. Apenas niños sometidos a PS presentaron bloqueo motor de grado moderado. El tiempo promedio de la necesidad de la primera dosis de analgésico fue similar entre los grupos. CONCLUSIONES: El BIHII presentó una superioridad sobre la IFO, especialmente en las primeras dos horas del postoperatorio. As tres técnicas anestésicas pueden ser utilizadas con seguridad y eficacia en el control de dolor postoperatorio de herniorrafia inguinal en niños.BACKGROUND AND OBJECTIVES: Postoperative pain increases cost and generates dissatisfaction among parents regarding to the analgesics prescribed to their children. Ropivacaine has a broad safety margin to be used for regional block in pediatric patients. The aim of this study was to compare caudal epidural block (CE with ilioinguinal/iliohypogastric nerve block (IINB and infiltration of surgical wound (ISW with ropivacaine for postoperative analgesia in children. METHODS: Eighty-seven children, all males, ages 1 to 5, who underwent elective unilateral inguinal herniorrhaphy participated in this study. Children were randomly assigned to receive CE, IINB, or ISW. The need for postoperative analgesia, length of time until the first dose, severity of pain, and degree of the motor blockade were evaluated. RESULTS: The need for analgesia and pain severity in the first two hours were greater for the ISW Group when compared with the CE and IINB Groups

  8. OUR EXPERIENCE WITH EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Uršula Reš Muravec

    2003-12-01

    Full Text Available Background. To evaluate the effects of regional labour analgesia used at the Hospital for Gynecology and Obstetrics in Postojna, Slovenia, in the year 2002.Patients and methods. In this retrospective study we enrolled 294 parturients who delivered in the year 2002 in the Postojna Maternity Hospital: in group 1 there were 147 parturients in whom three different regional analgesic techniques (study group were used at labour; in group 2 there were 147 parturients in whom regional analgesia was not used (control group. In the first step the two groups were compared in terms of maternal demographic data, duration and outcome of labour and 1' and 5' Apgar scores. In the second step the three regional analgesic groups were compared in terms of the course and outcome of labour, fetal condition, side and adverse effects of regional analgesic techniques, and patient satisfaction with a particular analgesic technique.Results. Regional labour analgesia was used in 147 (14% of the 1048 women who delivered in 2002: epidural analgesia (EPI was performed in 51.0%, combined spinal-epidural (CSE in 42.2% and spinal analgesia (SA in 6.8% of cases. The women in the regional analgesia group were significantly older, more educated, more often nulliparous and accompanied by their partner at labour than the women in the control group. Further, the duration of labour was significantly longer, oxytocin more frequently administered than in the control group. In terms of labour outcome there were no differences in the Cesarean section rates and 1- and 5-min Apgar scores minutes, but and the vacuum extraction rate was significantly higher in the regional analgesia group. Among the three regional analgesia techniques used, there were no statistically significant differences observed in terms of labour duration and outcome, and Apgar scores. The patient satisfaction was greatest with CSE. Adverse side effects such as weak muscles, reduced motion abilities, itching, nausea

  9. EPIDURAL LABOUR ANALGESIA IN IZOLA GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sabina Verem

    2018-02-01

    Full Text Available Background. The study presents the experience with epidural analgesia (EPA for pain relief in Izola General Hospital from 2003 to 2006, the differences of labour between epidural analgesia and without it and the parturients’ satisfaction. Methods. A retrospective observational study was performed. Data were compared between 214 parturients with EPA matched by 214 parturients without. The control parturient was the equiipara with a term birth and the cephalic presentation of fetus that delivered just before the parturient of the EPA group. Maternal age, labor length, rate of oxitocin use, instrumental deliveries and cesarean sections, Apgar scores and birthweights were compared. The questionnaire was used to estimate the pain in 62 parturients. Results. In GH Izola in 214 parturients (10 % EPA was applied for labour pain relief in the period from July 2003 till December 2006. In the EPA group there was a statistically significance compared with the control group: higher parturients’ mean age (30.5 vs 28.7 y.o.; p < 0.0005, longer labour length (278 vs 222 min; p < 0.0005, higher oxitocin use rate (93.4 % vs 72.9 %; p < 0.0001 and higher instrumental delivery rate (vacuum extraction 14 % vs 1.9 %; p < 0.0001. The cesarean section rates were equal in both groups. Despite the higher instrumental delivery rate and the longer labour length in the EPA group there were no worse perinatal outcomes, neither was statisticaly significant difference in Apgar scores compared with the control group. The mean intensity of pain was highest before the EPA application (VAS 7, lowest during the transition stage (VAS 1.5 and some higher during the second phase (VAS 2.7. Most of parturients in the EPA group were satisfied; 92 % of them evaluated the EPA as good or very good. Conclusions. EPA is a very effective method for pain control during labor. The parturients’ satisfaction with this pain control method is appropriate. Despite the higher instrumental

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

    NARCIS (Netherlands)

    Simon, Mischa J.G.

    2006-01-01

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

  11. Inadvertent epidural injection of drugs for intravenous use. A review.

    Science.gov (United States)

    Beckers, A; Verelst, P; van Zundert, A

    2012-01-01

    The frequency of inadvertent injection of drugs in the epidural space is probably underestimated and underreported, but it can cause serious morbidity and possibly mortality. The aim of this review is to collate reported incidents of this type, to describe the potential mechanisms of occurrence and to identify possible therapeutic solutions. We searched into medical databases and reviewed reference lists of papers retrieved. A list is reported of more than 50 drugs that were inadvertently injected into the epidural space. This list includes drugs which produce no, little or short-lasting neurological deficits, but also includes drugs that may be more etching and can result in temporary or even permanent neurological deficit. Most drugs do not lead to sequelae other than pain during injection or transient neurological complaints. Other drugs may have more deleterious consequences, such as paraplegia. Both the dose of the inadvertent injected drug and the time frame play an important role in the patient's outcome. "Syringe swap", "ampoule error", and epidural/intravenous line confusion due to inaccurate or absent colour coding of epidural catheters were the main sources of error. Preventive strategies, including non Luer-lock epidural injection ports, might increase safety.

  12. Bilateral asynchronous acute epidural hematoma : a case report

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    Ghodsi Mohammad

    2003-12-01

    Full Text Available Abstract Background Bilateral extradural hematomas have only rarely been reported in the literature. Even rarer are cases where the hematomas develop sequentially, one after removal of the other. Among 187 cases of operated epidural hematomas during past 4 years in our hospital, we found one case of sequentially developed bilateral epidural hematoma. Case Presentation An 18-year-old conscious male worker was admitted to our hospital after a fall. After deterioration of his consciousness, an emergency brain CT scan showed a right temporoparietal epidural hematoma. The hematoma was evacuated, but the patient did not improve afterwards. Another CT scan showed contralateral epidural hematoma and the patient was reoperated. Postoperatively, the patient recovered completely. Conclusions This case underlines the need for monitoring after an operation for an epidural hematoma and the need for repeat brain CT scans if the patient does not recover quickly after removal of the hematoma, especially if the first CT scan has been done less than 6 hours after the trauma. Intraoperative brain swelling can be considered as a clue for the development of contralateral hematoma.

  13. Epidural block and neostigmine cause anastomosis leak

    Directory of Open Access Journals (Sweden)

    Ataro G

    2016-05-01

    Full Text Available Getu Ataro Department of Anesthesia, Jimma University, Jimma, EthiopiaI read the article by Phillips entitled, “Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions”, published in the journal of Open Access Surgery with enthusiasm and found it crucial for perioperative management of patients with gastrointestinal (GI surgery, particularly anastomosis. I appreciate the author’s exhaustive search of literature and discussion with some limitation on review basics like methodology, which may affect the reliability of the review findings. The effects of risk factors for anastomosis leak, such as malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique, were well discussed.1 However, from anesthesia perspective, there are some other well-studied risk factors that can affect healing of anastomosis wound and cause anastomosis leak. Among others, the effect of neostigmine and epidural block has been reported in many studies since half a century ago. View the original paper by Phillips

  14. [Postraumatic epidural arachnoid spinal cyst: case report].

    Science.gov (United States)

    Hernández-León, O; Pérez-Nogueira, F R; Corrales, N

    2011-06-01

    Extradural arachnoid spinal cysts are unfrequent lesions that are associated with spinal trauma, surgery and less frequently with congenital anomalies. The clinical manifestations are similar to those seen with other compressive spinal cord lesions. Magnetic resonance techniques allow to diagnose correctly this pathology and to define its thopographic situation. The pathologic history of the patient is essencial to establish the ethiology. Surgery is the elective treatment in most cases. The patient is a 35 years old man who has a medical history of penetrating spinal trauma two years ago. In that instance he suffered an unilateral spinal cord section at D2-D3 level with the corresponding Brown Sequard syndrome. A small wound was detected at the skin dorsal level and it was closed without difficulties. At the beginning, he improved his motor right leg function with rehabilitation and vitamins. After two years of good recovery he came to our hospital suffering a neurological deterioration of six months of evolution. The physical examination revealed an spastic paraparesis. Magnetic resonance was performed demonstrating a cystic extradural collection compressing the spinal cord at D3-D4 level. Surgical decompressive treatment allowed to excise the cyst and it was possible to define a dural tear that was closed successfully. The outcome was good with restoration of the initial motor function that he had after the spinal trauma. Surgical management of postraumatic epidural arachnoid spinal cyst allows to detect the meningeal tear and to close it, which is highly effective on these kinds of lesions.

  15. Nontraumatic spinal epidural hematomas. MR features

    International Nuclear Information System (INIS)

    Loevblad, K.O.; Baumgartner, R.W.; Zambaz, B.D.; Remonda, L.; Ozdoba, C.; Schroth, G.

    1997-01-01

    Purpose: Spinal epidural hematoma (SEH) is a rare clinical entity with a bleak outcome. The aim of our study was to establish the value of MR findings in the diagnosis of nontraumatic SEH. Material and Methods: Seven patients with nontraumatic SEH were examined by MR at 1.5 T. Two patients were under anticoagulation therapy with heparin, and 2 others were taking salicylic acid. One patient had lupus erythematodes with a marked thrombocytopenia. One patient had a spinal arteriovenous malformation. Results: MR imaging permitted the accurate localization of extradural intraspinal expansive lesions which exhibited the characteristic signal intensities of blood. Five patients underwent laminectomy and evacuation of the hematoma. In the acute phase, the hematomas appeared isointense when compared with the spinal cord on T1-weighted images and hyperintense on T2-weighted images. Later the hematomas were hyperintense on T1-weighted images and showed signals identical to those of cerebrospinal fluid (CSF) on T2-weighted images. Conclusion: MR imaging established the exact diagnosis and localization of SEH in all cases. MR also can provide useful information about the age of the hematomas. (orig.)

  16. Tumor cardiaco en un paciente de mediana edad con enfermedad coronaria - una rara asociación

    Directory of Open Access Journals (Sweden)

    Ricardo P Silva

    2013-08-01

    Full Text Available Se describe una rara asociación de tumor cardíaco y enfermedad coronaria. Un varón de 42 años de edad fue admitido con queja de disnea. El electrocardiograma mostró ritmo sinusal, bloqueo de rama derecha y repolarización anormal de la pared ventricular anterior. El ecocardiograma mostró una estructura con ecogenicidad aumentada dentro de la aurícula izquierda, compatible con tumor cardíaco. El paciente fue enviado a cirugía; se estabilizó y fue dado de alta en el cuarto día post-operatorio sin complicaciones y sin síntomas.

  17. Tumor cardiaco en un paciente de mediana edad con enfermedad coronaria – una rara asociación

    Directory of Open Access Journals (Sweden)

    Ricardo P. Silva, MD., PhD.

    2013-07-01

    Full Text Available Se describe una rara asociación de tumor cardíaco y enfermedad coronaria. Un varón de 42 años de edad fue admitido con queja de disnea. El electrocardiograma mostró ritmo sinusal, bloqueo de rama derecha y repolarización anormal de la pared ventricular anterior. El ecocardiograma mostró una estructura con ecogenicidad aumentada dentro de la aurícula izquierda, compatible con tumor cardíaco. El paciente fue enviado a cirugía; se estabilizó y fue dado de alta en el cuarto día post-operatorio sin complicaciones y sin síntomas.

  18. Effect of programmed intermittent epidural boluses and continuous epidural infusion on labor analgesia and obstetric outcomes: a randomized controlled trial.

    Science.gov (United States)

    Ferrer, Leopoldo E; Romero, David J; Vásquez, Oscar I; Matute, Ednna C; Van de Velde, Marc

    2017-11-01

    Continuous epidural infusion and programmed intermittent epidural boluses are analgesic techniques routinely used for pain relief in laboring women. We aimed to assess both techniques and compare them with respect to labor analgesia and obstetric outcomes. After Institutional Review Board approval, 132 laboring women aged between 18 and 45 years were randomized to epidural analgesia of 10 mL of a mixture of 0.1% bupivacaine plus 2 µg/mL of fentanyl either by programmed intermittent boluses or continuous infusion (66 per group). Primary outcome was quality of analgesia. Secondary outcomes were duration of labor, total drug dose used, maternal satisfaction, sensory level, motor block level, presence of unilateral motor block, hemodynamics, side effects, mode of delivery, and newborn outcome. Patients in the programmed intermittent epidural boluses group received statistically less drug dose than those with continuous epidural infusion (24.9 vs 34.4 mL bupivacaine; P = 0.01). There was no difference between groups regarding pain control, characteristics of block, hemodynamics, side effects, and Apgar scores. Our study evidenced a lower anesthetic consumption in the programmed intermittent boluses group with similar labor analgesic control, and obstetric and newborn outcomes in both groups.

  19. [History of rachianesthesia and epidural anesthesia in Spain].

    Science.gov (United States)

    Gonzalo Rodríguez, Victoria; Rivero Martínez, Ma Dolores; Pérez Albacete, Mariano; López López, Ana I; Maluff Torres, Alejandro

    2007-10-01

    To show the beginning of spinal and epidural anesthesia in our country and the contributions of Spanish urologists. We reviewed books and writings of History of Medicine, Urology and Anesthesia and Doctoral thesis about spinal and epidural anesthesia. In the 20th century, surgeons also gave the anesthetic drugs to the patients. Spinal and epidural anesthesia were used for the first time in 1900. A lot of Spanish urologists like F Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V Sagarra Lascurain, Gómez Ulla, etc, did research, writings in scientific journals and Doctoral thesis about anesthesia.

  20. Primary epidural lymphoma without vertebral involvement in a HIV-positive patient

    International Nuclear Information System (INIS)

    Perez, M. O.; Grive, E.; Quiroga, S.; Rovira, A.

    1999-01-01

    Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin's lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs

  1. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...... of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our...

  2. Sickle cell disease with orbital infarction and epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Naran, A.D.; Fontana, L. [Dept. of Diagnostic Radiology, New York Methodist Hospital, Brooklyn, NY (United States)

    2001-04-01

    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  3. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    Energy Technology Data Exchange (ETDEWEB)

    Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)

    2001-07-01

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  4. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    International Nuclear Information System (INIS)

    Zizka, J.; Elias, P.; Michl, A.; Harrer, J.; Cesak, T.; Herman, A.

    2001-01-01

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  5. Sickle cell disease with orbital infarction and epidural hematoma

    International Nuclear Information System (INIS)

    Naran, A.D.; Fontana, L.

    2001-01-01

    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  6. Anestesia para cesariana em gestante com hipoplasia de aorta distal: relato de caso Anestesia para cesárea en embarazada con hipoplasia de aorta distal: relato de caso Anesthesia for cesarean section on a pregnant woman with hypoplasia of the distal aorta: case report

    Directory of Open Access Journals (Sweden)

    Leonardo de Andrade Reis

    2008-02-01

    ésico adequado à realização do ato cirúrgico.JUSTIFICATIVA Y OBJETIVOS: Anomalías vasculares maternas, potencialmente graves para el feto, pueden colocar en riesgo la perfusión uterina, suscitando cuidados mucho más puntuales por parte del equipo anestésico. El objetivo de este relato fue mostrar la conducta anestésica para operación en cesárea en una embarazada con hipoplasia de aorta distal, bien debajo de la emergencia de las arterias renales, con estenosis de la arteria renal y falta de arterias ilíacas. RELATO DEL CASO: Paciente de 30 años, 54 kg, en el 2° embarazo con una cesárea anterior sin intercurrencias. Durante la realización de ecografía de gestación en la 12ª semana se observó una interrupción de la aorta bien debajo de la salida de las arterias renales. A la paciente se le realizó cineangiocoronariografía que mostró hipoplasia de la aorta distal por debajo de las arterias renales, con ausencia de las arterias ilíacas. Durante la investigación clínica la paciente se mostró asintomática, con excepción de hipertensión arterial y claudicación a los grandes esfuerzos. La paciente fue sometida a la anestesia peridural continua, con titulación de la dosis anestésica necesaria para la realización de la cesárea. Inicialmente se inyectaron 50 mg de bupivacaína a 0,5% sin vasoconstrictor y 10 µg de sufentanil. Quince minutos después, la anestesia fue complementada con 25 mg más de bupivacaína a 0,5%, lo que fue suficiente para alcanzar un adecuado nivel de bloqueo. La cesárea transcurrió sin intercurrencias y el niño nació en buenas condiciones clínicas. CONCLUSIONES: El uso de anestesia peridural continua con dosis fraccionadas demostró ser una técnica anestésica segura para la realización de este procedimiento por reducir los riesgos de hipotensión arterial materna inherente al bloqueo espinal y también por minimizar la transferencia placentaria de fármacos que ocurren cuando se usa la anestesia general. La titulaci

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

    Directory of Open Access Journals (Sweden)

    Shubhra Goel

    2011-01-01

    Full Text Available This is a rare case of persistent Horner′s syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI/magnetic resonance angiography (MRA of head, neck, and chest were unremarkable. Medline search using terms Horner′s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner′s syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner′s syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner′s syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  8. Bloqueio bilateral do nervo pudendo para hemorroidectomia em paciente acondroplásico: relato de caso Bloqueo bilateral del nervio pudendo para hemorroidectomía en paciente acondroplásico: relato de caso Bilateral blockade of the pudend nerve to hemorrhoidectomy in achondroplasic patient: case report

    Directory of Open Access Journals (Sweden)

    Bruno Salomé de Morais

    2006-04-01

    ética espontánea. La anestesia de esos pacientes presenta varias particularidades. El objetivo del presente relato fue el de describir un caso de paciente acondroplásico, con previo historial de intervención quirúrgica de la columna para descompresión medular, sometido a Hemorroidectomía a través de bloqueo bilateral de los nervios pudendos. RELATO DEL CASO: Paciente del sexo masculino, 47 años, acondroplásico, que fue ingresado para la realización de hemorroidectomía.Al hacérsele el examen físico presentaba el cuello acortado con extensión limitada de la cabeza, Mallampati clase IV, distancia tireomentoniana de 6 cm y abertura de la boca de 3,5 cm. La columna vertebral presentaba cifosis torácica y lordosis lumbar acentuada, además de cicatriz quirúrgica en la región lumbar. Fue realizado el bloqueo bilateral de los nervios pudendos con ropivacaina a 1%, por vía transperineal, con una aguja aislada de 0,8 mm x 100 mm 21G (Stimuplex A100 BBraun, Melsungen, Germany conectada al estimulador de nervios periféricos (Stimuplex-DIG, BBraun.El paciente fue colocado en decúbito ventral y la cirugía iniciada después de 15 minutos da administración del anestésico. Durante todo el procedimiento, el paciente permaneció consciente y no relató ningún dolor o incomodidad. Hasta el momento del alta hospitalaria (22h después de la realización del bloqueo, el paciente no refirió dolor, incomodidad, náusea, vómito, bloqueo motor, retención o incontinencia urinaria. Después del alta, evolucionó bien presentando evacuación después de 31 horas de efectuada la cirugía. CONCLUSIONES: El caso mostró el uso del bloqueo bilateral de los nervios pudendos, con el auxilio del neuroestimulador como técnica anestésica aislada para la hemorroidectomía.BACKGROUND AND OBJECTIVES: The achondroplasic dwarfism or achondroplasia is the most common form of dwarfism and occurs, in most of the cases, as a result of spontaneous genetic alteration. The anesthesia in these

  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

    ólogo. El objetivo de este relato fue presentar un caso de rotura de catéter epidural en analgesia de parto. RELATO DEL CASO: Paciente del sexo femenino, 33 años, GII, PI, entró en la maternidad en trabajo de parto. Después de dos horas de evolución, la paciente solicitó analgesia. Al realizársele el examen, se encontraba en fase activa del trabajo de parto, con dilatación cervical de 5 cm, dinámica uterina regular, bolsa rota, con dolor clasificado por la Escala Visual Analógica - VAS 10. Se inicia la analgesia de parto por la técnica combinada con doble punción. Durante la evolución se hizo una complementación analgésica por catéter. En la retirada hubo una pequeña dificultad y su consiguiente rotura. Se optó entonces por la realización de una tomografía axial computadorizada y una radiografía de la región lumbar que no mostró la presencia del fragmento del catéter. Visto que la paciente evolucionó asintomática y clínicamente, y sin señales de irritación radicular, dolor o infección, se procedió a las debidas orientaciones y a su alta. CONCLUSIONES: Los catéteres epidurales en la región lumbar son a veces raros, difíciles de retirar. Los factores que pueden aumentar las chances de formación de nudos y el riesgo de rotura del catéter se relacionaron. En ese caso, uno de los principales factores involucrados fue la introducción excesiva del catéter epidural lumbar. Por suerte, las complicaciones neurológicas son todavía más raras y secundando las directrices de una tracción lenta y suave en la falta de parestesias en la mayoría de los casos, el catéter se retira con éxito.BACKGROUND AND OBJECTIVES: Breakage of epidural catheters during their removal is rare, but it has been described. The anesthesiologist should be aware of the complications and proper handling of those catheters. The objective of this report was to present a case of breakage of an epidural catheter in labor analgesia. CASE REPORT: A 33-year old female, gravida

  10. Dose de bupivacaína subaracnóidea necessária para cesariana é semelhante em mulheres obesas e com peso normal Las dosis de bupivacaína intratecal necesarias para cesáreas en mujeres obesas son similares a las usadas en mujeres con peso normal Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women

    Directory of Open Access Journals (Sweden)

    Yung Lee

    2009-12-01

    mujeres obesas y con peso normal. MÉTODO: Evaluamos embarazadas con peso normal (IMC 30 kg.m-2, con feto único a término, sometidas a cesáreas de elección. Ese fue un estudio mono ciego y de ubicación secuencial, usando el método up-down (modificado por la regla de Narayana. Todas las pacientes recibieron bloqueo combinado raquiepidural con administración intratecal de dosis variables de bupivacaína hiperbárica a 0.75% más 10 µg de fentanil y 100 µg de morfina. La primera paciente recibió 9 mg de bupivacaína. La anestesia se suplementó cuando fue necesario, a través de un catéter epidural. El éxito de la anestesia, definido como bloqueo sensitivo hasta por lo menos T6, sin necesidad de anestesia suplementaria, fue el objetivo primario. La ED95 para un resultado satisfactorio fue determinada por un modelo logístico sin transformación logarítmica de las dosis. RESULTADOS: Veinte y cuarto embarazadas con peso normal y dieciséis embarazadas obesas participaron en este estudio. La ED95 estimada para todas las pacientes fue de 12,92 mg (IC 95%: 11,49 a 34,77. La ED95 estimada para las embarazadas con peso normal y las embarazadas obesas fue similar, 12,78 mg (IC 95%: 10,75 a + infinito y 11,86 mg (CI 95%: 11,31 a 15,61, respectivamente. CONCLUSIONES: Si la anestesia raquídea con inyección única es utilizada en cesáreas, las pacientes con peso normal y obesas deben recibir dosis parecidas de bupivacaína hiperbárica. A pesar de que no fuimos capaces de determinar con exactitud la ED95 en nuestro estudio, sí que podemos afirmar que es de por lo menos 11,49 mg.BACKGROUND AND OBJECTIVES: The effect of BMI on the spread of intrathecal bupivacaine is controversial. This study assessed the ED95 of intrathecal bupivacaine for elective cesarean delivery in obese and normal weight women. METHODS: We studied normal weight (BMI 30 kg.m-2 women with singleton term pregnancies undergoing elective cesarean delivery. The study was conducted as a single blinded, up

  11. Case Report Thoracic epidural for modified radical mastectomy in a ...

    African Journals Online (AJOL)

    A 52-year-old woman was scheduled for modified radical mastectomy on ... a more risky alternative, and consent for the procedure was obtained. ... In a previous study, Balzarena documented the safety and superiority of thoracic epidural over general anaesthesia in 40 patients scheduled for mastectomy. In that study ...

  12. Post-operative analgesic effect of epidural bupivacaine alone and ...

    African Journals Online (AJOL)

    of analgesia, in addition to pain scoring using visual analogue scale (VAS) and ... have the compliant of inappeiteance and dullness at post operation. .... an induction agent. In addition, it was used as maintenance of general anaesthesia by incremental intravenous injections. Epidural analgesia. Pre operatively once the ...

  13. Effects of combined general anesthesia and thoracic epidural ...

    African Journals Online (AJOL)

    2015-11-02

    endocrine systems. Many factors such as .... operating room. A 20 G of epidural catheter was inserted under local analgesia (2 ml of 2% lidocaine) at T9–10, immediately before the induction of general anesthesia. The position of ...

  14. Graded epidural anaesthesia for Caesarean section in a parturient ...

    African Journals Online (AJOL)

    Open Access article distributed under the terms of the. Creative Commons License ... CASE REPORT. Graded epidural anaesthesia for Caesarean section in a parturient with Shone's syndrome: a case study. Anjum Naza*, Sugata Dasguptab, Bijoy Kumar Bandyopadhyayb and Hasibul Hasan Shirazeec. aDepartment of ...

  15. Serum Triamcinolone Levels following Cervical Interlaminar Epidural Injection

    Directory of Open Access Journals (Sweden)

    Tim J. Lamer

    2018-01-01

    Full Text Available Background. Cervical interlaminar epidural steroid injections (ESIs are commonly performed procedures to treat painful cervical radiculopathy, but little is known about the systemic absorption and serum levels of steroids following injection. The primary objective of this study was to investigate the pharmacokinetics of fluoroscopy-guided cervical epidural-administered triamcinolone acetonide in a cohort of patients with cervical radicular pain seeking treatment in a pain medicine clinic. Methods. The study cohort included eight patients undergoing a fluoroscopically guided C7-T1 interlaminar ESI at a pain medicine specialty clinic. Blood was collected prior to the ESI and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injection. The sample extract was analyzed by tandem mass spectrometry. Results. The terminal elimination half-life of cervical epidural-administered triamcinolone in a noncompartmental analysis was 219 hours. In the noncompartmental analysis, peak triamcinolone concentrations of 5.4 ng/mL were detected within 22.1 hours after administration. Conclusions. The pharmacokinetics of cervical epidural-administered triamcinolone is consistent with our previous study of lumbar ESI, demonstrating that the elimination half-life is longer than that which has been reported following intravenous triamcinolone. The elimination half-life was shorter following cervical ESI than that which has been reported following lumbar ESI.

  16. Epidural abscess with associated spondylodiscitis following prostatic biopsy.

    Science.gov (United States)

    Dobson, G; Cowie, C J A; Holliman, D

    2015-07-01

    Spondylodiscitis is often iatrogenic in nature. We report the case of a 69-year-old man presenting with spondylodiscitis and associated epidural abscess following transrectal ultrasonography guided prostate biopsy despite ciprofloxacin cover. To our knowledge, this is the first case of spondylodiscitis secondary to fluoroquinolone resistant Escherichia coli.

  17. Chronic spinal epidural hematoma in hemophilia A in a child

    International Nuclear Information System (INIS)

    Stanley, P.; McComb, J.G.; University of Southern California, Los Angeles

    1983-01-01

    A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery. (orig.)

  18. Combined spinal and epidural anaesthesia for an elective ...

    African Journals Online (AJOL)

    2012-02-02

    Feb 2, 2012 ... The epidural catheter was removed at the end of surgery, while the neuraxial block lasted a total of three hours and 58 minutes. Postoperatively, the patient had tramadol, piroxicam and paracetamol as per our protocol for analgesia, which was adequate. The mother had an uneventful postoperative course, ...

  19. Epidural Anaesthesia Reduces Peri-Operative Morbidity and ...

    African Journals Online (AJOL)

    Epidural Anaesthesia Reduces Peri-Operative Morbidity and Mortality in Patients With Significant Cardio-Respiratory Diseases: Report of Five Cases. ... of five patients with multiple co-morbid cardio-respiratory diseases who had surgeries in the presence of severe respiratory and cardiovascular systems compromise.

  20. Spontaneous Epidural Haematoma in Sickle Cell Anaemia: Case ...

    African Journals Online (AJOL)

    He presented to our unit with seven days history of frontal headache which was preceded by an episode of vaso-occlusive crisis necessitating admission and blood transfusion in a peripheral hospital. There was. ABSTRACT. Non traumatic spontaneous epidural Haematoma is a rare and often unmentioned complication of ...

  1. Post- operative analgesic effect of epidural bupivacaine alone and ...

    African Journals Online (AJOL)

    Ethiopian Veterinary Journal ... Haemoglobin, Packed cell volume, total erythrocyte and leukocyte counts showed a significant (p<0.05) decrease in 1 hour after surgery in both groups. ... However, further studies are needed to compare the efficacy and doses of this combination as epidural analgesic for various surgeries.

  2. Intracranial epidural hematoma in a newborn with DIC secondary to ...

    African Journals Online (AJOL)

    Epidural hematoma in newborns is rare, it occurs more frequently in infants born from nulliparous mothers with delivery difficulties. Intracranial hemorrhage in infants is usually secondary to vascular malformations, anticoagulation, inherited or acquired coagulopathy. Hematological disorders are infrequently associated with ...

  3. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

    Directory of Open Access Journals (Sweden)

    Weijun Wang

    2016-01-01

    Full Text Available Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL; postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes; no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n=1, 41–60 (n=1, and >60 (n=55; scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.

  4. Spontaneous Cervical Epidural Hematoma with Hemiparesis Mimicking Cerebral Stroke

    Directory of Open Access Journals (Sweden)

    Mehmet Tiryaki

    2014-01-01

    Full Text Available Aim. Spontaneous cervical epidural hematoma (SCEH is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INR results were 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding.

  5. Epidural versus intramuscular pethidine in postoperative pain relief ...

    African Journals Online (AJOL)

    Twenty-one patients received epidural pethidine 0,75 mg/kg in 10 ml normal saline for postoperative analgesia. A control group of 20 patients received intramuscular pethidine 1,5 mg/kg. Respiratory-and cardiovascular parilmeters in both groups were stable, and in both side-effects were similar and not serious. In the ...

  6. Surgical management of Stenson's duct injury using epidural ...

    African Journals Online (AJOL)

    Surgical management of Stenson's duct injury using epidural catheter: A novel technique. ... It is in the form of ductal exposure, laceration, total severing, or crushing of the duct. These conditions are difficult to ... Many techniques have been proposed for diagnosis and management of parotid duct injuries. This article ...

  7. Experience in the use of epidural anaesthesia | Ozoilo | Nigerian ...

    African Journals Online (AJOL)

    Background: Epidural anaesthesia is applicable for a wide range of surgical procedures and offers distinct advantages over general and spinal anaesthesia. It is however underutilised in our environment. We report a one year experience in the use of this technique. Our objective is to describe a one year experience in the ...

  8. ambulation during labor with combined spinal-epidural analgesia

    African Journals Online (AJOL)

    Adele

    risk of epidural catheter migration through the dural puncture hole; 2) the potential risk of increased drug leakage through the dural puncture hole; 3) the possibility of ... by Morgan at Queen Charlotte's Hospital in London, England. Use of the CSEA technique without the test dose for ambu- latory labor analgesia leaves the ...

  9. Epidural anaesthesia for surgery in advanced cancer | Soyannwo ...

    African Journals Online (AJOL)

    Patients with advanced cancer often present for surgery in a very poor clinical state. We report the use of epidural bupivacaine anaesthesia for surgical excision of a tumor and subsequent continuous infusion of bupivacaine and fentanyl for postoperative pain management in a 46 year old man with advanced sarcoma of the ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-01-01

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

  11. Epidural versus In postoperatIve intramuscular pain relief pethidine

    African Journals Online (AJOL)

    Bromage PR, Camparesi E, Chestnut D. Epidural narcotics for postoperati"e analgesia. Aneslh Analg (Clew) 1980; 59: 473-480. 17. Harcus AW, Smith R, Whittle B. Pain. 1st ed. Edinburgh: Churchill Living- stone, 1977: 176. 18. Wilson PR, Yaksh TL. Pharmacology of pain and analgesia. Anaeseh [mensh'e. Care 1980; 8: ...

  12. Epidural versus In postoperatIve intramuscular pain relief pethidine

    African Journals Online (AJOL)

    Twenty-one patients received epidural pethidine. 0,75 mg/kg in 10 ml normal saline for postoperative analgesia. A control group of 20 patients received intramuscular pethidine 1,5 mg/kg. Respiratory--and cardiovascular parilmeters in both groups were stable, and in both side-effects were similar and not serious. In the ...

  13. Surgical management of Stenson's duct injury using epidural catheter

    African Journals Online (AJOL)

    2012-07-05

    Jul 5, 2012 ... Successful management of parotid duct injury depends on early diagnosis and appropriate intervention, failing of ... to diagnose and manage the parotid duct injuries using an “epidural catheter” which is often used for inducing spinal anesthesia. .... Water-soluble contrast media have a definite advantage.

  14. Unintended Complication of Intracranial Subdural Hematoma after Percutaneous Epidural Neuroplasty

    OpenAIRE

    Kim, Sung Bum; Kim, Min Ki; Kim, Kee D.; Lim, Young Jin

    2014-01-01

    Percutaneous epidural neuroplasty (PEN) is a known interventional technique for the management of spinal pain. As with any procedures, PEN is associated with complications ranging from mild to more serious ones. We present a case of intracranial subdural hematoma after PEN requiring surgical evacuation. We review the relevant literature and discuss possible complications of PEN and patholophysiology of intracranial subdural hematoma after PEN.

  15. Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants.

    Science.gov (United States)

    Ross, Emma L; Reiter, Pamela D; Murphy, Michael E; Bielsky, Alan R

    2015-09-01

    To describe the use and adverse effects of chloroprocaine for epidural analgesia in young infants for infusion durations greater than 3.5 hours. A retrospective cohort review of the electronic medical record over a 14-month period. The level IV neonatal intensive care unit of a 414-bed free-standing children's hospital. Eighteen infants (mean age, 1.7 ± 1.8 months [0.03-6.3]; mean weight, 3.8 ± 1.3 kg [1.56-6.9]; n = 10 [55%] males) received 1% chloroprocaine for epidural analgesia postoperatively for up to 96-hour duration and met criteria for inclusion. Dosing requirements, placement of epidural catheter, supplementary analgesic therapy, respiratory support, vital signs, and incidence of adverse events associated with local anesthetics were collected. Epidural catheter placement was caudal (n = 8), lumbar (n = 6), or thoracic (n = 4). Mean operative time was 2.48 ± 1 hour (1-5). Initial chloroprocaine dose was 1.3 ± 0.5 mL/h (0.4-2.5) (3.5 ± 1 mg/kg per hour [1.4-5]) with a maximum dose of 1.5 ± 0.6 mL/h (0.4-3) (4.2 ± 1.1 mg/kg per hour [2.2-6.1]). Duration of epidural analgesia was 48.3 ± 21.5 hours (10-96). Duration of epidural infusion did not influence dosing requirement, suggesting the absence of drug tachyphylaxis. All patients received intermittent doses of opioid and nonopioid pain medications while receiving chloroprocaine. Two mechanically ventilated patients required continuous infusion of opioids. No adverse events were directly attributed to chloroprocaine use. Epidural 1% chloroprocaine, in doses of 0.4-3 mL/h (1.5-6.1 mg/kg per hour), was well tolerated in both mechanically ventilated and spontaneously breathing infants for up to 96 hours with no identified adverse effects or tachyphylaxis. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Estudo comparativo da eficácia analgésica pós-operatória de 20, 30 ou 40 mL de ropivacaína no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20, 30 o 40 mL de ropivacaína en el bloqueo de plexo braquial por la vía posterior A comparative study on the postoperative analgesic efficacy of 20, 30, or 40 mL of ropivacaine in posterior brachial plexus block

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2007-10-01

    fue determinar cuál volumen de anestésico local en el bloqueo de plexo braquial por la vía posterior propicia analgesia postoperatoria para esas operaciones de manera más eficiente. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por vía posterior fueron divididos aleatoriamente en tres grupos de 30. Grupo 1 - volumen de 20 mL; Grupo 2 - volumen de 30 mL; Grupo 3 - volumen de 40 mL. En todos los grupos, el anestésico usado fue la ropivacaína a 0,375%. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó secundando una escala numérica verbal (ENV en las primeras 24 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor promedio,tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. En el grupo de 20 mL hubo un mayor consumo de analgésicos no opioides después de la 12ª hora de postoperatorio. En los grupos de 30 y 40 mL la extensión del bloqueo fue significativamente mayor. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve analgesia eficaz para intervenciones quirúrgicas en el hombro. Los tres diferentes volúmenes estudiados promovieron analgesia similar. La mayor extensión del bloqueo con volúmenes mayores no se tradujo en una mejor analgesia.BACKGROUND AND OBJECTIVES: Arthroscopic surgeries of the shoulder are accompanied by severe postoperative pain. Among the analgesic techniques, brachial plexus block offers the best results. The objective of this study was to determine which volume of local anesthetic in the posterior brachial plexus block offers more adequate analgesia for those procedures. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided in three groups of 30 patients: Group 1 – volume of 20 mL; Groups 2 – volume of 30 m

  17. Human skin flora as a potential source of epidural abscess.

    Science.gov (United States)

    Sato, S; Sakuragi, T; Dan, K

    1996-12-01

    The mechanism of epidural infection associated with epidural block is not clearly understood. Resident organisms in skin specimens were studied after skin was prepared with disinfectants. Sixty-nine paired skin specimens were excised at incisional sites after skin disinfection with 10% povidone-iodine (10% PVP-I) or 0.5% chlorhexidine in 80% ethanol (0.5% CHE) from 60 patients having back surgery. One of the specimen pairs was placed in 10 ml brain-heart infusion broth and incubated in air at 37 degrees C for 96 h. The other specimen was sectioned at 3 microns and prepared with Gram's stain for examination with the microscope. Thirteen gram-positive staphylococcal species (Staphylococcus epidermidis, 69.2%; S. hyicus, 15.4%; and S. capitis, 15.4%) were isolated from cultures. The isolates were found in a significantly greater proportion of the skin specimens disinfected with 10% PVP-I than in those disinfected with 0.5% CHE (11 of 34 cultures [32.4%] vs. 2 of 35 cultures [5.7%]; P gram-positive cocci were observed with the microscope in 4 (11.8%) and 5 (14.3%) of 34 and 35 skin specimens disinfected with 10% PVP-I and 0.5% CHE, respectively. The cocci formed a dense colony in each follicle and in the stratum corneum. No organism was present in any of 17,584 sweat glands examined. In a large proportion of patients, isolation of viable organisms from excised skin specimens after disinfection with 10% PVP-I suggests that contamination of the epidural space by the skin flora may be a potential mechanism of epidural infection associated with epidural block.

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

    Directory of Open Access Journals (Sweden)

    Alyssa Kosturakis

    2015-01-01

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

  19. Retrospective study of the association between epidural analgesia during labour and complications for the newborn.

    Science.gov (United States)

    Herrera-Gómez, A; García-Martínez, O; Ramos-Torrecillas, J; De Luna-Bertos, E; Ruiz, C; Ocaña-Peinado, F M

    2015-06-01

    our objective was to determine the association between epidural analgesia and different variables. the effect on newborns of epidural analgesia administered to the mother during labour remains under debate. this association was retrospectively investigated in a cohort of 2399 children born in a Spanish public hospital. Only full-term (>37 weeks of gestation) deliveries were included. Other exclusion criteria were: induced delivery (medical or obstetric indication), elective caesarean section, or the presence of an important pregnancy risk factors (hypertension, diabetes, severe disease, toxaemia, retarded intrauterine growth, chronologically prolonged pregnancy, prolonged membrane rupture (>24 hours), oligoamnios, or polyhydramnios). The Mann-Whitney U test and Fisher׳s exact test were applied to determine the relationship between variables. Apgar index values at one minute and five minutes were slightly but significantly lower in neonates whose mothers had received epidural analgesia. Neonatal intensive care unit admission was significantly more frequent in the epidural versus non-epidural group. Resuscitation was significantly more frequent in the epidural versus non-epidural group. Early breast feeding onset was more frequent in the non-epidural group. The adverse effect of epidural analgesia on early lactation remained significant after adjusting for NICU admission and the need for resuscitation in a logistic regression analysis. Epidural analgesia may have adverse effects on newborns, although the risks are low, and further research is required to elucidate the causal nature of this relationship. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2008-12-01

    utiliza a menudo para procedimientos estéticos de la mama y existen pocos relatos de su uso en mastectomías con exploración axilar. El presente estudio comparó la técnica con anestesia general en operaciones oncológicas de la mama. MÉTODO: Cuarenta pacientes que se dividieron en dos grupos. En el grupo epidural (n = 20 se hizo una epidural torácica con bupivacaína y fentanil asociados a la sedación con midazolam. El otro grupo (n = 20, recibió anestesia general convencional con propofol, atracurio y fentanil y mantenimiento con O2 e isoflurano. En el intraoperatorio y durante la operación, se verificó la necesidad de complementación de la anestesia o de la sedación y variables hemodinámicas. En el postoperatorio fue registrado el tiempo para el alta de la sala de recuperación postanestésica y hospitalaria, la intensidad del dolor y el consumo de analgésicos, efectos adversos y la satisfacción con la técnica anestésica. RESULTADOS: Los grupos fueron similares y no hubo diferencia en la duración de la operación. Se hizo necesario complementar la sedación en un 100% de las pacientes que recibieron anestesia epidural y en un 15% fue complementada la analgesia con infiltración de anestésico local en la axila. Hubo una mayor incidencia de hipertensión arterial en el grupo de la anestesia general y de hipotensión entre las que recibieron epidural. Ocurrió prurito en un 55% de las pacientes con anestesia epidural. Náusea (30% y vómito (45%, fueron más frecuentes entre las que recibieron anestesia general. La analgesia postoperatoria tuvo una mejor calidad y el consumo de analgésicos fue menor en el grupo de la anestesia epidural. El período de internación también fue menor. CONCLUSIONES: La técnica epidural tiene algunas ventajas con relación a la anestesia general y puede ser considerada una opción para la anestesia en mastectomías oncológicas con vaciado axilar.BACKGROUND AND OBJECTIVES: Thoracic epidural block is frequently used for

  1. Bloqueio dos nervos ilioinguinal e iliohipogástrico guiado por ultra-sonografia associado à anestesia geral: relato de caso Bloqueo de los nervios íleoinguinal e íleohipogástrico guiado por ultrasonografía asociado a anestesia general: relato de caso Ultrasound-guided ileoinguinal and ileohypogastric nerve block associated with general anesthesia: case report

    Directory of Open Access Journals (Sweden)

    Diogo Brüggemann da Conceição

    2008-02-01

    herniorrafia inguinal en régimen ambulatorial. RELATO DEL CASO: Paciente del sexo masculino, 36 años, 74 kg, estado físico ASA I, listo para la realización de herniorrafia inguinal. Fue realizado el bloqueo de los nervios íleohipogástrico e íleoinguinal guiado por ultrasonografía con ropivacaína a 0,5% y enseguida fue realizada anestesia venosa total. El paciente tuvo alta 4 horas después del procedimiento con puntuación de dolor evaluado por la Escala Analógica Verbal de 3. CONCLUSIONES: El bloqueo de los nervios íleohipogástrico e íleoinguinal guiados por ultrasonografía en pacientes sometidos a herniorrafia inguinal en régimen ambulatorial, puede ser utilizado en el auxilio del control del dolor postoperatorio.BACKGROUND AND OBJECTIVES: Outpatient surgeries are becoming more frequent. Ilioinguinal and iliohypogastric nerve block has been used in postoperative analgesia of patients undergoing outpatient inguinal herniorrhaphy. Ultrasound-guided regional anesthesia increases the accuracy of deposition of the local anesthetic around the nerves. The objective of this report was to present a case of ultrasound-guided ilioinguinal and iliohypogastric nerve block for outpatient inguinal herniorrhaphy. CASE REPORT: A 36-year old male patient, 74 kg, physical status ASA I, was scheduled for inguinal herniorrhaphy. Ultrasound-guided iliohypogastric and ilioinguinal nerve block was accomplished with 0.5% ropivacaine, followed by total intravenous anesthesia. The patient was discharged from the hospital 4 hours after the procedure with a pain score of 3 in the Verbal Analogue Scale. CONCLUSION: Ultrasound-guided iliohypogastric and ilioinguinal nerve block in patients undergoing outpatient inguinal herniorrhaphy can be done as an aid to postoperative analgesia.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-01-01

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

  3. Efficacy of epidural neuroplasty versus transforaminal epidural steroid injection for the radiating pain caused by a herniated lumbar disc.

    Science.gov (United States)

    Kim, Hae Jong; Rim, Byeong Cheol; Lim, Jeong-Wook; Park, Noh Kyoung; Kang, Tae-Wook; Sohn, Min Kyun; Beom, Jaewon; Kang, Sangkuk

    2013-12-01

    To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc. Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment. In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00±1.52, 4.29±1.20, 2.64±0.93, 1.43±0.51 and those of FRI were 23.57±3.84, 16.50±3.48, 11.43±2.44, 7.00±2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22±2.05, 4.28±1.67, 2.56±1.04, 1.33±0.49 and those of FRI were 22.00±6.64, 16.22±5.07, 11.56±4.18, 8.06±1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (pherniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.

  4. Tensile strength decreases and perfusion pressure of 3-holed polyamide epidural catheters increases in long-term epidural infusion.

    Science.gov (United States)

    Kim, Pascal; Meyer, Urs; Schüpfer, Guido; Rukwied, Roman; Konrad, Christoph; Gerber, Helmut

    2011-01-01

    Epidural analgesia is an established method for pain management. The failure rate is 8% to 12% due to technical difficulties (catheter dislocation and/or disconnection; partial or total catheter occlusion) and management. The mechanical properties of the catheters, like tensile strength and flow rate, may also be affected by the analgesic solution and/or the tissue environment. We investigated the tensile strength and perfusion pressure of new (n=20), perioperatively (n=30), and postoperatively (n=73) used epidural catheters (20-gauge, polyamide, closed tip, 3 side holes; Perifix [B. Braun]). To prevent dislocation, epidural catheters were taped (n=5) or fixed by suture (n=68) to the skin. After removal, mechanical properties were assessed by a tensile-testing machine (INSTRON 4500), and perfusion pressure was measured at flow rates of 10, 20, and 40 mL/h. All catheters demonstrated a 2-step force transmission. Initially, a minimal increase of length could be observed at 15 N followed by an elongation of several cm at additional forces (7 N). Breakage occurred in the control group at 23.5±1.5 N compared with 22.4±1.6 N in perioperative and 22.4±1.7 N in postoperative catheters (Ptensile strength, whereas perfusion pressure at clinically used flow rates (10 mL/h) increased significantly from 19±1.3 to 44±72 mm Hg during long-term (≥7 days) epidural analgesia (Ptensile strength or perfusion pressure. Epidural catheter use significantly increases the perfusion pressure and decreases the tensile strength. Copyright © 2011 by American Society of Regional Anesthesia and Pain Medicine

  5. Assessment of the growth of epidural injections in the medicare population from 2000 to 2011.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Falco, Frank J E; Hirsch, Joshua A

    2013-01-01

    Among the many diagnostic and therapeutic interventions available for the management of chronic pain, epidural steroid injections are one of the most commonly used modalities. The explosive growth of this technique is relevant in light of the high cost of health care in the United States and abroad, the previous literature assessing the effectiveness of epidural injections has been sparse with highly variable outcomes based on technique, outcome measures, patient selection, and methodology. However, the recent assessment of fluoroscopically directed epidural injections has shown improved evidence with proper inclusion criteria, methodology, and outcome measures. The exponential growth of epidural injections is illustrated in multiple reports. The present report is an update of the analysis of the growth of epidural injections in the Medicare population from 2000 to 2011 in the United States. Analysis of utilization patterns of epidural procedures in the Medicare population in the United States from 2000 to 2011. The primary purpose of this assessment was to evaluate the use of all types of epidural injections (i.e., caudal, interlaminar, and transforaminal in the lumbar, cervical, and thoracic regions) with an assessment of specialty and regional characteristics. This assessment was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. Epidural injections in Medicare beneficiaries increased significantly from 2000 to 2011. Overall, epidural injections increased 130% per 100,000 Medicare beneficiaries with an annual increase of 7.5%. The increases per 100,000 Medicare recipients were 123% for cervical/thoracic interlaminar epidural injections; 25% for lumbar/sacral interlaminar, or caudal epidural injections; 142% for cervical/thoracic transforaminal epidural injections; and 665% for lumbar/sacral transforaminal epidural injections. The use of epidurals increased 224% in

  6. 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...

  7. Pacientes com seqüelas de poliomielite: a técnica anestésica impõe risco? Pacientes con secuelas de poliomielitis: ¿La técnica anestésica impone algún riesgo? Patients with sequelae of poliomyelitis: does the anesthetic technique impose risks?

    Directory of Open Access Journals (Sweden)

    Daniela Pessini Sobreira Rezende

    2008-06-01

    ésica en el neuroeje en los pacientes con secuela de poliomielitis. Los datos de la literatura son escasos. El objetivo de este estudio fue describir las técnicas anestésicas realizadas en pacientes sometidos a procedimientos quirúrgicos y a eventuales complicaciones. MÉTODO: Estudio retrospectivo de pacientes con secuelas de poliomielitis, sometidos a operaciones, por un período de cinco años. Evaluados los datos demográficos, estado físico (ASA, inicio de la enfermedad, el segmento corporal acometido, diagnóstico de síndrome pos-poliomielitis, operación y anestesia realizadas, analgesia postoperatoria, complicaciones intra y postoperatorias, acompañamiento ambulatorial e incidencia de alteraciones neurológicas. RESULTADOS: Evaluados 123 pacientes sometidos a 162 intervenciones quirúrgicas. La mayoría de los pacientes (n = 82; 66,6% presentaba secuela neurológica en un miembro inferior. La poliomielitis aguda sucedió como promedio a los 2 años y 4 meses de edad. Se sometieron a operaciones ortopédicas 87,7% de los pacientes. La técnica anestésica en un 64,1% de los casos fue por bloqueo en neuroeje. El bloqueo epidural fue el más utilizado. Complicaciones relatadas: punción inadvertida de la duramadre (n = 1; 0,61%, bradicardia (n = 1; 0,61%, hipotensión arterial (n = 2; 1,23%, apnea y rigidez de tórax (n = 1; 0,61% en el intraoperatorio. En el postoperatorio, vómitos (n = 2; 1,23%, retención urinaria (n = 4; 2,46% y síndrome doloroso complejo regional tipo I (n = 2; 1,23%. El acompañamiento ambulatorial fue de 22 meses y no se observó un empeoramiento neurológico. CONCLUSIONES: Los pacientes con secuela de poliomielitis, sometidos al bloqueo del neuroeje no presentaban ninguna complicación o empeoramiento neurológico en el postoperatorio que pudiese ser atribuido a la técnica anestésica.BACKGROUND AND OBJECTIVES: Several questions arise before performing neuro-axis block in patients with sequelae of poliomyelitis. Reports in the

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

    DEFF Research Database (Denmark)

    Basse, L; Werner, M; Kehlet, H

    2000-01-01

    . METHODS: This is a prospective, uncontrolled study with well-defined general anesthesia, postoperative analgesia, and nursing care programs in patients with a planned 2-day hospital stay, urinary catheter removal on the first postoperative morning, and epidural catheter removal on the second postoperative......BACKGROUND AND OBJECTIVES: Postoperative urinary retention may occur in between 10% and 60% of patients after major surgery. Continuous lumbar epidural analgesia, in contrast to thoracic epidural analgesia, may inhibit urinary bladder function. Postoperative urinary drainage has been common...... in patients with continuous epidural analgesia, despite the lack of scientific evidence for its indication after thoracic epidural analgesia. This study describes 100 patients who underwent elective colonic resection with 48 hours of continuous thoracic epidural analgesia and only 24 hours of urinary drainage...

  9. Effects of maternal epidural analgesia on the neonate--a prospective cohort study.

    Science.gov (United States)

    Shrestha, Bikash; Devgan, Amit; Sharma, Mukti

    2014-12-10

    Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase. A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation. There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia. Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

  10. Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor: A Randomized, Double-blind, Controlled Study.

    Science.gov (United States)

    Booth, Jessica L; Ross, Vernon H; Nelson, Kenneth E; Harris, Lynnette; Eisenach, James C; Pan, Peter H

    2017-07-01

    The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epidural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor characteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl.

  11. [Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor].

    Science.gov (United States)

    Ferreira, Céline; Macedo, Ana Luísa; Almeida, Valentina

    2018-03-01

    Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain. Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-12-01

    Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.) With 3 figs., 6 refs.

  13. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

    OpenAIRE

    Leary, Joyce; Swislocki, Arthur

    2013-01-01

    Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a...

  14. Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model.

    Science.gov (United States)

    Sae-Jung, Surachai; Jirarattanaphochai, Kitti; Sumananont, Chat; Wittayapairoj, Kriangkrai; Sukhonthamarn, Kamolsak

    2015-08-01

    Agreement study. To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model. Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated. Five identical sets of histopathological digital files of L5-L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed. Four hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81-0.86). The postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model.

  15. 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 ... for hysterectomy caused less PONV, but with less effective analgesia compared with general anaesthesia with postoperative continuous epidural morphine and bupivacaine....

  16. Effect of Epidural Block under General Anesthesia on Pulse Transit Time

    International Nuclear Information System (INIS)

    Choi, Byeong Cheol; Kim, Seong Min; Jung, Dong Keun; Kim, Gi Ryon; Lee, He Jeong; Jeon, Gye Rock

    2005-01-01

    Epidural block under general anesthesia has been widely used to control postoperative pain. In this anesthetic state many hemodynamic parameters are changed. Moreover pulse transit time is influenced by this memodynamic change. PPT change in the finger and the toe due to relaxation of arterial wall muscle after general anesthesia and epidural block under general anesthesia. This study, in the both general anesthesia and epidural block under general anesthesia, ΔPTT of the toe and of the finger are measured. In addition, ΔPTT(toe-finger) of the epidural block under general anesthesia and of the general anesthesia were compared

  17. 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...

  18. Histopathological Alterations after Single Epidural Injection of Ropivacaine, Methylprednizolone Acetate, or Contrast Material in Swine

    International Nuclear Information System (INIS)

    Kitsou, Maria-Chrysanthi; Kostopanagiotou, Georgia; Kalimeris, Konstantinos; Vlachodimitropoulos, Demetrios; Soultanis, Konstantinos; Batistaki, Chrysanthi; Kelekis, Alexis

    2011-01-01

    Purpose: The consequences from the injection of different types of drugs in the epidural space remains unknown. Increasing evidence suggests that localized inflammation, fibrosis, and arachnoiditis can complicate sequential epidural blockades, or even epidural contrast injection. We investigate the in vivo effect of epidural injections in the epidural space in an animal model. Materials and Methods: A group of ten male adult pigs, five punctures to each at distinct vertebral interspaces under general anesthesia, were examined, testing different drugs, used regularly in the epidural space (iopamidol, methylprednisolone acetate, ropivacaine). Each site was marked with a percutaneous hook wire marker. Histological analysis of the epidural space, the meninges, and the underlying spinal cord of the punctured sites along with staining for caspase-3 followed 20 days later. Results: The epidural space did not manifest adhesions or any other pathology, and the outer surface of the dura was not impaired in any specimen. The group that had the contrast media injection showed a higher inflammation response compared to the other groups (P = 0.001). Positive staining for caspase-3 was limited to <5% of neurons with all substances used. Conclusion: No proof of arachnoiditis and/or fibrosis was noted in the epidural space with the use of the above-described drugs. A higher inflammation rate was noted with the use of contrast media.

  19. Pneumocephalus and Sixth Nerve Palsy after Epidural Steroid Injection: Case Report and Review of the Literature.

    Science.gov (United States)

    Li, Wendy F; Kovacs, Kyle; Fisayo, Adeniyi A

    2017-11-01

    Pneumocephalus has been described as an unintended outcome after epidural injections. However, oculomotor palsy from pneumocephalus after epidural injection is very rare. We report a case of pneumocephalus-induced sixth nerve palsies and diplopia in an 87-year-old woman after epidural steroid injection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pneumocephalus-induced oculomotor palsy is a rare complication after epidural injection, a commonly performed medical procedure. Knowledge of this presentation will help emergency physicians distinguish between this entity and other causes of neurologic deficits. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. 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.

  1. Gas-Containing Cervical Epidural Abscess Accompanying Bacterial Meningitis in an Adult.

    Science.gov (United States)

    Kim, Dong Min; Kim, Seok Won

    2017-03-01

    Gas-containing spinal epidural abscesses are uncommon. Moreover, acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. Here, we report a rare case of a gas-containing cervical epidural abscess accompanying bacterial meningitis. In spite of aggressive fluid and continuous antibiotic therapy after the isolation of Streptococcus anginosus and Streptococcus constellatus in the cerebrospinal fluid cultures, the patient showed remaining motor dysfunction and bladder involvement. Our experience suggests that the effort to prevent neurologic deterioration by emergent surgical decompression and drainage of pus is mandatory to avoid additional spinal cord dysfunction in patients with spinal epidural abscesses accompanying bacterial meningitis.

  2. Traumatic epidural retroclival hematoma with odontoid fracture and cardiorespiratory arrest.

    Science.gov (United States)

    Pérez-Bovet, J; Garcia-Armengol, R; Martín Ferrer, S

    2013-12-01

    Case report. To describe a case or traumatic retroclival hematoma with features not previously reported. Single center. Description of a case, in the context of relevant literature on the subject. Traumatic retroclival hematomas are a rare, typically pediatric, entity. Only four cases of epidural hematoma in adult patients have been reported. We describe an additional case, the first with a fatal course in the acute setting. It is also the first retroclival hematoma associated to an odontoid base fracture. Retroclival hematomas are a rare diagnosis, to be considered in pediatric patients with flexion-extension, high-energy injuries. Morphology is typically epidural. Brain stem and cranial nerve symptoms are typical. Treatment is usually conservative. Outcome is regarded as favorable, with partial recovery and neurologic sequelae. Adult cases are extremely rare. The case we describe adds new characteristics to the scarcity of cases.

  3. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...... of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our...... reduction in frequency. An increase in days with use of medication was found. Increased awareness of low CSF pressure headache is emphasized and a controlled larger randomized study is needed to confirm the results. However the present results, allows us to conclude that EBP in treatment-refractory low CSF...

  4. Transient bladder and fecal incontinence following epidural blood patch

    Directory of Open Access Journals (Sweden)

    Miguel Angel Palomero-Rodríguez

    2015-01-01

    Full Text Available Epidural blood patch (EBP is the currently accepted treatment of choice for postdural puncture headache because of its high initial success rates and infrequent complications. Many authors recommended a small volume (10-20 mL of blood to be delivered for an effective EBP. Here, we report an obstetric patient who developed a transient bladder and fecal incontinence after 19 mL of blood EBP at L 1 -L 2 level. Since the magnetic resonance image did not demonstrate any definitive spinal cord lesion, the exact mechanism remains unclear. We suggest that accumulation of blood performed at L 1 to L 2 level in a closed relationship with the sacral cord, may have trigger a significant pressure elevation of the epidural space at this level, resulting in a temporal spinal cord-related injury in the sacral cord.

  5. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

    Directory of Open Access Journals (Sweden)

    Halim Tariq

    2008-01-01

    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  6. Spontaneous spinal epidural hemorrhage from intense piano playing.

    Science.gov (United States)

    Chang, Hui-Ju; Su, Fang Jy; Huang, Ying C; Chen, Shih-Han

    2014-06-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation.

  7. A Comparison of the Effectiveness of a Continuous Lumbar Epidural Infusion of Preservative Free Morphine with a Continuous Thoracic Epidural Infusion of 0.0625% Bupivacaine Plus Fentanyl in Providing Post-Thoracotomy Analgesia

    National Research Council Canada - National Science Library

    Williams, James

    1998-01-01

    ... to the thoracic epidural approach using Bupivacaine 0.0625% with Fentanyl. Data were collected on 20 subjects who presented for a thoracotomy and had consented to an epidural for their post-thoracotomy analgesia...

  8. MR imaging of epidural hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Dorsay, Theodore A.; Helms, Clyde A. [Duke University Medical Center, Department of Radiology, Erwin Road, Room 1504, Durham, NC 27710 (United States)

    2002-12-01

    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk

  9. Epidural Space Localization: A Novel Slingshot Approach | Fyneface ...

    African Journals Online (AJOL)

    The plunger with the rubber sling was pulled and tip of the syringe mounted on the hub of the Tuohy needle. The epidural space was located by the loss of resistance to air technique. Result: The mean age of the patients was 39.5±2.3 years while the mean height and weight were 163±4.1 cm and 78.9±3.8 kg respectively.

  10. Disseminated cat scratch disease with vertebral osteomyelitis and epidural abscess.

    Science.gov (United States)

    Abdel-Haq, Nahed; Abuhammour, Walid; Al-Tatari, Hossam; Asmar, Basim

    2005-11-01

    A 5-year-old boy with cat scratch disease presented with fever of unknown origin and osteomyelitis of the thoracic spine and epidural abscess. He did not have localizing signs or symptoms. Computed tomography of the abdomen, which was initially negative, showed hepatosplenic disease. Cat scratch disease has variable systemic presentations and should be included in the differential diagnosis of fever of unknown origin if an epidemiologic risk factor is present.

  11. Radiographic appearance of a post-epidural headache.

    LENUS (Irish Health Repository)

    Weekes, G

    2012-02-01

    We report the case of a 35-year-old lady who presented with a 6-day history of a postural headache following an uncomplicated epidural catheter insertion. Meningitis was initially suspected and a neurology review was obtained. CT and MRI brain revealed features suggestive of meningitis. However these radiological features are also consistent with post dural puncture headache (PDPH). This case highlights the under reported and possible misleading radiographical features of PDPH.

  12. Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

    Directory of Open Access Journals (Sweden)

    Tetsu Akimoto

    2014-01-01

    Full Text Available Hemiparesis develops in response to a wide range of neurological disorders, such as stroke, neoplasms and several inflammatory processes. Occasionally, it may also occur due to a lesion located in the high cervical spinal cord. In this concise review, we describe the features of spontaneous spinal epidural hematoma, which should be included in the large list of stroke mimics. Various concerns regarding the diagnostic and therapeutic conundrums relating to the condition are also discussed.

  13. Combined spinal epidural labour analgesia: Complications and their management

    OpenAIRE

    YILMAZ, Nurullah; KOCAMANOGLU, Ismail Serhat; ABANOZ, Hakan

    2016-01-01

    Combined spinal-epidural analgesia (CSEA) is an effective and increasingly popular analgesia method used in vaginal delivery. CSEA provides rapid and excellent analgesia, allows mobilization, reduces drug consumption significantly and generally causes negligible maternal and fetal /neonatal adverse effects /complications not requiring treatment. The resulting adverse effects /complications are often associated with technical and /or agent/agents used and cause maternal and fetal /neonatal or,...

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

    OpenAIRE

    Varaprasad

    2015-01-01

    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 seda...

  15. Quantitative assessment of differential sensory blockade after lumbar epidural lidocaine.

    Science.gov (United States)

    Tay, B; Wallace, M S; Irving, G

    1997-05-01

    A cutaneous current perception threshold (CPT) sensory testing device measures both large and small diameter sensory nerve fiber function and may be useful in evaluating differential neural blockade. Eight subjects received both lumbar epidural saline and lumbar epidural lidocaine. Five milliliters of normal saline was administered and the CPTs were measured. After the saline, 10 mL of 2% plain lidocaine was administered. CPTs, and sensation to touch, pinprick, and cold were subsequently measured. Saline had no effect on any measurements. Lidocaine caused an increase in all CPTs at the umbilicus and the knee reaching a statistical significance at 5 Hz for the umbilicus only. The great toe showed a slight increase of the 5 Hz stimulus and no increase of the 2000 or 250 Hz stimulus. There was a significant decrease in touch, pinprick, and cold sensation at the umbilicus and knee and a significant decrease in the cold sensation at the great toe. There was no effect on any measurements made at the mastoid. Epidural lidocaine resulted in a differential neural blockade as measured by a CPT monitor but not with crude sensory measurements.

  16. Localization of epidural space: A review of available technologies.

    Science.gov (United States)

    Elsharkawy, Hesham; Sonny, Abraham; Chin, Ki Jinn

    2017-01-01

    Although epidural analgesia is widely used for pain relief, it is associated with a significant failure rate. Loss of resistance technique, tactile feedback from the needle, and surface landmarks are traditionally used to guide the epidural needle tip into the epidural space (EDS). The aim of this narrative review is to critically appraise new and emerging technologies for identification of EDS and their potential role in the future. The PubMed, Cochrane Central Register of Controlled Clinical Studies, and Web of Science databases were searched using predecided search strategies, yielding 1048 results. After careful review of abstracts and full texts, 42 articles were selected to be included. Newer techniques for localization of EDS can be broadly classified into techniques that (1) guide the needle to the EDS, (2) identify needle entry into the EDS, and (3) confirm catheter location in EDS. An ideal method should be easy to learn and perform, easily reproducible with high sensitivity and specificity, identifies inadvertent intrathecal and intravascular catheter placements with ease, feasible in perioperative setting and have a cost-benefit advantage. Though none of them in their current stages of development qualify as an ideal method, many show tremendous potential. Some techniques are useful in patients with difficult spinal anatomy and infants, and thus are complementary to traditional methods. In addition to improving the existing technology, future research should aim at proving the superiority of these techniques over traditional methods, specifically regarding successful EDS localization, better safety profile, and a favorable cost-benefit ratio.

  17. Plasma concentrations of buprenorphine after epidural administration in conscious cats.

    Science.gov (United States)

    Duke-Novakovski, Tanya; Clark, Christopher R; Ambros, Barbara; Gilbert, Peter; Steagall, Paulo V M

    2011-06-01

    Buprenorphine plasma concentrations were measured after administering buprenorphine (20 μg/kg) into the lumbosacral epidural space of conscious cats chronically instrumented with an epidural catheter. Blood was collected from a jugular vein before injection and 15, 30, 45 and 60 min and 2, 3, 4, 5, 6, 8, 12 and 24 h after administration. Plasma buprenorphine concentrations were measured using ELISA. Background concentration (before injection) was 1.27 ± 0.27 ng/mL (mean ± SD). Including background concentration, the mean peak plasma concentration was obtained 15 min after injection (5.82 ± 3.75 ng/mL), and ranged from 3.79 to 2.20 ng/mL (30 min-3 h), remaining between 1.93 and 1.77 ng/mL (4-12 h), and declined to 1.40 ± 0.62 ng/mL at 24h. Elimination half-life was 58.8 ± 40.2 min and clearance 56.7 ± 21.5 mL/min. Results indicate early rapid systemic uptake of buprenorphine from epidural administration with plasma concentrations similar to using buccal or IM routes by 15 min postinjection. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

    Directory of Open Access Journals (Sweden)

    Rochana Girish Bakhshi

    2011-11-01

    Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

  19. Cervical Epidural and Retropharyngeal Abscess Induced by a Chicken Bone

    Directory of Open Access Journals (Sweden)

    Wei-Ting Hsu

    2011-09-01

    Full Text Available Retropharyngeal abscess is occasionally seen in children, but is less common in adults where it usually occurs secondary to iatrogenic oropharynx trauma or a perforated foreign body in the oropharynx. Spinal epidural abscess in combination with a retropharyngeal abscess, which may cause rapid and irreversible neurological deterioration, is not often found, as indicated by the very few reports in the literature. Here we report a 52-year-old male with a clinical history of seizure and mental retardation since childhood who presented at our emergency room with severe sore throat of 1 day’s duration. A chicken bone was removed successfully. However, he complained of progressive dysphagia, sore throat and posterior neck pain during the following 5 days. Flexible fiber-laryngoscopy showed bulging of the retropharyngeal wall and a small ulcer at the right posterior pharyngeal wall. A neck computed tomography (CT scan showed a retropharyngeal abscess at the oropharynx and hypopharynx level. His symptoms showed partial improvement after the administration of intravenous antibiotics. However, 2 weeks later he developed high fever, posterior neck pain and flaccid tetra-paresia. Emergent neck CT scan revealed a mild retropharyngeal abscess and epidural abscess formation between the second and third cervical vertebrae. The patient’s family refused drainage of the pre-vertebral and epidural pus. After receiving 2 months of antibiotics, the patient regained the mobility of his limbs

  20. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Simpson Judy M

    2006-12-01

    Full Text Available Abstract Background Anecdotal reports suggest that the addition of fentanyl (an opioid to epidural analgesia for women during childbirth results in difficulty establishing breastfeeding. The aim of this paper is to determine any association between epidural analgesia and 1 breastfeeding in the first week postpartum and 2 breastfeeding cessation during the first 24 weeks postpartum. Methods A prospective cohort study of 1280 women aged ≥ 16 years, who gave birth to a single live infant in the Australian Capital Territory in 1997 was conducted. Women completed questionnaires at weeks 1, 8, 16 and 24 postpartum. Breastfeeding information was collected in each of the four surveys and women were categorised as either fully breastfeeding, partially breastfeeding or not breastfeeding at all. Women who had stopped breastfeeding since the previous survey were asked when they stopped. Results In the first week postpartum, 93% of women were either fully or partially breastfeeding their baby and 60% were continuing to breastfeed at 24 weeks. Intrapartum analgesia and type of birth were associated with partial breastfeeding and breastfeeding difficulties in the first postpartum week (p Conclusion Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks. Although this relationship may not be causal, it is important that women at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support.

  1. From assistance towards restoration with epidural brain-computer interfacing.

    Science.gov (United States)

    Gharabaghi, Alireza; Naros, Georgios; Walter, Armin; Grimm, Florian; Schuermeyer, Marc; Roth, Alexander; Bogdan, Martin; Rosenstiel, Wolfgang; Birbaumer, Niels

    2014-01-01

    Today's implanted brain-computer interfaces make direct contact with the brain or even penetrate the tissue, bearing additional risks with regard to safety and stability. What is more, these approaches aim to control prosthetic devices as assistive tools and do not yet strive to become rehabilitative tools for restoring lost motor function. We introduced a less invasive, implantable interface by applying epidural electrocorticography in a chronic stroke survivor with a persistent motor deficit. He was trained to modulate his natural motor-related oscillatory brain activity by receiving online feedback. Epidural recordings of field potentials in the beta-frequency band projecting onto the anatomical hand knob proved most successful in discriminating between the attempt to move the paralyzed hand and to rest. These spectral features allowed for fast and reliable control of the feedback device in an online closed-loop paradigm. Only seven training sessions were required to significantly improve maximum wrist extension. For patients suffering from severe motor deficits, epidural implants may decode and train the brain activity generated during attempts to move with high spatial resolution, thus facilitating specific and high-intensity practice even in the absence of motor control. This would thus transform them from pure assistive devices to restorative tools in the context of reinforcement learning and neurorehabilitation.

  2. A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

    Directory of Open Access Journals (Sweden)

    Emine Rabia Koç

    2014-09-01

    Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking

  3. [Benefits of epidural analgesia in major neonatal surgery].

    Science.gov (United States)

    Gómez-Chacón, J; Encarnación, J; Couselo, M; Mangas, L; Domenech, A; Gutiérrez, C; García Sala, C

    2012-07-01

    The aim of this paper is to describe and evaluate the benefits of epidural anesthesia in major surgery neonatal. We have performed a matched case-control (2:1) study of patients undergoing neonatal major surgery (NMSs) who received intra-and postoperative epidural anesthesia (EA) and controls with conventional general anesthesia. The matching criteria were age, weight and baseline pathology. EA was administered by caudal puncture and epidural catheter placed with ultrasound support. Levobupivacaine was selected as anesthetic drug. The time to extubation, intestinal transit time, type of analgesia and complications were studied. This study is based on 11 cases (2 esophageal atresia, 2 diaphragmatic hernias, 1 necrotizing enterocolitis, 3 intestinal atresia, 2 anorectal malformation and 1 bladder exstrophy) and 22 controls. We observed statistically significant differences in time to extubation (95% CI OR 12 1.99 to 72.35; Chi2 p = 0.004, Mann U Whytney p = 0.013) and intestinal transit time (Mann Whitney U p analgesia. Therefore we believe that the intra-and postoperative EA helps improve postoperative management in neonates and should be preferred in centers where this technique is available.

  4. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less.

    Science.gov (United States)

    Moore, Albert R; Shan, William Li Pi; Hatzakorzian, Roupen

    2013-01-01

    Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to determine the characteristics associated with early epidural analgesia initiation. Information about women delivering at 37 weeks or greater gestation with epidural analgesia, who were not scheduled for cesarean delivery, was extracted from the McGill Obstetric and Neonatal Database. Patients were grouped into those who received epidural analgesia at a cervical dilation of ≤3 cm and >3 cm. Univariable and multivariable logistic regression was used to determine the maternal, neonatal, and labor characteristics that increased the risk of inclusion in the early epidural group. Of the 13,119 patients analyzed, multivariable regression demonstrated odds ratios (OR) of 2.568, 5.915 and 10.410 for oxytocin augmentation, induction, and dinoprostone induction of labor (P analgesia (OR 0.780, P analgesia (P neonatal weight (OR 0.943, P analgesia. Labor augmentation and induction, nulliparity, rupture of membranes spontaneously and before labor starts, increasing maternal weight, and decreasing neonatal weight are associated with early epidural analgesia. Many of these variables are also associated with cesarean delivery.

  5. Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients : A Report from the Multicenter Perioperative Outcomes Group

    NARCIS (Netherlands)

    Lee, Linden O.; Bateman, Brian T.; Kheterpal, Sachin; Klumpner, Thomas T.; Housey, Michelle; Aziz, Michael F.; Hand, Karen W.; MacEachern, Mark; Goodier, Christopher G.; Bernstein, Jeffrey; Bauer, Melissa E.; Lirk, Philip; Wilczak, Janet; Soto, Roy; Tom, Simon; Cuff, Germaine; Biggs, Daniel A.; Coffman, Traci; Saager, Leif; Levy, Warren J.; Godbold, Michael; Pace, Nathan L.; Wethington, Kevin L.; Paganelli, William C.; Durieux, Marcel E.; Domino, Karen B.; Nair, Bala; Ehrenfeld, Jesse M.; Wanderer, Jonathan P.; Schonberger, Robert B.; Berris, Joshua; Lins, Steven; Coles, Peter; Cummings, Kenneth C.; Maheshwari, Kamal; Berman, Mitchell F.; Wedeven, Christopher; LaGorio, John; Fleishut, Peter M.; Ellis, Terri A.; Molina, Susan; Carl, Curtis; Kadry, Bassam; van Klei, Wilton A A; Pasma, Wietze; Jameson, Leslie C.; Helsten, Daniel L.; Avidan, Michael S.

    BACKGROUND:: Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. The authors reviewed a large

  6. 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.

  7. Estudo comparativo entre ultrassom e neuroestimulação no bloqueio do plexo braquial pela via axilar Estudio comparativo entre ultrasonido y neuroestimulación en el bloqueo del plexo braquial por la vía axilar A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block

    Directory of Open Access Journals (Sweden)

    Diogo Brüggemann da Conceição

    2009-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O uso do ultrassom em Anestesia Regional vem crescendo. Existem poucos estudos comparando o uso do ultrassom com a neuroestimulação. O objetivo deste estudo foi comparar a execução do bloqueio do plexo braquial pela via axilar guiado por neuroestimulação com dupla injeção e guiado por ultrassonografia em procedimentos cirúrgicos na mão. Para isto, foram comparados o tempo de realização, a taxa de sucesso e complicações. MÉTODO: Após a aprovação do Comitê de Ética em Pesquisa do Hospital Governador Celso Ramos foram selecionados 40 pacientes escalados para operações eletivas na mão com bloqueio de plexo braquial via axilar. Os pacientes foram distribuídos aleatoriamente eletronicamente em dois grupos de 20 pacientes: Grupo Neuroestimulação (NE e Grupo Ultrassonografia (US. Foram comparados tempo de realização, taxa de sucesso e taxa de complicações. RESULTADOS: As taxas de bloqueio completo, falha parcial e falha total não apresentaram diferença estatística significativa entre os grupos US e NE. O tempo médio para realização do procedimento no grupo US (354 segundos não apresentou diferença estatística significativa quando comparado ao grupo NE (381 segundos. Pacientes do grupo NE apresentaram maior taxa de punção vascular (40% quando comparados ao grupo US (10%, p JUSTIFICATIVA Y OBJETIVOS: El uso del ultrasonido en Anestesia Regional ha venido creciendo. Existen pocos estudios comparando el uso del ultrasonido con la neuroestimulación. El objetivo de este estudio, fue comparar la ejecución del bloqueo del plexo braquial por la vía axilar, guiado por neuroestimulación con doble inyección y guiado por ultrasonido en procedimientos quirúrgicos en la mano. Para eso, se compararon el tiempo de realización, la tasa de éxito y las complicaciones. MÉTODO: Después de la aprobación por parte del Comité de Ética en Investigación del Hospital Governador Celso Ramos, se

  8. Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    Deepti Saigal

    2013-01-01

    Full Text Available Background: Although different techniques have been developed for administering combined spinal epidural (CSE anaesthesia, none can be described as an ideal one. Objectives: We performed a study to compare two popular CSE techniques: Double segment technique (DST and single segment (needle through needle technique (SST with another alternative technique: Paramedian epidural and midline spinal in the same intervertebral space (single space dual needle technique: SDT. Methods: After institutional ethical clearance, 90 consenting patients undergoing elective lower limb orthopaedic surgery were allocated to receive CSE into one of the three groups (n=30 each: Group I: SST, Group II: SDT, Group III: DST using computerized randomization. The time for technique performance, surgical readiness, technical aspects of epidural and subarachnoid block (SAB and morbidity were compared. Results: SDT is comparable with SST and DST in time for technique performance (13.42±2.848 min, 12.18±6.092 min, 11.63±3.243 min respectively; P=0.268, time to surgical readiness (18.28±3.624 min, 17.64±5.877 min, 16.87±3.137 min respectively; P=0.42 and incidence of technically perfect block (70%, 66.66%, 76.66%; respectively P=0.757. Use of paramedian route for epidural catheterization in SDT group decreases complications and facilitates catheter insertion. There was a significant number of cases with lack of dural puncture appreciation (SST=ten, none in SDT and DST; P=0.001 and delayed cerebrospinal fluid reflux (SST=five, none in SDT and DST; P=0.005 while performance of SAB in SST group. The incidence of nausea, vomiting, post-operative backache and headache was comparable between the three groups. Conclusion: SDT is an acceptable alternative to DST and SST.

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

    OpenAIRE

    P K Dilesh; S Eapen; S Kiran; Vivek Chopra

    2014-01-01

    Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this s...

  10. 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

    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...... of disappearance of lidocaine from the epidural space as assessed by plasma lidocaine concentration curves during the first and third injection (0.5 +/- 0.1 and 0.3 +/- 0.04 microgram.mL-1.min-1, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)...

  11. Influência da procainamida sobre o bloqueio neuromuscular produzido pelo rocurônio e investigação sobre o mecanismo de ação da procainamida na junção neuromuscular Influencia de la procainamida sobre el bloqueo neuromuscular producido por el rocuronio e investigación sobre el mecanismo de acción de la procainamida en la junción neuromuscular Influence of procainamide on the neuromuscular blockade caused by rocuronium and investigation on the mechanism of action of procainamide on the neuromuscular junction

    Directory of Open Access Journals (Sweden)

    Thalita Duque Martins

    2007-02-01

    el bloqueo neuromuscular producido por la d-tubocurarina ya está comprobada, pero sin embargo el mecanismo es controvertido. El objetivo del estudio fue el de evaluar la influencia de la procainamida en el bloqueo neuromuscular producido por el rocuronio e investigar los mecanismos de esa interacción. MÉTODO: Se utilizaron 15 ratones (250 a 300 g en preparación descrita por Bülbring. Se formaron los siguientes grupos (n = 5 cada: procainamida - 20 µg.mL-1 (Grupo I; rocuronio - 4 µg.mL-1 (Grupo II y rocuronio - 4µg.mL-1 y procainamida - 20µg.mL-1 (Grupo III. Se evaluó: 1 la amplitud de las contracciones musculares bajo la estimulación indirecta en cada grupo, antes y después de la adición de los fármacos; 2 los potenciales de placa terminal en miniatura (PPTM; 3 la eficacia de la 4-aminopiridina en la reversión del bloqueo neuromuscular. El mecanismo de la interacción se estudió en Biventer cervicis (n = 5 y diafragma de ratón desnervado (n = 5, observándose la influencia de la procainamida en la respuesta a la acetilcolina antes y después de la adición de la procainamida. RESULTADOS: De forma aislada, la procainamida no alteró las respuestas neuromusculares. El bloqueo producido con el Grupo III fue de 68,6% ± 7,1%, con una diferencia significativa (p = 0,0067 con relación al Grupo II (10,4% ± 4,5%, revertido por la 4-aminopiridina. La procainamida ocasionó un aumento en la frecuencia de los PPTM, seguido de bloqueo revertido por la 4-aminopiridina. En Biventer cervicis, la procainamida aumentó la respuesta a la acción de contracción de la acetilcolina, resultado no observado con el diafragma desnervado. CONCLUSIONES: La procainamida potenció el bloqueo producido por el rocuronio. Las alteraciones observadas con PPTM y Biventer cervicis identificaron una acción presináptica. El antagonismo de la 4-aminopiridina sobre el bloqueo de los PPTMs sugirió la desensibilización de los receptores por la procainamida.BACKGROUND AND OBJECTIVES

  12. Bloqueio isquiático-femoral guiado por ultra-som para revisão de coto de amputação: relato de caso Bloqueo isquiático-femoral guiado por ultrasonido para revisión de muñón de amputación: relato de caso Ultrasound-guided sciatic-femoral block for revision of the amputation stump: case report

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2008-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O emprego da ultra-sonografia na anestesia regional vem se tornando cada vez mais difundido pelo seu papel facilitador e pela sua eficácia. A visualização direta por meio da ultra-sonografia permite que se identifiquem os nervos periféricos, independentemente da capacidade de se obter estimulação sensitiva ou motora. RELATO DO CASO: Paciente submetido à revisão de coto de amputação no nível do joelho sob bloqueio isquiático-femoral guiado por ultra-som com 40 mL de ropivacaína a 0,5%, promovendo bloqueio sensitivo completo e anestesia cirúrgica de excelente qualidade. CONCLUSÕES: A assistência ultra-sonográfica é capaz de ampliar o espectro de utilização dos bloqueios periféricos nas intervenções cirúrgicas sobre membros amputados em situações em que a neuroestimulação não pode ser utilizada.JUSTIFICATIVA Y OBJETIVOS: El uso del ultrasonido en la anestesia regional se ha venido convirtiendo cada vez más en algo muy difundido por su rol de facilitador y por su eficacia. La visualización directa a través del ultrasonido permite que se identifiquen los nervios periféricos, independientemente de la capacidad de poder obtenerse una estimulación sensitiva o motora. RELATO DEL CASO: Paciente sometido a revisión de muñón de amputación al nivel de la rodilla bajo bloqueo isquiático-femoral guiado por ultrasonido con 40 mL de ropivacaína a 0,5%, promoviendo bloqueo sensitivo completo y anestesia quirúrgica de excelente calidad. CONCLUSIONES: La asistencia ultra sonográfica es capaz de ampliar el espectro de utilización de los bloqueos periféricos en las intervenciones quirúrgicas sobre miembros amputados en situaciones en que la neuro estimulación no puede ser utilizada.BACKGROUND AND OBJECTIVES: The use of ultrasound in regional blocks has become increasingly used because its role as a facilitator and its efficacy. Direct ultrasound visualization allows the identification of

  13. Descending volleys generated by efficacious epidural motor cortex stimulation in patients with chronic neuropathic pain

    NARCIS (Netherlands)

    Lefaucheur, Jean-Pascal; Holsheimer, J.; Goujon, Colette; Keravel, Yves; Nguyen, Jean-Paul

    Epidural motor cortex stimulation (EMCS) is a therapeutic option for chronic, drug-resistant neuropathic pain, but its mechanisms of action remain poorly understood. In two patients with refractory hand pain successfully treated by EMCS, the presence of implanted epidural cervical electrodes for

  14. Epidural steroids in the management of chronic spinal pain and radiculopathy.

    Science.gov (United States)

    Boswell, Mark V; Hansen, Hans C; Trescot, Andrea M; Hirsch, Joshua A

    2003-07-01

    Epidural injections with or without steroids are used extensively in the management of chronic spinal pain. However, evidence is contradictory with continuing debate about the value of epidural steroid injections in chronic spinal syndromes. The objective of this systematic review is to determine the effectiveness of epidural injections in the treatment of chronic spinal pain. Data sources include relevant literature identified through searches of MEDLINE, EMBASE (Jan 1966- Mar 2003), manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings. Both randomized and non-randomized studies were included in the review based on the criteria established by the Agency for Healthcare Research and Quality (AHRQ). Studies were excluded from the analysis if they were simply review or descriptive and failed to meet minimum criteria. The results showed that there was strong evidence to indicate effectiveness of transforaminal epidural injections in managing lumbar nerve root pain. Further, evidence was moderate for caudal epidural injections in managing lumbar radicular pain. The evidence in management of chronic neck pain, chronic low back pain, cervical radiculopathy, spinal stenosis, and post laminectomy syndrome was limited or inconclusive. In conclusion, the evidence of effectiveness of transforaminal epidural injections in managing lumbar nerve root pain was strong, whereas, effectiveness of caudal epidural injections in managing lumbar radiculopathy was moderate, while there was limited or inconclusive evidence of effectiveness of epidural injections in managing chronic spinal pain without radiculopathy, spinal stenosis, post lumbar laminectomy syndrome, and cervical radiculopathy.

  15. Tuberculous lumbar spinal epidural abscess in a young adult (case report

    Directory of Open Access Journals (Sweden)

    Hasan Ghazwan Abdulla

    2018-01-01

    Conclusion: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess.

  16. Audit of epidural anaesthesia services at a district hospital in Nigeria ...

    African Journals Online (AJOL)

    Background: Epidural anaesthesia and analgesia is considered the 'gold standard' analgesic technique for major surgery. However, its practice is limited in most hospitals in Nigeria. The objective of this review was to determine the rate of administration of epidural anaesthesia and to review the challenges affecting its ...

  17. Cat scratch disease with cervical vertebral osteomyelitis and spinal epidural abscess.

    Science.gov (United States)

    Tasher, Diana; Armarnik, Erez; Mizrahi, Avram; Liat, Ben Sira; Constantini, Shlomi; Grisaru-Soen, Galia

    2009-09-01

    Cat scratch disease has variable clinical presentations and should be considered in the differential diagnosis of vertebral osteomyelitis and epidural abscess if there is a history of contact with cats. We report a 5-year-old boy with cat scratch disease who presented with painful torticollis and osteomyelitis of the cervical spine associated with an epidural abscess.

  18. Pregnancy-related spinal epidural capillary-cavernous haemangioma: magnetic resonance imaging and differential diagnosis

    International Nuclear Information System (INIS)

    Hakan, T.; Berkman, M.Z.; Demir, M.K.; Aker, F.V.

    2007-01-01

    Full text: Epidural haemangiomas are very rare tumours of the spine. Only a few case reports have been published and most of them were cavernous or capillary. To the best of our knowledge, we report the first case of a histologically confirmed epidural capillary-cavernous haemangioma of the thoracic spine presented in the MRI

  19. Effect of epidural blockade and oxygen therapy on changes in subcutaneous oxygen tension after abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg, J; Pedersen, U; Erichsen, C J

    1994-01-01

    The effect of oxygen therapy (37% by face mask) and epidural local anesthetic blockade (9 ml 0.5% bupivacaine at Th9-11 level) on wound oxygenation was evaluated in eight otherwise healthy patients undergoing elective colorectal resection. The patients were monitored continuously for subcutaneous...... without epidural blockade and 15 (10-20) min with blockade (P surgery....

  20. 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 ...

  1. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome.

    Science.gov (United States)

    Hasegawa, Junichi; Farina, Antonio; Turchi, Giovanni; Hasegawa, Yuko; Zanello, Margherita; Baroncini, Simonetta

    2013-02-01

    We aimed to clarify whether the short-term adverse neonatal outcomes associated with epidural analgesia are due to the epidural analgesia itself or to the instrumental delivery. A retrospective case-control study was conducted to evaluate the relationship between epidural analgesia, labor length, and perinatal outcomes. A total of 350 pregnant women at term who delivered under epidural analgesia (cases) were compared with 1400 patients without epidural analgesia (controls). Vacuum extraction (6.5 vs. 2.9 %) and cesarean section (19.9 vs. 11.1 %) were more frequently performed in the cases than controls (p neonatal variables stratified by mode of delivery were not different in cases and controls, except for a slightly lower umbilical arterial pH in spontaneous delivery for the cases group. However, the Apgar scores and umbilical arterial pH were significantly lower in the neonates delivered by vacuum extraction compared with those in the neonates delivered by spontaneous delivery or cesarean section, regardless of whether epidural analgesia was performed. A multivariable analysis showed that vacuum extraction much more consistently affected the arterial pH than the analgesia itself (the β coefficients were -0.036 for epidural analgesia vs. -0.050 for vacuum extraction). Epidural analgesia was associated with slowly progressing labor, thus resulting in an increased rate of instrumental delivery. This instrumental delivery appears to adversely affect the neonatal outcomes more strongly than the analgesia itself.

  2. A new technique for long time catheterization of sacral epidural canal in rabbits.

    Science.gov (United States)

    Erkin, Yüksel; Aydın, Zeynep; Taşdöğen, Aydın; Karcı, Ayşe

    2013-01-01

    In this study we aimed to develop a simple and practical technique for chronic sacral epidural catheterization of rabbits. We included ten rabbits weighing 2-2.5 kg in the study. After anesthesia and analgesia, we placed an epidural catheter by a 2 cm longitudinal skin incision in the tail above the sacral hiatus region. We confirmed localization by giving 1% lidocaine (leveling sensory loss and motor function loss of the lower extremity). The catheter was carried forward through a subcutaneous tunnel and fixed at the neck. Chronic caudal epidural catheter placement was succesful in all rabbits. The catheters stayed in place effectively for ten days. We encountered no catheter complications during this period. The localization of the catheter was reconfirmed by 1% lidocaine on the last day. After animals killing, we performed a laminectomy and verified localization of the catheter in the epidural space. Various methods for catheterization of the epidural space in animal models exist in the literature. Epidural catheterization of rabbits can be accomplished by atlanto-occipital, lumbar or caudal routes by amputation of the tail. Intrathecal and epidural catheterization techniques defined in the literature necessitate surgical skill and knowledge of surgical procedures like laminectomy and tail amputation. Our technique does not require substantial surgical skill, anatomical integrity is preserved and malposition of the catheter is not encountered. In conclusion, we suggest that our simple and easily applicable new epidural catheterization technique can be used as a model in experimental animal studies.

  3. Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

    Science.gov (United States)

    Rossen, Janne; Klungsøyr, Kari; Albrechtsen, Susanne; Løkkegård, Ellen; Rasmussen, Steen; Bergholt, Thomas; Skjeldestad, Finn E

    2018-03-07

    Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  4. Reversibility of lumbar epidural lipomatosis in obese patients after weight-reduction diet

    International Nuclear Information System (INIS)

    Borstlap, A.C.W.; Rooij, W.J.J. van; Sluzewski, M.; Leyten, A.C.M.; Beute, G.

    1995-01-01

    We present three obese patients with symptomatic lumbar epidural lipomatosis. All three were treated with a calorie-controlled diet and considerable weight reduction was achieved. MRI demonstrated a reduction in the epidural fat and relief of thecal sac compression in all three; two also improved clinically. (orig.). With 3 figs., 1 tab

  5. Single-stage epidural catheter lavage with posterior spondylodesis in lumbar pyogenic spondylodiscitis with multilevel epidural abscess formation.

    Science.gov (United States)

    Tschoeke, Sven K; Kayser, Ralph; Gulow, Jens; Hoeh, Nicolas von der; Salis-Soglio, Georg von; Heyde, Christoph

    2014-11-01

    Despite significant advances in the conservative management of pyogenic spondylodiscitis, consecutive instability, deformity, and/or neurologic compromise demands a prompt surgical intervention. However, in rare cases involving additional multilevel epidural abscess formation, the appropriate surgical strategy remains controversial. In this retrospective cohort analyses, we evaluated the efficacy of a single-stage posterior approach with the addition of a one-time multilevel epidural lavage via the surgically exposed interlaminar fenestration of the infected segment. From January 2009 through December 2010, 73 patients presenting pyogenic spondylodiscitis with instability of the lumbar spine were admitted. In all cases, the surgical strategy included a radical resection of the affected intervertebral disc and stabilization by intervertebral fusion using a titanium cage with autologous bone grafting in a level-dependent posterior approach with additional pedicle screw-and-rod instrumentation. In cases where multilevel abscess formation was evident, the standard surgical procedure was complemented by drainage and irrigation of the abscess from posterior by carefully advancing a soft infant feeding tube via the surgically exposed epidural space under fluoroscopic guidance. All patients received complementary oral antibiotic therapy for 12 weeks and were followed-up for a minimum of 12 months postoperatively. Ten patients (three male and seven female patients; mean age: 64.9 ± 10.9 years) presented with an additional lumbar epidural abscess extending beyond three levels proximal or distal to the infected disc. In all 10 patients the laboratory-chemical inflammatory parameters (leukocyte count, C-reactive protein) remained within the physiologic range after completing antibiotic therapy throughout the 1-year follow-up period. The plain radiographs and magnetic resonance imaging demonstrated solid fusion and the complete remission of the initial abscess formation after

  6. Spontaneous idiopathic spinal epidural hematoma: two different presentations of the same disease Hematoma epidural espinal espontáneo: dos diferentes presentaciones clínicas de la misma enfermedad Hematoma epidural espinhal espontâneo: duas diferentes apresentações da mesma doença

    Directory of Open Access Journals (Sweden)

    Asdrúbal Falavigna

    2010-09-01

    Full Text Available We report two cases of spontaneous spinal epidural hematoma with different clinical presentations without precipitating factors and a brief review of the literature. Our case first developed acute and had progressive cervical spinal cord signs that determined emergency decompressive laminectomy. On the other hand, the second patient, who was chronic, was operated almost five months after the initial symptoms and the radiological diagnosis was a large facet cyst. Early surgical intervention is the chosen treatment for spontaneous spinal epidural hematomas. Spinal surgeons should bear in mind that spontaneous spinal epidural hematomas may have different clinical presentations according to their location in order to perform a differential diagnosis.Fueron relatados dos casos de hematoma epidural espinal espontáneo con diferentes presentaciones clínicas sin factores precipitantes, y fue hecha una breve revisión de la literatura. Nuestro caso 1 tuvo un desarrollo agudo y mostró señales progresivas en la columna cervical que determinaron una laminectomía descompresiva de emergencia. Por otro lado, el segundo paciente, crónico, fue operado casi cinco meses después de los síntomas iniciales y el diagnóstico radiológico fue de un gran quiste sinovial. La intervención quirúrgica temprana es el tratamiento de elección para hematomas espontáneos epidurales espinales. El tratamiento quirúrgico representa la forma más común de terapia para todos los tipos de presentaciones clínicas. Debemos considerar que el tratamiento conservador (o no sea más común en casos de presentación leve, principalmente en pacientes con hematoma espinal crónico. Para realizar un diagnóstico diferencial, los cirujanos deben recordar que los hematomas epidurales espinales espontáneos pueden tener distintas presentaciones clínicas según su ubicación.Os autores relatam dois casos de hematoma epidural espinhal espontâneo com diferentes apresentações cl

  7. Influence on number of top-ups after implementing patient controlled epidural analgesia: A cohort study.

    Science.gov (United States)

    van Samkar, Ganapathy; Hermanns, Henning; Lirk, Philipp; Hollmann, Markus W; Stevens, Markus F

    2017-01-01

    Postoperative epidural analgesia often needs rate readjustment using top-ups. Patient-controlled epidural analgesia (PCEA) is said to reduce the requirement of epidural top-ups when compared to continuous epidural analgesia (CEA). We compared CEA and PCEA in major thoracic and abdominal surgery, in a cohort study. The primary endpoint was the required number of epidural top-ups. Secondary endpoints were pain scores, side effects and workload differences. We analysed 199 patients with CEA and 187 with PCEA. Both groups had similar pain scores. The total number of top-ups was 75 in 57 patients (CEA) versus 20 top-ups in 18 patients (PCEA). (p = 0.0001) Sedation tended to occur more frequently in patients with CEA versus PCEA, 5.5% vs 1.6% (p = 0.05). Implementation of PCEA led to a decreased number of top-ups, fewer side-effects and decreased use of the postoperative care unit.

  8. The Effects of Rifampin, Povidone-Iodine and Hydrogen Peroxide on the Formation of Epidural Fibrosis in the Experimental Epidural Fibrosis Model.

    Science.gov (United States)

    Kizilay, Zahir; Cetin, Nesibe Kahraman; İsmailoglu, Özgur; Yılmaz, Ali; Omurlu, İmran Kurt; Coskun, Mehmet Erdal; Aktaş, Serdar

    2016-08-01

    The aim of the study was to determine the effect of direct application of rifampin, povidone-iodine, and hydrogen peroxide on the formation of epidural fibrosis in rats. Forty-eight adult male Wistar albino rats were equally and randomly divided into four groups (laminectomy, topical rifampin, topical povidone-iodine, and topical hydrogen peroxide). Laminectomy was performed at the T12 level in all rats. Four weeks later, the extent of epidural fibrosis was assessed both macroscopically and histopathologically. ANOVA test was used for the evaluation of dural thickness. Kruskal-Wallis test was used for the pathology and macroscopic evaluation. Chi-square test was used for evaluation of the arachnoid involvement. p value hydrogen peroxide were effective in reducing epidural fibrosis formation. The results of our study provide the experimental evidence of the preventive effects of topical application of povidone-iodine and hydrogen peroxide over epidural fibrosis.

  9. Combined spinal epidural analgesia for labor using sufentanil epidurally versus intrathecally: a retrospective study on the influence on fetal heart trace

    NARCIS (Netherlands)

    Everaert, Nele; Coppens, Marc; Vlerick, Peter; Braems, Geert; Wouters, Patrick; de Hert, Stefan

    2015-01-01

    Objective: We retrospectively compared a protocol using sufentanil and ropivacaine intrathecally with a protocol in which only ropivacaine was administered intrathecally and sufentanil was used epidurally to evaluate whether banning sufentanil from the intrathecal space results in a decreased

  10. Comparación de las técnicas anestésicas de bloqueo mandibular troncular convencional directa y Gow-Gates en exodoncia de molares mandibulares

    OpenAIRE

    Proaño de Casalino, Doris; Facultad de Estomatología, Universidad Peruana Cayetano Heredia. Lima,; Guillén Galarza, Manuel Fernando; Escuela de Estomatología. Universidad Nacional de Trujillo. Trujillo

    2014-01-01

    Se presenta una evaluación clínica para determinar si existen diferencias entre el bloqueo mandibularproducido por la técnica troncular convencional directa y la técnica Gow-Gates en pacientes quenecesitaron exodoncias mandibulares, considerando como indicadores: dolor a la penetración einyección anestésica, tiempo de aparición de los primeros síntomas de anestesia, territorioanestesiado a los 5, 10 y 15 minutos, penetración intravascular, anestesia del nervio Bucal Largoy resultado anestésic...

  11. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less

    OpenAIRE

    Moore, Albert; Li Pi Shan,William; Hatzakorzian,Roupen

    2013-01-01

    Albert R Moore, William Li Pi Shan, Roupen Hatzakorzian Department of Anaesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada Background: Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to deter...

  12. [Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain].

    Science.gov (United States)

    Beyaz, Serbülent Gökhan

    A cross-sectional study. We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain.

    Science.gov (United States)

    Beyaz, Serbülent Gökhan

    A cross-sectional study. We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  14. 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.

  15. Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

    Science.gov (United States)

    Wyshak, Grace; Ringer, Steven A.; Johnson, Lise C.; Rivkin, Michael J.; Lieberman, Ellice

    2012-01-01

    OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation. METHODS: We studied all low-risk nulliparous women with singleton pregnancies ≥37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (≤99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders. RESULTS: Maternal temperature >100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (≤99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1- and 5-min Apgar scores 101°F had a two- to sixfold increased risk of all adverse outcomes examined. CONCLUSIONS: The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied. PMID:22291120

  16. Epidural anesthesia as a cause of acquired spinal subarachnoid cysts

    International Nuclear Information System (INIS)

    Sklar, E.M.L.; Quencer, R.M.; Green, B.A.; Post, M.J.D.; Montalvo, B.M.

    1988-01-01

    Six patients with acquired spinal subarachnoid cysts secondary to epidural anesthesia were evaluated with MR imaging (seven patients) and intraoperative US (three patients). The cysts were located in the lower cervical and thoracic spine. Adhesions and irregularity of the cord surface were frequently noted. Associated intramedullary lesions, including intramedullary cysts and myelomalacia, were seen in two of the patients. Arachnoiditis was unsuspected clinically in three patients, and MR imaging proved to be the diagnostic examination that first suggested the cause of the patients symptoms. The underlying mechanism for the formation of these cysts is a chemically induced arachnoiditis

  17. Continuous cervical epidural analgesia for Isshiki type - I thyroplasty

    Science.gov (United States)

    Trivedi, Vandana

    2010-01-01

    Thyroplasty is an operation on the upper airway to improve voice quality in patients with unilateral vocal cord paralysis. It is a difficult anaesthetic procedure that requires sharing the airway with the surgeon. We describe a good anaesthetic technique, which provides a safe airway with excellent operating conditions, using continuous cervical epidural anaesthesia and postoperative analgesia in three patients. The use of a regional anaesthetic technique provides excellent anaesthesia and analgesia while allowing the patient to phonate at the request of the surgeon intraoperatively. PMID:20532074

  18. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer

    2004-01-01

    = 130), plasma and erythrocyte volumes were measured. At the same time points, mean corpuscular volume and hematocrit were measured. Systolic and diastolic blood pressure, heart rate, and hemoglobin were measured every 5 min throughout the study. Volume kinetic analysis was performed for the volunteers....... Hemoglobin concentrations were not significantly altered by the epidural blockade or ephedrine administration but decreased significantly after hydroxyethyl starch administration. Volume kinetic analysis showed that the infused fluid expanded a rather small volume, approximately 1.5 l. The elimination...

  19. Intra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T V

    1993-01-01

    In situ saphenous vein arterial bypass flow was studied in 16 patients with respect to level of epidural anaesthesia. Arterial pressure and electromagnetic flow were used to evaluate arterial tone by intra-arterial (i.a.) papaverine. Eight patients had a low epidural block (... patients were operated during high epidural anaesthesia (> Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated...... during low epidural anaesthesia (P i.a. papaverine was not significantly different in patients operated in low epidural and general anaesthesia (n = 8). In eight patients with insulin-dependent diabetes mellitus who had low epidural anaesthesia, the increase...

  20. [YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia].

    Science.gov (United States)

    Tulgar, Serkan; Selvi, Onur; Serifsoy, Talat Ercan; Senturk, Ozgur; Ozer, Zeliha

    Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87±4.28 vs. 5.84±2.90, p=0.044 and 3.89±5.43 vs. 1.19±3.35, p=0.01 respectively). Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  1. YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Serkan Tulgar

    Full Text Available Abstract Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. Material and method A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1 evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2 was designed for evaluating patient information. Results After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p > 0.05. There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p > 0.05. Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87 ± 4.28 vs. 5.84 ± 2.90, p = 0.044 and 3.89 ± 5.43 vs. 1.19 ± 3.35, p = 0.01 respectively. Conclusion Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions.

  2. Abscesso epidural em paciente portador de piomiosite tropical: relato de caso e revisão da literatura Absceso epidural en paciente portador de piomiositis tropical: relato de caso y revisión de la literatura Epidural abscess in patient with tropical pyomyositis: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Rodrigo Rezende

    2012-09-01

    Full Text Available A piomiosite é uma infecção muscular profunda subaguda que pode originar abscessos intramusculares únicos ou múltiplos. Está associada a infecções sistêmicas, diabetes mellitus, terapia imunossupressora, AIDS e mieloma múltiplo. Descrevemos um caso de piomiosite tropical com acometimento da coluna vertebral que evoluiu para abscesso epidural, em paciente com história pregressa de espondilite anquilosante em tratamento com medicações imunossupressoras e apresentou trauma direto na coxa direita previamente ao início dos sintomas. O objetivo deste trabalho é descrever o acometimento raro da coluna vertebral em pacientes com piomiosite tropical, com apenas um caso descrito na literatura mundial, destacando a necessidade dos métodos complementares na investigação diagnóstica para o adequado tratamento e as possíveis complicações dessa doença. Os pacientes imunossuprimidos com dores musculares subagudas devem ser investigados quanto à piomiosite tropical e o diagnóstico precoce é fundamental para o sucesso do tratamento.La piomiositis es una infección muscular profunda y subaguda que puede originar abscesos intramusculares únicos o múltiples. Se vincula a infecciones sistémicas, diabetes mellitus, terapia inmunosupresora, SIDA [AIDS] y mieloma múltiple. Describimos un caso de piomiositis tropical, con acometimiento de la columna vertebral, que evolucionó para absceso epidural, en paciente con historial anterior de espondilitis anquilosante en tratamiento con medicaciones inmunosupresoras y que presentó traumatismo derecho, en el muslo derecho, previamente al inicio de los síntomas. El objetivo de este trabajo es describir el acometimiento raro de la columna vertebral en pacientes con piomiositis tropical, con solamente un caso descrito en la literatura mundial, destacando la necesidad de los métodos complementarios, en la investigación de diagnóstico, para el apropiado tratamiento y las posibles complicaciones de

  3. Efficacy and safety of combined spinal: Epidural versus epidural technique for labor analgesia in parturients with rheumatic valvular heart disease

    Directory of Open Access Journals (Sweden)

    Babita Ghai

    2013-01-01

    Full Text Available Background: Hemodynamic changes induced by labor pain and apprehension in addition to physiological changes may pose risk to parturients with rheumatic heart disease (RHD. Therefore, it is important to provide adequate pain relief during labor in these patients. We planned this study to compare the efficacy and safety of epidural (E versus combined spinal - epidural (CSE for labor analgesia in parturients with rheumatic valvular heart disease. Methods: Twenty-five parturients with RHD included in this study were randomized to one of the two groups - E group (n = 12, received 6 mL of 0.0625% bupivacaine with 25 μg fentanyl or CSE group (n = 13, received 25 μg of fentanyl with 1.25 mg bupivacaine diluted to 1 mL in subarachnoid space. Afterward, a continuous infusion of 0.1% bupivacaine with 2 μg/mL fentanyl was started at 6-8 mL/h. Primary outcome, analgesic efficacy, was assessed by visual analog scale (VAS for pain. VAS ≤ 3 was considered as effective analgesia. Rescue analgesia in the form of epidural bolus was given if VAS > 3. Results: Demographic characteristics of the patients were comparable. Mitral stenosis was the predominant valvular lesion. The VAS at which the parturients received analgesia was comparable. The mean time to achieve effective analgesia was significantly faster in CSE group (4.46 ± 0.87 min compared with group E (15.09 ± 5.7 min (P < 0.001. Significantly lower median pain scores were recorded until the initial 15 min in CSE group. Afterward, median VAS for pain was comparable between the groups. VAS for pain was significantly low at all time intervals than baseline in both the groups. Maternal satisfaction and incidence of cesarean rate and complication were comparable between the groups. Conclusion: Both epidural and CSE are equally effective and safe for labor analgesia in parturients with rheumatic valvular heart disease. However, CSE technique provides a faster onset of analgesia.

  4. Effects of sodium hyaluronate and methylprednisolone alone or in combination in preventing epidural fibrosis.

    Science.gov (United States)

    Shaban, Madhat; Aras, Yavuz; Aydoseli, Aydin; Akcakaya, Mehmet Osman; Sencer, Altay; Bayindir, Cicek; Izgi, Nail

    2013-10-01

    Epidural fibrosis and leptomeningeal adhesion formation are common causes of failed back surgery syndrome (FBSS). We employed a rat model of lumbar laminectomy to evaluate the histopathological effects of sodium hyaluronate (HA) and methylprednisolone (MP) alone or in combination on post-laminectomy epidural fibrosis. Thirty-two male Sprague-Dawley rats were divided into four groups. All rats underwent three-level lumbar laminectomy. In the treatment groups, HA solution, MP, or a combination of both was applied locally to the epidural spaces of the laminectomy fields. No neurological deficits or pathological wound site changes were observed in any of the groups. At the end of the sixth week, all rats were sacrificed, and the laminectomy vertebral column areas were removed en-bloc. Specimens were evaluated by an expert neuropathologist according to histopathological criteria. The results of the three treatment groups were separately compared with the control group to assess epidural fibrosis. Minimal reduction in the rate of epidural fibrosis was observed in the groups treated with HA or MP compared with the control group. However, no significant difference in epidural fibrosis was noted between the combined treatment group and the control group. Our study showed that MP and HA, given separately, significantly reduce post-laminectomy epidural fibrosis; however, the combination of these drugs is not effective. Further investigation is needed to address the causative drug interactions.

  5. Epidural Combined with General Anesthesia versus General Anesthesia Alone in Patients Undergoing Free Flap Breast Reconstruction.

    Science.gov (United States)

    Lou, Feifei; Sun, Zhirong; Huang, Naisi; Hu, Zhen; Cao, Ayong; Shen, Zhenzhou; Shao, Zhimin; Yu, Peirong; Miao, Changhong; Wu, Jiong

    2016-03-01

    Addition of epidural anesthesia may have several benefits. The purpose of this study was to investigate the effectiveness and safety of epidural anesthesia combined with general anesthesia in patients undergoing free flap breast reconstruction. A retrospective chart review identified 99 patients who underwent free flap breast reconstruction under general anesthesia alone (46 patients) or general anesthesia plus epidural anesthesia (53 patients) between 2011 and 2014. Mean arterial blood pressure was measured before induction, after flap elevation but before flap transfer, 15 minutes after flap revascularization, and at the end of surgery. Postoperative pain was assessed using a visual analogue scale. The incidence of flap thrombosis was 3.8 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 1). Flap failure was 0 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 0.213). Patients in the epidural anesthesia/general anesthesia group had lower visual analogue scale scores at 2 hours (0.76 ± 0.62 versus 2.58 ± 0.99; p surgery. Epidural anesthesia/general anesthesia combination improves postoperative pain and side effects without increasing the risk of flap thrombosis. Therapeutic, III.

  6. Hemiparesis Caused by Cervical Spontaneous Spinal Epidural Hematoma: A Report of 3 Cases

    Directory of Open Access Journals (Sweden)

    Kinya Nakanishi

    2011-01-01

    Full Text Available We report three cases of spontaneous spinal epidural hematoma (SSEH with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.

  7. Women's acute anxiety variations before and after epidural anesthesia for childbirth.

    Science.gov (United States)

    Fernández-Campos, Francisco J; Escrivá, Dolores; Palanca, José M; Ridocci, Francisca; Barrios, Carlos; Gallego, Juan

    2017-06-01

    This study assessed changes in anxiety during different phases of childbirth in a sample of women demanding epidural anesthesia. Prospective, longitudinal case series. A total of 133 women who demanded epidural anesthesia for childbirth answered the questionnaires. Anxiety state was measured using the State Trait Anxiety Inventory (STAI) questionnaire. The STAI-S (anxiety state) was administered in three phases during childbirth: Phase 1 was before applying epidural anesthesia, Phase 2 was 45 min after the application of epidural anesthesia and Phase 3 was at less than 24 h after delivery. Data were collected in two general hospitals: a third-level public hospital and a well-recognized private hospital. STAI scores. Anxiety state decreases significantly after applying the epidural anesthesia (Phase 2) compared to before anesthesia (Phase 1), and it remains low levels 24 h after childbirth (Phase 3). There were statistically significant differences in STAI scores between the different phases administrated (Phases 1 and 2: p anxiety state in women in any of the three phases. Women's anxiety decreases significantly after applying epidural anesthesia, and it remains low 24 h after delivery. Anxiety against childbirth was not influenced by the health system used by women, by the condition of primiparous or multiparous, or by the educational level. Women who received an epidural anesthesia with a cesarean section reported higher rates of anxiety state after birth.

  8. Neonatal neurobehavioral organization after exposure to maternal epidural analgesia in labor.

    Science.gov (United States)

    Bell, Aleeca F; White-Traut, Rosemary; Medoff-Cooper, Barbara

    2010-01-01

    To explore relationships between maternal epidural analgesia and two measures of neurobehavioral organization in infants at the initial feeding 1 hour after birth. Prospective comparative design. Inner-city community hospital, Chicago, Illinois. Convenience sample of 52 low-risk, mainly Black and Latino, mother/infant dyads. Mothers self-selected to labor with epidural or no labor pain medication. Neonatal neurobehavioral organization was measured in term infants at the initial feeding 1 hour after birth. A nutritive sucking apparatus generated data on total number of sucks and sucking pressure. Video recordings of infants (before and after the initial feeding) were coded for behavioral states, with analysis on frequency of alertness. Total number of sucks and sucking pressure were not related to epidural exposure, although an epidural drug dosage effect on total number of sucks was evident when gender was a factor. Unmedicated girls demonstrated more sucks than girls in the high-dosage epidural group (p=.027). Overall, girls exhibited stronger sucking pressure than boys (p=.042). Frequency of alertness was not related to epidural exposure, although longer labor was related to greater alertness (p=.003), and Latino infants were more alert than Black infants (p=.002). Results suggest attenuated neonatal nutritive sucking organization in girls after exposure to high maternal epidural dosages. In comparison to boys, girls may have enhanced neurobehavioral organization at birth. Race/ethnicity and alertness may have spurious associations in which hidden factors drive the relationship.

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

    Directory of Open Access Journals (Sweden)

    Marcelo Negrão Lutti

    2002-04-01

    diferença entre os grupos. CONCLUSÕES: O fentanil ou o sufentanil contínuos em bolus acionados pelo paciente, por via peridural, nas doses utilizadas neste estudo, apresentaram excelente analgesia pós-operatória. No entanto, o sufentanil apresentou efeitos colaterais mais intensos que o fentanil.JUSTIFICATIVA Y OBJETIVOS: Los opioides han sido utilizados por vía peridural asociados o no a anestésicos locales para analgesia pós-operatoria de forma continua y/o en bolus controlado por el paciente. El objetivo de este estudio fue comparar la analgesia pós-operatoria entre el fentanil y sufentanil en infusión continua y en bolus por vía peridural, en pacientes sometidos a la reconstrucción de ligamento de la rodilla. MÉTODO: Participaron del estudio 70 pacientes con edad entre 16 y 47 anos, estado físico ASA I y II, divididos aleatoriamente en dos grupos: Grupo F (fentanil y Grupo S (sufentanil. Todos los pacientes fueron sometidos a anestesia peridural con bupivacaína a 0,5% (100 mg con epinefrina 1:200.000 asociada a fentanil (100 mg. Al final de la cirugía, los pacientes recibieron fentanil (Grupo F o sufentanil (Grupo S por vía peridural en régimen de infusión continua más bolus liberados por el paciente. En el Grupo F fue utilizada solución fisiológica (85 ml conteniendo fentanil 500 µg (10 ml y bupivacaína (5 ml a 0,5%. En el Grupo S fue utilizada solución fisiológica (92 ml conteniendo sufentanil 150 µg (3 ml y bupivacaína (5 ml a 0,5%. Para los dos grupos la bomba de infusión fue programada inicialmente en 5 ml.h-1, con dosis de 2 ml en bolus liberado por el paciente en un intervalo de 15 minutos. Fueron comparados los siguientes parámetros: dolor, número de bolus accionados, consumo de opioides, bloqueo motor, sedación y efectos colaterales. RESULTADOS: No hubo diferencia significativa entre los grupos cuanto la calidad de la analgesia, siendo la mayoría de buena calidad (EAV 0 a 2. Hubo diferencia significativa cuanto al número de

  10. Bupivacaína levógira a 0,5% pura versus mistura enantiomérica de bupivacaína (S75-R25 a 0,5% em anestesia peridural para cirurgia de varizes Bupivacaína levógira a 0,5% pura versus mezcla enantiomerica bupivacaína (S75-R25 a 0,5% en anestesia peridural para cirugía de várices Plain 0.5% levogyrous bupivacaine versus 0.5% bupivacaine enantiomeric mixture (S75-R25 in epidural anesthesia for varicose vein surgery

    Directory of Open Access Journals (Sweden)

    José Delfino

    2001-12-01

    permitir conclusões definitivas.JUSTIFICATIVA Y OBJETIVOS: La cardiotoxicidad de la bupivacaína racémica (50:50 aún es la grande variable relacionada a la seguridad de indicación en los bloqueos regionales que exigen masas y volúmenes elevados. Recientes experimentaciones en animales sugerían que la modificación de la relación enantiomérica de la bupivacaína racémica podría contribuir para su eficacia terapéutica y diminución de su toxicidad potencial. El objetivo del presente estudio fue comparar la eficiencia de la mezcla enantiomerica de bupivacaína (S75-R25 con la levógira pura S(-100 en la anestesia peridural lumbar para cirugías de várices de los miembros inferiores. MÉTODO: El estudio envolvió 30 pacientes del sexo femenino con edades entre 15 y 65 años, estado físico ASA I ó II, programados para cirugía electiva de várices. En test aleatorio y duplamente encubierto, los pacientes fueron divididos en dos grupos de 15: Grupo S75-R25 - 20 ml (100 mg de mezcla enantiomerica de bupivacaína a 0,5% (S75-R25 - y Grupo Levógiro - 20 ml (100 mg de bupivacaína levógira S(-100% a 0,5% sin adyuvante. Fueron comparadas las características del bloqueo sensitivo y motor, bien como la incidencia de efectos colaterales. RESULTADOS: Fueron detectadas diferencias intergrupales relacionadas a las características demográficas y un mayor tiempo quirúrgico en el grupo S75-R25. La dispersión mas rápida y la menor potencia analgésica de la mistura isomérica exhibieron significancia estadística. No hubo diferencia significativa relacionada a la ocurrencia de efectos colaterales. El grupo levógiro presentó menor relajamiento muscular. CONCLUSIONES: La reducción de la incidencia de efectos colaterales, la receptividad del método por los pacientes, la ausencia de sintomatologia neurológica transitoria pós-operatoria apuntan para la aplicación segura de ambas las soluciones en anestesia peridural lumbar para cirugía de várices de los miembros

  11. The effects of epidural bupivacaine on ischemia/reperfusion-induced liver injury.

    Science.gov (United States)

    Sarikus, Z; Bedirli, N; Yilmaz, G; Bagriacik, U; Bozkirli, F

    2016-01-01

    Several animal studies showed beneficial effects of thoracic epidural anesthesia (TEA) in hippocampal, mesenteric and myocardial IR injury (2-4). In this study, we investigated the effects of epidural bupivacaine on hepatic ischemia reperfusion injury in a rat model. Eighteen rats were randomly divided into three groups each containing 6 animals. The rats in Group C had sham laparotomy. The rats in the Group S were subjected to liver IR through laparotomy and 20 mcg/kg/h 0.9% NaCl was administered to these rats via an epidural catheter. The rats in the Group B were subjected to liver IR and were given 20 mcg/kg/h bupivacaine via an epidural catheter. Liver tissue was harvested for MDA analysis, apoptosis and histopathological examination after 60 minutes of ischemia followed by 360 minutes of reperfusion. Blood samples were also collected for TNF-α, IL-1β, AST and ALT analysis. The AST and ALT levels were higher in ischemia and reperfusion group, which received only normal saline via the thoracic epidural catheter, compared to the sham group. In the ischemia reperfusion group, which received bupivacaine via the epidural catheter, IL-1 levels were significantly higher than in the other groups. TNF-α levels were higher in the Groups S and B compared to the sham group. Bupivacaine administration induced apoptosis in all animals. These results showed that thoracic epidural bupivacaine was not a suitable agent for preventing inflammatory response and lipid peroxidation in experimental hepatic IR injury in rats. Moreover, epidural bupivacaine triggered apoptosis in hepatocytes. Further research is needed as there are no studies in literature investigate the effects of epidural bupivacaine on hepatic ischemia reperfusion injury (Tab. 3, Fig. 3, Ref. 34).

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

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    Sukhminder Jit Singh Bajwa

    2011-01-01

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

  13. Intraventricular Hemorrhage after Epidural Blood Patching: An Unusual Complication

    Directory of Open Access Journals (Sweden)

    Mohammad Sorour

    2014-01-01

    Full Text Available The authors present two cases of intraventricular hemorrhage (IVH believed to be a result of epidural blood patching. The first was a 71-year-old woman who had new onset of nontraumatic IVH on computed tomography (CT scan after undergoing an epidural blood patch (EBP. This amount of intraventricular blood was deemed an incidental finding since it was of very small volume to account for her overall symptoms. The second patient, a 29-year-old woman, was found to have nontraumatic IVH three days after undergoing an EBP. This was seen on CT scan of the head for workup of pressure-like headaches, nausea, vomiting, and absence seizures. Conservative management was followed in both instances. Serial CT scan of the head in our first patient displayed complete resolution of her IVH. The second patient did not have follow-up CT scans because her overall clinical picture had improved significantly. This highlights a potential sequel of EBP that may be observed on CT scan of the head. In the event that IVH is detected, signs and symptoms of hydrocephalus should be closely monitored with the consideration for a future workup if warranted by the clinical picture.

  14. Labor epidural analgesia is independent risk factor for neonatal pyrexia.

    Science.gov (United States)

    Agakidis, Charalampos; Agakidou, Eleni; Philip Thomas, Sumesh; Murthy, Prashanth; John Lloyd, David

    2011-09-01

    To explore whether epidural analgesia (EA) in labor is independent risk factor for neonatal pyrexia after controlling for intrapartum pyrexia. Retrospective observational study of 480 consecutive term singleton infants born to mothers who received EA in labor (EA group) and 480 term infants delivered to mothers who did not receive EA (NEA group). Mothers in the EA group had significantly higher incidence of intrapartum pyrexia [54/480 (11%) vs. 4/480 (0.8%), OR = 15.1, p neonatal pyrexia [68/480 (14.2%) vs. 15/480 (3.1%), OR = 5.1, p Neonates in the EA group had a median duration of pyrexia of 1 h (maximum 5 h) with a peak temperature within 1 h. Stepwise logistic regression analysis showed that maternal EA was independent risk factor for neonatal pyrexia (>37.5°C) after controlling for intrapartum pyrexia (>37.9°C) and other confounders (OR = 3.44, CI = 1.9-6.3, p neonates. It is unnecessary to investigate febrile offspring of mothers who have had epidurals unless pyrexia persists for longer than 5 h or other signs or risk factors for neonatal sepsis are present.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-08-01

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

  16. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....

  17. Cervical spinal epidural abscess following acupuncture and wet-cupping therapy: A case report.

    Science.gov (United States)

    Yao, Yindan; Hong, Wenke; Chen, Huimin; Guan, Qiongfeng; Yu, Hu; Chang, Xianchao; Yu, Yaoping; Xu, Shanhu; Fan, Weinv

    2016-02-01

    Report of an uncommon complication of acupuncture and wet cupping. A 54-year-old man presented with neck pain and fever. Magnetic resonance imaging of the cervical spine revealed an epidural abscess at C4 to T2. The symptoms related to epidural abscess resolved partially after treatment with antibiotics. Acupuncture and wet-cupping therapy should be taken into consideration as a cause of spinal epidural abscesses in patients who present with neck pain and fever. Furthermore, acupuncture and wet-cupping practitioners should pay attention to hygienic measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Cardiopulmonary Arrest and Pneumoencephaly Developing after Epidural Oxygen-ozone Mixture Therapy.

    Science.gov (United States)

    Beyaz, Serbülent Gökhan; Altaş, Cafer; Sayhan, Havva

    2018-01-01

    Pain treatment can comprise a combination of pharmacological, interventional, surgical, physical, psycological methods. Interventional procedures, particularly minimally invasive percutaneous therapies, have been widely used in recent years. Corticosteroid, hyperbaric saline or oxygen-ozone therapy is a safe procedure for patients in whom pain cannot be relieved by epidural adhesiolysis or other treatments. Complication related to oxygen-ozone therapy have been reported rarely in lumbar sciatalgia. Herein, we present a patient who developed cardiopulmonary arrest and pneumoencephaly as a rare but life-threatening complication of oxygen-ozone therapy, for epidural lysis, applied to the epidural space due to low back pain.

  19. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  20. Cervical epidural abscess: rare complication of bacterial endocarditis with streptococcus viridans: a case report.

    Science.gov (United States)

    Oh, Jae-Sang; Shim, Jai-Joon; Lee, Kyeong-Seok; Doh, Jae-Won

    2015-03-01

    Although many patients with infective endocarditis (IE) complain of joint, muscle, and back pain, infections at these sights are rare. The incidence of spinal abscess in cervical spine complicating endocarditis is very rare. Although the surgical management is the mainstay of treatment, conservative treatment can get success in selected patients. We report a patient with cervical epidural abscess due to Streptococcus viridans endocarditis. Both epidural abscess and IE were managed conservatively with intravenous antibiotics for 8 weeks, with recovery. It is important to remind spinal epidural abscess can occur in those patients with bacterial endocarditis.

  1. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

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    Joyce Leary

    2013-01-01

    Full Text Available Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues.

  2. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections.

    Science.gov (United States)

    Leary, Joyce; Swislocki, Arthur

    2013-01-01

    Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues.

  3. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E

    2012-09-01

    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  4. Programmed intermittent epidural bolus versus continuous epidural infusion for pain relief during termination of pregnancy: a prospective, double-blind, randomized trial.

    Science.gov (United States)

    Leone Roberti Maggiore, U; Silanos, R; Carlevaro, S; Gratarola, A; Venturini, P L; Ferrero, S; Pelosi, P

    2016-02-01

    Pain is a major concern during medical abortion but no evidence-based recommendations for optimal analgesia during medical termination of pregnancy are available. We compared two methods of epidural analgesia during second trimester termination of pregnancy, with the primary aim of assessing the incidence of motor block. Women were randomly assigned to receive continuous epidural infusion (CEI Group; n=52) or programmed intermittent epidural bolus (PIEB Group; n=52). Assessment of motor block was performed every hour. Patients with a modified Bromage score <6 were considered to have motor block. Motor block occurred more frequently in the CEI Group compared with the PIEB Group (46.2% vs. 5.8%, P<0.001). Pain scores were low and comparable between groups. Patients in the CEI Group experienced nausea more frequently than those in the PIEB Group (34.6% vs. 13.5%, P=0.022). The degree of satisfaction was higher in the PIEB Group compared with the CEI Group. During second trimester termination of pregnancy in our patient groups, a programmed intermittent epidural bolus technique was associated with less motor block and greater patient satisfaction than continuous epidural infusion. Both techniques had similar analgesic efficacy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Needle Tip Position and Bevel Direction Have No Effect in the Fluoroscopic Epidural Spreading Pattern in Caudal Epidural Injections: A Randomized Trial

    Directory of Open Access Journals (Sweden)

    Won Kyoung Kwon

    2016-01-01

    Full Text Available Background. Caudal epidural steroid injections (CESIs are an effective treatment for pain. If the injection spreads in a specific pattern depending on the needle position or bevel direction, it would be possible to inject the agent into a specific and desired area. Objectives. We conducted a prospective randomized trial to determine if the needle position and bevel direction have any effect on the epidural spreading pattern in CESI. Methods. Demographic data of the patient were collected. During CESI, the needle position (middle or lateral and direction (ventral or dorsal were randomly allocated. Following fluoroscope-guided injection of 4 mL contrast media and 10 mL of injectates, the epidural spreading patterns (ventral or dorsal, bilateral or lateral were imaged. Results. In the 210 CESIs performed, the needle tip position and bevel direction did not influence the epidural spreading patterns at L4-5 and L5-S1 disc levels. A history of Lumbar spine surgery was associated with a significantly limited spread to each disc level. A midline needle tip position was more effective than the lateral position in spreading to the distant disc levels. Conclusions. Neither the needle tip position nor the bevel direction affected the epidural drug spreading pattern during CESI.

  6. Estudo comparativo da eficácia analgésica pós-operatória de 20 mL de ropivacaína a 0,5, 0,75 ou 1% no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20 mL de ropivacaina a 0,5, 0,75 ó 1% en el bloqueo de plexo braquial por la vía posterior Comparative study for the postoperative analgesic efficacy of 20 mL at 0.5, 0.75, and 1% ropivacaine in posterior brachial plexus block

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2008-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As intervenções cirúrgicas por via artroscópica no ombro estão relacionadas com a dor pós-operatória de grande intensidade. Dentre as técnicas de analgesia, o bloqueio do plexo braquial é a que oferece os melhores resultados. O objetivo deste estudo foi determinar qual concentração de anestésico local no bloqueio de plexo braquial pela via posterior propicia analgesia pós-operatória mais prolongada para essas operações. MÉTODO: Noventa pacientes submetidos ao bloqueio do plexo braquial pela via posterior foram divididos aleatoriamente em três grupos de 30. Grupo 1: 20 mL de ropivacaína a 0,5%; Grupo 2: 20 mL de ropivacaína a 0,75%; Grupo 3: 20 mL de ropivacaína a 1%. O bloqueio foi avaliado por meio da pesquisa de sensibilidade térmica utilizando-se algodão embebido em álcool e a dor pós-operatória foi avaliada seguindo-se uma escala numérica verbal (ENV nas primeiras 48 horas. RESULTADOS: Nos três grupos a analgesia pós-operatória foi similar segundo os parâmetros avaliados; ENV de dor média, tempo até a primeira queixa de dor e consumo de opióides no pós-operatório. CONCLUSÕES: Este estudo mostrou que o bloqueio do plexo braquial pela via posterior é uma técnica que promove analgesia eficaz para intervenções cirúrgicas no ombro. Utilizando-se 20mL de ropivacaína, as três diferentes concentrações estudadas promovem analgesia similar.JUSTIFICATIVA Y OBJETIVOS: Las intervenciones quirúrgicas por vía artroscópica en el hombro se relacionan con el dolor postoperatorio de gran intensidad. Entre las técnicas de analgesia, el bloqueo del plexo braquial es la que ofrece los mejores resultados. El objetivo de este estudio fue determinar cuál concentración de anestésico local en el bloqueo de plexo braquial por la vía posterior, propicia analgesia postoperatoria más prolongada para esas operaciones. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por la v

  7. Penggunaan Teknik Obat dan Permasalahan Blokade Epidural di Wilayah Jawa Barat pada Tahun 2015

    Directory of Open Access Journals (Sweden)

    Muhammad Ibnu

    2017-12-01

    Full Text Available Blokade epidural merupakan salah satu jenis anestesi regional yang memiliki rentang implikasi lebih luas dibanding dengan blokade spinal. Perbedaan teknik maupun rejimen obat untuk blokade epidural meningkat seiring dengan meningkatnya ketertarikan di bidang anestesi regional dikarenakan teknik anestesi regional memberikan efek analgesi yang efektif tanpa memengaruhi kesadaran pasien dan meningkatkan kenyamanan pasien. Tujuan penelitian ini mencari data mengenai penggunaan, teknik, rejimen obat, dan permasalahan yang dialami oleh dokter anestesi di Jawa Barat dalam melakukan blokade epidural. Penelitian ini dilakukan pada bulan Agustus hingga September 2016 di Departemen Anestesiologi dan Terapi Intensif Rumah Sakit Dr. Hasan Sadikin Bandung. Penelitian ini bersifat deskriptif dengan pengambilan data menggunakan kuesioner dan pendekatan cross sectional. Kuesioner dikirimkan kepada 120 dokter spesialis anestesi di Jawa Barat melalui jasa pos dan 30 kuesioner diberikan langsung kepada dokter spesialis anestesi yang bekerja di Rumah Sakit Dr. Hasan Sadikin Bandung. Angka respons yang didapatkan sebesar 47,3%. Hasil penelitian ini didapatkan dokter spesialis anestesi yang masih melakukan blokade epidural pada tahun 2015 sebesar 73,2%, teknik penusukan yang paling banyak dilakukan adalah pendekatan midline sebesar 73%, dan identifikasi rongga epidural paling banyak dengan pendekatan lost of resistance sebesar 80,7%. Obat anestesi lokal yang paling banyak digunakan untuk blokade epidural adalah bupivakain sebesar 95,9%. Adjuvan yang paling banyak digunakan adalah fentanil sebesar 92,3%. Permasalahan yang berkaitan dalam pelaksanaan tindakan blokade epidural pada tahun 2015 paling banyak adalah permasalahan staf di ruangan dalam membantu menangani pasien dengan epidural, yaitu sebesar 38,03%. Epidural Blockade Administration Technique and Issues in West Java in 2015 Epidural blockade is one of the regional anesthesia techniques with wider implication

  8. [Prevention of epidural fibrosis. Initial experiences with non-resorbable membrane].

    Science.gov (United States)

    Ivanic, G M; Wild, A; Pink, T P; Homann, N C

    2002-05-01

    Scars around the neural structures after opening the spinal canal are common and severe problems in spine surgery. This paper presents the use of a special membrane to avoid epidural scarring in two cases.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  10. Distance from skin to epidural space: Correlation with body mass index (BMI

    Directory of Open Access Journals (Sweden)

    Komaljit Kaur Ravi

    2011-01-01

    Conclusions: We formulated predictive equation of depth of epidural space from skin in relation to BMI based on linear regression analysis as: Depth (mm = a + b (BMI. Where a = 17.7966 and b = 0.9777.

  11. Pure spinal epidural cavernous hemangioma: A case series of seven cases

    Directory of Open Access Journals (Sweden)

    Ignatius Ngene Esene

    2016-01-01

    Conclusion: PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.

  12. 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.

  13. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

    Directory of Open Access Journals (Sweden)

    Paulo V. M. Steagall

    2017-05-01

    Full Text Available This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect, perioperative analgesia, and reduced side effects associated with systemic administration of drugs. However, the potential for cardiorespiratory compromise, neurotoxicity, and other adverse effects should be considered when using the epidural route of administration. When these variables are considered, the epidural technique is useful as a complementary method of anesthesia for preventive and postoperative analgesia and/or as part of a balanced anesthesia technique.

  14. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

    Science.gov (United States)

    Steagall, Paulo V. M.; Simon, Bradley T.; Teixeira Neto, Francisco J.; Luna, Stelio P. L.

    2017-01-01

    This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect), perioperative analgesia, and reduced side effects associated with systemic administration of drugs. However, the potential for cardiorespiratory compromise, neurotoxicity, and other adverse effects should be considered when using the epidural route of administration. When these variables are considered, the epidural technique is useful as a complementary method of anesthesia for preventive and postoperative analgesia and/or as part of a balanced anesthesia technique. PMID:28553642

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

    NARCIS (Netherlands)

    Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Hollmann, M.W.; Woiski, M.D.; Porath, M.; Berg, H.J. van den; Beek, E. van; Borchert, O.W.; Schuitemaker, N.; Sikkema, J.M.; Kuipers, A.H.; Logtenberg, S.L.; Salm, P.C. van der; Oude Rengerink, K.; Lopriore, E.; Akker-van Marle, M.E. van den; Cessie, S. le; Lith, J.M. van; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  16. 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

  17. 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.

    2015-01-01

    To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an

  18. Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia : a randomised equivalence trial

    NARCIS (Netherlands)

    Logtenberg, Slm; Oude Rengerink, K; Verhoeven, C J; Freeman, L M; van den Akker, Esa; Godfried, M B; van Beek, E; Borchert, Owhm; Schuitemaker, N; van Woerkens, Ecsm; Hostijn, I; Middeldorp, J M; van der Post, J A; Mol, B W

    OBJECTIVE: To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women. DESIGN: Randomised controlled equivalence trial. SETTING: Eighteen midwifery practices and six hospitals in the

  19. 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.; Rengerink, Katrien Oude; 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.

    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

  20. Intrathecal hematoma and arachnoiditis mimicking bacterial meningitis after an epidural blood patch.

    Science.gov (United States)

    Roy-Gash, F; Engrand, N; Lecarpentier, E; Bonnet, M P

    2017-11-01

    We present a case of arachnoiditis and an intrathecal hematoma after an epidural blood patch. A 24-year-old parturient underwent an epidural blood patch three days after an accidental dural puncture during epidural labor analgesia. Four days later, the patient developed severe lower back pain, bilateral leg pain, persistent headache and fever. Bacterial meningitis was initially suspected and antibiotics started. Lumbar magnetic resonance imaging was performed and showed an intrathecal hematoma, with no blood in the epidural space. This report briefly reviews the few cases in the literature of arachnoiditis caused by an intrathecal hematoma and discusses the mechanism which resulted in blood in the subarachnoid space. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  2. The effect of Gel Foam on post laminectomy epidural fibrosis in rabbits

    OpenAIRE

    Esmaelee H; Mesgaree M; Kallagee E; Lotfinia I

    2009-01-01

    "nBackground: Epidural fibrosis (EF) is a part of normal physiological tissue response to laminectomy and it may be an important cause of failed back surgery syndrome (FBSS). The objective of this study was to evaluate the effect of using gel foam after laminectomy on reduction of epidural fibrosis. "nMethods: In this prospective study forty five rabbits were recruited. The cases undergone bilateral laminectomy at the L4 and L5 lumbar levels under an approved surgical protocol. Afte...

  3. [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. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  4. Primary Epidural Peripheral Primitive Neuroectodermal Tumor of the Lumbar Spine: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Woo Jung; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Paik, Seung Sam; Jun, Young Jin [Dept. of Pathology, Hanyang University Hospital, Seoul (Korea, Republic of); Lee, Young Ho [Dept. of Pediatrics, Hanyang University Hospital, Seoul (Korea, Republic of)

    2011-05-15

    A primitive neuroectodermal tumor (PNET) is a highly malignant tumor in children and young adults, and extremely rare in the spine. We report a case of a primary epidural peripheral PNET of the lumbar spine. The present extremely rare case of primary epidural peripheral PNET of the lumbar spine illustrates the unexpected occurrence and should be included in differential diagnoses for patients with spinal tumors.

  5. Symptomatic epidural lipomatosis of the spinal cord in a child: MR demonstration of spinal cord injury

    Energy Technology Data Exchange (ETDEWEB)

    Munoz, Alberto [Department of Radiology, Section of Neuroradiology, 505 Parnassus Av, L-371, University of California-San Francisco, CA 94143-0628 (United States); Servicio de Radiodiagnostico, Seccion de Neurorradiologia, Hospital Universitario ' ' 12 de Octubre' ' , 28040 Madrid (Spain); Barkovich, James A. [Department of Radiology, Section of Neuroradiology, 505 Parnassus Av, L-371, University of California-San Francisco, CA 94143-0628 (United States); Mateos, Fernando; Simon, Rogelio [Seccion de Neurpediatria, Servicio de Neurologia, Hospital Universitario ' ' 12 de Octubre' ' , 28041 Madrid (Spain)

    2002-12-01

    We report a case of symptomatic epidural lipomatosis in an 8-year-old girl with Cushing's syndrome secondary to longstanding high-dose steroid therapy for Crohn's disease. MR imaging of the spine revealed massive diffuse epidural fat compressing the entire spinal cord with T2 prolongation in the central gray matter of the cord suggesting ischemic myelopathy. This finding has not been previously demonstrated on imaging. A proposed mechanism underlying these findings is discussed. (orig.)

  6. Laparo-endoscopic single-site (LESS) cholecystectomy with epidural vs. general anesthesia.

    Science.gov (United States)

    Ross, Sharona B; Mangar, Devanand; Karlnoski, Rachel; Camporesi, Enrico; Downes, Katheryne; Luberice, Kenneth; Haines, Krista; Rosemurgy, Alexander S

    2013-05-01

    Laparo-endoscopic single-site (LESS) surgery involves a single umbilical incision, lending itself to epidural anesthesia. This prospective, randomized study was undertaken to evaluate epidural anesthesia for patients undergoing LESS cholecystectomy, to assess the feasibility, and to analyze all intraoperative and postoperative complications. The secondary objectives were to determine differences in postoperative pain and time until PACU discharge-to-home readiness between patients. With institutional review board approval, 20 patients with chronic cholecystitis, cholelithiasis, and/or biliary dyskinesia were randomized to receive spinal epidural anesthesia (n = 10) or general anesthesia (n = 10). Postoperative pain at rest was recorded in the PACU every 10 min, and at rest and walking at discharge using the visual analog scale (VAS). Operative time and time until PACU discharge-to-home readiness were recorded. Results are expressed as mean ± SD. Patient age, American Society of Anesthesiologists class, and body mass index were similar. There were no additional ports/incisions, conversions to "open" operations, or conversions to general anesthesia. There were no differences in operative duration. Time until postanesthesia care unit discharge-to-home ready was not significantly different. The most common postoperative adverse event was urinary retention (1 epidural and 3 general anesthesia patients). Resting postoperative VAS pain score at discharge was 4.7 ± 2.5 vs. 2.2 ± 1.6 (p = 0.02, general versus epidural anesthesia respectively); the stressed VAS pain score at discharge was 6.1 ± 2.3 vs. 3.1 ± 2.8 (p = 0.02, general versus epidural anesthesia respectively). LESS cholecystectomy with epidural anesthesia was completed with no operative or anesthetic conversions, and less postoperative pain at discharge. Epidural anesthesia appears to be a preferable alternative to general anesthesia for patients undergoing LESS cholecystectomy.

  7. Epidural interlaminar injections in severe degenerative lumbar spine: fluoroscopy should not be a luxury.

    Science.gov (United States)

    Filippiadis, Dimitrios K; Rodt, Thomas; Kitsou, Maria-Chrysanthi; Batistaki, Chrysanthi; Kelekis, Nikolaos; Kostopanagiotou, Georgia; Kelekis, Alexis

    2017-09-12

    To assess technical efficacy, accuracy, and safety of epidural (interlaminar) injections performed blindly in patients with a severely degenerated lumbar spine. Over 12 consecutive months, 138 patients with a severe degenerative lumbar spine underwent epidural (interlaminar) injection as therapy for low back pain and neuralgia. Patients had already undergone a blind epidural infiltration with minimum or no pain reduction. The session was repeated in the angiography suite. Patients were placed in the lateral decubitus position. The injection was performed without image guidance by an anaesthesiologist; the target level was defined before the beginning of the procedure. Once air resistance loss was felt it was presumed that the needle was inside the epidural space. Verification of needle position was performed by injection of 1-3 mL of iodinated contrast medium under fluoroscopy in a lateral projection. Correct needle position inside the epidural space was documented in 82/138 cases (59.4%); unexpected extraepidural location was seen in 56/138 cases (40.6%). Target level was reached in 96/138 cases (69.6%); in 42/138 cases (30.4%) the needle was positioned in a non-target level. In 5/138 (3.6%) cases, there was inadvertent intradural position of the needle. Image guidance was subsequently used for correct positioning of the needle, which was feasible in all cases. Blind interlaminar epidural injections lack the accuracy of exact needle location that imaging guidance offers in approximately 40% of cases, when there is difficult spine anatomy and the initial epidural approach has failed to provide pain relief. Image guidance for interlaminar epidural injection ensures accurate needle placement, enhancing the safety and efficacy of the procedure. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Anestesia epidural na cirurgia descompressiva lombossacral de cães

    Directory of Open Access Journals (Sweden)

    E.A. Tudury

    2014-06-01

    Full Text Available Objetivou-se avaliar viabilidade, eficácia, vantagens e desvantagens da anestesia epidural lombossacral, junto à anestesia geral inalatória, em cirurgias de descompressão da cauda equina, tendo em vista que essas cirurgias são procedimentos longos e dolorosos. Para isso, foram utilizados 11 cães adultos com sinais clínicos de síndrome da cauda equina, que foram submetidos à anestesia geral inalatória e deixados no estágio anestésico mais superficial. Depois, realizou-se a anestesia epidural em seis dos 11 pacientes, por punção espinhal em L7-S1, com bupivacaína a 0,5%. Os parâmetros fisiológicos (cardíacos, vasculares, respiratórios, temperatura corporal e glicemia foram aferidos antes da medicação pré-anestésica, 10 minutos após esta, 30 minutos depois da epidural, depois da laminectomia, assim como após 60 minutos e 90 minutos da epidural, tanto no grupo com epidural como naquele sem esta (controle. Os animais que possuíam bloqueio epidural apresentaram redução significativa no consumo de anestésico inalatório e no tempo de extubação, não apresentando déficits neurológicos causados pela anestesia epidural, quando comparados com o grupo-controle. Conclui-se que a técnica de anestesia epidural é eficiente e vantajosa na realização de cirurgias descompressivas lombossacrais, pois proporciona menor risco anestésico para o animal.

  9. ASSESSMENT OF THE EFFICTIVENESS OF EPIDURAL ANESTHESIA IN TREATMENT OF RECTAL CANCER

    Directory of Open Access Journals (Sweden)

    S. V. Avdeev

    2015-01-01

    Full Text Available The comparative analysis of the efficacy of anesthetic management in 53 patients with operable rectal cancer was carried out. In the study group patients (n=29, preemptive thoracic epidural analgesia was used. In the control group, (n=24, anesthesia was induced with sevofluorane and fentanyl. Preemptive thoracic epidural analgesia provided a reliable blockade of nociceptors and neural pathways, normalized stress response and decreased the severity of the systemic inflammatory response by stimulating the production of antiinflammatory cytokines.

  10. ASSESSMENT OF THE EFFICTIVENESS OF EPIDURAL ANESTHESIA IN TREATMENT OF RECTAL CANCER

    OpenAIRE

    S. V. Avdeev; S. G. Afanasyev; S. I. Savosina; V. V. Faltin; L. V. Gerdt; M. N. Stakheeva; S. A. Tuzikov

    2015-01-01

    The comparative analysis of the efficacy of anesthetic management in 53 patients with operable rectal cancer was carried out. In the study group patients (n=29), preemptive thoracic epidural analgesia was used. In the control group, (n=24), anesthesia was induced with sevofluorane and fentanyl. Preemptive thoracic epidural analgesia provided a reliable blockade of nociceptors and neural pathways, normalized stress response and decreased the severity of the systemic inflammatory response by st...

  11. [Epidural injections of steroids in the treatment of patients with chronic sciatica in discopathy].

    Science.gov (United States)

    Popiołek, A; Domanik, A; Mazurkiewicz, G

    1991-01-01

    The authors tried to assess the effectiveness of the treatment with epidural steroid injections in cases with lumbar discopathy and chronic ischialgia++. Thirty patients were given one or two injections of Depo-Medrol or Polcortolon with added bupivacaine++ into the epidural space. The same number of patients were treated without such injections. Control examinations after 21 days showed greater and earlier improvement after Depo-Medrol . The results of Polcortolon were less evident. No side effects were observed.

  12. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

    OpenAIRE

    Steagall, Paulo V. M.; Simon, Bradley T.; Teixeira Neto, Francisco J.; Luna, Stelio P. L.

    2017-01-01

    This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect), perioperative analgesia, and reduced side ...

  13. 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...... increased, while no such changes could be detected using epidural analgesia. The ability to increase mean body temperature by increasing heat production was negatively correlated to age....

  14. Contralateral delayed epidural hematoma following intracerebral hematoma surgery

    Science.gov (United States)

    Solomiichuk, Volodymyr O.; Drizhdov, Konstantin I.

    2013-01-01

    Background: Delayed epidural hematoma (EDH) is an uncommon finding in patients after intracranial hematomas evacuation. It occurs in 6.7-7.4% of cases. A total of 29 reports were found in literature. Between them were no cases of delayed contralateral EDH after intracerebral hematoma evacuation. Case Description: This paper represents a clinical case of a 28-year-old male patient with opened penetrating head injury, who underwent left frontal lobe intracerebral hematoma evacuation and one day later a contralateral EDH was found and successfully surgically treated. Conclusion: Contralateral EDH is a life-threatening neurosurgical emergency case, which can occur during first 24 hours after decompressive craniectomy. Control CT scans must be performed next day after the operation to verify and treat contralateral EDH timely. PMID:24233058

  15. Endovascular Treatment of Incoercible Epistaxis and Epidural Cerebral Hematoma

    Science.gov (United States)

    Bortoluzzi, M.; Pavia, M.

    2006-01-01

    Summary A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle meningeal artery. The procedure stopped the epistaxis and no further enlargement of the EDH was observed, avoiding its surgical treatment. Endovascular surgery may be an effective procedure to stop the arterial meningeal bleeding sustaining acute EDH and may be a useful tool in the management of special cases of post traumatic EDH. PMID:20569576

  16. Thoracic epidural analgesia reduces gastric microcirculation in the pig

    DEFF Research Database (Denmark)

    Ambrus, Rikard; Strandby, Rune B; Secher, Niels H.

    2016-01-01

    BACKGROUND: Thoracic epidural analgesia (TEA) is used for pain relief during and after abdominal surgery, but the effect of TEA on the splanchnic microcirculation remains debated. We evaluated whether TEA affects splanchnic microcirculation in the pig. METHODS: Splanchnic microcirculation...... was assessed in nine pigs prior to and 15 and 30 min after induction of TEA. Regional blood flow was assessed by neutron activated microspheres and changes in microcirculation by laser speckle contrast imaging (LSCI). RESULTS: As assessed by LSCI 15 min following TEA, gastric arteriolar flow decreased by 22...... regional blood flow 30 min following induction of TEA (p = 0.048). These manifestations took place along with a drop in systolic blood pressure (p = 0.030), but with no significant change in mean arterial pressure, cardiac output, or heart rate. CONCLUSION: The results indicate that TEA may have an adverse...

  17. Cerebrospinal fluid cutaneous fistula following obstetric epidural analgaesia. Case report.

    Science.gov (United States)

    Fedriani de Matos, J J; Quintero Salvago, A V; Gómez Cortés, M D

    2017-10-01

    Cutaneous fistula of cerebrospinal fluid is a rare complication of neuroaxial blockade. We report the case of a parturient in whom an epidural catheter was placed for labour analgesia and 12h after the catheter was removed, presented an abundant asymptomatic fluid leak from the puncture site, compatible in the cyto-chemical analysis with cerebrospinal fluid. She was treated with acetazolamide, compression of skin orifice of the fluid leakage, antibiotic prophylaxis, hydration and rest, and progressed satisfactorily without requiring blood patch. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Lumbar epidural catheter placement in the presence of low back tattoos: a review of the safety concerns.

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    Welliver, Dawn; Welliver, Mark; Carroll, Tammy; James, Peggy

    2010-06-01

    Current fashion in body art includes low back tattoos of varying designs and colors, a trend that presents unique concerns for anesthesia providers. Does the placement of epidural catheters risk the introduction of tattoo pigment dyes into the epidural space through the process of coring? Are there specific risks associated with tattoo dyes and epidural needle placement? We performed a comprehensive review of the literature using multiple search databases with the intent to form guidelines for practice using a level of evidence taxonomy. The available evidence does not identify any specific risks associated with epidural catheter placement through low back tattoos, although tissue coring with tissue transport to deeper sites has been confirmed. Continued investigation is necessary before comprehensive practice guidelines regarding the practice of placing epidural needles and catheters through lumbar tattoos can be developed. We suggest avoidance of piercing tattoos when performing epidural punctures until there is sound evidence of short-term and long-term safety.

  19. [Iatrogenic cervical epidural hematoma: case report and review of the literature].

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    Jusué-Torres, I; Ortega-Zufiria, J M; Tamarit-Degenhardt, M; Navarro Torres, R; López-Serrano, R; Riqué-Dormido, J; Aragonés-Cabrerizo, P; Gómez-Angulo, J C; Poveda-Nuñez, P; Jerez-Fernández, P; Del Pozo-García, J M

    2011-08-01

    Around 600 spinal epidural hematoma cases have been previously reported. Incidence of paraplegia after epidural anesthesia varies between 0,0005 and 0,02%. Several possible etiologies have been described in the literature, including surgery, trauma, anticoagulant therapy, arteriovenous malformations, pregnancy and lumbar puncture. Spinal and epidural anesthesic procedures represent the tenth most common cause. But in combination with anticoagulant therapy, the forementioned procedures increase its incidence until reaching the fifth most common etiological group. We report the case of an 80 year-old-man with a cervical epidural hematoma who had a good outcome with conservative management. 80 year-old-man that developed intense cervicalgia with lower limbs weakness showing complete paraplegia and arreflexia 2 hours after analgesic treatment with epidural cervical infiltration for cervicoartrosis. Cervical MRI showed epidural cervical hematoma between C4 and T1 levels. The patient is transferred to our facilities in order to perform surgery. But after showing fast recovery, medical conservative management was elected. After one month, the patient's condition has improved showing no neurological deficits and complete resorption is seen in MRI. Nowadays, trend is to perform surgery in patients with spinal hematoma and significant neurological deterioration during the first hours. However, good neurological outcomes can be achieved with conservative management, in well selected patients with non progressive, incomplete and partial deficits. Presently, we can not predict which is the best treatment for each case.

  20. Calcified epidural hematoma in pediatric age group: A report of two cases

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    A Trivedi

    2010-01-01

    Full Text Available The authors present a rare case of calcified (ossified chronic epidural hematoma developed in a six-and-a-half-year-old female patient who was operated for cerebellar astrocytoma 6 months earlier. There was no history of trauma. Ossified epidural hematoma was seen as an incidental finding in the follow-up in computed tomography scan after 6 months of primary glioma surgery. Ossified chronic epidural hematoma with thick collagenous wall and newly formed bone on dura was excised. The development of calcified chronic subdural hematoma after decompressive intracranial surgery is a well-known occurrence, but the fact that a calcified epidural hematoma, which is rare and which can also develop after decompressive surgery, and the occurrence of calcified (ossified epidural hematoma after postfossa a glioma surgery is not yet reported. The second case is a 9-year-old male anemic child with a history of fall while playing 5 months earlier who presented with headache of 3 months duration. He had bifrontal calcified epidural hematoma operated by craniotomy and excision of calcified dural edge.

  1. Tropical pyomyositis of erector spinae complicated with spinal epidural abscess.

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    Zheng, Yun-Cong; Chen, Ching-Chang; Wei, Kuo-Chen; Chen, Jyi-Feng; Lee, Shih-Tseng; Liao, Cheng-Chih

    2015-01-01

    This is a retrospective case series. Tropical pyomyositis of erector spinae muscle (ESPM) is a rare muscular infection which may extend into the intraspinal canal to become spinal epidural abscess (ESPM-SEA). If left untreated, it may cause catatrophic spinal cord dysfunction and lead to irreversible paralysis. A series of eight such cases is presented, in order to provide proper surgical options and clarify the prognostic factors of the disease. Merely six sporadic case reports had been found in the literature. Surgical debridement and laminectomy to drain the intraspinal abscess combined with systemic antibiotics were the choice of treatment to treat the disease with good therapeutic effect. Inpatient charts of the patients were reviewed. The therapeutic effect and functional neurological recovery are correlated with the demographic characteristics of the patients, neurological deficits before drainage, and the different procedures of drainage. Old age, long ESPM-SEA (>6.5 vertebral segments), spinal cord dysfunction as well as complete paralysis before the interventional procedures are significantly correlated with poor functional neurological recovery (Sperman's coefficient correlation, all pESPM combined with adequate systemic antibiotics could cure if infection presents with lumbar radiculopathy only, but it failed to rescue the spinal cord dysfunction in two patients present with complete paralysis. Surgical drainage of ESPM with mini-laminotomy to drain ESPM-SEA combined with systemic antibiotics provided good functional recovery of patients, despite of prolonged pre-operative complete paralysis. Early drainage of the ESPM and related epidural abscess combined with systemic antibiotics can provide excellent therapeutic effect of ESPM-SEA. Open drainage with mini-laminotomy is superior to pig-tail drainage when spinal cord dysfunction occurred associated with ESPM-SEA. Copyright © 2014 Elsevier B.V. All rights reserved.

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

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    Florentino Fernandes Mendes

    2005-02-01

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

  3. Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS: a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

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    Friedly Janna L

    2012-03-01

    Full Text Available Abstract Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone. Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization

  4. Medición del daño genético inducido por el basuco en linfocitos humanos empleando la prueba de micronúcleos con Citocalasina B

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    AP. Ocampo

    2001-07-01

    Full Text Available El bazuco es una mezcla compleja que se deriva del proceso de extracción de la cocaína. El frecuente consumo de bazuco constituye un problema de salud pública. La prueba de micronúcleos en linfocitos humanos de sangre periférica por bloqueo de la citocinesis con Citocalasina B, es más sensible y precisa para evaluar daño  cromosómico porque permite registrar micronúcleos originados de fragmentos de cromosomas o cromosomas enteros en células que se han dividido una sola vez. El objetivo del presente estudio fue evaluar el daño genético, inducido por el bazuco en linfocitos humanos in vitro empleando la prueba de micronúcleos con Citocalasina B.

  5. A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation

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    Yang Zhang

    2017-02-01

    Conclusion: Patients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.

  6. Thermographic skin temperature measurement compared with cold sensation in predicting the efficacy and distribution of epidural anesthesia.

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    Bruins, Arnoud A; Kistemaker, Kay R J; Boom, Annemieke; Klaessens, John H G M; Verdaasdonk, Rudolf M; Boer, Christa

    2018-04-01

    Due to the high rates of epidural failure (3-32%), novel techniques are required to objectively assess the successfulness of an epidural block. In this study we therefore investigated whether thermographic temperature measurements have a higher predictive value for a successful epidural block when compared to the cold sensation test as gold standard. Epidural anesthesia was induced in 61 patients undergoing elective abdominal, thoracic or orthopedic surgery. A thermographic picture was recorded at 5, 10 and 15 min following epidural anesthesia induction. After 15 min a cold sensation test was performed. Epidural anesthesia is associated with a decrease in skin temperature. Thermography predicts a successful epidural block with a sensitivity of 54% and a PPV of 92% and a specificity of 67% and a NPV of 17%. The cold sensation test shows a higher sensitivity and PPV than thermography (97 and 93%), but a lower specificity and NPV than thermography (25 and 50%). Thermographic temperature measurements can be used as an additional and objective method for the assessment of the effectiveness of an epidural block next to the cold sensation test, but have a low sensitivity and negative predictive value. The local decrease in temperature as observed in our study during epidural anesthesia is mainly attributed to a core-to-peripheral redistribution of body heat and vasodilation.

  7. A COMPARATIVE STUDY OF EPIDURAL VS. GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY

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    Jayadheer D

    2016-07-01

    Full Text Available BACKGROUND Laparoscopic cholecystectomy has many benefits for patients including reduced postoperative pain, postoperative stay, and fewer wound-related complications. Specifically, obese patients and patients with severe respiratory diseases are benefited with laparoscopic procedures. The procedure is normally performed under general anaesthesia. But off late, this procedure was tried under regional successfully especially under epidural anaesthesia. Various reports in the literature suggest the safety of the use of spinal, epidural, and combined spinal-epidural anaesthesia in laparoscopic procedures. The advantages of regional anaesthesia include: Prevention of airway manipulation, an awake and spontaneously breathing patient intraoperatively, minimal nausea and vomiting, effective postoperative analgesia, and early ambulation and recovery. However, regional anaesthesia maybe associated with a few side effects such as the requirement of a higher sensory level, more severe hypotension, shoulder discomfort due to diaphragmatic irritation, and respiratory embarrassment caused by pneumoperitoneum. Further studies maybe required to establish the advantage of regional anaesthesia over general anaesthesia for its eventual global use in different patient populations. METHODS 40 patients with the ASA (American Society of Anaesthesiologists class I and II were enrolled after taking prior written consent for laparoscopic cholecystectomy at King George Hospital, Visakhapatnam. These 40 patients were divided into two groups of equal size and randomised using random numbers. One group was given general anaesthesia and in the other group procedures were performed under epidural anaesthesia. Two patients in the epidural group required general anaesthesia. RESULTS 40 patients were divided and studied of which the results proved that general anaesthesia was better over epidural anaesthesia except for the disadvantages namely cost factor, PONV, and high risk of

  8. Dual renin-angiotensin system blockade plus oral methylprednisone for the treatment of proteinuria in IgA nephropathy Doble bloqueo del sistema renina-angiotensina más metilprednisona oral para el tratamiento de la proteinuria en la nefropatía por IgA

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    Hernán Trimarchi

    2007-10-01

    Full Text Available Renin-angiotensin system inhibition is a widely accepted approach to initially deal with proteinuria in IgA nephropathy, while the role of immunosuppressants remains controversial in many instances. A prospective, uncontrolled, open-label trial was undertaken in patients with biopsy-proven IgA nephropathy with proteinuria > 0.5 g/day and normal renal function to assess the efficacy of a combination treatment of angiotensin converting enzyme inhibitors plus angiotensin receptor blockers enalapril valsartan coupled with methylprednisone to decrease proteinuria to levels below 0.5 g/day. Twenty patients were included: Age 37.45 ± 13.26 years (50% male; 7 patients (35% were hypertensive; proteinuria 2.2 ± 1.86 g/day; serum creatinine 1.07 ± 0.29 mg/dl; mean follow-up 60.10 ± 31.47 months. IgA nephropathy was subclassified according to Haas criteria. Twelve patients (60% were class II; seven (35% were class III and one (5% class V. All patients received dual reninangiotensin system blockade as tolerated. Oral methylprednisone was started at 0.5 mg/kg/day for the initial 8 weeks and subsequently tapered bi-weekly until the maintenance dose of 4 mg was reached. Oral steroids were discontinued after 24 weeks (6 months of therapy but renin-angiotensin inhibition remained unchanged. At 10 weeks of therapy proteinuria decreased to 0.15 ± 0.07 g/day (P El doble bloqueo del sistema renina-angiotensina con inhibidores de la enzima convertidora de angiotensina junto a bloqueadores del receptor tipo I de angiotensina II es aceptado como tratamiento en la proteinuria de la nefropatía por IgA, ya que el rol de los inmunosupresores continúa siendo controvertido. Estudio prospectivo, no controlado, abierto para pacientes con nefropatía por IgA con proteinurias >0.5 g/día y creatininas séricas <1.4 mg/dl, para evaluar la eficacia de tratamiento de enalapril más valsartán asociado a metilprednisona vía oral para disminuir las proteinurias a <0.5 g

  9. 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.

  10. CONSERVATIVE THERAPY VERSUS EPIDURAL STEROID INFILTRATION IN MANAGEMENT OF CHRONIC LOW BACK ACHE

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    Vivian Roshan D

    2015-11-01

    Full Text Available BACKGROUND: Sciatica due to lumbar intervertebral disc herniation is one of the most common causes of radicular pain in an adult working population. This study aims at studying the effectiveness of conservative management of lumbar disc herniation as an alternative to surgical measures. METHODS: A prospective study of 100 patients with lumbar disc herniations who were treated conservatively were followed up at intervals of 1 month, 6 months and 1 year. Patients planned for conservative treatment were treated with pharmacological therapy, rest and physiotherapy. Those planned for epidural steroid injections were administered a single dose of steroid one level higher than the lesion in the epidural space. The collected data was analyzed by Chi square. RESULTS: Our results showed that in both genders, epidural steroid infiltration yielded better results than conservative treatment. Occupation had no discernible effect on the magnitude of disc herniation. People with sedentary lifestyle recovered better with epidural steroid infiltration as compared to the heavy physical labor group. Irrespective of disc bulge, protrusion or extrusion, the epidural steroid injection group showed significant improvement in symptoms as compared to conservative treatment. Smokers tended to show delay in the recovery as compared with the non-smoker group. The amount of disc herniation is not directly proportional to the outcome of treatment. CONCLUSIONS: Epidural steroid infiltration showed significant improvement in symptoms of lumbar intervertebral disc herniation thereby avoiding disc surgery. Conservative management for atleast 4 to 6 weeks can be recommended followed by epidural steroid in those patients without improvement. Cessation of smoking should be an integral part of the treatment.

  11. Taurine Reduced Epidural Fibrosis in Rat Models after Laminectomy via Downregulating EGR1.

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    Yang, Lei; Tang, Jian; Chen, Hongtao; Ge, Dawei; Sui, Tao; Que, Jun; Cao, Xiaojian; Ge, Yingbin

    2016-01-01

    Epidural fibrosis, a common complication after laminectomy, has been demonstrated to be closely associated with poor surgical outcomes. Previous studies showed that taurine had remarkable anti-fibrotic effects on lung and liver fibrosis. We performed this study to investigate the effects of taurine in rat models of epidural fibrosis after laminectomy and to explore the potential molecular mechanism. Laminectomy was performed on each rat to establish epidural fibrosis model. After taurine treatment, Masson's trichrome and immunohistochemistry staining were used to examine epidural fibrosis. Cell viability was determined using the Cell Counting Kit-8 assay. Annexin V/Propidium Iodide double staining was performed to detect fibroblasts apoptosis. Microarray was adopted to identify significantly changed mRNAs. mRNA expression was measured by qRT-PCR. Lentivirus infection was performed to establish stable knockdown and overexpression cell lines. The expression of fibrosis-related proteins was determined via Western blot. Taurine treatment markedly reduced laminectomy-induced epidural fibrosis in rat models. However, this effect of taurine was independent on TGF-β/Smad pathway, evidenced by no change in the expression of TGF-β and its receptors. Besides, taurine had almost no effect on cell apoptosis. Interestingly, taurine treatment significantly decreased expression of EGR1 (Early growth response protein 1), an enhancer of fibrosis, both in vivo and in vitro. Furthermore, overexpression of EGR1 increased activation of fibroblasts, while EGR1 knockdown achieved an opposite effect, indicating that EGR1 plays a key role in the inhibitory effect of taurine on TGF-β-induced fibrosis. Reduced epidural fibrosis in vivo and decreased activation of fibroblasts in vitro after taurine treatment was mediated by EGR1. Taurine promises to be a potential prevention for epidural fibrosis after laminectomy. © 2016 The Author(s) Published by S. Karger AG, Basel.

  12. A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor.

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    Sharma, Shiv K; Rogers, Beverly B; Alexander, James M; McIntire, Donald D; Leveno, Kenneth J

    2014-03-01

    It has been suggested that the development of maternal fever during epidural analgesia could be due to intrapartum infection. We investigated whether antibiotic prophylaxis before epidural placement decreases the rate of epidural-related fever. In this double-blind, placebo-controlled trial, 400 healthy nulliparous women requesting epidural analgesia were randomly assigned to receive either cefoxitin 2 g or placebo immediately preceding initiation of epidural labor analgesia. Maternal tympanic temperature was measured hourly, and intrapartum fever was defined as a maternal temperature of ≥38°C. Neonates born to women with fever were evaluated for possible sepsis, and available placentas were evaluated for the presence of neutrophilic inflammation. The primary outcome was maternal fever during epidural analgesia. Thirty-eight percent of women in the cefoxitin group and 40% of women in the placebo group developed fever (P = 0.68). The risk difference (95% confidence interval) for fever ≥38°C during labor (antibiotic versus placebo) was -2.0% (-11.5 to 7.5), and for fever >39°C during labor was -1.5% (-4.7 to 1.7). Approximately half of each study group had placental neutrophilic inflammation, but administration of cefoxitin had no significant effect on any grade of neutrophilic inflammation. Fever developed significantly more often in the women with placental neutrophilic inflammation compared with those without such inflammation (73/158 vs 33/144, P labor epidural analgesia is associated with placental inflammation, but fever and placental inflammation were not reduced with antibiotic prophylaxis. This finding suggests that infection is unlikely to be the cause in its development.

  13. Reduction of epidural fibrosis and dural adhesions after lamina reconstruction by absorbable cement: an experimental study.

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    Zeinalizadeh, Mehdi; Miri, Seyed Mojtaba; Ardalan, Farid Azmoodeh; Maleki, Farid; Zakeri, Marjan; Aghajanzadeh, Elham; Habibi, Zohreh

    2014-01-01

    Post-laminectomy epidural fibrosis complicates revision spine surgery and is implicated in cases of "failed back syndrome." Several materials have been used to minimize epidural fibrosis with varying results. The aim of this study was to examine the impact of reconstruction of laminectomy site with a type of absorbable cement (Jectos) to reduce epidural fibrosis. This investigation is an experimental controlled study, which is designed to evaluate the preventive effects of laminectomy site reconstruction in rat laminectomy model. Twenty wistar rats were included in this study and divided randomly to two equal groups, namely, subject and control. In both groups, laminectomy was performed in L2 and L4 levels. Control group received no additional treatment. In the subject group, L4 levels were reconstructed by Jectos and L2 levels were non-reconstructed as internal controls. Six months after surgery the rats were sacrificed and the dural adhesion and epidural fibrosis were evaluated macroscopically and microscopically. The study was financially supported by Brain and Spinal Cord Injuries Repair Center. None of the authors have any conflict of interest. Non-reconstructed levels in both groups showed dense epidural fibrosis with marked dural adherence. L4 reconstructed levels in subject group showed reduced epidural fibrosis macroscopically (p=.024) and microscopically (p=.041). No foreign body reaction or ossification occurred at reconstructed sites. In the present study, lamina reconstruction with absorbable cement was a safe method that significantly reduced post-laminectomy epidural fibrosis and dural adhesions in rat laminectomy model. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Case report: bilateral tunneled epidural catheters to prevent unilateral analgesia for cancer-related pain

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    Padalia RB

    2017-07-01

    Full Text Available Raj B Padalia,1 Corey J Reeves,2 Neal Shah,1 Ankur A Patel,3 Devang M Padalia4 1Pain Medicine, University of South Florida, Tampa, FL, USA; 2Physical Medicine and Rehabilitation, University of South Florida, Tampa, FL, USA; 3Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA; 4Interventional Pain, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA Objective: Unilateral analgesia often occurs with epidural analgesia. Traditional methods of troubleshooting this problem can be insufficient in obtaining adequate pain relief in a timely manner for terminal cancer patients. This case report demonstrates a safe and effective solution which can be utilized in these circumstances.Case report: A 55-year-old female with stage IV pancreatic cancer and life expectancy of a few weeks presented to the interventional pain clinic with intractable sacral pain. The decision to place an epidural catheter and external pump for analgesia was made. An epidural catheter placed at the L5-S1 level showed contrast spread only along the right nerve roots and a test dose produced only right-sided analgesia. Suspecting compartmentalization of the epidural space, a second left-sided epidural catheter was placed and bilateral analgesia was achieved by using both catheters. This dual catheter technique gave the patient effective bilateral analgesia until she passed away several weeks later. Conclusion: The bilateral epidural catheter technique is safe and effective in patients who present with persistent unilateral epidural analgesia despite exhausting traditional solutions. Keywords: pain management, palliative care, cancer, regional techniques

  15. Pressure inside the neuroendoscope: correlation with epidural intracranial pressure during neuroendoscopic procedures.

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    Salvador, Lydia; Valero, Ricard; Carazo, Jesús; Caral, Luis; Rios, José; Carrero, Enrique; Tercero, Javier; de Riva, Nicolas; Hurtado, Paola; Ferrer, Enrique; Fábregas, Neus

    2010-07-01

    During neuroendoscopic procedures, pressure inside the neuroendoscope (PIN) monitored through the irrigation channel correlates with the occurrence of postoperative complications. Our aim was to analyze the reliability of PIN measurement as a surrogate for intracranial pressure (ICP) by comparing PIN with simultaneously epidural ICP measurement as the standard. Seventeen consecutive patients undergoing neuroendoscopy were studied prospectively. Type and length of procedure and PIN and epidural ICP values during neuroendoscopy were recorded. Lin's concordance coefficient and Bland-Altman analysis of agreement were used to assess correspondence between the 2 systems. A consistent relation between PIN and epidural ICP waveforms was observed during neuroendoscopic navigation. A strong Pearson correlation between PIN and epidural ICP data were found in 15 patients. Epidural ICP values were systematically higher than PIN values in 15 patients. Lin concordance coefficients showed moderate global agreement between the 2 methods, at 0.58 (95% confidence interval, 0.577-0.592). In 6 cases (35.2%) concordance was good according to this analysis, in 7 cases (41.2%) agreement was moderate/fair, and in 4 cases (23.5%) agreement was poor. The Bland-Altman analysis of patient data showed good agreement between the PIN and epidural ICP measurements for most patients, although discrepancies were greater at higher ICP values for 11 patients. Bland-Altman analysis of the complete dataset, after the normalization of individual's measurements, showed good overall agreement. PIN measurement seems useful for evaluating ICP changes related to neuroendoscopic procedures and seems to be more consistent than epidural ICP at high pressures.

  16. Modulación de la muerte de monocitos infectados con Mycobacterium tuberculosis: papel del Ca Ca2+ 2+ 2+, , IL-10 y de PLA2 y correlación con el crecimiento intracelular de la micobacteria

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    Luis Fernando García

    2003-01-01

    Full Text Available En macrófagos murinos infectados con Mycobacterium tuberculosis
    (Mtb el balance entre TNFa e IL-10 modula la apoptosis (1,2. Además, la infección activa flujos de calcio responsables del
    daño mitocondrial y la regulación dependiente de cAMP (3. En
    nuestro laboratorio se ha observado que el PPD y el Mtb inducen
    apoptosis y necrosis en monocitos de pacientes tuberculosos, mientras que en monocitos de controles sólo apoptosis, indicando que los mecanismos de muerte podrían asociarse con la patogénesis de la enfermedad y con el control de la infección. Ensayos de bloqueo muestran que ambos tipos de muerte celular pueden ser modulados por TNFa e IL-10; el anti-TNFa inhibe la apoptosis y la anti-IL-10 la aumenta disminuyendo la necrosis; sin embargo, los mecanismos moduladores de la necrosis son desconocidos. En este proyecto hemos postulado que en presencia de las señales antiapoptóticas de la IL-10, un segundo factor, probablemente el calcio, podría activar otras vías como lipasas y proteasas diferentes a caspasas, que llevan a la muerte celular independiente de la apoptosis.

  17. Pre-puncture ultrasound guided epidural insertion before vaginal delivery.

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    Nassar, Mahmoud; Abdelazim, Ibrahim A

    2015-10-01

    Palpation method is widely used in clinical practice to identify the puncture site during combined spinal-epidural (CSE) blocks. Tuffier's line, is an anatomical landmark between two iliac crests (inter-cristal), which is widely used to identify the puncture site during CSE blocks is not always an indicator for specific vertebral level or inter-vertebral space. One hundred and Ten (110) women were scheduled for normal vaginal delivery and were randomized into two equal groups; palpation group and an ultrasound guided group to detect the efficacy of puncture ultrasound before CSE blocks to increase chances of successful CSE procedure on the first attempt and to reduce the number of attempts or punctures during insertion of CSE catheter. There were no significant differences between two studied groups regarding; maternal age, weight and height, while, there was a significant difference between two studied groups regarding; parity. Percentage of successful CSE procedure on the first attempt was significantly higher (67.27%) in ultrasound compared to palpation group (40%). Number of punctures (attempts) were significantly less in ultrasound (1.2 ± 0.6) compared to palpation group (2.3 ± 0.8) and the number of redirections was also significantly less in ultrasound (1.4 ± 0.5) compared to palpation group (2.8 ± 1.6). Although, time to identify puncture site was significantly longer in ultrasound compared to palpation group and total procedure time was longer in ultrasound (9.1 ± 1.5 min) compared to palpation group (6.2 ± 1.2 min), there was no significant difference between two studied groups regarding; time to identify puncture site and total procedure time. Two cases of dural puncture in palpation versus no cases in ultrasound group and two cases of intravascular catheter placement (one in each group), with no significant difference between two groups. Pre- puncture ultrasound guided epidural insertion before vaginal delivery, increases the chance of a

  18. Epidural steroids in the management of chronic spinal pain: a systematic review.

    Science.gov (United States)

    Abdi, Salahadin; Datta, Sukdeb; Trescot, Andrea M; Schultz, David M; Adlaka, Rajive; Atluri, Sairam L; Smith, Howard S; Manchikanti, Laxmaiah

    2007-01-01

    Epidural injection of corticosteroids is one of the most commonly used interventions in managing chronic spinal pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of epidural injections. Consequently, debate continues as to the value of epidural steroid injections in managing spinal pain. To evaluate the effect of various types of epidural steroid injections (interlaminar, transforaminal, and caudal), in managing various types of chronic spinal pain (axial and radicular) in the neck and low back regions. A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials, and criteria of Cochrane Musculoskeletal Review Group for randomized trials were used. Data sources included relevant English literature performed by a librarian experienced in Evidence Based Medicine (EBM), as well as manual searches of bibliographies of known primary and review articles and abstracts from scientific meetings within the last 2 years. Three reviewers independently assessed the trials for the quality of their methods. Subgroup analyses were performed among trials with different control groups, with different techniques of epidural injections (interlaminar, transforaminal, and caudal), with different injection sites (cervical/thoracic, lumbar/sacral), and with timing of outcome measurement (short- and long-term). The primary outcome measure is pain relief. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Short-term improvement is defined as 6 weeks or less, and long-term relief is defined as 6 weeks or longer. In managing lumbar radicular pain with interlaminar lumbar epidural steroid injections, the evidence is strong for short-term relief and limited for long-term relief. In managing cervical radiculopathy with cervical interlaminar epidural steroid injections

  19. Saline as the sole contrast agent for successful MRI-guided epidural injections.

    Science.gov (United States)

    Deli, Martin; Fritz, Jan; Mateiescu, Serban; Busch, Martin; Carrino, John A; Becker, Jan; Garmer, Marietta; Grönemeyer, Dietrich

    2013-06-01

    To assess the performance of sterile saline solution as the sole contrast agent for percutaneous magnetic resonance imaging (MRI)-guided epidural injections at 1.5 T. A retrospective analysis of two different techniques of MRI-guided epidural injections was performed with either gadolinium-enhanced saline solution or sterile saline solution for documentation of the epidural location of the needle tip. T1-weighted spoiled gradient echo (FLASH) images or T2-weighted single-shot turbo spin echo (HASTE) images visualized the test injectants. Methods were compared by technical success rate, image quality, table time, and rate of complications. 105 MRI-guided epidural injections (12 of 105 with gadolinium-enhanced saline solution and 93 of 105 with sterile saline solution) were performed successfully and without complications. Visualization of sterile saline solution and gadolinium-enhanced saline solution was sufficient, good, or excellent in all 105 interventions. For either test injectant, quantitative image analysis demonstrated comparable high contrast-to-noise ratios of test injectants to adjacent body substances with reliable statistical significance levels (p < 0.001). The mean table time was 22 ± 9 min in the gadolinium-enhanced saline solution group and 22 ± 8 min in the saline solution group (p = 0.75). Sterile saline is suitable as the sole contrast agent for successful and safe percutaneous MRI-guided epidural drug delivery at 1.5 T.

  20. Saline as the Sole Contrast Agent for Successful MRI-guided Epidural Injections

    Energy Technology Data Exchange (ETDEWEB)

    Deli, Martin, E-mail: martin.deli@web.de [University of Witten/Herdecke, Department of Radiology and Microtherapy, Groenemeyer Institute for Microtherapy (GIMT) (Germany); Fritz, Jan, E-mail: jfritz9@jhmi.edu [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States); Mateiescu, Serban, E-mail: mateiescu@microtherapy.de; Busch, Martin, E-mail: busch@microtherapy.de [University of Witten/Herdecke, Department of Radiology and Microtherapy, Groenemeyer Institute for Microtherapy (GIMT) (Germany); Carrino, John A., E-mail: jcarrin2@jhmi.edu [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science (United States); Becker, Jan, E-mail: j.becker@microtherapy.de; Garmer, Marietta, E-mail: garmer@microtherapy.de; Groenemeyer, Dietrich, E-mail: dg@microtherapy.de [University of Witten/Herdecke, Department of Radiology and Microtherapy, Groenemeyer Institute for Microtherapy (GIMT) (Germany)

    2013-06-15

    Purpose. To assess the performance of sterile saline solution as the sole contrast agent for percutaneous magnetic resonance imaging (MRI)-guided epidural injections at 1.5 T. Methods. A retrospective analysis of two different techniques of MRI-guided epidural injections was performed with either gadolinium-enhanced saline solution or sterile saline solution for documentation of the epidural location of the needle tip. T1-weighted spoiled gradient echo (FLASH) images or T2-weighted single-shot turbo spin echo (HASTE) images visualized the test injectants. Methods were compared by technical success rate, image quality, table time, and rate of complications. Results. 105 MRI-guided epidural injections (12 of 105 with gadolinium-enhanced saline solution and 93 of 105 with sterile saline solution) were performed successfully and without complications. Visualization of sterile saline solution and gadolinium-enhanced saline solution was sufficient, good, or excellent in all 105 interventions. For either test injectant, quantitative image analysis demonstrated comparable high contrast-to-noise ratios of test injectants to adjacent body substances with reliable statistical significance levels (p < 0.001). The mean table time was 22 {+-} 9 min in the gadolinium-enhanced saline solution group and 22 {+-} 8 min in the saline solution group (p = 0.75). Conclusion. Sterile saline is suitable as the sole contrast agent for successful and safe percutaneous MRI-guided epidural drug delivery at 1.5 T.

  1. Use of decorin to prevent epidural fibrosis in a post-laminectomy rat model.

    Science.gov (United States)

    Turkoglu, Erhan; Dinc, Cem; Tuncer, Cengiz; Oktay, Murat; Serbes, Gokhan; Sekerci, Zeki

    2014-02-05

    The formation of epidural fibrosis adjacent to the dura mater is a complex multi-step process that is associated with a marked reduction in tissue cellularity and the excessive deposition of extracellular matrix components. Extensive epidural fibrosis is a major cause of post-laminectomy syndrome. Decorin strongly inhibits fibrosis formation in various tissues via blockade of transforming growth factor-β1. The aim of this study was to investigate the effects of a topical application of decorin on the formation of epidural fibrosis in a rat laminectomy model. Twenty-four female Wistar albino rats (250-350 g) were equally and randomly divided into three groups (control, spongostan and decorin). Laminectomy was performed between the L3 and L5 levels in all rats. The dura mater was directly exposed to spongostan soaked with saline (2 cc/kg) or decorin (100 µg/kg). Four weeks later, the laminectomized spine of the rats was completely removed between the L3 and L5 levels. The extent of the epidural fibrosis and arachnoidal involvement was histopathologically evaluated and graded. Our data revealed that epidural fibrosis was significantly reduced in the group treated with decorin compared to the spongostan and control groups (Plaminectomy rat model. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Cauda Equina Syndrome Following an Epidural Lysis Procedure: A Case Report

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    Yasemin Turan

    2017-08-01

    Full Text Available Epidural lysis is known to be one of the therapy methods used following an unsuccessful low back surgery. Despite its proven effectiveness, several complications associated with epidural lysis procedure have been reported. The most common complications are dural perforation, breaking of the catheter and infections. Cauda equina syndrome is a rare complication seen after epidural lysis. A 51-year-old female complaining of lower back pain for six years underwent an epidural lysis procedure at the lumbar 3-4-5 level. Following the procedure, the patient was not able to walk due to weakness starting in both lower extremities, besides, she had fecal and urinary incontinence. After being diagnosed with cauda equina syndrome, a rehabilitation program was administered. After three months, the patient was ambulant with a bilateral dynamic carbon fiber ankle foot orthoses and a walker. It should be kept in mind that serious complications such as cauda equina syndrome, which may considerably affect the patients’ quality of life in a negative way, might develop after an epidural lysis procedure.

  3. Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation

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    Sang Ho Moon

    2017-01-01

    Full Text Available Background. Lower back pain is a common reason for disability and the most common cause is lumbar disc herniation. Percutaneous epidural adhesiolysis has been applied to relieve pain and increase the functional capacity of patients who present this condition. Objectives. In this study, we retrospectively evaluated the factors which predict the outcome of percutaneous epidural adhesiolysis in patients who were diagnosed with lumbar disc herniation. Methods. Electronic medical records of patients diagnosed with lumbar disc herniation who have received percutaneous epidural adhesiolysis treatment were reviewed. The primary outcome was the factors that were associated with substantial response of ≥4 points or ≥50% of pain relief in the numerical rating scale pain score 12 months after the treatment. Results. Multivariate logistic regression analysis demonstrated that the presence of high-intensity zone (HIZ at magnetic resonance imaging was a predictor of substantial response to percutaneous epidural adhesiolysis for 12 months (P=0.007. The presence of a condition involving the vertebral foramen was a predictor for unsuccessful response after 12 months (P=0.02. Discussion and Conclusion. The presence of HIZ was a predictor of favorable long-term outcome after percutaneous epidural adhesiolysis for the treatment of lower back pain with radicular pain caused by lumbar disc herniation.

  4. Saline as the Sole Contrast Agent for Successful MRI-guided Epidural Injections

    International Nuclear Information System (INIS)

    Deli, Martin; Fritz, Jan; Mateiescu, Serban; Busch, Martin; Carrino, John A.; Becker, Jan; Garmer, Marietta; Grönemeyer, Dietrich

    2013-01-01

    Purpose. To assess the performance of sterile saline solution as the sole contrast agent for percutaneous magnetic resonance imaging (MRI)-guided epidural injections at 1.5 T. Methods. A retrospective analysis of two different techniques of MRI-guided epidural injections was performed with either gadolinium-enhanced saline solution or sterile saline solution for documentation of the epidural location of the needle tip. T1-weighted spoiled gradient echo (FLASH) images or T2-weighted single-shot turbo spin echo (HASTE) images visualized the test injectants. Methods were compared by technical success rate, image quality, table time, and rate of complications. Results. 105 MRI-guided epidural injections (12 of 105 with gadolinium-enhanced saline solution and 93 of 105 with sterile saline solution) were performed successfully and without complications. Visualization of sterile saline solution and gadolinium-enhanced saline solution was sufficient, good, or excellent in all 105 interventions. For either test injectant, quantitative image analysis demonstrated comparable high contrast-to-noise ratios of test injectants to adjacent body substances with reliable statistical significance levels (p < 0.001). The mean table time was 22 ± 9 min in the gadolinium-enhanced saline solution group and 22 ± 8 min in the saline solution group (p = 0.75). Conclusion. Sterile saline is suitable as the sole contrast agent for successful and safe percutaneous MRI-guided epidural drug delivery at 1.5 T.

  5. Evaluation of S1 motor block to determine a safe, reliable test dose for epidural analgesia.

    Science.gov (United States)

    Daoud, Z; Collis, R E; Ateleanu, B; Mapleson, W W

    2002-09-01

    Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a hazard, with the potential to cause total spinal anaesthesia and maternal collapse. Sacral block appears early after intrathecal injections compared with epidural ones, and we therefore used SI motor block to determine a safe and reliable test dose for epidural catheter misplacement. Mothers booked for elective Caesarean section were given various intrathecal doses of bupivacaine with fentanyl during routine combined spinal-epidural anaesthesia. Using sequential allocation we found that the ED50 for SI motor block 10 min after intrathecal injection was bupivacaine 7 mg with fentanyl 14 micrograms (95% CI, 6.2-7.8 mg). We then used intrathecal bupivacaine 13 mg to look for the ED95. We found the calculated ED97.5 to be bupivacaine 9.7 mg with fentanyl 19.4 micrograms (95% CI, 8.7-11.4). We conclude that testing for SI motor block 10 min after epidural injection of bupivacaine 10 mg is a reliable test to detect accidental intrathecal injection in the obstetric population.

  6. Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

    Science.gov (United States)

    Xu, Zhendong; Su, Jing; Liu, Zhiqiang

    2014-01-01

    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) (Panalgesia. 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 option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation. PMID:25386749

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Vértigo con nistagmo vertical por administración de morfina intratecal y reversión con naloxona

    Directory of Open Access Journals (Sweden)

    Jorge De All

    2011-10-01

    Full Text Available La anestesia regional combinada es utilizada frecuentemente como herramienta para el tratamiento del dolor postoperatorio. Los efectos secundarios de los opioides utilizados por esta vía son similares a los que se presentan luego de la administración sistémica. La aparición de vértigo con nistagmo vertical es un efecto adverso muy pocas veces descripto con el uso de morfina por vía intratecal, epidural o endovenosa. Comunicamos el caso de un paciente que presentó esta complicación en el postoperatorio de una nefrectomía parcial, luego de la administración de morfina intratecal, con resolución completa mediante el uso de naloxona endovenosa.

  9. Foot salvage and improvement of microvascular blood flow as a result of epidural spinal cord electrical stimulation

    NARCIS (Netherlands)

    Jacobs, M. J.; Jörning, P. J.; Beckers, R. C.; Ubbink, D. T.; van Kleef, Maarten; Slaaf, D. W.; Reneman, R. S.

    1990-01-01

    Epidural spinal cord electrical stimulation has been suggested as an alternative treatment in patients with limb-threatening ischemia in whom vascular reconstructive surgery is not possible anymore. We studied the effects of epidural spinal cord electrical stimulation on microcirculatory blood flow

  10. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M. [University of Arkansas for Medical Sciences, Pediatric Radiology, Little Rock, AR (United States)

    2016-01-15

    Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

  11. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

    International Nuclear Information System (INIS)

    Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M.

    2016-01-01

    Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

  12. Human Lumbar Ligamentum Flavum Anatomy for Epidural Anesthesia: Reviewing a 3D MR-Based Interactive Model and Postmortem Samples

    NARCIS (Netherlands)

    Reina, Miguel A.; Lirk, Philipp; Puigdellívol-Sánchez, Anna; Mavar, Marija; Prats-Galino, Alberto

    2016-01-01

    The ligamentum flavum (LF) forms the anatomic basis for the loss-of-resistance technique essential to the performance of epidural anesthesia. However, the LF presents considerable interindividual variability, including the possibility of midline gaps, which may influence the performance of epidural

  13. Inserting epidural patient controlled analgesia into a peripheral venous line.

    Science.gov (United States)

    2016-01-01

    A case is reported from the Safety Reporting System in Anaesthesia and Resuscitation database. The event occurred in a patient undergoing abdominal surgery in whom an epidural catheter was inserted for analgesia. After the intervention, the patient was transferred to the recovery unit where the patient controlled analgesia (PCA) is programmed. Due to an error, the PCA was connected to a peripheral venous line, which was detected early without harm to the patient. Communication and analysis of this incident served to introduce a new drug delivery protocol through PCA pumps, including the obligation to prescribe the PCA in the electronic system, a dual computerised check immediately before connecting PCA, labelling the medication bag as well as the proximal and distal lines, standardisation of daily visits to patients, and monthly monitoring of results. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Remote Postoperative Epidural Hematoma after Subdural Hygroma Drainage

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    Wellingson Silva Paiva

    2010-01-01

    Full Text Available Objective. Subdural hygroma is reported to occur in 5%–20% of all patients with closed head trauma, the treatment is controversial and in symptomatic cases surgical drainage is need. We report on a new case with remote acute epidural hematoma (AEH after subdural hygroma drainage. Case Presentation. A 38-year-old man suffered blunt head trauma and had diffuse axonal injury grade III in CT scan. A CT scan that was late performed showed an increasing subdural fluid collection with mild mass effect and some effacement of the left lateral ventricle. We perform a trepanation with drainage of a hypertensive subdural collection with citrine aspect. Postoperative tomography demonstrated a large left AEH. Craniotomy and evacuation of the hematoma were performed. Conclusion. The mechanism of remote postoperative AEH formation is unclear. Complete reliance on neurologic monitoring, trust in an early CT scan, and a relative complacency after an apparently successful initial surgery for hygroma drainage may delay the diagnosis of this postoperative AEH.

  15. Cervical Epidural Anaesthesia for Radical Mastectomy and Chronic Regional Pain Syndrome of Upper Limb - A Case Report

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    Ashok Jadon

    2009-01-01

    Full Text Available A 47-yrs-female patient presented with carcinoma right breast, swelling and allodynia of right upper limb. radical mastectomy with axillary clearance and skin grafting was done under cervical epidural anaesthesia through 18G epidural catheter placed at C6/C7 level. Postoperative analgesia and rehabilitation of affected right upper limb was managed by continuous epidural infusion of 0.125% bupivacaine and 2.5 µg/ml -1 clonidine solution through epidu-ral catheter for 5 days and physiotherapy. This case report highlights the usefulness of cervical epidural analgesia in managing a complex situation of carcinoma breast with associated periarthitis of shoulder joint and chronic regional pain syndrome (CRPS of right upper limb.

  16. Total spinal anaesthesia as a complication of local anaesthetic test-dose administration through an epidural catheter.

    Science.gov (United States)

    Steffek, M; Owczuk, R; Szlyk-Augustyn, M; Lasinska-Kowara, M; Wujtewicz, M

    2004-10-01

    We describe a case of total spinal anaesthesia, which occurred after a 3-ml lignocaine (20 mg ml(-1)) test dose was administered through an epidural catheter in a 79-year-old patient scheduled for gastrectomy under combined general and epidural anaesthesia. The surgery was postponed, and the patient required admission to the intensive therapy unit. Spinal MRI from the total spinal cord did not reveal any pathology. During the next 24 h the patient recovered and after 11 days was successfully operated on under general anaesthesia. No late complications followed. We presume that during placement, the epidural catheter had migrated to the spinal canal as a result of technical difficulties. Although controversial, we consider that administering a standard test dose of local anaesthetic via an epidural catheter is recommended, especially in high-risk patients and when epidural space identification or catheter placement poses technical difficulties. A test dose of local anaesthetic does not fully prevent complications.

  17. Evaluation of caudal epidural anesthesia efficacy by measurement of feet skin temperature in children

    Directory of Open Access Journals (Sweden)

    M. Yu. Kurochkin

    2015-04-01

    Full Text Available Caudal epidural anesthesia in children is not performed in pure form, but only in combination with superficial general anesthesia. Therefore, a search for reliable evaluation criteria of the caudal epidural block onset in children remains actual. Aim. To evaluate effectiveness of caudal epidural anesthesia efficacy by measurement of feet skin temperature in children. Methods and results. We investigated feet skin temperature before the caudal blockade by bupivacaine and after 15–20 minutes in 30 children. The control group included 20 children who underwent total intravenous anesthesia. The study showed that feet skin temperature after caudal blockade significantly increased from 30,1±0,15°C to 33,0±0,1°C (10% and in the control group it did not change significantly. Conclusion. Thus, feet skin thermometry may be considered to be a reliable non-invasive method for assessing the onset of the caudal block.

  18. Postoperative Paraplegia as a Result of Undiagnosed Primitive Neuroectodermal Tumor, Not Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Pei-Ching Hung

    2007-10-01

    Full Text Available Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.

  19. Effect of amniotic membrane to reduce postlaminectomy epidural adhesion on a rat model.

    Science.gov (United States)

    Choi, Hyu Jin; Kim, Kyoung Beom; Kwon, Young-Min

    2011-06-01

    Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model. A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks. The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B. This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model.

  20. Diagnosis of anterior cervical spinal epidural abscess by US and MRI in a newborn

    Energy Technology Data Exchange (ETDEWEB)

    Gudinchet, F.; Chapuis, L. (University Hospital, Lausanne (Switzerland). Dept. of Radiology); Berger, D. (University Hospital, Lausanne (Switzerland). Dept. of Pediatric Surgery)

    1991-11-01

    A 10-day-old girl who initially presented with fever developed over five days a complete paresis of both upper arms and swallowing difficulty. After emergency drainage of a retropharyngeal abscess, cervical US demonstrated a cervical anterior epidural mass compressing the cord. MRI confirmed the diagnosis of spinal epidural abscess secondary to C4-C5 spondylodiscitis. Surgical removal of the abscess was followed by complete disappearance of the neurologic symptoms after six months of follow-up. This is the first case of spinal epidural abscess in a newborn to be diagnosed by US and MRI preoperatively. The advantages of these non-invasive imaging modalities are discussed, and compared to myelography. (orig.).

  1. Technique of fiber optics used to localize epidural space in piglets.

    Science.gov (United States)

    Ting, Chien-Kun; Chang, Yin

    2010-05-24

    Technique of loss-of-resistance in epidural block is commonly used for epidural anesthesia in humans with approximately 90% successful rate. However, it may be one of the most difficult procedures to learn for anesthesia residents in hospital. A two-wavelength (650 nm and 532 nm) fiber-optical method has been developed according to the characteristic reflectance spectra of ex-vivo porcine tissues, which are associated with the needle insertion to localize the epidural space (ES). In an in-vivo study in piglets showed that the reflected lights from ES and its surrounding tissue ligamentum flavum (LF) are highly distinguishable. This indicates that this technique has potential to localize the ES on the spot without the help of additional guiding assistance.

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

    Science.gov (United States)

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

    2016-01-01

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

  3. 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.

  4. Hematoma epidural espinal espontâneo durante a gravidez: registro de um caso

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    Ivan Hack

    1984-03-01

    Full Text Available Registro de caso de paciente no oitavo mês de gestação que desenvolveu hematoma epidural espinal espontâneo dorsolombar. A gravidez, determinando aumento da pressão intra-abdominal e, como consequência, aumento da pressão venosa no plexo epidural, poderia ter sido o fator desencadeante no hematoma- A paciente foi submetida a cirurgia precocemente, porém não apresentou recuperação do déficit sensitivo-motor. São discutidos aspectos clínicos, do tratamento cirúrgico, da evolução e da etiologia dos hematomas epidurals espinais espontâneos.

  5. A Rare Case: Isolated Testicular and Epidural Abscess Associated with Brucellosis

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    Tugce Kalayci

    2014-08-01

    Full Text Available Coincidence of isolated testicular abscess and epidural-paravertebral abscess is a rare complication of brucellosis. A 24-year-old male patient was admitted to our clinic with 2 months ongoing back pain, night sweats and left scrotal pain. Septal cystic lesion with dense content in the left testis was considered to isolated testicular abscess in scrotal Doppler examination. Multiple spinal epidural and right paraspinal abscess were detected in the spinal magnetic resonance imaging. The patient was treated with drainage of abscess and oral antibiotics. The rare combination of spinal epidural and testicular abscess should be kept in the mind if a patient presented with low back pain and scrotal pain in regions where brucellosis was endemic.

  6. Long-lasting increase in axonal excitability after epidurally applied DC.

    Science.gov (United States)

    Jankowska, Elzbieta; Kaczmarek, Dominik; Bolzoni, Francesco; Hammar, Ingela

    2017-08-01

    Effects of direct current (DC) on nerve fibers have primarily been investigated during or just after DC application. However, locally applied cathodal DC was recently demonstrated to increase the excitability of intraspinal preterminal axonal branches for >1 h. The aim of this study was therefore to investigate whether DC evokes a similarly long-lasting increase in the excitability of myelinated axons within the dorsal columns. The excitability of dorsal column fibers stimulated epidurally was monitored by recording compound action potentials in peripheral nerves in acute experiments in deeply anesthetized rats. The results show that 1 ) cathodal polarization (0.8-1.0 µA) results in a severalfold increase in the number of epidurally activated fibers and 2 ) the increase in the excitability appears within seconds, 3 ) lasts for >1 h, and 4 ) is activity independent, as it does not require fiber stimulation during the polarization. These features demonstrate an unexplored form of plasticity of myelinated fibers and indicate the conditions under which it develops. They also suggest that therapeutic effects of epidural stimulation may be significantly enhanced if it is combined with DC polarization. In particular, by using DC to increase the number of fibers activated by low-intensity epidural stimuli, the low clinical tolerance to higher stimulus intensities might be overcome. The activity independence of long-lasting DC effects would also allow the use of only brief periods of DC polarization preceding epidural stimulation to increase the effect. NEW & NOTEWORTHY The study indicates a new form of plasticity of myelinated fibers. The differences in time course of DC-evoked increases in the excitability of myelinated nerve fibers in the dorsal columns and in preterminal axonal branches suggest that distinct mechanisms are involved in them. The results show that combining epidural stimulation and transspinal DC polarization may dramatically improve their outcome and

  7. Incidence of delayed hair re-growth, pruritus, and urinary retention after epidural anaesthesia in dogs.

    Science.gov (United States)

    Kalchofner Guerrero, K S; Guerrero, T G; Schweizer-Kölliker, M; Ringer, S K; Hässig, M; Bettschart-Wolfensberger, R

    2014-04-16

    Delayed hair re-growth, pruritus and urinary retention are known complications after epidural anaesthesia in dogs. The aim of this study was to prospectively evaluate the effect of epidurally administered drugs on the occurrence of these complications in dogs. Ninety dogs were included in this study. Eighty client-owned dogs undergoing surgery were randomly assigned to one of three epidural treatment groups: either morphine and bupivacaine (MB), bupivacaine (B), or saline solution 0.9% (S) was administered epidurally to these patients. Ten dogs were only clipped in the lumbosacral area (C). Follow-up started 4 weeks after clipping and was performed every 4-5 weeks in cases of delayed hair re-growth or pruritus. Hair re-growth in the lumbosacral area was observed and compared to hair re-growth in the surgical field and the fentanyl patch area. Cytological analysis and a trichogram were performed if hair re-growth was delayed after 6 months. Time interval to first urination postoperatively was recorded (n = 80). Hair re-growth was delayed in 11 dogs (12.2%; B: n = 7, S: n = 2, MB: n = 1, C: n = 1) with no differences between groups. Pruritus was evident in two dogs (2.2%; MB: n = 1, S: n = 1). After 6 months, hair had started to re-grow in all but one dog (B). After 10 months the coat of this dog had re-grown. Time to first urination did not differ between groups. No direct correlation between the particular drugs injected epidurally and delayed hair re-growth, pruritus and urinary retention could be shown. Dog owners should be informed that hair re-growth after epidural anaesthesia could be markedly delayed.

  8. Reduced incidence of chronic postsurgical pain after epidural analgesia for abdominal surgery.

    Science.gov (United States)

    Bouman, Esther A; Theunissen, Maurice; Bons, Sabrina A; van Mook, Walther N; Gramke, Hans-F; van Kleef, Maarten; Marcus, Marco A

    2014-02-01

    Chronic postsurgical pain (CPSP) is a common complication of surgery with high impact on quality of life. Peripheral and central sensitization caused by enhanced and prolonged afferent nociceptive input are considered important mechanisms for the development of CPSP. This case-control study investigated whether epidural analgesia is associated with a reduced incidence of CPSP after open abdominal surgery. Six months after surgery, Short-Form-36 Health Survey (SF-36) pain scores, possible predictors of chronic pain, and quality of life were assessed. Patients treated with epidural analgesia in combination with general anesthesia (epidural group, N = 51) were compared to patients undergoing matched surgical procedures receiving general anesthesia alone (GA-group, N = 50). Multivariate analysis was performed by logistic regression analysis. Twenty-six (25.7%) patients experienced chronic pain, 9 in the epidural group (17.6%), 17 in the GA-group (34%), crude odds ratio (OR) 0.42 (95% confidence interval (CI) 0.16 to 1.05). After adjustment for the most prominent predictors of CPSP, such as age, sex, pre-operative pain, and acute postoperative pain, the OR for chronic pain in the epidural group was 0.19 (95% CI 0.05 to 0.76). Patients with CPSP reported a significantly lower quality of life compared to patients without CPSP (SF-36 total score median (IQR) 39.2 (27.2 to 56.7) vs. 84.3 (69.9 to 92.5, P abdominal surgery. Postoperative epidural analgesia is associated with a reduced incidence of CPSP after abdominal surgery. © 2013 World Institute of Pain.

  9. A Radiographic Measurement of the Anterior Epidural Space at L4-5 Disc Level.

    Science.gov (United States)

    Xu, Rui-Sheng; Wu, Jie-Shi; Lu, Hai-Dan; Zhu, Hao-Gang; Li, Xia; Dong, Jian; Yuan, Feng-Lai

    2017-05-01

    To observe the morphology character of the anterior epidural space at the L 4-5 disc level and to provide an anatomical basis for safely and accurately performing a percutaneous endoscopic lumbar discectomy (PELD). Fifty-five cases with L 5 S 1 lumbar disc herniation were included in this study, and cases with L 4-5 disease were excluded. When the puncture needle reached the epidural space at the L 5 S 1 level, iohexol was injected at the pressure of 50 cm H 2 O during the PELD, then C-Arm fluoroscopy was used to obtain standard lumbar frontal and lateral images. The widths of epidural space at the level of the L 4 lower endplate, the L 5 upper endplate, as well as the middle point of the L 4-5 disc were measured from the lumbar lateral X-ray film. Epidural space at the L 4-5 disc plane performs like a trapezium chart with a short side at the head end and a long side at the tail end in the lumbar lateral X-ray radiograph, while the average widths of epidural space were 10.2 ± 2.5, 12.3 ± 2.3, and 13.8 ± 2.6 mm at the upper, middle, and lower level of the L 4-5 disc. Understanding the morphological characteristics of epidural space will contribute to improving the safety of the tranforaminal percutaneous endoscopy technique. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  10. Epidural analgesia in labour and neonatal respiratory distress: a case-control study.

    Science.gov (United States)

    Kumar, Manoj; Chandra, Sue; Ijaz, Zainab; Senthilselvan, Ambikaipakan

    2014-03-01

    Epidural analgesia is the commonest mode for providing pain relief in labour, with a combination of bupivacaine and fentanyl most often used in practice. To test whether late-preterm and term neonates exposed to opioids in epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period. A case-control study was conducted of singleton infants born during January 2006 to December 2010. Cases were neonates ≥34 weeks gestation, who developed respiratory distress within 24 h of life requiring supplemental oxygen ≥2 h and/or positive pressure ventilation in the neonatal intensive care unit. Controls were gestation and site-matched neonates who did not develop any respiratory distress within the same period. The information on exposure to epidural analgesia and on potential confounding variables was obtained from the standardised delivery record, routinely filled out on all women admitted to the labour wards. In our study, 206 cases and 206 matched controls were enrolled. Exposure to epidural analgesia was present in 146 (70.9%) cases as compared with 131 (63.6%) of the controls. The association between exposure to epidural analgesia and respiratory distress in neonates was statistically significant upon adjustment for all potential confounders (adjusted OR: 1.75, 95% CI 1.03 to 2.99; p = 0.04). When data was separately analysed for term and late-preterm infants, the results were consistent across these subpopulations, showing no interaction effect. Late-preterm and term infants exposed to maternal epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period.

  11. Specially trained registered nurses can safely manage epidural analgesia infusion in laboring patients.

    Science.gov (United States)

    Charles, Lenore A; Korejwa, Elise; Kent, Donna Curtis; Raniero, Debbie

    2015-06-01

    To discover evidence for defining the registered nurse's (RN's) role in the management of epidural analgesia in the labor and delivery setting. The Labor Epidural Nurse Safety (LENS) study consisted of two parts. The first part was a 10-year retrospective review of the outcomes of 2,568 laboring women for whom epidural catheters had been placed and verified by an anesthesiologist or certified registered nurse anesthetist, then continuous epidural infusion initiated, and basal rate or patient-controlled epidural analgesia (PCEA) dose increased, if needed, within specified parameters by specially trained labor and delivery RNs. The second part compared the outcomes of the neonates born to the 2,568 women in the first part of the study with neonates born to mothers who received PCEA with a continuous infusion initiated and managed exclusively by anesthesiologists and/or certified registered nurse anesthetists at two control sites. Maternal outcomes were quantified by incidences of clinically significant hypotension and sentinel events, such as respiratory distress, cardio/respiratory distress, loss of consciousness, and seizures. Evidence of neonatal outcomes was collected by comparing Apgar scores. No sentinel events occurred, and there was no increase in maternal hypotensive events in the RN-managed group. There were no statistically significant differences in Apgar scores between the experimental and control groups. Specially trained RNs can safely initiate continuous infusions and increase the basal rate of epidural analgesia infusions or PCEA doses administered to laboring women, after insertion and confirmation of correct catheter placement by a qualified anesthesia provider, without adversely affecting maternal and fetal/neonatal outcomes. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  12. Influência da nifedipina no bloqueio neuromuscular produzido pelo atracúrio e pelo cisatracúrio: estudo em preparações nervo frênico-diafragma de rato Influencia de la nifedipina en el bloqueo neuromuscular producido por atracurio y cisatracurio: estudio en preparación nervio frénico diafragma de ratón Influence of nifedipine on the neuromuscular block produced by atracurium and cistracurium: study in rat phrenic-diaphragmatic nerve preparation

    Directory of Open Access Journals (Sweden)

    Silmara Rodrigues de Sousa

    2006-04-01

    produzido pelo atracúrio e cisatracúrio. Estudos eletrofisiológicos demonstraram ação pré-sináptica e ausência de ação despolarizante sobre a fibra muscular.JUSTIFICATIVA Y OBJETIVOS: Los bloqueadores de canales de calcio pueden reaccionar con los bloqueadores neuromusculares potenciando sus efectos. Los estudios sobre esta interacción presentan resultados controvertidos. En algunos estudios estas drogas produjeron el bloqueo neuromuscular, o contractura, o no se observó ningún efecto sobre las respuestas musculares esqueléticas. El estudio evaluó los efectos de la nifedipina sobre la respuesta muscular y su posible relación con los bloqueadores neuromusculares en el diafragma del ratón. MÉTODO: Fueron utilizados 25 ratones, con peso entre 250 y 300 g sacrificadas con anestesia con pentobarbital (40 mg.kg-1 por vía intraperitoneal. La preparación fue montada de acuerdo con la técnica descripta por Bulbring. El diafragma fue mantenido bajo tensión, conectado con un transductor isométrico y sometido a estímulo indirecto de 0,1 Hz de frecuencia. Las contracciones del diafragma fueron registradas en un fisiógrafo. Para la evaluación de los efectos de las drogas en la transmisión neuromuscular, las mismas fueron añadidas aisladamente o asociadas a la preparación en las siguientes concentraciones: nifedipina (4 µg.mL-1; atracurio (20 µg.mL-1; cisatracurio (3 µg.mL-1 . En las preparaciones nervio frénico-diafragma se evaluaron: 1 la amplitud de las respuestas del músculo diafragma al estímulo indirecto, antes y 45 minutos después de la adición de nifedipina y de los bloqueadores neuromusculares aisladamente y después de la asociación de las drogas; 2 los efectos de la nifedipina en los potenciales de la membrana (PM y potenciales de la placa terminal en miniatura (PPTM. RESULTADOS: La nifedipina, cuando empleada aisladamente, no cambió la amplitud de las respuestas musculares, pero aumentó significativamente la actividad bloqueadora

  13. Delayed onset of a spinal epidural hematoma after facet joint injection

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    Mirko Velickovic

    2016-10-01

    Full Text Available The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.

  14. Conservative treatment of lumbar disc herniation. Epidural steroid injection and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Ohmura, Munehisa; Sakanaka, Hideki; Wada, Eiji; Inaoka, Masahiro; Yonenobe, Sakuo [Kansai Rosai Hospital, Amagasaki, Hyogo (Japan)

    1996-01-01

    A study was made on the efficacy of the epidural injection of steroids in 65 patients of lumbar disc herniation. It was recognized that epidural steroids were effective in 49 cases (75 percent) and the effect was closely correlated with the prognosis of lumbar disc herniation. On follow-up MRI studies, a definite decrease in the size of the herniated nucleus pulposus was observed in six patients of the sequestration type: disappearance in five. No definite change was observed except for one patient in the protrusion type. (author).

  15. Posterior epidural migration of lumbar ruptured disc: report of two cases

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    Yoon, Deug Hee; Lee, Sang Ho; Park, Hyeon Seon; Park, Jy Young; Chung, Seung Eun; Jo, Byung June [Wooridul Spine Hospital, Seoul (Korea, Republic of)

    2006-02-15

    Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.

  16. [Dose-response relationship of ropivacaine for epidural block in early herpes zoster guided by CT].

    Science.gov (United States)

    Xie, K Y; Ma, J B; Xu, Q; Huang, B; Yao, M; Ni, H D; Deng, J J; Chen, G D

    2017-12-26

    Objective: To determine the dose-response relationship of ropivacaine for epidural block in early herpes zoster by CT guided. Methods: From January 2015 to February 2017, according to the principle of completely random digital table, 80 patients with early herpes zoster who were prepared for epidural block were divided into 4 groups(each group 20 patients): in group A the concentration of ropivacaine was 0.08%, in group B was 0.10%, in group C was 0.12% and in group D was 0.14%.Under CT guidance, epidural puncture was performed in the relevant section, mixing liquid 5.0 ml (with 10% iodohydrin)were injected into epidural gap.CT scan showed that the mixing liquid covered the relevant spinal nerve segmental.The numeric rating scale(NRS) values before treatment and at 30 minutes, the incidence of adverse reactions were recorded, and the treatment were evaluated. The response to ropivacaine for epidural block in early herpes zoster was defined as positive when the NRS values was less than or equal to one.The ED(50), ED(95) and 95% confidence interval ( CI ) of ropivacaine for epidural block in early herpes zoster guided by CT were calculated by probit analysis. Results: The NRS values before treatment were 5.00(4.00, 6.00), 5.00(4.25, 6.00), 5.50(5.00, 6.00) and 5.00(4.00, 6.00), the difference was no significant( Z =2.576, P =0.462). The NRS values at 30 minutes decreased and the effective rate of the treatment increased(χ(2)=8.371, P =0.004), following ropivacaine dose gradient increasing, they were 1.50(1.00, 2.00), 1.00(1.00, 2.00), 0.50(0.00, 1.00) and 0.00(0.00, 1.00), the difference was statistically significant ( Z =17.421, P =0.001). There was one case in group C and four cases in group D were hypoesthesia, others were no significant adverse reactions occurred. The ED(50) and ED(95) (95% CI ) of ropivacaine for epidural block in early herpes zoster guided by CT were 0.078%(0.015%-0.095%)and 0.157%(0.133%-0.271%), respectively. Conclusion: Ropivacaine for

  17. Sarcoma de Ewing epidural lombar primário: Relato de caso

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    Kadri Paulo Abdo do Seixo

    2002-01-01

    Full Text Available Relatamos o caso de uma jovem de 15 anos, com quadro de paraparesia de inicio agudo, secundário a processo expansivo epidural na coluna lombar, cujo diagnóstico histopatológico foi consistente com sarcoma de Ewing, sem envolvimento ósseo. Revisando a literatura encontramos apenas outros 17 casos de sarcoma de Ewing extra-esquelético de localização primária no espaço epidural raqueano.

  18. MR demonstration of spontaneous acute epidural hematoma of the thoracic spine

    International Nuclear Information System (INIS)

    Avrahami, E.; Tadmor, R.; Feibel, M.; Itzhak, Y.; Tel Aviv Univ.; Ram, Z.; Tel Aviv Univ.

    1989-01-01

    Two patients with spontaneous epidural hematoma of the thoracic spine are presented. The magnetic resonance (MR) examination performed within the first hours following the onset of symptoms demonstrated an epidural elongated lesion impinging on the spinal cord, compatible with hematoma. In one of the patients this finding was surgically confirmed. The second patient improved under steroid treatment. The MR findings were highly suggestive of the pathological nature of the lesion. The MR examination should replace other diagnostic procedures, such as computerised tomography (CT) and myelography. (orig.)

  19. Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez-Barquero, A.; Pinto, J.I. [Univ. Hospital ' ' Marques de Valdecilla' ' , Santander (Spain). Dept. of Neurosurgery; Abascal, F.; Garcia-Valtuille, R.; Cerezal, L. [Hospital Mompia, Cantabria, (Spain). Dept. of Radiology; Figols, F.J. [Univ. Hospital Marques de Valdecilla, Santander (Spain). Dept. of Pathology

    2000-10-01

    An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2-L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. (orig.)

  20. 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 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....... 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...

  1. Effect of Body Mass Index in Patients Administered Epidural Steroid Injection for Back Pain

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    Pinar Karaca Baysal

    2016-07-01

    Full Text Available Aim: The aim is to investigate the efficacy of epidural steroid injection applied for lumbar discopathy pain to obese and non-obese patients with continuing complaints of back pain, despite the application of medical treatment and physical therapy. Material and Method: The study included 119 patients aged 31-73 years who presented at the Algology Clinic with complaints of back and leg pain which had been ongoing for at least 6 months and with single level disc pathologies, and for whom epidural steroid injection was planned. The patients were separated into 2 groups as obese (BMI >30 and non-obese (BMI

  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

    of an antenatal education program in small classes on use of epidural analgesia. Methods: Data from the NEWBORN trial were used. A total of 1766 women from the Copenhagen area, Denmark were randomized to participate in either antenatal education in small groups or standard care. Data were analysed according...... 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. Initiation of labor analgesia with injection of local anesthetic through the epidural needle compared to the catheter

    Directory of Open Access Journals (Sweden)

    Ristev G

    2017-12-01

    Full Text Available Goran Ristev,1 Angela C Sipes,1 Bryan Mahoney,2 Jonathan Lipps,1 Gary Chan,3 John C Coffman1 1Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 2Department of Anesthesiology, Mount Sinai St. Luke’s and Mount Sinai Roosevelt, New York, NY, USA; 3Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Background: The rationale for injection of epidural medications through the needle is to promote sooner onset of pain relief relative to dosing through the epidural catheter given that needle injection can be performed immediately after successful location of the epidural space. Some evidence indicates that dosing medications through the epidural needle results in faster onset and improved quality of epidural anesthesia compared to dosing through the catheter, though these dosing techniques have not been compared in laboring women. This investigation was performed to determine whether dosing medication through the epidural needle improves the quality of analgesia, level of sensory blockade, or onset of pain relief measured from the time of epidural medication injection. Methods: In this double-blinded prospective investigation, healthy term laboring women (n=60 received labor epidural placement upon request. Epidural analgesia was initiated according to the assigned randomization group: 10 mL loading dose (0.125% bupivacaine with fentanyl 2 µg/mL through either the epidural needle or the catheter, given in 5 mL increments spaced 2 minutes apart. Verbal rating scale (VRS pain scores (0–10 and pinprick sensory levels were documented to determine the rates of analgesic and sensory blockade onset. Results: No significant differences were observed in onset of analgesia or sensory blockade from the time of injection between study groups. The estimated difference in the rate of pain relief (VRS/minute was 0.04 (95% CI: −0.01 to 0.11; p=0

  4. The lucid interval associated with epidural bleeding: evolving understanding.

    Science.gov (United States)

    Ganz, Jeremy C

    2013-04-01

    The aim of this paper was to elucidate the evolution of our understanding of the term "lucid interval." A number of texts were reviewed to assess their suitability for analysis. The primary requirement was that the text contain detailed descriptions of a series of patients. Details of the clinical course, the findings and timing of surgery, and, when relevant, the time of death and postmortem findings were required. Books written by Henri-François Le Dran, Percival Pott, and James Hill fulfilled these criteria. Surgical findings included the presence and type of fractures, changes in the bone, separation of periosteum, malodorous or purulent material, tense brain, and hematoma. Postmortem findings supplemented and/or complemented the surgical findings. The courses of the patients were then tabulated, and the correlation between different clinical and operative findings was thereby determined. Our understanding of a lucid interval began in the early 18th century with the work of Henri-François Le Dran and Percival Pott in London. They did not, however, demonstrate an interval without symptoms between trauma and deterioration in patients with epidural hematomas (EDHs). The interval they described was longer than usually expected with EDHs and occurred exclusively in patients who had a posttraumatic infection. In 1751, James Hill, from Dumfries, Scotland, described the first hematoma-related lucid interval in a patient with a subdural hematoma. The first case of a lucid interval associated with an EDH was described by John Abernethy. In the 19th century, Jonathan Hutchinson and Walter Jacobson described the interval as it is known today, in cases of EDH. The most recent work on the topic came from studies in Cincinnati and Oslo, where it was demonstrated that bleeding can separate dura mater and that hemorrhage into the epidural space can be shunted out via the veins. This shunting could delay the accumulation of a hematoma and thus the rise in intracranial pressure

  5. Cervical transforaminal epidural steroid injections: more dangerous than we think?

    Science.gov (United States)

    Scanlon, Graham C; Moeller-Bertram, Tobias; Romanowsky, Shawn M; Wallace, Mark S

    2007-05-15

    Survey/case series. To survey pain physicians about neurologic infarctions following cervical transforaminal epidural steroid injections (TF-ESIs). Cervical TF-ESIs are commonly performed in patients with cervical radiculopathy, although there are no randomized controlled studies supporting their efficacy. Eight case reports of brain and spinal cord infarction have been published. In addition, one of the investigators (M.S.W.) has reviewed 4 cases of major cerebellum/brainstem infarction following cervical TF-ESIs with methylprednisolone. To better characterize these complications, anonymous surveys were sent to all U.S. physician members of the American Pain Society. Respondents were asked about awareness of complications, year of occurrence, practice setting and specialty of the treating physician, use of fluoroscopy/contrast/local anesthetic/corticosteroid, doses administered, and CT/MRI/autopsy findings. Overall response rate was 21.4% (287 of 1340). In all, 78 complications were reported, including 16 vertebrobasilar brain infarcts, 12 cervical spinal cord infarcts, and 2 combined brain/spinal cord infarcts. Brain infarcts invariably involved the cerebellum, brainstem, or posterior cerebral artery territory. Thirteen cases resulted in a fatal outcome: 5 with brain infarcts, 1 with combined brain/spinal cord infarcts, 1 following high spinal anesthesia, 1 associated with a seizure, and 5 with unspecified etiology. All 4 cases with corticosteroid alone involved methylprednisolone, resulting in 3 cerebellar infarcts and 1 posterior cerebral territory infarct. Of these, 3 had fatal outcomes and 2 autopsies revealed no vertebral artery trauma. This study demonstrates a significant risk of serious neurologic injury after cervical TF-ESIs. A growing body of evidence supports an embolic mechanism, whereby inadvertent intra-arterial injection of particulate corticosteroid causes a distal infarct. Embolism to the distal basilar artery region can cause midbrain, pons

  6. Postoperative Lumbar Epidural Hematoma In A Patient With Leukemia. Case Report [hematoma Epidural Lombar Pós-cirurgico Em Paciente Com Leucemia. Relato De Caso

    OpenAIRE

    Pasqualini W.; Tebet M.A.; De Carvalho M.O.P.

    2012-01-01

    A ocorrência de hematoma epidural como complicação pós-cirúrgica é relativamente baixa. O reconhecimento dessa patologia no diagnóstico diferencial nas paraplegias pós-cirúrgicas imediatas e o tratamento precoce por meio de intervenção cirúrgica com a descompressão do canal são fatores que estão diretamente relacionados à melhora do quadro neurológico. Este relato de caso é de um hematoma epidural no pós-operatório imediato de descompressão por estenose do canal vertebral lombar em paciente c...

  7. Alteraciones electrocardiográficas y factores de riesgo cardiovascular en pacientes con diabetes tipo 2

    Directory of Open Access Journals (Sweden)

    Rodríguez-Morán Martha

    1999-01-01

    Full Text Available Objetivo. Determinar cuáles son las alteraciones del ritmo y la conducción cardiaca más frecuentes en pacientes con diabetes tipo 2 sin cardiopatía previa y establecer su asociación con los factores de riesgo cardiovascular. Material y métodos. Se incluyeron pacientes con diabetes tipo 2 sin presencia o antecedentes de cardiopatía. Se determinaron los factores de riesgo cardiovascular, el índice de masa corporal y los niveles séricos de glucosa, colesterol y triglicéridos. Se registró electrocardiograma convencional en reposo. La asociación de las variables en estudio con la ocurrencia de arritmias se calculó con un modelo de análisis multivariado ajustado por sexo. Resultados. Se integraron 199 pacientes: 113 mujeres (56.8% y 86 hombres (43.2%, y se identificó algún tipo de alteración electrocardiográfica en 29.1% de los sujetos. El hemibloqueo fascicular anterior (HFA y el bloqueo completo de rama derecha del Haz de His (BRDHH, constituyeron 75.9% de las alteraciones identificadas. Los pacientes con trastornos del ritmo y la conducción tienen niveles más elevados de colesterol y triglicéridos. La aparición de arritmias se relaciona directamente con el incremento de la edad (r= 0.75, p= 0.01. En el análisis multivariado ajustado por sexo la hipercolesterolemia y la edad se asociaron significativamente con las alteraciones del ritmo y la conducción: RM 1.5, IC95% 1.1-4.6, p< 0.05 y RM 1.3, IC95% 1.0-5.2, p< 0.05, respectivamente. Conclusiones. Las alteraciones del ritmo y la conducción cardiaca más frecuentes en la diabetes tipo 2 son el HFA y el BRDHH; la hipercolesterolemia y la edad son los factores asociados a su presencia.

  8. Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho Bloqueo 3 en 1 prolongado versus analgesia sistemica en el tratamiento del dolor postoperatorio después de la reconstrucción del ligamento cruzado anterior de la rodilla Extended three-in-one block versus intravenous analgesia for postoperative pain management after reconstruction of anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Víctor A. Contreras-Domínguez

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (3-em-1 é usado para a analgesia pós-operatória de artroplastia de quadril e joelho com bons resultados, apresentando vantagens sobre outras técnicas de analgesia locorregional ou sistêmica e com baixa incidência de complicações. O objetivo deste estudo foi avaliar clinicamente a utilidade do bloqueio femoral contínuo em comparação com a analgesia por via venosa na reconstrução do ligamento cruzado anterior. MÉTODO: Foi realizado um estudo prospectivo, controlado, com 60 pacientes com estado físico ASA I. Os paciente foram divididos em dois grupos: Grupo 1 (n = 30: bloqueio femoral contínuo com infusão de bupivacaína e clonidina; Grupo 2 (n = 30: infusão por via venosa de cetoprofeno. A intervenção cirúrgica foi realizada sob raquianestesia e sedação. O tratamento da dor pós-operatória foi feito com analgesia controlada pelo paciente (PCA usando morfina. A dor pós-operatória foi registrada 2, 4, 6, 24 e 36 horas após a intervenção cirúrgica usando a Escala Visual Analógica (VAS. O consumo de morfina, a satisfação dos pacientes e as complicações também foram registradas. RESULTADOS: No Grupo 1, o VAS pós-operatório entre 4 e 48 horas após a intervenção cirúrgica foi de 21 mm ± 2 e no Grupo 2 foi de 45 mm ± 4 (p JUSTIFICATIVA Y OBJETIVOS: El bloqueo femoral continuo (tres-en-uno se usa para la analgesia postoperatoria de artroplastia de cadera y rodilla con buenos resultados, presentando ventajas sobre otras técnicas de analgesia loco regional o sistemica y con baja incidencia de complicaciones. El objetivo de este estudio fue el de evaluar clínicamente la utilidad del bloqueo femoral continuo en comparación con la analgesia intravenosa en la reconstrucción del ligamento cruzado anterior. MÉTODOS: Se realizó un estudio prospectivo controlado con 60 pacientes de estado físico ASA I. Los pacientes fueron divididos en dos grupos: Grupo 1 (n

  9. A Study on Epidural Tramadol Compared with Epidural Fentanyl Combined with Low Dose Bupivacaine for the Control of Metastatic Cancer Pain

    Directory of Open Access Journals (Sweden)

    Resham Bahadur Rana

    2010-04-01

    Full Text Available Background: Despite advances in the knowledge of pathophysiology of pain and its management, patients continue to suffer from pain in many terminal stage cancer. Tramadol hydrochloride is a weak opioid with analgesic properties, and can be tried for cancer pain management. Objectives: This study was performed to find out the efficacy of the analgesic property of Tramadol through epidural route in cancer patients as an combination with low dose(.125% Bupivacaine and to compare with Fentanyl, a μ opioid agonist. Methods: 50 Cancer patients with or without previous pain management were randomly allocated to one of the two study regime- Group-A (tramadol 50 mg and Group-B (Fentanyl 50 mgm in combination with .125% Bupivacaine. Drugs were administered epidurally 6 hourly, 8 hourly and 12 hourly respectively for the 1st, 2nd and 3rd day. Low dose bupivacaine was added to both groups to enhance quality. Pain scores, blood pressure, respiratory rate, heart rate, side effects and patients' satisfaction score was recorded 6 hourly for 72 hrs. The data yielded from this study were compiled and analyzed by unpaired and paired ‘t' test with 95% confidence limit. A value of P< 0.05 was considered to be significant. ÷ square test was done for some of the data. Results: Pain scores were significantly decreased in both the groups but were not significantly different. The incidence of side effects including nausea and vomiting was found in both the groups and was not significantly different between the two groups. Conclusion: The use of epidural Tramadol in selected cancer pain patients (especially pain in lower abdomen and lower back may be very useful and is comparable to opioid in certain situations. Key words: Metastatic cancer pain; Epidural tramadol. DOI: 10.3329/bsmmuj.v2i2.4760 BSMMU J 2009; 2(2: 66-72

  10. Comparison of the therapeutic effect between a transforminal along with a caudal epidural injection, as well as two-level transforaminal epidural injections ina radiculopathy patient

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Jung Han; Hwang, Cheol Mog; Cho, Young Jun; Kim, Keun Won; Kim, Young Joong; Seo, Jae Young; Lim, Seong Joo [Dept. of Diagnostic Radiology, Konyang University Hospital, Deajeon (Korea, Republic of); Kang, Byeong Seong [Dept. of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan (Korea, Republic of)

    2017-01-15

    The aim of this study was to evaluate the therapeutic effect of a transforaminal epidural steroid injection (TFESI) along with a caudal epidural steroid injection (ESI), compared to two-level TFESIs in a multi-level radiculopathy patient. A total of 895 lumbar ESIs were performed in 492 patients with multi-level radiculopathy from January 2012 to January 2015. Before injections were performed, the initial Numeric Rating Scale (NRS) score was assessed in all patients, categorized into no pain (excellent), mild (good, NRS: 1-3), moderate (fair, NRS: 4-6), and severe pain (poor, NRS: 7-10). Therapeutic effects were examined for two groups: one-level TFESI along with caudal and ESI two-level TFESIs. Patient outcomes were assessed by NRS in a serial follow-up at one, three, and six months. One TFESI along with caudal ESI was performed in 274 patients and two TFESIs for 218. For the former group with one TFESI along with caudal ESI, excellent results were shown: 219 (79.9%) patients after one month, 200 (72.9%) after three, and 193 (70.4%) after six months. In the patient group with two TFESIs (n = 218) the outcomes were also very good: 152 (69.7%) after one month, 131 (60.0%) after three months, and 123 (56.4%) patients after six months. The therapeutic effect of one TFESI along with caudal ESI was better than two TFESIs in for one, threes, and six months (p < 0.01). Transforaminal epidural steroid with caudal epidural injection is a more effective tool for lumbosacral radiculopathy than two level transforaminal injections in multi-level radiculopathy patients.

  11. The effect of pre-emptive intravenous Dexketoprofen + thoracal epidural analgesia on the chronic post-thoracotomy pain.

    Science.gov (United States)

    Comez, Mehmet; Celik, Mine; Dostbil, Aysenur; Aksoy, Mehmet; Ahiskalioglu, Ali; Erdem, Ali Fuat; Aydin, Yener; İnce, İlker

    2015-01-01

    Post thoracotomy chronic pain is a severe problem that affects the majority of patients and decreases the quality of life. The purpose of this study is to evaluate the long-term effects of thoracal epidural levobupivacaine and intravenous dexketoprofen analgesia formed pre-emptively on the wound site pain after major thoracotomy operations. This randomised, prospective and double-blind study was performed with 60 patients undergoing thoracic surgery. Patients were divided into three groups; Control Group (Group C), Pre-emptive Epidural Group (Group PE) and Pre-emptive Dexketoprofen + Epidural Group (Group PED). Patients in the Group C did not receive epidural analgesics and i.v. dexketoprofen before and during the operation. 10-15 ml 0.125% levobupivacaine was given to cases in Group PE pre-emptively through epidural catheter before the anesthesia induction. The cases in Group PED were given 10-15 ml 0.125% epidural levobupivacaine and 50 mg dexketoprofen with i.v. infusion pre-emptively. The VAS score was found to be lower in Group PED during postoperative 24 and 48 hours and before the discharge (P0.05). A statistically significant decrease was determined in the VAS score in Group PED during the sixth month, compared to the other groups (Pdexketoprofen and thoracal epidural analgesia reduce the chronic post-thoracotomy pain.

  12. [The Effectiveness of Epidural Droperidol for Prophylaxis of Postoperative Nausea and Vomiting: A Comparative Study of Droperidol and Adrenaline].

    Science.gov (United States)

    Toyonaga, Shinya; Shinozuka, Norihiro; Dobashi, Tamae; Iiyori, Nao; Sudo, Tomoko

    2016-05-01

    Intravenous droperidol has strong evidence for antiemetic efficacy in high risk patients for prevention of postoperative nausea and vomiting (PONV). However it is not clear whether continuous epidural administration of doroperidol prevent PONV. It has been reported that epidural adrenaline decreases PONV; therefore we prospectively compared the effectiveness of epidural droperidol and adrenaline for prophylaxis of PONV. Eighty-six patients were scheduled for abdominal gynecological surgery under general-epidural anesthesia in the study. Patients were randomly assigned to droperidol group or adrenaline group. We investigated the incidences of PONV, the frequency of using the antiemetics. There was no statistical difference between the groups. The incidences of PONV were 27.9% (doropeidol group) and 58.1% (adrenaline group), respectively (P = 0.0046). The frequency of the anti-emetics use were 18.6% and 41.9%, respectively (P = 0.0189). There was one patient who needed cancellation of continuous epidural administration for vomiting in adrenaline group, but no patient in doropeidol group. The results suggest that epidural droperidol effectively decreases PONV in high risk patients. However epidural adrenaline might be ineffective.

  13. Análisis de la frecuencia de cefalea pospunción de la duramadre y tratamiento más común en el Hospital General de México

    OpenAIRE

    López-Herranz, P.

    2014-01-01

    Objetivo: Analizar la frecuencia de cefalea pospunción de la duramadre (CPPD) y el tratamiento más utilizado para esta complicación anestésica en los quirófanos centrales del Hospital General de México. Método: Estudio retrospectivo, transversal, observacional y descriptivo. Se revisaron las hojas de anestesia de mujeres y hombres, con técnica anestésica de bloqueo epidural y punción accidental de la duramadre. Se analizó la presentación de cefalea pospunción dural y el tratamiento más fre...

  14. an unusual cause of clotted blood in epidural catheter : case studies

    African Journals Online (AJOL)

    pharyngeal temperature probe, intra-arterial blood pressure monitoring and a central venous pressure catheter. Three hours after the commencement of surgery we failed to inject a second bolus via the epidural catheter, as marked resistance to the injection was encountered. The initial patent catheter was now.

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

    DEFF Research Database (Denmark)

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

    1990-01-01

    Twenty patients scheduled for elective abdominal surgery received epidural analgesia with 20 ml 0.5% ropivacaine or 0.5% bupivacaine. Epidural blood flow was measured by an epidural 133Xe clearance technique on the day before surgery (no local anaesthetic) and again 1 h before surgery, 30 min after...... injection of the local anaesthetic during continuous infusion (8 ml/h). Median initial blood flow was 5.0 ml/min and 6.0 ml/min per 100 g tissue in patients receiving ropivacaine and bupivacaine, respectively. After epidural bupivacaine, blood flow increased in 8 of 10 patients to 6.9 ml/min per 100 g...... tissue (P less than 0.05) in contrast to a decrease in 9 of 10 patients to 3.3 ml/min per 100 g tissue after ropivacaine (P less than 0.05), (P less than 0.01 between groups). The median level of sensory analgesia was T3.5 and T4.5 in the ropivacaine and bupivacaine group, respectively (P greater than 0...

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

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    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

  17. NERVE BLOCKING (PAIN CONTROL AFTER THORACOTOMY WITH BUPIVACAINE:EPIDURAL VS INTERCOSTAL

    Directory of Open Access Journals (Sweden)

    A GHAFOURI

    2001-09-01

    Full Text Available Introduction. Use of analgesics is an evitable and necessary part of thoracic surgery. This study was designed to compare analgesic effects of persistent thoracic epidural anesthesia versus persistent intercostal nerve block and determine their role in opioid need after thoracotomy. Methods. 116 patients above 20 years old who were candidate for thoracotomy through either posterolateral or thoracoabdominal incision were situatedin one of three group for pain relief. For the first group, pain relieved by petidine and pentazosin. In 2nd group, pain relived by thoracic epidural anesthesia with bupivacaine catheters which were inserted between costal and plural space. In 3rd group, bupivacaine was introduced through 3rd and 4th intercostal space by catheter (2 mg/kg in devided doses. Pain was meseared by visual analogue scale and quantified by surgical residents through a method bupivacaine was injected. If Bupivacaine did not relieve pain, then opioid was used as adjuvant. Results. The study showed that epidural group needed less opioids and had more cooperation in comparison with two other group. The intercostal group complained of pain at chest tube site. Discussion. In thoracotomized patients, pain control is more effective via epidural anesthesia in turns of opioid side effects, expenses and patient comfort.

  18. Epidural anesthesia: Views and outcomes of women in labor in a ...

    African Journals Online (AJOL)

    Background: Pain during childbirth is a well known cause of dissatisfaction amongst women in labor. The use of epidural analgesia in labor is becoming widespread due to its benefit in terms of pain relief. Method: After approval of the local Ethics Committee on Research and obtaining informed written consent, 50 American ...

  19. Epidural cystic masses associated with interspinous bursitis, synovial and discal cysts

    International Nuclear Information System (INIS)

    Santos, Frederico Guilherme de Paula Lopes; Souza, Ricardo Andre de; Brotto, Marcos Pama D'Almeida; Suguita, Fabio Massaaki; Amaral, Denise Tokechi; Amaral, Lazaro Luis Faria do

    2009-01-01

    The authors describe some cases of epidural cysts, namely synovial, discal, ligamentum flavum cysts, and cysts secondary to interspinous bursitis, all of these conditions determining radicular, dural sac compression or spinal canal stenosis. Magnetic resonance imaging findings and localization of these entities are described. (author)

  20. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain

    NARCIS (Netherlands)

    Centeno, Christopher; Markle, Jason; Dodson, Ehren; Stemper, Ian; Hyzy, Matthew; Williams, Christopher; Freeman, Michael

    2017-01-01

    BACKGROUND: Epidural steroid injections (ESI) are the most common pain management procedure performed in the US, however evidence of efficacy is limited. In addition, there is early evidence that the high dose of corticosteroids used can have systemic side effects. We describe the results of a case

  1. Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report.

    Science.gov (United States)

    Dornbos, David; Morin, Jocelyn; Watson, Joshua R; Pindrik, Jonathan

    2016-12-01

    Osteomyelitis of the spine with associated spinal epidural abscess represents an uncommon entity in the pediatric population, requiring prompt evaluation and diagnosis to prevent neurological compromise. Cat scratch disease, caused by the pathogen Bartonella henselae, encompasses a wide spectrum of clinical presentations; however, an association with osteomyelitis and epidural abscess has been reported in only 4 other instances in the literature. The authors report a rare case of multifocal thoracic osteomyelitis with an epidural abscess in a patient with a biopsy-proven pathogen of cat scratch disease. A 5-year-old girl, who initially presented with vague constitutional symptoms, was diagnosed with cat scratch disease following biopsy of an inguinal lymph node. Despite appropriate antibiotics, she presented several weeks later with recurrent symptoms and back pain. Magnetic resonance imaging revealed 2 foci of osteomyelitis at T-8 and T-11 with an associated anterior epidural abscess from T-9 to T-12. Percutaneous image-guided vertebral biopsy revealed B. henselae by polymerase chain reaction analysis, and she was treated conservatively with doxycycline and rifampin with favorable clinical outcome.

  2. Update on biomaterials for prevention of epidural adhesion after lumbar laminectomy

    Directory of Open Access Journals (Sweden)

    Huailan Wang

    2018-04-01

    Full Text Available Summary: Lumbar laminectomy often results in failed back surgery syndrome. Most scholars support the three-dimensional theory of adhesion: Fibrosis surrounding the epidural tissues is based on the injured sacrospinalis behind, fibrous rings and posterior longitudinal ligaments. Approaches including using the minimally invasive technique, drugs, biomaterial and nonbiomaterial barriers to prevent the postoperative epidural adhesion were intensively investigated. Nevertheless, the results are far from satisfactory. Our review is based on various implant biomaterials that are used in clinical applications or are under study. We show the advantages and disadvantages of each method. The summary will help us to figure out ideas towards new techniques.The translational potential of this article: This review summarises recent biomaterials-related clinical and basic research that focuses on prevention of epidural adhesion after lumbar laminectomy. We also propose a novel possible translational method where a soft scaffold acts as a physical barrier in the early stage, engineered adipose tissue acts as a biobarrier in the later stage in the application of biomaterials and adipose-derived mesenchymal stem cells are used for prevention of epidural adhesion. Keywords: Adhesion, Biomaterials, Fibrosis, Implant, Laminectomy

  3. Impact of Helmet Use on Severity of Epidural Hematomas in Cambodia.

    Science.gov (United States)

    Gupta, Saksham; Iv, Vycheth; Sam, Nang; Vuthy, Din; Klaric, Katherine; Shrime, Mark G; Park, Kee B

    2017-04-01

    Traumatic brain injury is a major cause of morbidity and mortality worldwide, often necessitating neurosurgical intervention to evacuate intracranial bleeding. Since the early 2000s, Cambodia has been undergoing a rapid increase in motorcycle transit and in road traffic accidents, but the prevalence of helmet usage remains low. Epidural hematomas are severe traumatic brain injuries that can necessitate neurosurgical intervention. This is a retrospective cohort study of patients with epidural hematoma secondary to motorcycle accidents who presented to a major national tertiary care center in Phnom Penh, Cambodia, between November 2013 and March 2016. All patients were diagnosed with computed tomography of the head. In this cohort, 21.6% of patients in motorcycle accidents presented with epidural hematoma and 89.1% of patients were men, 47.6% were intoxicated, and were 87.8% were not wearing helmets at the moment of impact. Not wearing a helmet was associated with a 6.90-fold increase in odds of presenting with a moderate-to-severe Glasgow coma scale score and a 3.76-fold increase in odds of requiring craniotomy or craniectomy for evacuation of hematoma. Male sex was also associated with increased odds of higher clinical severity at presentation and indication for craniotomy or craniectomy, and alcohol intoxication at the time of accident was not associated with either. Helmet usage is protective in reducing the severity of presentation and need for neurosurgical intervention for patients with epidural hematoma secondary to motorcycle accidents. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia.

    Science.gov (United States)

    Pandazi, Ageliki; Kanellopoulos, Ilias; Kalimeris, Konstantinos; Batistaki, Chrysanthi; Nikolakopoulos, Nikolaos; Matsota, Paraskevi; Babis, George C; Kostopanagiotou, Georgia

    2013-11-01

    Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA. Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively. Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p PCA group (p PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.

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

    DEFF Research Database (Denmark)

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

    1989-01-01

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

  6. Effects of etidocaine administered epidurally on changes in somatosensory evoked potentials after dermatomal stimulation

    DEFF Research Database (Denmark)

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

    1991-01-01

    The effect of lumbar epidural anesthesia with similar volumes (approximately 20 ml) of 1% and 1.5% etidocaine 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...

  7. Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report.

    Science.gov (United States)

    Cupler, Zachary A; Anderson, Michael T; Stancik, Thomas J

    2017-09-01

    The purpose of this case study was to describe the differential diagnosis of a thoracic epidural abscess in a Navy veteran who presented to a chiropractic clinic for evaluation and management with acupuncture within a Veterans Affairs Medical Center. An afebrile 59-year-old man with acute thoracic spine pain and chronic low back pain presented to the chiropractic clinic at a Veterans Affairs Medical Center for consideration for acupuncture treatment. The veteran elected to trial acupuncture once per week for 4 weeks. A routine thoracic magnetic resonance imaging scan without gadolinium detected a space-occupying lesion after the patient failed to attain 50% reduction of pain within 2 weeks with conservative care. The patient was diagnosed with a multilevel thoracic spondylodiscitis epidural abscess and was treated same day with emergency debridement and laminectomy of T7-8 with a T6-9 fusion. The patient had complete recovery without neurological compromise and completed an antibiotic regimen for 6 weeks. A Navy veteran with acute thoracic spine and chronic low back pain appeared to respond initially but failed to achieve clinically meaningful outcomes. Follow-up advanced imaging detected a thoracic spondylodiscitis epidural abscess. Early diagnosis and immediate intervention are important to preserving neurological function and limiting morbidity in cases of spondylodiscitis epidural abscess.

  8. The association between incentive spirometry performance and pain in postoperative thoracic epidural analgesia.

    Science.gov (United States)

    Harris, David J; Hilliard, Paul E; Jewell, Elizabeth S; Brummett, Chad M

    2015-01-01

    Effective use of postoperative incentive spirometry improves patient outcomes but is limited by pain after thoracic and upper abdominal surgery. Thoracic epidurals are frequently used to provide analgesia and attenuate postoperative pulmonary dysfunction. We hypothesized that, in patients with thoracic epidurals for thoracic and abdominal surgery, high pain scores would be associated with poorer incentive spirometry performance, even when accounting for other variables. Retrospective study of 468 patients who underwent upper abdominal or thoracic surgery using postoperative thoracic epidural analgesia between June 1, 2009, and August 31, 2013, at a single tertiary academic center. The association between incentive spirometry performance and pain was assessed as the primary outcome. Other independent predictors of incentive spirometry performance were also identified. Postoperative incentive spirometry performance was found to be inversely proportional to pain score, which correlated significantly stronger with deep breathing pain compared with pain at rest (-0.33 vs -0.14 on postoperative day 1; -0.23 vs -0.12 on postoperative day 2). Pain with deep breathing was independently associated with poorer incentive spirometry performance in the multivariable linear regression model (P spirometry performance could be used as another indicator of thoracic epidural efficacy. This may be particularly useful in patients reporting high pain scores postoperatively.

  9. The effect of oophorectomy on epidural fibrosis after laminectomy: an experimental study in rats.

    Science.gov (United States)

    Çirci, Esra; Özalay, Metin; Caylak, Berrin; Bacanli, Didem; Derincek, Alihan; Tuncay, I Cengiz

    2013-01-01

    The aim of this study was to examine the effect of oophorectomy in the formation of epidural fibrosis in a rat laminectomy model. Thirty-six 12-month-old adult female Sprague-Dawley rats were used in this study. Rats were evenly divided into two groups; oophorectomized and sham-operated. Bilateral oophorectomy was performed on the 18 rats in the oophorectomized group. Three weeks after oophorectomy, rats in both groups underwent complete bilateral laminectomy at the L2 and L3 vertebral levels. Rats were divided into 3 equal groups and sacrificed in groups of 4 at the 4th, 8t, and 12th weeks postoperatively and the lumbar spine excised en bloc, fixed and decalcified. Sections were stained with hematoxylin and eosin and Masson's trichrome were used to evaluate epidural fibrosis, acute inflammation, chronic inflammation, and vascular proliferation. The mean histological sum grade of the epidural fibrosis was greater in the oophorectomized group (p>0.05). Endogenous estrogen could have an effect on epidural fibrosis formation after lumbar laminectomy in rats.

  10. 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...... on analgesic requirements and postoperative pain after TKA....

  11. Labour epidural analgesia audit in a tertiary state hospital in South ...

    African Journals Online (AJOL)

    Method: A retrospective one-year audit reviewed available records for indications for-, complications of-, and patient satisfaction ... Conclusions: At this tertiary referral hospital in the Western Cape, only 2.2% of parturients received labour epidural analgesia, possibly ..... education, would prevent such complications.

  12. Epidural anesthesia: Views and outcomes of women in labor in a ...

    African Journals Online (AJOL)

    2010-02-08

    Feb 8, 2010 ... American Society of Anesthesiologists (ASA) class I-II consecutive multiparous women in labor requesting pain relief were ... epidural analgesia group were satisfied with the experience of labor than those who did not receive this form of analgesia ... although lack of patient education and awareness.

  13. Increasing the labour epidural rate in a state hospital in South Africa ...

    African Journals Online (AJOL)

    indications, complications and patient satisfaction. Comparison was made ... patient satisfaction. Literature on labour epidural rates in developing countries is limited, but the situation at TBH could be comparable to that described in a study from the Shijiazhuan ..... nursing human resources, and inadequate education of the.

  14. A RARE CASE OF QUADRIPLEGIA DUE TO SPINAL EPIDURAL HAEMATOMA FOLLOWING SPINAL ANAESTHESIA

    OpenAIRE

    Meher Kumar; Rakesh

    2015-01-01

    Quadriplegia following spinal anaesthesia due to spinal epidural haematoma is a rare but critical complication that usually occurs within 24 hours to a few days of the procedure. I report a case of a 32 year old male who underwent Uretero - Renal Scopy (URS) and double ‘J’ (DJ) stenting for right ureteric calculus under spinal ...

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Transient Coma Due To Epidural Anesthesia: The Role of Loss of Sensory Input.

    LENUS (Irish Health Repository)

    Dardis, Christopher

    2015-12-21

    Epidural anesthesia is the most commonly used method of pain relief during labor in the USA. It is not classically associated with alterations in level of alertness. Coma during the procedure is rare, with a reported incidence of 0.1-0.3%.

  17. epidural injection use for low back pain associated with sciatica at ...

    African Journals Online (AJOL)

    2012-09-06

    Sep 6, 2012 ... Objective: To assess the effects of lumbar epidural steroid injections in patients with radiculopathy. (sciatica), by assessing reduction of pain at short term (3 weeks) and intermediate term (12 weeks). Design: This was a prospective study done between August 2005 and July 2011 at Kikuyu Orthopaedic.

  18. Epidural injection use for low back pain associated with sciatica at ...

    African Journals Online (AJOL)

    Objective: To assess the effects of lumbar epidural steroid injections in patients with radiculopathy (sciatica), by assessing reduction of pain at short term (3 weeks) and intermediate term (12 weeks). Design: This was a prospective study done between August 2005 and July 2011 at Kikuyu Orthopaedic and Rehabilitation ...

  19. 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

  20. Epidural labor analgesia: A comparison of ropivacaine 0.125% versus 0.2% with fentanyl

    Directory of Open Access Journals (Sweden)

    Yogesh Kumar Chhetty

    2013-01-01

    Conclusion: We conclude that both the concentrations of ropivacaine (0.2% and 0.125% with fentanyl are effective in producing epidural labor analgesia. However, 0.2% concentration was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids.