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Xiang J, Cao C, Chen J, Kong F, Nian S, Li Z, Li N. Efficacy and safety of ketamine as an adjuvant to regional anesthesia: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2024; 94:111415. [PMID: 38394922 DOI: 10.1016/j.jclinane.2024.111415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 12/03/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
STUDY OBJECTIVE To identify whether adding ketamine to the local anesthetics (LA) in the regional anesthesia could prolong the duration of analgesia. DESIGN A Systematic review and meta-analysis of randomized controlled trials. SETTING The major dates were obtained in the operating room and the postoperative recovery ward. PATIENTS A total of 1011 patients at ASA physical status I and II were included in the analysis. Procedure performed including cesarean section, orthopedic, radical mastectomy, urological or lower abdominal surgery and intracavitary brachytherapy implants insertion. INTERVENTIONS After an extensive search of the electronic database, patients received regional anesthesia combined or not combined general anesthesia and with or without adding ketamine to LA were included in the analysis. The regional anesthesia includes spinal anesthesia, brachial plexus block, pectoral nerve block, transversus abdominis plane block and femoral and sciatic nerve block. MEASUREMENT The primary outcome was the duration of analgesia. Secondary outcomes were the duration and onset time of motor and sensory block as well as the ketamine-related adverse effect. Data are expressed in mean differences in continuous data and odds ratios (OR) for dichotomous data with 95% confidence intervals. The risk of bias of the included studies was evaluated using the revised Cochrane risk of bias tool for randomized trials. The quality of evidence for each outcome was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group system. MAIN RESULT Twenty randomized controlled trials were included in the analysis. When ketamine was used as an adjuvant to LA, the duration of analgesia could be prolonged(172.21 min, 95% CI, 118.20 to 226.22; P<0.00001, I2 = 98%), especially in the peripheral nerve block(366.96 min, 95% CI, 154.19 to 579.74; P = 0.0007, I2 = 98%). Secondary outcomes showed ketamine could prolong the duration of sensory block(29.12 min, 95% CI, 10.22 to 48.01; P = 0.003, I2 = 96%) but no effect on the motor block(6.94 min, 95% CI,-2.65 to 16.53;P = 0.16, I2 = 84%), the onset time of motor and sensory block (motor onset time, -1.17 min, 95% CI, -2.67 to 0.34; P = 0.13, I2 = 100%; sensory onset time, -0.33 min, 95% CI,-0.87 to 0.20; P = 0.23, I2 = 96%) as well as the ketamine-related adverse effect(OR, 1.97, 95% CI,0.93 to 4.17;P = 0.08, I2 = 57%). CONCLUSION This study indicates that ketamine could be an ideal adjuvant to local anesthetics regardless of the types of anesthesia. Overall, the quality of the evidence is low.
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Affiliation(s)
- Jiajia Xiang
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China; Kunming Medical University, Kunming, Yunnan, China
| | - Chunyan Cao
- Department of Obstetrics and Gynecology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Jiayu Chen
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Fanyi Kong
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Sunqi Nian
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhigui Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China.
| | - Na Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China.
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Chang G, Moiteiro Manteigas H, Strutton PH, Mullington CJ. An evaluation of a healthy participant laboratory model of epidural hyperthermia: a physiological study. Int J Obstet Anesth 2024; 57:103961. [PMID: 38199895 DOI: 10.1016/j.ijoa.2023.103961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Hyperthermia complicates 21% of cases of intrapartum epidural analgesia, but the mechanism is unclear. One hypothesis is that blockade of cholinergic sympathetic nerves prevents active vasodilation and sweating, thus limiting heat loss. Because labour increases heat production, this could create a situation in which heat production exceeds loss, causing body temperature to rise. This physiological study tested a novel laboratory model of epidural-related hyperthermia, using exercise to simulate the increased heat production of labour and surface insulation to simulate the effect of epidural analgesia. METHODS Twelve healthy non-pregnant participants (six female) cycled an ergometer for two hours at 20 Watts (W) on two occasions: once with surface insulation (intervention) and once without (control). Core temperature, skin temperature (eight sites), and heat loss (eight sites) were recorded. Mean body temperature and heat production were calculated. Values are mean (SD). RESULTS Exercise increased heat production on both visits (intervention 38 (18) W; control 37 (31) W; P = 0.94). Total heat loss was less on the intervention visit (intervention 115 (19) W; control 129 (23) W; P = 0.002). Core temperature increased on both visits (intervention 0.21 (0.37)°C; control 0.19 (0.27)°C; P < 0.001). The increase in mean body temperature was greater on the intervention visit (intervention 0.47 (0.41)°C; control 0.25 (0.19)°C; P = 0.007). CONCLUSIONS This laboratory model predicts that labour epidural analgesia limits heat loss by >14 W. Once the model is validated, it could be used to test the efficacy of potential interventions to prevent and treat epidural-related maternal hyperthermia.
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Affiliation(s)
- G Chang
- MSk Lab, Imperial College London, London, UK
| | - H Moiteiro Manteigas
- MSk Lab, Imperial College London, London, UK; Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | | | - C J Mullington
- MSk Lab, Imperial College London, London, UK; Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK.
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Chao WH, Cheng WS, Hu LM, Liao CC. Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study. BMC Anesthesiol 2023; 23:338. [PMID: 37803290 PMCID: PMC10557188 DOI: 10.1186/s12871-023-02284-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Epidural anesthesia (EA) is the regional anesthesia technique preferred over spinal anesthesia for pregnant women requiring cesarean section and post-operative pain control. EA failure requires additional sedation or conversion to general anesthesia (GA). This may be hazardous during sedation or GA conversion because of potentially difficult airways. Therefore, this retrospective study aimed to determine the risk factors for epidural failure during cesarean section anesthesia. METHODS We retrospectively analyzed parturients who underwent cesarean section under EA and catheterization at the Chang Gung Memorial Hospital in Taiwan between January 1 and December 31, 2018. Patient data were collected from the medical records. EA failure was defined as the administration of any intravenous anesthetic at any time during a cesarean section, converting it into GA. RESULTS A total of 534 parturients who underwent cesarean section were recruited for this study. Of them, 94 (17.6%) experienced EA failure during cesarean section. Compared to the patients with successful EA, those with EA failure were younger (33.0 years vs. 34.7 years), had received EA previously (60.6% vs. 37%), were parous (72.3% vs. 55%), and had a shorter waiting time (14.9 min vs. 16.5 min) (p < 0.05). Younger age (OR 0.91, 95% CI 0.86-0.95), history of epidural analgesia (OR 2.61, 95% CI 1.38-4.94), and shorter waiting time (OR 0.91, 95% CI 0.87-0.97) were estimated to be significantly associated with a higher risk of epidural anesthesia failure. CONCLUSION The retrospective study found that parturients of younger age, previous epidural catheterization history, and inadequate waiting time may have a higher risk of EA failure. Previous epidural catheterization increased the risk of EA failure by 2.6-fold compared to patient with no history of catheterization.
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Affiliation(s)
- Wei-Hsiang Chao
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Wen-Shan Cheng
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Li-Ming Hu
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Chia-Chih Liao
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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Hussey PT, Sowell J, Hussey H, Townsley MM. Tacrolimus-Induced Akinetic Mutism or Epidural Catheter Migration: A Case Report. A A Pract 2023; 17:e01699. [PMID: 37463290 DOI: 10.1213/xaa.0000000000001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Differential diagnosis of the underlying cause of new-onset total body paralysis can be challenging and unsatisfying. In akinetic mutism, a rare side effect of tacrolimus, patients become apathetic, mute, and lose voluntary muscle movement. Epidural subarachnoid migration can present with similar symptoms. Delayed emergence/paralysis after anesthesia can include the common culprits of residual operative medications, stroke, as well as tacrolimus-induced akinetic mutism and thoracic epidural migration. We present a case of new-onset total body paralysis, presenting on postoperative day 1 following a double-lung transplant in a patient started on tacrolimus with a thoracic epidural catheter in place.
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Affiliation(s)
- Patrick T Hussey
- From the Department of Anesthesiology and Perioperative Medicine
| | - Josiah Sowell
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hanna Hussey
- From the Department of Anesthesiology and Perioperative Medicine
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Sambugaro B, De Gennaro C, Hattersley RD, Vettorato E. Extradural anaesthesia-analgesia in dogs undergoing cholecystectomy: A single centre retrospective study. Front Vet Sci 2022; 9:966183. [PMID: 36157172 PMCID: PMC9500543 DOI: 10.3389/fvets.2022.966183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To assess the effects of extradural anaesthesia-analgesia (EAA) in dogs undergoing cholecystectomy. Materials and methods Medical records of dogs undergoing cholecystectomy between 2011 and 2019 were retrieved and allocated to two groups depending if analgesia was provided systemically (group SA) or extradurally (EAA). Preoperative data, intraoperative antinociceptive medications, postoperative analgesia, perioperative complications, and food intake were compared. Results Overall 41 medical records were included in the study: 19 and 22 dogs were allocated to groups SA and EAA, respectively. In group EAA, an extradural catheter was placed preoperatively in 8 dogs; in the remaining, it was placed postoperatively but an extradural injection was performed preoperatively. The extradural catheter tip was between the 4th lumbar and the 10th thoracic vertebrae. Intraoperatively, nociception was more likely to occur in group SA [OR 55.42 (2.97–1,035.06)]. During the first 24 and 48 h postoperatively, more dogs in group SA required methadone [OR 24 (2.81–268.4) and OR 11.56 (2.37–45.06), respectively] and additional analgesic drugs [OR 25 (3.47–281.9) and OR 35.29 (1.86–668.2), respectively] compared to group EAA. Voluntary postoperative food intake was also significantly higher in group EAA. Clinical significance Compared to systemic analgesia, the use of extradural anaesthesia-analgesia reduced perioperative analgesic requirement and promoted postoperative food intake in dogs undergoing cholecystectomy.
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Local and Regional Anaesthetic Techniques in Canine Ovariectomy: A Review of the Literature and Technique Description. Animals (Basel) 2022; 12:ani12151920. [PMID: 35953908 PMCID: PMC9367435 DOI: 10.3390/ani12151920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This review stems from a general trend of increasing attention toward surgical nociception in the veterinary field. Indeed, veterinarian anaesthetists are becoming more careful in relieving perioperative nociception, improving the analgesic protocols and therefore optimising surgical outcomes. Canine ovariectomy is a common surgical procedure with a moderate level of pain. Therefore, intraoperative analgesia is very important because pain causes various systemic inflammatory effects that slow patient recovery. This review aims to collect all recent information about local and regional anaesthetic/analgesic techniques in a review of the literature describing the technique utilised. In addition, the present review aims to provide practical guidelines for veterinary practitioners to improve the anaesthetic techniques in canine neutering through an overview of the available literature. In fact, the methods described, considering the relative simplicity of execution, can be used in daily routine practice. Abstract Canine ovariectomy is an elective surgery with a moderate level of pain. Despite its relative simplicity, it requires surgical pain management. This study aimed to collect all recent information about local and regional anaesthetic/analgesic techniques in a review of the literature describing the technique utilised. The various procedures described in this review use local anaesthetics to improve analgesia in the routine systemic anaesthetic protocol. The approach described in this paper is called multimodal analgesia and is used in addition to the normal standard anaesthetic protocol. These techniques proved effective in minimising responses to the surgical stimulus and ensured adequate intraoperative and postoperative analgesia. The routine use of multimodal analgesia is considered a useful alternative for pain management in canine ovariectomy, in that it minimises patient suffering, improves the recovery of rescue analgesia, increases drug savings, and improves animal outcomes. In addition, the use of these local and regional techniques ensures satisfactory analgesic coverage that lasts for the first hours postoperatively.
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Herrera‐Linares ME, Martínez M. Transient respiratory arrest after quadratus lumborum block in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Miguel Martínez
- Anaesthesia Department Northwest Veterinary Specialists Runcorn UK
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Sarotti D, Ala U, Franci P. Epidural anesthesia in dogs undergoing hindlimb orthopedic surgery: effects of two injection sites. J Vet Med Sci 2022; 84:457-464. [PMID: 35067493 PMCID: PMC8983285 DOI: 10.1292/jvms.21-0289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This prospective clinical trial evaluated the effects of epidural anesthesia (EA) placed at the lumbosacral compared to the L5-L6 junction in dogs undergoing hindlimb orthopedic surgery. In all, 98 dogs were randomly assigned to receive injection at either L7-S1 (LS group) or L5-L6 (LL group) at the same local anesthetic regimen (1 mg/kg bupivacaine 0.5% and 0.1 mg/kg morphine 1%). Fentanyl (1 µg/kg) was the intraoperative rescue analgesia (iRA) administered if mean arterial pressure increased by 30% above pre-stimulation value. Procedural failure, iRA, hypotension, motor block resolution, and postoperative side effects were recorded. There were 7/47 (15%) epidural procedural failures in the LS group and 8/51 (16%) (P=1.00) in the LL group; iRA was administered in 21/40 (52%) LS group dogs and in 13/43 (30%) LL group dogs, respectively (P=0.047). The incidence of hypotension was 10/40 (25%) and 16/43 (37%) in the LS group and the LL group, respectively (P=0.25). Proprioceptive residual deficit at 8 hr after EA was recorded in 3/26 (12%) in group LS dogs and in 13/26 (50%) group LL dogs, respectively (P=0.01). The proprioceptive residual deficit at 24 hr in one dog (LL group) resolved within 36 hr. No episodes of postoperative urinary retention, pruritus or neurological damage were recorded. The L5-L6 EA decreased significantly iRA but delays the proprioceptive recovery time. Further studies are needed to determine whether a lower bupivacaine dose reduces the duration of the residual block retaining the same incidence of iRA.
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Affiliation(s)
| | - Ugo Ala
- Department of Veterinary Science, University of Turin
| | - Paolo Franci
- Department of Veterinary Science, University of Turin
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Lidocaine Ameliorates Psoriasis by Obstructing Pathogenic CGRP Signaling-Mediated Sensory Neuron-Dendritic Cell Communication. J Invest Dermatol 2022; 142:2173-2183.e6. [PMID: 35032503 DOI: 10.1016/j.jid.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 01/30/2023]
Abstract
Psoriasis is a chronic immune-mediated skin disorder with the nervous system contributing to its pathology. The neurogenic mediators of psoriasis are elusive and whether the intervention of cutaneous nervous system can treat psoriasis remains to be determined. Here we conducted a pilot study using epidural injection of lidocaine to treat patients with psoriasis. Lidocaine treatment markedly reduced patients' clinical scores, and improved an imiquimod (IMQ)-induced rat model of psoriasis as competent as systemic delivery of a TNF-α antibody. IMQ application elicited aberrant cutaneous nerve outgrowth and excessive generation of neuropeptide calcitonin gene-related peptide (CGRP) from dorsal root ganglion (DRG) neurons, both of which were inhibited by epidural lidocaine treatment. Single-cell RNA sequencing unveiled the overrepresentation of CGRP receptors in dermal dendritic cell (DC) populations of patients with psoriasis. Through disturbing CGRP signaling, lidocaine inhibited IL-23 production by DCs co-cultured with DRG neurons. Thus, epidural nerve block with lidocaine demonstrates an effective therapy for psoriasis, which suppresses both inordinate sensory nerve growth in the inflamed skin and CGRP-mediated IL-23 production from psoriatic DCs.
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Yagihara M, Uemura A, Nakajima Y. Epidural space "ballooning" during local anaesthetic injection in infants and children: An ultrasound observational study. Acta Anaesthesiol Scand 2021; 65:1484-1489. [PMID: 34258752 DOI: 10.1111/aas.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infants and children require a larger dose of a local anaesthetic (LA) to establish epidural analgesia than adults, but the reason for this remains unclear. We hypothesised that prominent ventro-dorsal expansion of the epidural space limits cranio-caudal spread of LA in infants. Accordingly, we studied the dimensions of the epidural space with real-time ultrasound (US) before and after epidural injection. METHODS Ninety-six infants and children aged 0-12 years who underwent abdominal surgery under combined epidural and general anaesthesia were examined in this prospective observational study. Using a micro-convex probe, US recordings of the posterior epidural space were performed while a LA (0.5 ml kg-1 ) was infused at 0.54 ml s-1 . The width in the ventro-dorsal dimension (VDD) of the posterior epidural space before and after injection was recorded; the change in VDD was defined as "ballooning". Correlations between "ballooning" and patient age, body mass index, and volume and rate of LA administration were analysed. RESULTS "Ballooning" correlated positively but weakly with age (R2 = 0.25; p < .001) and the infused LA volume (R2 = 0.32; p < .001). The "magnitude of ballooning" ("ballooning" per ml of injected LA) correlated negatively but weakly with age (R2 = 0.27; p < .001). CONCLUSIONS "Magnitude of ballooning" of the epidural space become inconspicuous with growing during epidural injection. This effect may slow the cranio-caudal spread of LA and explain partially why larger volumes of LA are required to effect a block in children.
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Affiliation(s)
- Masahiro Yagihara
- Department of Anesthesiology and Intensive Care Hamamatsu University School of Medicine Hamamatsu Japan
| | - Aki Uemura
- Department of Anesthesiology Anshin Hospital Kobe Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care Hamamatsu University School of Medicine Hamamatsu Japan
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Mehmood R, McGuire AJ, Mansoor Z, Fink AB, Atanasov G. Regional Anaesthetic Techniques and Their Implications During the COVID Pandemic. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:2222-2228. [PMID: 34568762 PMCID: PMC8453463 DOI: 10.1007/s42399-021-01035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 01/08/2023]
Abstract
The current pandemic has highlighted the need to protect both patients and medical staff. The increased use of regional anaesthesia as a primary anaesthetic modality for operations and other invasive procedures has limited the number of aerosol-generating procedures performed during general anaesthesia. Its use is further characterized by decreases in postoperative pain and length of hospitalization. This article provides an overview of regional anaesthetic techniques (peripheral nerve locks, epidural and spinal anaesthesia) and their uses during the COVID pandemic.
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Affiliation(s)
- Raafay Mehmood
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ainsley John McGuire
- Faculty of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Zainab Mansoor
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Gabriel Atanasov
- First Faculty of Medicine, Charles University, Prague, Czech Republic
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Schlesinger T, Weibel S, Steinfeldt T, Sitter M, Meybohm P, Kranke P. Intraoperative management of combined general anesthesia and thoracic epidural analgesia: A survey among German anesthetists. Acta Anaesthesiol Scand 2021; 65:1490-1496. [PMID: 34383293 DOI: 10.1111/aas.13971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Evidence concerning combined general anesthesia (GA) and thoracic epidural analgesia (EA) is controversial and the procedure appears heterogeneous in clinical implementation. We aimed to gain an overview of different approaches and to unveil a suspected heterogeneity concerning the intraoperative management of combined GA and EA. METHODS This was an anonymous survey among Members of the Scientific working group for regional anesthesia within the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) conducted from February 2020 to August 2020. RESULTS The response rate was 38%. The majority of participants were experienced anesthetists with high expertise for the specific regimen of combined GA and EA. Most participants establish EA in the sitting position (94%), prefer early epidural initiation (prior to skin incision: 80%; intraoperative: 14%) and administer ropivacaine (89%) in rather low concentrations (0.2%: 45%; 0.375%: 30%; 0.75%: 15%) mostly with an opioid (84%) in a bolus-based mode (95%). The majority reduce systemic opioid doses intraoperatively if EA works sufficiently (minimal systemic opioids: 58%; analgesia exclusively via EA: 34%). About 85% manage intraoperative EA insufficiency with systemic opioids, 52% try to escalate EA, and only 25% use non-opioids, e.g. intravenous ketamine or lidocaine. CONCLUSIONS Although, consensus seems to be present for several aspects (patient's position during epidural puncture, main epidural substance, application mode), there is considerable heterogeneity regarding systemic opioids, rescue strategies for insufficient EA, and hemodynamic management, which might explain inconsistent results of previous trials and meta-analyses.
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Affiliation(s)
- Tobias Schlesinger
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg Wuerzburg Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg Wuerzburg Germany
| | - Thorsten Steinfeldt
- Department of Anaesthesiology, Intensive Care and Pain Medicine BG Klinikum Frankfurt am Main Frankfurt am Main Germany
- Scientific Working Group for Regional AnaesthesiaGerman Society of Anaesthesiology and Intensive Care Medicine (DGAI) Nuernberg Germany
| | - Magdalena Sitter
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg Wuerzburg Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg Wuerzburg Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wuerzburg Wuerzburg Germany
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Tonge M, Robson K, Alderson B. Single thoracic epidural injection for intra‐ and post‐lateral thoracotomy analgesia in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary Tonge
- Department of Small Animal Clinical Science University of Liverpool Neston UK
| | - Katherine Robson
- Department of Small Animal Clinical Science University of Liverpool Neston UK
| | - Briony Alderson
- Department of Small Animal Clinical Science University of Liverpool Neston UK
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Ferreira TH, Fink DM, Mans C. Evaluation of neuraxial administration of bupivacaine in bearded dragons (Pogona vitticeps). Vet Anaesth Analg 2021; 48:798-803. [PMID: 34326001 DOI: 10.1016/j.vaa.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the success rate, onset, duration and extent of motor/sensory block following neuraxial injection of two dosages of bupivacaine in bearded dragons (Pogona vitticeps). STUDY DESIGN Prospective, randomized, blinded, crossover experimental study. ANIMALS A total of 10 adult bearded dragons (0.3 ± 0.1 kg). METHODS After sedation with alfaxalone (15 mg kg-1 subcutaneously), neuraxial injections were performed with 1 or 2 mg kg-1 bupivacaine hydrochloride (0.5%, treatments BUP-1 and BUP-2, respectively) in a randomized treatment sequence with a 7 day washout period. If the initial bupivacaine injection was not successful within 10 minutes, a second injection was performed at the same dose. Mechanical stimulation of limbs, 25%, 50%, 75% of the trunk's length and cloacal tone were assessed. RESULTS Success rate following the first neuraxial injection was 95%, which increased to 100% after the second injection. Motor/sensory block were noted by 5 minutes after the injection of bupivacaine at either dose. BUP-2 was associated with more cranial spread. The median (range) duration of cloacal tone loss was longer following treatment BUP-2 [120 (75-225) minutes] than followed treatment BUP-1 [83 (25-135) minutes; p = 0.03]. Duration of pelvic limb motor block was comparable between both doses, lasting a median of 68 minutes in both treatments (p = 0.94). There was a transient, not clinically relevant increase from baseline in heart rate in treatment BUP-1 only. No significant difference from baseline in respiratory rate was noted in either treatment; however, two animals in treatment BUP-2 became apneic (10-20 minutes). CONCLUSIONS AND CLINICAL RELEVANCE Bupivacaine (1 mg kg-1) is recommended for neuraxial anesthesia in bearded dragons. In treatment BUP-2, extensive cranial spread resulted in apnea and motor block of the thoracic limb in several animals; therefore this dose is not recommended.
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Affiliation(s)
- Tatiana H Ferreira
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, USA.
| | - Dustin M Fink
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Christoph Mans
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin - Madison, Madison, WI, USA
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Nahrwold DA, Muncey AR, Aldawoodi NN, Evans RM, Hoffman JP. Rupture of an epidural filter connector during bolus administration of local anesthetic: a case report. BMC Anesthesiol 2021; 21:143. [PMID: 33980179 PMCID: PMC8114482 DOI: 10.1186/s12871-021-01372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidural catheters are routinely placed for many surgical procedures and to treat various pain conditions. Known complications arising from epidural catheter equipment malfunction include epidural pump failure, epidural catheter shearing, epidural catheter connector failure, epidural filter connector cracking, and loss-of-resistance syringe malfunction. Practitioners need to be aware of these potentially dangerous complications and take measures to mitigate the chances of causing significant patient harm. We report on the complete breakage of an epidural filter connector during epidural bolus administration of local anesthetic by hand with a syringe. CASE PRESENTATION A B. Braun Perifix® epidural catheter was placed in a 73-year-old male scheduled for radical prostatectomy. During the operation, a continuous infusion of local anesthetic was administered through the epidural catheter in addition to general endotracheal anesthesia. At the conclusion of surgery and after extubation, the patient endorsed incisional pain. The epidural filter connector broke in half as a bolus of local anesthetic was administered by hand with a syringe. The local anesthetic sprayed widely throughout the room as the fragmented epidural filter connector became a projectile object that recoiled and struck the patient. CONCLUSIONS This incident placed the patient and surrounding healthcare providers at substantial risk for injury and infection from the fractured epidural filter connector becoming a projectile object and from the local anesthetic spray. The most plausible cause of this event was from a large amount of pressure being applied to the filter connector. This may have occurred by excessive force being applied by hand to the syringe, by the presence of a clogged filter, or by the catheter being kinked or blocked proximal to the filter. Being aware of this deleterious complication and potentially modifying existing epidural bolus techniques, such as using smaller syringes with less applied force and checking all epidural components vigilantly prior to and during bolus administration, can help anesthesia providers deliver the safest possible care to patients with epidural catheters.
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Affiliation(s)
- Daniel A Nahrwold
- H. Lee Moffitt Cancer Center & Research Institute, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA.
| | - Aaron R Muncey
- H. Lee Moffitt Cancer Center & Research Institute, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Nasrin N Aldawoodi
- H. Lee Moffitt Cancer Center & Research Institute, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Raymond M Evans
- H. Lee Moffitt Cancer Center & Research Institute, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
| | - Jamie P Hoffman
- H. Lee Moffitt Cancer Center & Research Institute, University of South Florida Morsani College of Medicine, 12902 USF Magnolia Dr, Tampa, FL, 33612, USA
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An optimal epidural catheter placement site for post-cesarean section analgesia with double-space technique combined spinal-epidural anesthesia: a retrospective study. JA Clin Rep 2021; 7:3. [PMID: 33398592 PMCID: PMC7782655 DOI: 10.1186/s40981-020-00405-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/11/2022] Open
Abstract
Background Epidural anesthesia affects lower extremities, which often prevents early mobilization postoperatively. The incidence of numbness and motor weakness in the lower extremities with respect to epidural catheter placement site in cesarean section (CS) is uncertain. We aimed to investigate the effect of catheter placement site on postoperative lower extremities numbness and motor weakness in patients who received combined spinal–epidural anesthesia (CSEA) for CS including analgesic effects and optimal epidural placement site in CS. Methods We retrospectively included 205 patients who underwent CS with CSEA at the University of Tsukuba Hospital between April 2018 and March 2020, and assessed numbness and motor weakness in the lower extremities. We also examined whether differences in the intervertebral space of epidural catheter placement and epidural effect on the lower extremities are related to analgesic effects. ANOVA and Mann–Whitney U test were used for statistical analysis. Results The incidence of numbness and motor weakness were 67 (33%) and 28 (14%), respectively. All patients with motor weakness had numbness. A more caudal placement was associated with increased incidence of affected lower extremities. There was no significant difference in the analgesic effect depending on the catheter placement site. When the lower extremities were affected, the number of additional analgesics increased (p < 0.001). Patient-controlled epidural analgesia was used for fewer days in patients with motor weakness (p = 0.046). Conclusion In CS, epidural catheter placement at T10–11 or T11–12 interspace is expected to reduce effect on the lower extremities and improve quality of postoperative analgesia.
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Cima DS, Credie LDFGA, Futema F, Luna SPL. Lumbar Epidural: Anatomical and Clinical Study in Dogs Submitted to Ovariohysterectomy. Front Vet Sci 2020; 7:527812. [PMID: 33240944 PMCID: PMC7669829 DOI: 10.3389/fvets.2020.527812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022] Open
Abstract
Epidural anesthesia minimizes perioperative pain in dogs. It is considered that epidural solution dispersion in cadavers is similar to alive dogs. The objective of the anatomical study was to compare the dispersion of 0.2 mL/kg 0.25% bupivacaine and iohexol via lumbar epidural (L1–L2) under fluoroscopic guidance in 10 thawed cadavers (GC) and 13 female dogs (G0.25) (5–15 kg; body score 4/5). The objective of the clinical study was to evaluate postoperative analgesic consumption and sedation for 6 h after extubation of dogs submitted to ovariohysterectomy when using 0.25% (G0.25; n = 10) bupivacaine with the intraoperative use of fentanyl (GF; n = 10). Parametric data were compared by the t-test and non-parametric data by the Mann Whitney test. Pain and sedation scores were evaluated over time by the Friedman test, followed by the Dunn test. Alive dogs presented greater epidural dispersion (17 ± 3 vertebrae) than thawed cadavers (11 ± 4 vertebrae; p = 0.002). All dogs treated with fentanyl and only one dog treated with 0.25% epidural bupivacaine presented pain scores above the cut-off point of the Glasgow Composite Measure Pain Scale Short-Form (GCMPS-SF) and required postoperative rescue analgesia up to 6 h after extubation. The sedation score was higher at all postoperative moments compared to preoperative moments in the G0.25 and GF, except for evaluations performed at 5 and 6 h after extubation in the GF. Greater sedation was observed immediately after extubation in the GF compared to the G0.25, and there was greater sedation in the G0.25 compared to the GF from 3 to 6 h after extubation. The conclusion of the anatomical study was that L1–L2 epidural bupivacaine dispersion is lower in canine thawed cadavers than in alive dogs. Conclusion of the clinical study was that lumbar epidural anesthesia improved postoperative analgesia and produced longer postoperative sedation when compared to fentanyl.
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Affiliation(s)
- Daniela Santilli Cima
- Department of Anesthesiology, Medical School, São Paulo State University (Unesp), Botucatu, Brazil
| | | | - Fábio Futema
- School of Veterinary Medicine, São Judas Tadeu University, São Paulo, Brazil
| | - Stelio Pacca Loureiro Luna
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (Unesp), Botucatu, Brazil
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Boff G, Naspolini B, Marco CD, Andrades J, Caye P, Kalb A, Guim T, Gehrcke M. Dispersão da lidocaína administrada por via epidural em cães posicionados em decúbito lateral ou esternal. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-11664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi verificar clinicamente a dispersão da lidocaína no espaço epidural de cães posicionados em diferentes decúbitos. Foram utilizados 16 cães, com peso médio de 17,5 quilogramas. Esses foram tranquilizados com acepromazina, anestesiados com propofol e alocados em dois grupos, conforme o decúbito de posicionamento: decúbito esternal (GE) e decúbito lateral direito (GLD). Ambos os grupos receberam lidocaína a 2%, no volume de 0,25mL/kg, e permaneceram no mesmo decúbito por 20 minutos. Em seguida, avaliou-se o bloqueio dos membros pélvicos e a extensão do bloqueio, a partir da sétima vértebra lombar, por meio de pinçamento interdigital e do panículo paravertebral. Foi, então, realizada cirurgia de orquiectomia. Após tal procedimento, avaliou-se o tempo total de bloqueio dos membros pélvicos. Todos os cães apresentaram bloqueio bilateral, sem diferenças quanto à extensão cranial entre os grupos, sendo a mediana de 7,5 (1-14) vértebras para GE e de 4 (1-14) para GLD. O tempo de bloqueio dos membros direito e esquerdo foi de 123 ± 26 e 130 ± 20 minutos, para GE, e de 120 ± 21 e 121 ± 20 minutos, para GLD, sem diferenças entre os grupos ou entre os membros. Conclui-se que o decúbito não interfere na distribuição da lidocaína administrada por via epidural.
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Affiliation(s)
- G.A. Boff
- Universidade Federal de Pelotas, Brazil
| | | | | | | | - P. Caye
- Universidade Federal de Pelotas, Brazil
| | - A.C. Kalb
- Universidade Federal de Pelotas, Brazil
| | - T.N. Guim
- Universidade Federal de Pelotas, Brazil
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Kaushal S, Singh S, Sharma A. A randomised study comparing the extent of block produced by spinal column height and body weight-based formulae for paediatric caudal analgesia. Indian J Anaesth 2020; 64:477-482. [PMID: 32792711 PMCID: PMC7398024 DOI: 10.4103/ija.ija_824_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/19/2020] [Accepted: 05/04/2020] [Indexed: 11/08/2022] Open
Abstract
Background and Aims: Height and weight-based formulae are used for calculation of dose of medications for caudal analgesia but these have not been compared. We compared spinal column height-based Spiegel and weight-based Takasaki and Armitage formulae for achieving maximum height of sensory neuraxial block after caudal epidural analgesia in paediatric patients. Methods: In this double-blind randomised study, children aged between 1 and 6 years and planned for infra-umbilical surgery were randomly allocated to receive caudal epidural block (targeting T10level block) with 0.25% bupivacaine, using a volume calculated by modified Spiegel formula (group I), Takasaki formula (group II), and Armitage formula (group III). The Institute ethics committee reviewed and approved the study protocol. The primary endpoint of the study was the difference in the number of spinal segments blocked as assessed by pinprick method. The secondary endpoint was the difference in volume of 0.25% bupivacaine used among the groups. The groups were compared using one-way ANOVA. Results: Seventy-five patients (25 in each group) completed the study as per protocol. The mean number of spinal segments blocked was significantly different among groups (P < 0.001) with patients in group I (13.8 ± 0.83) showing significantly lower number of spinal segments blocked as compared to that in group II (15.8 ± 1.06; P < 0.001), and group III (16.8 ± 1.28; P < 0.001). The mean volume of 0.25% bupivacaine used in group I was significantly lower (P < 0.001) than that in group II and group III. Conclusion: Dose calculation in caudal epidural analgesia as per spinal column height-based modified Spiegel formula was more precise than bodyweight-based Takasaki and Armitage formulae.
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Affiliation(s)
- Sonali Kaushal
- Department of Anaesthesiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Surinder Singh
- Department of Anaesthesiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Sharma
- Department of Anaesthesiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Sudheshna KD, Gopinath R, Ayya SS, Kar P, Kumar RV. High vs mid thoracic epidural analgesia - A comparative study on the ease of insertion and effects on pain, hemodynamics, and oxygenation in patients undergoing thoracotomies. Ann Card Anaesth 2019; 22:383-387. [PMID: 31621673 PMCID: PMC6813698 DOI: 10.4103/aca.aca_169_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Thoracic epidural analgesia offers effective perioperative pain relief in patients undergoing thoracotomies apart from attenuating stress responses. It helps in fast tracking by facilitating early mobilization and improving respiratory function. Literature on high (T1-T2 level) thoracic segmental analgesia for thoracotomy is less. Aim The aim of present study was to compare the ease of insertion, effect on pain relief in high (T1-T2 level) vs mid (T5-T6) approach of thoracic epidural. Setting and Design The present study was a randomized control trial conducted at our institute. Materials and Methods About 52 patients aged between 18-65 years scheduled for elective thoracotomies under general and thoracic epidural anesthesia were randomized into two groups. Intraoperatively ease of epidural insertion, extent of blockade, and postoperatively pain relief were assessed. Ropivacaine with fentanyl was used for epidural analgesia. Statistical Analysis Data were presented as mean ± standard deviation and analyzed by the Student's t test, Chi-square test, and non-parametric test whereever applicable. A P value <0.05 was considered statistically significant. Results We observed that high thoracic epidural anesthesia was easier to place (time taken 123.42 vs 303.08 s) P < 0.05, with less number of attempts (1.27 vs 1.92) P < 0.05. Extent of blockade, postoperative pain scores, rescue analgesia requirement, hemodynamics, and oxygenation were comparable. Conclusion We conclude that high thoracic epidural is easier to insert, provides adequate pain relief, and stable hemodynamics with the advantage of patient comfort and safety.
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Affiliation(s)
- K Durga Sudheshna
- Department of Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka, India
| | - Ramachandran Gopinath
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Syama Sundar Ayya
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Prachi Kar
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ravinuthala V Kumar
- Department of Cardio Thoracic Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Bolger AA, Stewart PA. Anesthetic Considerations of Hereditary Neuropathy With Liability to Pressure Palsies in an Obstetric Patient. A A Pract 2019; 13:126-129. [DOI: 10.1213/xaa.0000000000001010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Matsusaki T, Kaku R, Ono D, Taniguchi A, Morimatsu H. Radio contrast imaging for continuous epidural infusion in humans: a report of three cases. J Pain Res 2019; 12:1077-1082. [PMID: 30988638 PMCID: PMC6438137 DOI: 10.2147/jpr.s193500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There are no reports of human research on continuous epidural contrast injection, and there are no definite methods to investigate the spread of drugs injected continuously into the epidural space. We investigated the feasibility of continuous epidural contrast injection in patients undergoing computed tomography (CT)-guided therapy. In this study, a combination of a contrast agent mixed with 0.75% ropivacaine was used as the test drug. The main outcome evaluated was the feasibility of continuous epidural contrast imaging by CT scan following epidural injection of a contrast agent with 0.75% ropivacaine. We studied three patients who underwent CT-guided procedures and found that continuous epidural contrast injection was possible without any deleterious effects, such as an allergic reaction. The spread of the contrast agent was not consistent with the level of the clinical analgesic effect. Continuous epidural contrast injection is a feasible procedure. The results of our study might contribute to future research on continuous epidural contrast administration, as well as provide patients with superior analgesia.
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Affiliation(s)
- Takashi Matsusaki
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan,
| | - Ryuji Kaku
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan,
| | - Daisuke Ono
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan,
| | - Arata Taniguchi
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan,
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan,
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Rubio-Haro R, Morales-Sarabia J, Ferrer-Gomez C, de Andres J. Regional analgesia techniques for pain management in patients admitted to the intensive care unit. Minerva Anestesiol 2019; 85:1118-1128. [PMID: 30945513 DOI: 10.23736/s0375-9393.19.13447-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Controlling pain should be a priority in the clinical practice of intensive care units (ICUs). Monomodal analgesic approaches, such as the administration of opioids, are widely employed; however, the widespread use of opioids has catastrophic consequences, given their multiple side effects and the development of dependence. Regional analgesia (RA), with single or continuous dosing using neuraxial and peripheral catheters, can play an important role in multimodal analgesia for management of pain in critical care patients. RA provides superior pain control, as compared to systemic treatments, and is associated with a lower rate of side effects. Nevertheless, RA remains underused in ICUs. Many critically ill, post-surgical or traumatically injured patients would benefit from these techniques. For these reasons, we aim to establish a set of potential indications integrating the use of RA in analgesia protocols routinely used in ICUs. We performed a review of literature sources with contrasted evidence levels to present RA techniques and their potential applications in ICU patients.
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Affiliation(s)
- Ruben Rubio-Haro
- Department of Anesthesia, General University Hospital, Valencia, Spain
| | | | | | - José de Andres
- Department of Anesthesiology, Critical Care and Pain Management, General University Hospital, Valencia University Medical School, Valencia, Spain -
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Ferreira TH, Mans C. Evaluation of neuraxial anesthesia in bearded dragons (Pogona vitticeps). Vet Anaesth Analg 2019; 46:126-134. [DOI: 10.1016/j.vaa.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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Son WG, Jang M, Jo SM, Kim H, Shin CW, Lee I. Cranial versus caudal thoracic epidural anesthesia using three volumes of lidocaine in conscious Beagle dogs. Vet Anaesth Analg 2019; 46:96-105. [DOI: 10.1016/j.vaa.2018.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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Skjellerup N. Successful spinal anaesthesia for caesarean section in a patient with Marfan syndrome complicated by dural ectasia. Int J Obstet Anesth 2018; 35:88-92. [PMID: 30060836 DOI: 10.1016/j.ijoa.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/16/2022]
Abstract
Marfan syndrome is a connective tissue disorder that may be complicated during pregnancy by aortic dissection. Caesarean section may be selected to avoid the haemodynamic challenges of vaginal birth. The common occurrence of dural ectasia in patients with Marfan syndrome is known to be associated with failed neuraxial anaesthesia. This report describes the administration of spinal anaesthesia to a woman with Marfan syndrome, and discusses why a hypobaric bupivacaine and opioid mixture, warmed to 37°C and injected intrathecally with the patient seated, produced successful surgical anaesthesia.
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Affiliation(s)
- N Skjellerup
- Christchurch Public Hospital, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch, New Zealand.
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Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: A case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian J Anaesth 2018; 62:75-78. [PMID: 29416155 PMCID: PMC5787896 DOI: 10.4103/ija.ija_693_17] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Post-operative pain after minimally invasive video-assisted thoracoscopic surgery (VATS) in adults is commonly managed with oral and parenteral opioids and invasive regional techniques such as thoracic epidural blockade. Emerging research has shown that the novel erector spinae plane (ESP) block, can be employed as a simple and safe alternative analgesic technique for acute post-surgical, post-traumatic and chronic neuropathic thoracic pain in adults. We illustrate this by presenting a paediatric case of VATS, in which an ESP block provided better analgesia, due to greater dermatomal coverage, as well as reduced side-effects when compared with a thoracic epidural that had previously been employed on the same patient for a similar procedure on the opposite side.
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Affiliation(s)
- Sanjib Das Adhikary
- Department of Anaesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ashlee Pruett
- Department of Anaesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mauricio Forero
- Department of Anesthesia, McMaster University, Hamilton, Ontario
| | - Venkatesan Thiruvenkatarajan
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia.,Department of Anaesthesia, The Queen Elizabeth Hospital, Adelaide, South Australia
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28
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Kalava A, Clendenen S, McKinney JM, Bojaxhi E, Greengrass RA. Bilateral thoracic paravertebral nerve blocks for placement of percutaneous radiologic gastrostomy in patients with amyotrophic lateral sclerosis: a case series. Rom J Anaesth Intensive Care 2017; 23:149-153. [PMID: 28913488 DOI: 10.21454/rjaic.7518/232.scl] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIMS To assess the efficacy of bilateral thoracic paravertebral nerve blocks (PVB) in providing procedural anesthesia and post-procedural analgesia for placement of percutaneous radiologic gastrostomy tubes (PRG) in patients with amyotrophic lateral sclerosis (ALS). METHODS We prospectively observed 10 patients with ALS scheduled for PRG placement that had bilateral thoracic PVBs at thoracic 7, 8, and 9 levels with administration of a mixture of 3 mL of 1% ropivacaine, 0.5 mg/mL dexamethasone, and 5 μg/mL epinephrine at each level. The success of the block was assessed after 10 minutes. PRG placement was done in the interventional radiology suite without sedation. All patients were followed up via phone 24 hours after the procedure. RESULTS All 10 patients had successful placement of PRG with PVBs as the primary anesthetic. Segmental anesthesia over the surgical site in all cases was successful with first attempt of the blocks. Three patients had significant hypotension after the block, requiring boluses of vasopressors and intravenous fluids. All patients reported high levels of satisfaction and sleep quality on the night of the procedure. CONCLUSIONS Bilateral thoracic PVBs provided satisfactory procedural anesthesia and post-procedural analgesia, and thus, seem promising as a safe alternative to sedation in ALS patients having PRG placement.
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Affiliation(s)
- Arun Kalava
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA.,Department of Anesthesiology, Tampa General Hospital, Tampa, FL, USA
| | - Steven Clendenen
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - J Mark McKinney
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Roy A Greengrass
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
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Padalia RB, Reeves CJ, Shah N, Patel AA, Padalia DM. Case report: bilateral tunneled epidural catheters to prevent unilateral analgesia for cancer-related pain. Local Reg Anesth 2017; 10:79-82. [PMID: 28790864 PMCID: PMC5529603 DOI: 10.2147/lra.s135809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Raj B Padalia
- Pain Medicine, University of South Florida, Tampa, FL, USA
| | - Corey J Reeves
- Physical Medicine and Rehabilitation, University of South Florida, Tampa, FL, USA
| | - Neal Shah
- Pain Medicine, University of South Florida, Tampa, FL, USA
| | - Ankur A Patel
- Edward Via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - Devang M Padalia
- Interventional Pain, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
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Dos Santos Silva P, Fantinato-Neto P, Silva ANE, Junior EHB, Carregaro AB. Thoracolumbar epidural anaesthesia with 0.5% bupivacaine with or without methadone in goats. Ir Vet J 2017; 70:15. [PMID: 28560030 PMCID: PMC5446691 DOI: 10.1186/s13620-017-0093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 05/11/2017] [Indexed: 11/21/2022] Open
Abstract
Background Epidural anaesthesia is one of the most commonly used locoregional techniques in ruminants. The lumbosacral epidural technique is reasonably easy to perform and requires low volumes of local anaesthetic drug to allow procedures caudal to the umbilicus. However, surgical procedures in the flank of the animal would require an increased volume of drugs. The anaesthetized area provided by thoracic epidural technique is larger than the lumbosacral technique; however the former is rather challenging to perform. Therefore, access through lumbosacral area to introduce a catheter into the thoracolumbar space is a potential alternative to thoracic access. Epidural anaesthesia is achieved with local anaesthetics; opioids can be added to improve analgesia. This study aimed to evaluate the effects of 0.5% bupivacaine with or without methadone, administered through an epidural catheter inserted through the lumbosacral access and advanced to the thoracolumbar space, on thoracolumbar epidural anaesthesia in goats. Methods Six animals received two treatments each in a randomized crossover study: BUP treatment consisted of 0.5% bupivacaine (1 mL per each 10 cm of spine column; 1 ± 0.2 mg/kg BW) and BMT treatment was the same; however 1 mL of bupivacaine was replaced by 1 mL (0.22 ± 0.03 mg/kg BW) of methadone (10 mg/mL). The treatments were administered near to T11-T12 through an epidural catheter. Motor blockade and analgesia were evaluated by electrical stimulation. Results Heart rate, respiratory rate, ruminal motility and rectal temperature were evaluated before and after the treatment. Motor blockade was observed on both treatments, up to 6 h post-treatment. Analgesia was observed on BUP up to 4 h and on BMT up to 6 h post-treatment. Physiological values did not change at any moment. Conclusions Bupivacaine-methadone combination promoted longer-lasting analgesia in goats compared to bupivacaine alone when administered through an epidural catheter into the thoracolumbar space. Electronic supplementary material The online version of this article (doi:10.1186/s13620-017-0093-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Priscila Dos Santos Silva
- Department of Veterinary Science, School of Animal Science and Food Engineering, University of São Paulo, 225th, Duque de Caxias Norte Avenue, Campus Pirassununga, 13635-000 Pirassununga, SP Brazil
| | - Paulo Fantinato-Neto
- Department of Veterinary Science, School of Animal Science and Food Engineering, University of São Paulo, 225th, Duque de Caxias Norte Avenue, Campus Pirassununga, 13635-000 Pirassununga, SP Brazil.,Moura Lacerda University Center, 1520th, Dr. Oscar de Moura Lacerda Avenue, Campus Ribeirão Preto, 14076-510 Ribeirão Preto, SP Brazil
| | - André Nicolai Elias Silva
- Department of Veterinary Science, School of Animal Science and Food Engineering, University of São Paulo, 225th, Duque de Caxias Norte Avenue, Campus Pirassununga, 13635-000 Pirassununga, SP Brazil
| | - Eduardo Harry Birgel Junior
- Department of Veterinary Science, School of Animal Science and Food Engineering, University of São Paulo, 225th, Duque de Caxias Norte Avenue, Campus Pirassununga, 13635-000 Pirassununga, SP Brazil
| | - Adriano Bonfim Carregaro
- Department of Veterinary Science, School of Animal Science and Food Engineering, University of São Paulo, 225th, Duque de Caxias Norte Avenue, Campus Pirassununga, 13635-000 Pirassununga, SP Brazil
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Steagall PVM, Simon BT, Teixeira Neto FJ, Luna SPL. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs. Front Vet Sci 2017; 4:68. [PMID: 28553642 PMCID: PMC5427076 DOI: 10.3389/fvets.2017.00068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/20/2017] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Paulo V M Steagall
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Bradley T Simon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Francisco J Teixeira Neto
- Faculty of Veterinary Medicine and Animal Science, Department of Veterinary Surgery and Anaesthesiology, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Stelio P L Luna
- Faculty of Veterinary Medicine and Animal Science, Department of Veterinary Surgery and Anaesthesiology, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
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Moliner Velázquez S, Rubio Haro R, De Andrés Serrano C, De Andrés Ibáñez J. Regional analgesia in postsurgical critically ill patients. ACTA ACUST UNITED AC 2016; 64:144-156. [PMID: 27939017 DOI: 10.1016/j.redar.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
Regional analgesia intrinsically, based on its physiological effects, is routinely used for the perioperative treatment of pain associated with surgical procedures. However, in other areas such as the non-surgical treatment of acute pain for patients in a critical condition, it has not been subjected to specific prospective studies. If we confine ourselves to the physiological effects of the nerve block, in a situation of stress, the indications for regional anaesthesia in this group of patients extend to the management of a wide variety of medical as well as postsurgical conditions, of trauma patients and of other painful procedures performed in the patient's bed. The critical patient certainly must be analyzed individually as their own primary conditions is of vital importance, as well as any associated conditions they have developed that can potentially increase the risk of systemic toxicity or morbidity, such as, coagulopathies, infection, immunosuppressive states, sedation and problems associated with mechanical ventilation. This review aims to assess the role of regional analgesia in critically ill patients, placing it within the algorithm decision tree of the professional responsible for patients in critical care units, all based on the evidence of potential benefits according to the published literature.
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Affiliation(s)
- S Moliner Velázquez
- Servicio de Anestesia, Reanimación y Unidad Multidisciplinar de Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - R Rubio Haro
- Facultad de Medicina, Universidad de Valencia, Valencia, España
| | | | - J De Andrés Ibáñez
- Servicio de Anestesia, Reanimación y Unidad Multidisciplinar de Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España.
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Hong JH, Oh JH, Park KB. Analysis of thoracic epidurography and correlating factors affecting the extent of contrast medium spread. Korean J Pain 2016; 29:255-261. [PMID: 27738504 PMCID: PMC5061642 DOI: 10.3344/kjp.2016.29.4.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background Thoracic epidural anesthesia is frequently used to maintain intraoperative and postoperative analgesia. Frequently, 3 ml of local anesthetic is used as a test dose, or for intermittent epidural injection. We assessed the extent of the spread of 3 ml of contrast medium in the thoracic epidural space and attempted to identify any correlating factors affecting the epidurography. Methods A total of 70 patients were enrolled in the study, and thoracic epidural catheterizations were performed under fluoroscopic guidance. Using 3 ml of contrast medium, epidurography was evaluated to confirm the number of spinal segments covered by the contrast medium. Correlation analysis was performed between patient characteristics (sex, age, body mass index, weight, height, and location of catheter tip) and the extent of the contrast spread. Results The mean number of vertebral segments evaluated by contrast medium was 7.9 ± 2.2 using 3 ml of contrast medium. The contrast spread in the cranial direction showed more extensive distribution than that in the caudal direction, with statistical significance (P < 0.01). Patient height demonstrated a negative correlation with the extent of distribution of contrast medium (r = −0.311, P < 0.05). Conclusions Thoracic epidurography using 3 ml of contrast medium results in coverage of a mean of 7.9 ± 2.2 spinal segments, with more extensive cranial spread, and patient height showed a weak negative correlation with the distribution of contrast medium.
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Affiliation(s)
- Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, School of Medicine, Daegu, Korea
| | - Jung Hue Oh
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, School of Medicine, Daegu, Korea
| | - Ki Bum Park
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, School of Medicine, Daegu, Korea
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Sommerfield D, Ramgolam A, Barker A, Bergesio R, von Ungern-Sternberg BS. Epidural insertion height for ureteric reimplant surgery; does location matter? Paediatr Anaesth 2016; 26:951-9. [PMID: 27061337 DOI: 10.1111/pan.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical correction of vesicoureteric reflux through ureteric reimplantation is a common, highly successful treatment. Postoperative pain can be severe and may relate to somatic wound pain from the lower abdominal incision or from visceral bladder spasm pain. AIM To conduct a prospective quality improvement audit to compare four perioperative analgesic techniques. METHODS Observational data were collected on 217 patients following open ureteroneocystostomy over 5 days. The patients were split into four groups: (i) 'morphine' infusion; (ii) 'caudal'-single-shot caudal; (iii) 'epidural'-epidural catheter inserted at T10-L2 given a bolus, followed by an infusion of 0.125% bupivacaine with fentanyl 2 μg·ml(-1) ; (iv) 'caudal catheter'-caudal placed epidural catheter was treated similar to the epidural catheter. Data regarding postoperative analgesic interventions were recorded. Intravesical pethidine was used for bladder spasm pain and i.v. morphine for wound pain. RESULTS Over the study period, the caudal catheter technique (mean interventions/patient = 1.8 ± 2.6) and the single-shot caudal (6.1 ± 4) needed significantly less bladder spasm interventions than morphine (9.2 ± 4) and epidural (8.0 ± 4.4) patients. For wound pain, the caudal catheter (8.8 ± 3.3) and epidural groups (11.4 ± 3.2) needed significantly less interventions than morphine (16.1 ± 3) and caudal (15.3 ± 3.3) patients. Overall, caudal catheter patients on average required about half the number of pain interventions and were associated with less high nursing workload. CONCLUSIONS Despite some limitations in data collection and study design, the caudal catheter technique was superior at reducing pain interventions, particularly bladder spasm interventions. Overall epidural analgesia was not superior to a single-shot caudal followed by opioid infusion. The issue of bladder spasm may be similar to the phenomenon of sacral sparing in obstetric epidural anesthesia. Thus, regional techniques, such as caudal epidural, targeting a better balance between sacral and lumber nerves are required.
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Affiliation(s)
- David Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Anoop Ramgolam
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,Paediatric Respiratory Physiology, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Andrew Barker
- Department of Paediatric Surgery, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Ric Bergesio
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
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Park JY, Kim DH, Lee K, Choi SS, Leem JG. Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain. Medicine (Baltimore) 2016; 95:e5206. [PMID: 27787378 PMCID: PMC5089107 DOI: 10.1097/md.0000000000005206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
There is no study of optimal volume of contrast medium to use in cervical interlaminar epidural injections (CIEIs) for appropriate spread to target lesions. To determine optimal volume of contrast medium to use in CIEIs. We analyzed the records of 80 patients who had undergone CIEIs. Patients were divided into 3 groups according to the amount of contrast: 3, 4.5, and 6 mL. The spread of medium to the target level was analyzed. Numerical rating scale data were also analyzed. The dye had spread to a point above the target level in 15 (78.9%), 22 (84.6%), and 32 (91.4%) patients in groups 1 to 3, respectively. The dye reached both sides in 14 (73.7%), 18 (69.2%), and 23 (65.7%) patients, and reached the ventral epidural space in 15 (78.9%), 22 (84.6%), and 30 (85.7%) patients, respectively. There were no significant differences of contrast spread among the groups. There were no significant differences in the numerical rating scale scores among the groups during the 3 months. When performing CIEIs, 3 mL medication is sufficient volume for the treatment of neck and upper-extremity pain induced by lower cervical degenerative disease.
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Affiliation(s)
| | | | | | | | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Correspondence: Jeong-Gil Leem, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: )
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Blichfeldt-Eckhardt MR, Laursen CB, Berg H, Holm JH, Hansen LN, Ørding H, Andersen C, Licht PB, Toft P. A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery. Anaesthesia 2016; 71:1441-1448. [DOI: 10.1111/anae.13621] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - C. B. Laursen
- Department of Respiratory Medicine; Odense University Hospital; Odense Denmark
| | - H. Berg
- Department of Anesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
| | - J. H. Holm
- Department of Anesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
| | - L. N. Hansen
- Department of Anesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
| | - H. Ørding
- Department of Anaesthesiology; Vejle Hospital; Vejle Denmark
| | - C. Andersen
- Department of Anesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
| | - P. B. Licht
- Department of Cardiothoracic Surgery; Odense University Hospital; Odense Denmark
| | - P. Toft
- Department of Anesthesiology and Intensive Care; Odense University Hospital; Odense Denmark
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Ahn SG, Lee J, Park HJ, Kim YH. Ultrasound-guided pararadicular block using a paramedian sagittal oblique approach for managing low back pain in a pregnant woman -A case report-. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.3.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Seul Gi Ahn
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jisoo Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Needle Tip Position and Bevel Direction Have No Effect in the Fluoroscopic Epidural Spreading Pattern in Caudal Epidural Injections: A Randomized Trial. Pain Res Manag 2016; 2016:4158291. [PMID: 27445609 PMCID: PMC4904617 DOI: 10.1155/2016/4158291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022]
Abstract
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.
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Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part II. Gynecol Oncol 2016; 140:323-32. [PMID: 26757238 PMCID: PMC6038804 DOI: 10.1016/j.ygyno.2015.12.019] [Citation(s) in RCA: 274] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 12/15/2022]
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Greater Cephalad Extent of Thoracic Epidural Sensory Anesthesia After Lidocaine and Epinephrine Test Dose Correlates With Analgesic Consumption and Pain Burden After Uterine Fibroid Artery Embolization. Reg Anesth Pain Med 2016; 41:56-64. [DOI: 10.1097/aap.0000000000000327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Boling B, Key C, Wainscott J, Rebel A. Harlequin syndrome as a complication of epidural anesthesia. Crit Care Nurse 2015; 34:57-61. [PMID: 24882829 DOI: 10.4037/ccn2014870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Harlequin syndrome is a rare neurological condition that results in unilateral facial flushing and sweating. Although the syndrome is generally a benign condition with complete resolution if appropriate treatment is initiated, unilateral facial flushing can be a sign of several serious conditions and should be thoroughly investigated. Sudden onset of facial flushing related to harlequin syndrome developed in a patient who had bilateral lung transplant with postoperative epidural anesthesia for pain control. Differential diagnosis includes neurovascular disease (acute stroke), malignant neoplasm of brain or lung, Horner syndrome, idiopathic hyperhidrosis, and Frey syndrome. Harlequin syndrome is often easily treated by discontinuing the anesthetic or adjusting placement of the epidural catheter.
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Affiliation(s)
- Bryan Boling
- Bryan Boling is a staff nurse in the cardiothoracic vascular intensive care unit and a doctoral student in the acute care nurse practitioner program at the University of Kentucky, Lexington.Christopher Key is a staff anesthesiologist, Department of Anesthesiology, University of Alabama, Birmingham.Justin Wainscott is an attending physician on the acute pain service, Department of Anesthesiology, University of Kentucky.Annette Rebel is an attending physician on the critical care service, Department of Anesthesiology, and program director of the critical care fellowship program, University of Kentucky.
| | - Christopher Key
- Bryan Boling is a staff nurse in the cardiothoracic vascular intensive care unit and a doctoral student in the acute care nurse practitioner program at the University of Kentucky, Lexington.Christopher Key is a staff anesthesiologist, Department of Anesthesiology, University of Alabama, Birmingham.Justin Wainscott is an attending physician on the acute pain service, Department of Anesthesiology, University of Kentucky.Annette Rebel is an attending physician on the critical care service, Department of Anesthesiology, and program director of the critical care fellowship program, University of Kentucky
| | - Justin Wainscott
- Bryan Boling is a staff nurse in the cardiothoracic vascular intensive care unit and a doctoral student in the acute care nurse practitioner program at the University of Kentucky, Lexington.Christopher Key is a staff anesthesiologist, Department of Anesthesiology, University of Alabama, Birmingham.Justin Wainscott is an attending physician on the acute pain service, Department of Anesthesiology, University of Kentucky.Annette Rebel is an attending physician on the critical care service, Department of Anesthesiology, and program director of the critical care fellowship program, University of Kentucky
| | - Annette Rebel
- Bryan Boling is a staff nurse in the cardiothoracic vascular intensive care unit and a doctoral student in the acute care nurse practitioner program at the University of Kentucky, Lexington.Christopher Key is a staff anesthesiologist, Department of Anesthesiology, University of Alabama, Birmingham.Justin Wainscott is an attending physician on the acute pain service, Department of Anesthesiology, University of Kentucky.Annette Rebel is an attending physician on the critical care service, Department of Anesthesiology, and program director of the critical care fellowship program, University of Kentucky
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Kawalilak LT, Tucker RL, Greene SA. USE OF CONTRAST-ENHANCED COMPUTED TOMOGRAPHY TO STUDY THE CRANIAL MIGRATION OF A LUMBOSACRAL INJECTATE IN CADAVER DOGS. Vet Radiol Ultrasound 2015; 56:570-4. [DOI: 10.1111/vru.12264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/19/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lukas T. Kawalilak
- Veterinary Clinical Sciences; Washington State University; Pullman WA 99164-6610
| | - Russell L. Tucker
- Veterinary Clinical Sciences; Washington State University; Pullman WA 99164-6610
| | - Stephen A. Greene
- Veterinary Clinical Sciences; Washington State University; Pullman WA 99164-6610
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Shin S, Kim JY, Kim WO, Kim SH, Kil HK. Ultrasound visibility of spinal structures and local anesthetic spread in children undergoing caudal block. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2630-2636. [PMID: 25220270 DOI: 10.1016/j.ultrasmedbio.2014.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/14/2014] [Accepted: 06/30/2014] [Indexed: 06/03/2023]
Abstract
This study assessed ultrasound visibility of spinal structures in children and observed the extent of local anesthetic spread within the epidural space during caudal block. Spinal structures were evaluated with ultrasound from the sacral area to the thoracic area in 80 children, and drug spread levels were observed after caudal injection of 0.5, 1.0, 1.25 and 1.5 mL/kg local anesthetic. The conus medullaris, dural sac and dura mater were easily identified with ultrasound in most children. However, ligamentum flavum visibility declined with increasing vertebral level and markedly decreased at the thoracic level in children older than 7 mo or heavier than 8.5 kg. Drug spread was higher with increasing volume (p < 0.001) and in children ≤12 mo more than children >12 mo (p < 0.001); drug spread was significantly correlated with age (R(2) = 0.534). Spread levels assessed with ultrasound were roughly two to three segments lower than those in previous radiologic studies.
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Affiliation(s)
- Seokyung Shin
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Oak Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Keum Kil
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Son WG, Jang M, Jo SM, Yoon J, Lee I. The volume effect of lidocaine on thoracic epidural anesthesia in conscious Beagle dogs. Vet Anaesth Analg 2014; 42:414-24. [PMID: 25327756 DOI: 10.1111/vaa.12232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the volume effect of local anesthetic solution on thoracic epidural analgesia in dogs. STUDY DESIGN Prospective, experimental trial. ANIMALS Five healthy adult Beagle dogs weighing 9.7 ± 1.3 kg. METHODS A catheter was inserted into the seventh thoracic epidural space using a lumbosacral approach, and secured with suture under total intravenous (IV) anesthesia with propofol. Each dog was administered four volume treatments (0.05, 0.10, 0.15 and 0.20 mL kg(-1)) of 2% lidocaine via the catheter at 12 hour intervals. In every treatment, dogs were re-anesthetized with propofol (6 mg kg(-1), IV) and isoflurane, and received iohexol at each volume to visualize the epidural distribution (ED) through computed tomography. Three hours after epidurography, when dogs had recovered from anesthesia, the appropriate volume of lidocaine was injected through the catheter, and sensory blockade (SB) in dermatomes was evaluated by pinching with a mosquito forceps. Results were presented as median (range), and the volume effect on ED and SB was analyzed with one-way Kruskal-Wallis anova. RESULTS In proportion to volumes (0.05, 0.10, 0.15 and 0.20 mL kg(-1)), there were significant increases in the extent of ED from 7.4 (5.5-9.0) to 10.4 (8.0-12.0), 13.2 (12.5-13.0), and 15.2 (13.0-18.0) vertebrae, respectively, p < 0.001, and in SB from 2.7 (1.0-5.0) to 6.8 (4.5-10.5), 9.9 (6.5-13.0), and 13.1 (11.0-15.0) dermatomes, respectively, p < 0.001. Unilateral ED and SB were observed in all treatments with various grades, and this distribution was more frequent in the low volume treatments. In the high volume treatments, temporary complications including Horner's syndrome, ataxia, paraplegia, depression, stupor, and intermittent cough occurred often. CONCLUSIONS AND CLINICAL RELEVANCE The increase in volume of local anesthetic solution improved SB by resulting in more consistent bilateral dermatome blockade as well as an extended blockade. However, caution should be exerted, as higher volume injections of lidocaine caused side effects in all dogs.
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Affiliation(s)
- Won-gyun Son
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
| | - Min Jang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
| | - Sang-min Jo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
| | - Junghee Yoon
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
| | - Inhyung Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
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Shaparin N, Bernstein J, White RS, Kaufman A. Bevel direction of epidural needles reliably predicts direction of catheter placement and contrast spread in human cadavers: results of a pilot study. J Clin Anesth 2014; 26:587-90. [PMID: 25267610 DOI: 10.1016/j.jclinane.2014.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/03/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To confirm the relationship between bevel orientation, catheter direction, and radiopaque contrast spread in the lumbar region. DESIGN Pilot cadaver study. SETTING Anatomy laboratory of a university hospital. MEASUREMENTS Cadavers were randomized to two groups of 4 cadavers each. In Group 1, needle bevel direction at epidural entry was cephalad; in Group 2, it was caudad. After placement of each epidural catheter in L4-L5 interspace, 2 mL of radiopaque contrast was injected and a lumbar posterior-anterior radiograph was obtained. Catheter direction and direction of radiopaque contrast spread were collected. MAIN RESULTS Due to the inability to access the epidural space secondary to surgical changes in the lumbar spine, one cadaver in the cephalad group was excluded. In 7 of 7 (100%) cadavers, the catheter tip direction according to the radiograph corresponded directly with bevel direction. CONCLUSIONS A strong relationship exists between bevel orientation and catheter direction; however, catheter position does not reliably predict the direction in which the injected fluid spreads in all cadavers.
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Affiliation(s)
- Naum Shaparin
- Department of Anesthesiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Jeffrey Bernstein
- Department of Anesthesiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY 10467, USA.
| | - Robert S White
- Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Andrew Kaufman
- Department of Anesthesiology, Rutgers-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
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Patient-controlled epidural levobupivacaine with or without fentanyl for post-cesarean section pain relief. BIOMED RESEARCH INTERNATIONAL 2014; 2014:965152. [PMID: 24982917 PMCID: PMC4055260 DOI: 10.1155/2014/965152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/07/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study. METHODS We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion. RESULTS There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups. CONCLUSION Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.
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Sagiroglu G, Meydan B, Copuroglu E, Baysal A, Yoruk Y, Altemur Karamustafaoglu Y, Huseyin S. A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery. World J Surg Oncol 2014; 12:96. [PMID: 24885545 PMCID: PMC4063422 DOI: 10.1186/1477-7819-12-96] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/07/2014] [Indexed: 12/12/2022] Open
Abstract
Background We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. Methods One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. Results The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. Conclusions TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile.
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Affiliation(s)
- Gonul Sagiroglu
- Department of Anesthesiology, Faculty of Medicine Houses, Trakya University, D- Bloc, No: 8, Edirne, Turkey.
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Yoshida T, Fujiwara T, Furutani K, Ohashi N, Baba H. Effects of ropivacaine concentration on the spread of sensory block produced by continuous thoracic paravertebral block: a prospective, randomised, controlled, double-blind study. Anaesthesia 2014; 69:231-9. [DOI: 10.1111/anae.12531] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
Affiliation(s)
- T. Yoshida
- Division of Anesthesiology; Niigata University Graduate School of Medical and Dental Sciences; Niigata-city Japan
| | - T. Fujiwara
- Division of Anesthesiology; Niigata University Graduate School of Medical and Dental Sciences; Niigata-city Japan
| | - K. Furutani
- Division of Anesthesiology; Niigata University Graduate School of Medical and Dental Sciences; Niigata-city Japan
| | - N. Ohashi
- Division of Anesthesiology; Niigata University Graduate School of Medical and Dental Sciences; Niigata-city Japan
| | - H. Baba
- Division of Anesthesiology; Niigata University Graduate School of Medical and Dental Sciences; Niigata-city Japan
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WINK J, WOLTERBEEK R, AARTS LPHJ, KOSTER SCE, VERSTEEGH MIM, VEERING BTH. Upper thoracic epidural anaesthesia: effects of age on neural blockade and cardiovascular parameters. Acta Anaesthesiol Scand 2013; 57:767-75. [PMID: 23421557 DOI: 10.1111/aas.12087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Segmental dose reduction with increasing age after thoracic epidural anaesthesia (TEA) has been documented. We hypothesised that after a fixed loading dose of ropivacaine at the T3-T4 level, increasing age would result in more extended analgesic spread. In addition, other aspects of neural blockade and haemodynamic changes were studied. METHODS Thirty-five lung surgery patients were included in three age groups. Thirty-one patients received an epidural catheter at the T3-T4 interspace followed by an injection of 8-ml ropivacaine 0.75%. Analgesia was assessed with pinprick and temperature discrimination. Motor block was tested using the Bromage and epidural scoring scale for arm movements score. An arterial line was inserted for invasive measurement of blood pressure, cardiac index (CI) and stroke volume (SV). RESULTS There was no influence of age on quality of TEA except for the caudal border of analgesia being somewhat lower in the middle and older age group compared with the young age group. Heart rate (6.0 ± 5.9, P < 0.001), mean arterial pressure (16.1 ± 15.6, P < 0.001), CI (0.55 ± 0.49, P < 0.001) and SV (9.6 ± 14.6, P = 0.001) decreased after TEA for the total group. Maximal reduction in heart rate after TEA was more extensive in the young age group compared with the other age groups. There was no effect of age on other cardiovascular parameters. CONCLUSION We were unable to demonstrate an effect of age on the maximal number of spinal segments blocked after TEA; however, the caudad spread of analgesia increased with advancing age. In addition, reduction of heart rate was greater in the youngest group.
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Affiliation(s)
- J. WINK
- Department of Anaesthesiology; Leiden University Medical Center; Leiden; The Netherlands
| | - R. WOLTERBEEK
- Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; Leiden; The Netherlands
| | - L. P. H. J. AARTS
- Department of Anaesthesiology; Leiden University Medical Center; Leiden; The Netherlands
| | - S. C. E. KOSTER
- Department of Anaesthesiology; Leiden University Medical Center; Leiden; The Netherlands
| | - M. I. M. VERSTEEGH
- Department of Cardiothoracic Surgery; Leiden University Medical Center; Leiden; The Netherlands
| | - B. T. H. VEERING
- Department of Anaesthesiology; Leiden University Medical Center; Leiden; The Netherlands
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