Continuous Epidural Anesthesia Research Articles

Emergency Open Appendectomy Under Continuous Lumbar Epidural Anesthesia in a Patient with Massive Ameloblastoma

Background: Open appendectomy is still performed in the Philippines. The choice of anesthetic technique should tailor the patient's profile and the disease’s extent. This case presents a unique scenario involving a patient with a known case of ameloblastoma, complicating her anesthetic management Method: A 29-year-old female presented with migratory abdominal pain associated with symptoms of acute appendicitis. She was scheduled for an emergency open appendectomy under continuous lumbar epidural anesthesia, selected for its advantage in providing reliable surgical anesthesia in a probable prolonged surgery. Result: Epidural anesthesia provided adequate sensorimotor blockade during the three-hour surgery. Patient had an uneventful postoperative course and was discharged two days after the operation. This case presents the need for tailored anesthetic approaches in managing patients with unique medical histories undergoing common surgical procedures. These findings contribute to the limited studies on open appendectomy under continuous lumbar epidural anesthesia in a patient with massive ameloblastoma.

Continuous Epidural Catheter for Postoperative Analgesia in Children: A Case Report

The management of postoperative pain in children and infants has now become a significant concern. Continuous epidural anesthesia is a proven method for controlling acute pain after surgery. We present the case of thoracic epidural analgesia used for the repair of an extensive burn involving the back and trunk, assisted by a skin graft, in a 6-year-old girl. Department of Pediatric Intensive Care Unit, Children's Hospital of Rabat. In pediatric surgery, postoperative pain awareness is crucial for medical and paramedical teams. Continuous epidural anesthesia, utilizing suitable equipment, is feasible for young children. Its advantages during long procedures are manifold: it eliminates the need for central analgesics, ensuring stable cardiovascular function and a calm awakening post-surgery. Moreover, it provides high-quality analgesia in the postoperative phase, decreasing morbidity and easing care for children. With safe analgesics and advances in locoregional anesthesia, managing postoperative pain in pediatrics has markedly improved.

Clinical Study on the Effect of General Anesthesia Combined with Continuous Epidural Anesthesia on Patients Undergoing Radical Gastrectomy for Gastric Cancer

Clinical Study on the Effect of General Anesthesia Combined with Continuous Epidural Anesthesia on Patients Undergoing Radical Gastrectomy for Gastric Cancer

Analgesic Efficacy of Quadratus Lumborum Block in Patients Undergoing Nephrectomy: A Systematic Review and Meta-Analysis.

To evaluate the analgesic efficacy of quadratus lumborum block (QLB) in adults undergoing nephrectomy. Systematic review and meta-analysis. Adult patients (≥18 years of age) received nephrectomy under general anesthesia. We searched PubMed, Embase, the Cochrane Library, and Web of Science on January 10, 2022, including randomized controlled trials that evaluated the analgesic efficacy of QLB for patients undergoing nephrectomy. A total of 12 randomized controlled trials (N = 821 patients) were included in the study. Compared with the non-block, single-shot QLB reduced postoperative opioid consumption (mean difference [MD], -8.37 mg intravenous morphine equivalent; 95% confidence interval [CI], -12.19 to -4.54 mg) and pain scores at 2 hours, 6 hours, 12 hours, and 24 hours at rest and during movement after nephrectomy. Single-shot QLB also prolonged the time to first analgesic request (MD, 6.44 hours; 95% CI, 2.23 to 10.65 hours), shortened the length of hospital stay (MD, -0.32day; 95% CI, -0.55 to -0.09day), and decreased the incidence of postoperative nausea and vomiting (risk ratio, 0.48; 95% CI, 0.36 to 0.65). Compared with continuous epidural anesthesia, repeated QLB could provide comparable postoperative analgesic benefits. Single-shot QLB provided a statistically significant but clinically small improvement in postoperative analgesia and recovery for patients undergoing nephrectomy. The QLB would be beneficial as part of multimodal analgesia. Future research might need to determine which approach of QLB is superior for postoperative analgesia after nephrectomy.

Low-dose spinal block combined with epidural volume extension in a high-risk cardiac patient: A case-based systematic literature review.

Anesthetic management of patients with severe cardiac disease can be challenging during prolonged surgical procedures. Thus, alternative neuraxial anesthetic techniques have been described to avoid general anesthesia in these patients. A case-based systematic literature review on low-dose spinal block combined with different methods of epidural block extension in high-risk cardiac patients was performed. We describe the successful management of a patient with poor left ventricular function who underwent excision arthroplasty of an infected hip prosthesis under low-dose spinal block with levobupivacaine 5 mg and fentanyl 15 μg combined with saline epidural volume extension (EVE). Epidural ropivacaine 0.75% was administered as a bolus of 5 ml followed by an infusion at 5 ml/h later during the course of surgery. Although continuous spinal anesthesia (CSA) or epidural anesthesia may limit hemodynamic instability, the possibility of devastating central nervous system infection may prevent CSA use, and epidural block alone may be less reliable than CSA. Epidural block alone may require large volumes of concentrated local anesthetic to obtain sacral block, which may produce hemodynamic instability. The EVE, particularly using saline EVE, has rarely been described in high-risk cardiac patients as an alternative to CSA or epidural block alone, with the intention to avoid general anesthesia, but it has demonstrated efficacy and a low rate of complications. Hemodynamic stability was maintained in most cases.

Clinical effects of free superficial peroneal artery perforator flaps in repairing skin and soft tissue defects of the hallux

Objective: To explore the clinical effects of free superficial peroneal artery perforator flaps in repairing skin and soft tissue defects of the hallux. Methods: A retrospective observational study was conducted. From January 2020 to January 2021, 13 patients with skin and soft tissue defects of the hallux who met the inclusion criteria were admitted to Department of Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, including 12 males and 1 female, aged 26 to 53 years. Before operation, the perforating point of the superficial peroneal artery perforator was located by color Doppler ultrasound on the calf on the same side of the affected hallux and marked on the body surface. The operation was performed under spinal anesthesia combined with continuous epidural anesthesia. The area of skin and soft tissue defect after debridement was 4.5 cm×2.5 cm to 12.0 cm×3.0 cm. According to the size and shape of the wound, the superficial peroneal artery perforator flap was designed with the line between the fibular head and the lateral malleolus tip parallel shifting 2 cm to the tibial side as the flap axis line, and the perforating point of the perforator near the midpoint of the axis line as the center. The cut area of the flap was 5.0 cm×3.0 cm to 13.0 cm×4.0 cm, and part of the deep fascia was cut when the pedicle was freed. The donor site wound was sutured directly. During the operation, the number and type of the perforator and the cutting time of the flap were recorded, and the length of the perforator pedicle and diameter of the perforator were measured. The survival of the flap, the healing time and the healing condition of the donor and recipient areas were recorded after operation. The color, texture, elasticity of the flap, standing and walking functions of patients, the recovery of the donor area, and the patients' satisfaction with the recovery of the donor and recipient areas were recorded during the follow-up. At the last follow-up, the sensation of the flap was evaluated by the British Medical Association sensory function evaluation standard, the function of the affected limb was evaluated by the American Society of Foot and Ankle Surgery scoring system, and the excellent and good rate of the function of the affected limb was calculated. Results: A total of 13 perforators of the superficial peroneal artery were detected during the operation, all of which were septocutaneous perforators, and the perforator diameter was 0.3 to 0.5 mm. The vascular pedicle length was 2 to 5 cm. Flap cutting time was 11 to 26 minutes. The flaps of 13 patients all survived completely. The wounds at the donor and recipient sites healed well 9 to 18 days after operation. During follow-up of 6 to 14 months, the flaps had good color, texture, and elasticity; 11 patients had no obvious bloated appearance, and the other 2 patients underwent flap thinning and plastic surgery in the second stage because of their bloated appearance; all the patients returned to normal walking and standing functions. There was only one linear scar left in the donor site, with no obvious scar hyperplasia or hyperpigmentation. All the patients were satisfied with the recovery of the donor and recipient areas. At the last follow-up, the sensation of the flap was evaluated as grade S3 in 2 cases, grade S2 in 9 cases, and grade S1 in 2 cases; the function of the affected limb was evaluated as excellent in 7 cases and good in 6 cases, with an excellent and good rate of 100%. Conclusions: The free superficial peroneal artery perforator flap has relatively constant vascular anatomy, which is thin and wear-resistant, with less damage to the donor site after flap excision, and can preserve the shape and function of the hallux to the greatest extent. It is an effective method for repairing skin and soft tissue defect of the hallux.

Computed tomography guided percutaneous trans discal splanchnic nerve block for cancer pain treatment. Case report

Two cases of percutaneous transdiscal splanchnic nerve block for cancer pain treatment presented. Case 1. 50 years old man with pancreatic head and trunk cancer T4N1M0. Patients condition: intractable pain in upper abdomen during last two weeks, dysphagia, weight loss. Cholecysto-entero, gastro-entero and entero- entero anastomoses performed under epidural+general anesthesia. During 7 postoperative days pain relieved by continuous epidural anesthesia (0.2% ropivacain 5ml/hour). On postoperative day 8 epidural catheter removed due to dis lodgement. Morphine sulphate 10 mg iv injections with 4 hour intervals and cox- 2 pathway inhibitors was not sufficient for pain relief (pain score – 6-8 VAS). Splanchnic neurolysis performed on postoperative day 14. Patient laid in prone position on the computed tomography table. After marking of injection sites, definition of needles traces and deep local infiltration with 1% lidocain, two 22 gauge 20 cm Chiba needles had been inserted transdiscally on the level of T12/ L1. Pain relieved after injection of 4 ml 2% lidocaine on each side10 ml 10% aqueous phenol had been injected on each side for neurolytic block 0.1 g cefazolin injected intradiscally Patient had complete pain relief until day 5, when he felt severe continuous pain on his upper right abdomen. After two weeks of follow-up incomplete right splanchnic block diagnosed and to perform of repeated right side splanchnic neurolysis had been decided. On day 14 after 1-st neurolysis, a 3½ inch 25 gauge Quincke needle had been inserted in right retrocrural space on the level of L1. After contrast and 4ml 2% lidocaine injection, 15 ml 95% alcohol injected Pain relieved completely. No additional analgesia requirements lifetime (10 weeks). Case 2. 62 years old male with gastric cancer. Cancer recurrence after partial gastrectomy and severe intractable abdominal pain. 120 mg morphine hydrochloride daily, pain score 6-8 VAS. T12-L1 computed tomography guided transdiscal splanchnic nerve block performed in patient prone position. After marking of injection site at left side from vertebral column and deep infiltration with 1% lidocaine, a 22G 20 cm Chiba needle had been inserted. 0.1g cefazolin injected intradiscally. Intervertebral disk penetrated centrally and contrast spread was equal on both sides between aorta and L1 vertebra. Pain relieved after injection of 5 ml 2% lidocaine and 15 ml 95% alcohol. After procedure pain score – 3-4, patient was needed in 10 mg morphine hydrochloride and 150 mg lyrica daily. Computed tomography guided transdiscal splanchnic neurolysis is a safe and effective treatment tool for upper abdomen cancer pain relief. In cases of incomplete neurolysis repeated neurolytic block may be helpful.

Оптимізація анестезіологічного забезпечення пері- та післяопераційного періоду при хірургічному лікуванні колоректального раку

Мета дослідження — вибір оптимального методу анестезіологічного захисту хворих від операційної агресії при хірургічному лікуванні колоректального раку. Проведено порівняльний аналіз клінічних показників і результатів лікування при використанні атаралгезії з подальшою аналгезією наркотичними анальгетиками та комбінованої методики з використанням низькопотокової анестезії севофлураном та епідуральної аналгезії з подальшим подовженим епідуральним знеболюванням. Показано вірогідну перевагу комбінованої методики перед тотальною внутрішньовенною анестезією за рахунок нормодинамічного типу гемодинаміки упродовж всієї операції, ранньої регресії постнаркозної депресії і можливості екстубації пацієнта в операційній, ефективної аналгезії в ранньому післяопераційному періоді. Методика подовженої епідуральної аналгезії порівняно з опіатною аналгезією забезпечила значне зниження потреби в опіоїдних анальгетиках, ефективну і якісну аналгезію в післяопераційному періоді, нівелювала побічні ефекти опіатних препаратів, знизила тривалість перебування пацієнта у відділенні інтенсивної терапії. Впроваджена методика дозволила знизити частоту післяопераційної летальності, кількість ускладнень, середню тривалість ліжко-дня і частоту повернень пацієнтів у відділення інтенсивної терапії.

Comparison of block characteristics in continuous spinal anesthesia and continuous epidural anesthesia for lower limb orthopedic surgeries: An interventional study

Background: Continuous epidural anesthesia (CEA) is commonly used in routine practice even though it needs a higher dose of local anesthetics (LA) and is sometimes associated with a patchy or unilateral block. Despite advantages, continuous spinal anesthesia (CSA) is underutilized because of concern related to infection and postdural puncture headache. Our aim was to compare the block characteristics and hemodynamic changes following CSA and CEA in lower limb orthopedic surgeries. Materials and Methods: After approval from the Institutional Scientific and Ethics Committee and Registration with (Clinical Trials Registry of India/2021/02/031575), a prospective, double-blind, randomized study was conducted in 144 patients, American Society of Anesthesiologists I-II, aged 18–65 years, scheduled for lower limb orthopedic surgeries. Patients were randomly divided into two groups according to anesthesia technique used (n = 72), i.e., Group CSA and Group CEA. Block characteristics, hemodynamic variables, intraoperative LA requirement, and complications were recorded. Results: Demographic and surgical data, grade of sensory and motor blockade, and incidence of complications were comparable in both the groups. Induction time was significantly shorter in CSA (8.14 ± 0.88 min vs. 15.75 ± 3.29 min, P < 0.0001). Performance time (5.31 ± 0.92 min vs. 4.92 ± 1 min; P = 0.008), duration of blockade (68.3 ± 4.23 min vs. 65.54 ± 4 min; P < 0.0001), and analgesia (230.48 ± 40.76 min vs. 222.86 ± 39.79 min; P = 0.024) were significantly longer in CSA. A significant fall in diastolic blood pressure and mean arterial pressure occurred in CEA. LA requirement was significantly lower in CSA (11.62 ± 2.5 mg vs. 65.35 ± 7.71 mg; P < 0.00001). Conclusions: Considering shorter induction time, prolonged sensory blockade, and analgesia with greater hemodynamic stability, CSA could be preferred over CEA for lower limb orthopedic surgeries.

Impact and Outcomes of Regional Anesthesia Techniques in Elderly Patients With Fracture of Proximal Femur: A Retrospective Study.

BackgroundAlthough subarachnoid block (SAB) is the most popular regional anesthesia (RA) technique for fixation of femur fractures, continuous lumbar epidural (CLE) anesthesia, and lumbosacral plexus blocks (LSPB) are also employed in specific situations. The choice of RA technique depends on either the choice of the anesthesiologist or based on the underlying comorbidities. At our institute, we anesthetize elderly patients who come for fixation of femur fracture with multiple comorbidities using RA techniques as mentioned based on comorbidities and overall general condition. MethodsIn a cohort of 184 elderly patients, we analyzed RA techniques employed over a period of five years in elderly patients admitted with fractures of the proximal femur, its hemodynamic implications and thus attempted to find the suitable RA technique with minimal adverse events after ethics committee approval. We also compared the length of stay in the hospital in relation to RA techniques.ResultsThe demographic data was comparable with no significant difference in administering the three RA techniques. SAB, CLE and LSPB was implemented at 33.33%, 35.96%, and 30.7% respectively. Perioperative noradrenaline infusion was a feature in patients who received SAB (p<0/001). The higher number of CLE and LSPB patients had a length of stay of fewer than 48 hours whereas most SAB patients had a length of stay of more than 48 hrs (p<0.001).ConclusionElderly patients with multiple comorbidities should be offered CLE instead of SAB so as to maintain stable hemodynamics. RA technique in an elderly patient with multiple comorbidities should be standardized so as to provide uneventful surgical anesthesia.

Anatomical dimensions of the lumbar dural sac predict the sensory block level of continuous epidural analgesia during labor

BackgroundThe anatomical dimensions of the lumbar dural sac determine the sensory block level of spinal anesthesia; however, whether they show the same predictive value during continuous epidural anesthesia (CEA) remains undetermined. We designed the present study to verify the efficacy of the anatomical dimensions of the lumbar dural sac in predicting the sensory block level during labor analgesia.MethodsA total of 122 parturients with singleton pregnancies requesting labor analgesia were included in this study. The lumbar dural sac diameter (DSD), lumbar dural sac length (DSL), lumbar dural sac surface area (DSA), and lumbar dural sac volume (DSV) were measured with an ultrasound color Doppler diagnostic apparatus. CEA was performed at the L2-L3 interspace. After epidural cannulation, an electronic infusion pump containing 0.08% ropivacaine and sufentanil 0.4 μg/ml was connected. The sensory block level was determined with alcohol-soaked cotton, a cotton swab, and a pinprick. The analgesic efficacy of CEA was determined with a visual analog scale (VAS). The parturients were divided into two groups, “ideal analgesia” and “nonideal analgesia,” and the groups were compared by t test. Pearson’s correlation was performed to evaluate the association between the anatomical dimensions of the lumbar dural sac and sensory block level. Multiple linear regression analysis was used to create a model for predicting the sensory block level.ResultsIn the ideal analgesia group, the height, DSL, DSA, DSV and DSD were significantly smaller, and the body mass index (BMI) was significantly larger (P < 0.05). In addition, the DSL demonstrated the strongest correlation with the peak level of pain block (r = − 0.816, P < 0.0001; Fig. 2A), temperature block (r = − 0.874, P < 0.0001; Fig. 3A) and tactile block (r = − 0.727, P < 0.0001; Fig. 4A). Finally, the multiple linear regression analysis revealed that DSL and BMI contributed to predicting the peak sensory block level.ConclusionIn conclusion, our study shows that the sensory block level of CEA is higher when the DSL, DSA, DSV and DSD of puerperae are lower. DSL and BMI can be treated as predictors of the peak sensory block level in CEA during labor analgesia.

Anesthetic Management for Patients With Pheochromocytoma : Series of Three Cases

1.1. Background. This study describes a case series that addresses the complex anesthetic management of adrenalectomy for patients with pheochromocytoma. It is a rare tumor, originating in the chromaffin cells of the adrenal medulla and a catecholamine-secreting agent, whose most common triad of symptoms is headache, sweating and tachycardia. 1.2. Cases: The first case corresponds to a 47-year-old woman with a history of three acute myocardial infarctions with a lesion located unilaterally in the left adrenal gland. After adrenal removal and due to persistence of hypertension, it was necessary to perform a left nephrectomy. The second case describes the conduction of a multimodal and opioid-free anesthesia of a 26-year-old female patient with dilated cardiomyopathy who underwent video laparoscopic right adrenalectomy The first report involves the case of a 14-year-old male patient with von Hippel-Lindau Syndrome, who underwent bilateral open adrenalectomy. All three cases were successfully preoperatively prepared and operated on and were discharged home between the 5th and 6th day compensated and without physiological changes. No genetic study of the three patients was performed. Continuous epidural anesthesia was performed in two patients, without hypotension and need for vasopressor. 1.3. Conclusion: In this pathology, it is essential to emphasize the extreme importance of the multidisciplinary approaches carried out in the three cases. We can affirm affirm that the favorable outcomes were only possible thanks to a great joint effort and judicious for monitoring the Endocrinology and Pediatrics services and for the coordinated relationship between the anesthetic and surgical teams, which were essential for obtaining hospital discharge in the first six days after surgery

A Randomized Study Comparing the Efficacy of Ultrasound Guided Lumbar Plexus Block and Epidural Anesthesia for Postoperative Analgesia in Patients Undergoing Total Hip Replacement.

Patients undergoing total hip replacement (THR) experience severe postoperative pain. The advantage of pain relief by continuous epidural anesthesia (CEA) is offset by various adverse effects. Ultrasound guided (USG) continuous lumbar plexus block (LPB) has emerged as an alternative approach for postoperative analgesia in patients undergoing THR, especially where epidural is difficult or contraindicated. This randomized controlled trial compared USG-LPB with CEA for postoperative pain relief until 48 hours in patients undergoing THR, with 0.5% ropivacaine (15 mL) used as boluses for both CEA and LPB. The mean time to the first bolus was 380.60 ± 77.66 min in the LPB group whereas it was 307.40 ± 83.60 min in the epidural group (P = 0.002). Thus, patients in the LPB group took more than one hour longer than the epidural group to take their first bolus, which is clinically meaningful besides being statistically significant. The pain score on movement was also significantly lower, and patient satisfaction higher, in the LPB group. There were no significant intergroup differences about motor power, pain at rest, total ropivacaine consumption, and adverse effects. USG-LPB is an effective alternative to CEA combined with general anesthesia for postoperative analgesia after THR.

COMBINED SPINAL EPIDURAL ANAESTHESIA VERSUS EPIDURAL ANAESTHESIA: A COMPARATIVE STUDY

Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Com­bined Spinal Epidural Anaesthesia (CSEA) technique and Continuous epidural anaesthesia both have been extensively used in elective gynaecological surgeries. This prospective cross-sectional comparative study was designed to compare the quality of anaesthesia between CSEA and Epi­dural anaesthesia.&#x0D; Methods: Sixty-four patients between age group 15- 65 years of ASA grade I, II were randomly di­vided into 2 groups. Group A patients received CSEA using “double needle double interspace tech­nique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block with catheter using 10 ml of 0.5% plain bupivacaine. In all patients, subse­quent dosage of 2 ml per unblocked segment 0.5% plain bupivacaine was administered through the epidural catheter to achieve a block up to T4-5. Mean was calculated using t-test, median with Mann Whitney U test and Chi-square test where appropriate and the Statistical Analysis was done using SPSS program, version 11.0.&#x0D; Results: The surgical anaesthesia and motor blockade occurred significantly early in CSEA group. Duration of analgesia was significantly shorter in CSEA (84.1±40.6 min) as compared to epidural group (138.6±32.9 min). The total amount of bupivacaine required to attain the same target level was two times in epidural group (p&lt;0.05). Haemodynamic changes were comparable in both the groups. No neurological side effects were observed.&#x0D; Conclusions: Sequential CSEA is superior alternative to epidural block, which combines the advan­tages of spinal and epidural while minimizing their drawbacks in elective gynaecological surgeries.&#x0D;

Combined spinal epidural anaesthesia versus epidural anaesthesia: a comparative study

Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Com­bined Spinal Epidural Anaesthesia (CSEA) technique and Continuous epidural anaesthesia both have been extensively used in elective gynaecological surgeries. This prospective cross-sectional comparative study was designed to compare the quality of anaesthesia between CSEA and Epi­dural anaesthesia.&#x0D; Methods: Sixty-four patients between age group 15- 65 years of ASA grade I, II were randomly di­vided into 2 groups. Group A patients received CSEA using “double needle double interspace tech­nique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block with catheter using 10 ml of 0.5% plain bupivacaine. In all patients, subse­quent dosage of 2 ml per unblocked segment 0.5% plain bupivacaine was administered through the epidural catheter to achieve a block up to T4-5. Mean was calculated using t-test, median with Mann Whitney U test and Chi-square test where appropriate and the Statistical Analysis was done using SPSS program, version 11.0.&#x0D; Results: The surgical anaesthesia and motor blockade occurred significantly early in CSEA group. Duration of analgesia was significantly shorter in CSEA (84.1±40.6 min) as compared to epidural group (138.6±32.9 min). The total amount of bupivacaine required to attain the same target level was two times in epidural group (p&lt;0.05). Haemodynamic changes were comparable in both the groups. No neurological side effects were observed.&#x0D; Conclusions: Sequential CSEA is superior alternative to epidural block, which combines the advan­tages of spinal and epidural while minimizing their drawbacks in elective gynaecological surgeries.

Comparison of intrathecal morphine with continuous patient-controlled epidural anesthesia versus intrathecal morphine alone for post-cesarean section analgesia: a randomized controlled trial

BackgroundSeveral neuraxial techniques have demonstrated effective post-cesarean section analgesia. According to previous reports, it is likely that patient-controlled epidural analgesia (PCEA) without opioids is inferior to intrathecal morphine (IM) alone for post-cesarean section analgesia. However, little is known whether adding PCEA to IM is effective or not. The aim of this study was to compare post-cesarean section analgesia between IM with PCEA and IM alone.MethodsFifty patients undergoing elective cesarean section were enrolled in this prospective randomized study. Patients were randomized to one of two groups: IM group and IM + PCEA group. All patients received spinal anesthesia with 12 mg of 0.5% hyperbaric bupivacaine, 10 μg of fentanyl, and 150 μg of morphine. Patients in IM + PCEA group received epidural catheterization through Th11–12 or Th12-L1 before spinal anesthesia and PCEA (basal 0.167% levobupivacaine infusion rate of 6 mL/h, bolus dose of 3 mL in lockout interval of 30 min) was commenced at the end of surgery. A numerical rating scale (NRS) at rest and on movement at 4,8,12,24,48 h after the intrathecal administration of morphine were recorded. In addition, we recorded the incidence of delayed ambulation and the number of patients who requested rescue analgesics. We examined NRS using Bonferroni’s multiple comparison test following repeated measures analysis of variance; p < 0.05 was considered as statistically significant.ResultsTwenty-three patients in each group were finally analyzed. Mean NRS at rest was significantly higher in IM group than in IM + PCEA group at 4 (2.7 vs 0.6), 8 (2.2 vs 0.6), and 12 h (2.5 vs 0.7), and NRS during mobilization was significantly higher in IM group than in IM + PCEA group at 4 (4.9 vs 1.5), 8 (4.8 vs 1.9), 12 (4.9 vs 2), and 24 h (5.7 vs 3.5). The number of patients who required rescue analgesics during the first 24 h was significantly higher in IM group compared to IM + PCEA group. No significant difference was observed between the groups in incidence of delayed ambulation.ConclusionsThe combined use of PCEA with IM provided better post-cesarean section analgesia compared to IM alone.Trial registrationUMIN-CTR (Registration No. UMIN000032475). Registered 6 May 2018 – Retrospectively registered.

Continuous Spinal Anesthesia versus Combined Spinal Epidural Anesthesia for Major Orthopedic Hip Surgeries

Abstract Background hip replacement surgery is common among elderly patients. These patients have increased risk for perioperative mortality and morbidity due to additional comorbidities, such as cardiac, endocrine, renal, cerebral and respiratory diseases. Aim of the Work to compare between continuous spinal anesthesia and combined spinal epidural anesthesia in patients scheduled for elective major hip surgeries as regards their effectiveness and possible complications during operation. Patients and Methods after obtaining the approval of the ethical committee of faculty of medicine, Ain-Shams University, and patients’ written informed consents, this prospective randomized clinical trial study was conducted at Ain Shams University Hospitals at the orthopedics operating theatre. Seventy two patients aged older than 30 years, of both sexes and American Society of Anesthesiologists (ASA) class I, II, scheduled for elective major hip surgeries like total hip replacement or hemi arthroplasty were included in the study. All Patients were assigned randomly by using a computer generated program with closed envelops to one of the two equal groups:CSAgroup(36)patient and CSEgroup(36)patient. Results there was no statistically significant differences between the CSA and CSE groups as regards demographic data; Age, Sex or BMI. Baseline HR was similar in both groups. The heart rate was significantly higher in the CSE group at 5 min and 15 min when compared to CSA group. The mean blood pressure was significantly lower in group CSE at 5min anf 15 min when compared to CSA group.The total dose of bupivacaine 0.5% mg collectively given was much lower in the CSA group than the CSE group. The onset of sensory block (time between the end of injection and the time to reach T10sesnsory level) and degree of motor block between two groups showed no statistically significant difference but the level of sensory block was significantly higher in CSE group than CSA group.there was no significant difference as regard PDPH, Post operative nausea and vomiting, Bradycardia but there was significant difference as regard incidence of hypotension being higher in CSE group than CSA group. The time of first analgesic request showed no significant difference between the two groups Conclusion both continuous spinal anesthesia and compined spinal epidural anesthesia are safe anesthetic techniques for lower limb surgeries. CSA offers possibilities of more hemodynamic stability with smaller doses of local anesthetics than CSE with rapid onset of sensory block and good extendede post operative analgesia.

Effect of continuous epidural anesthesia on labor analgesia and pregnancy outcome

Objective To observe the clinical effect of continuous epidural anesthesia on labor analgesia and its effect on pregnancy outcome. Methods From July 2017 to June 2018, 110 hospitalized women giving birth in the Maternal and Child Health Care Hospital of Zhuji were selected and randomly divided into two groups according to the digital table, with 55 cases in each group.The control group was given conventional treatment.The observation group was treated with continuous epidural anesthesia for labor analgesia.The duration of labor, analgesic effect, delivery outcome, adverse reactions and neonatal status were compared between the two groups. Results The active time [(231.76±82.08)min], the second stage of labor [(63.94±22.56)min], and the total stage of labor [(309.42±120.15)min] in the observation group were all shorter than those in the control group[(275.62±85.31)min, (91.05±26.27)min, (380.84±121.63)min], and the differences were statistically significant(t=2.748, 5.806, 3.098, P=0.007, 0.001, 0.003). The analgesia satisfaction of the observation group was 100.00%(55/55), which was higher than 83.64%(46/55) of the control group, and the difference was statistically significant(χ2=9.802, P=0.002). In the observation group, the amount of vaginal bleeding [(241.62±30.54)mL], analgesic effect time [(62.80±11.96)s] were better than those in the control group[(270.55±40.83)mL, (135.18±20.73)s], and the differences were statistically significant(t=4.208, 22.429, P=0.001, 0.001). The rate of natural birth in the observation group was 87.27%(48/55), which was higher than that in the control group[70.91%(39/55)], and the difference was statistically significant(χ2=4.453, P=0.035). The incidence of neonatal distress in the observation group was 1.82%(1/55), and the incidence of asphyxia was 3.64%(2/55), which were lower than those in the control group [12.73%(7/55), 16.36%(9/55)], the differences were statistically significant(χ2=4.853, 4.950, P=0.028, 0.026). Conclusion Continuous epidural anesthesia in parturient analgesia can shorten the labor process and achieve satisfactory analgesic effect, which is helpful to improve the outcome of labor and neonatal condition. Key words: Anesthesia and analgesia; Anesthesia, epidural; Parturition; Labor, obstetric; Natural childbirth; Pregnancy outcome; Infant, newborn; Asphyxia neonatorum

Continuous Anesthesia : Spinal Versus Epidural For Lower Limb Surgeries

Background : The use of continuous spinal anesthesia (CSA) has been slow because the high risk of post dural puncture headache (PDPH). However, recent researches suggest significant reduction in PDPH when intrathecal catheters are used. This study aimed to compare between (CSA) & continuous epidural anesthesia (CEA) in lower limb surgeries.Patients & Methods : A comparative randomized prospective clinical study to compare onset, effect & side effects between (CSA) & (CEA) in LL surgeries. 46 patients, 21 - 60 years of age who were scheduled for elective LL surgeries, expected to last from 2 - 6 hours, were included in this study & divided into two groups of 23 each. Group S (CSA) & Group E (CEA). All patients were assessed for : hemodynamics , technical implementation period , sensory & motor onset , quality of the block , technical problems , post operative visual analogue scale (VAS) & any complications.Results : Regarding sensory & motor onset time & technical implementation period all were shorter in group S than group E. There was no significant difference as regard hemodynamics, duration of sensory recession & number of top up doses in both groups. There were no neurological sequelae nor (PDPH) in any patient in both groups.Conclusion : (CSA) using a 20 G catheter is an easy technique, better onset & quality, ↓ risk of systemic toxicity & no ↑ risk of (PDPH) when compared to (CEA).Key Words : Continuous , Anesthesia , Spinal , Epidural.

Comparison of ropivacaine combined with sufentanil for epidural anesthesia and spinal-epidural anesthesia in labor analgesia

BackgroundTo compare the application and efficacy of ropivacaine combined with sufentanil for continuous epidural anesthesia (CEA) and combined spinal-epidural anesthesia (CSEA) in labor analgesia.MethodsThree hundred sixty pregnant women requesting labor analgesia from October 2017 to August 2018 were selected retrospectively. According to the anesthetic method, subjects were divided into CSEA group and CEA group. Ropivacaine combined with sufentanil were used in all subjects. The labor time, visual analogue scale (VAS), Apgar score of newborn, adverse pregnancy outcomes and adverse drug reactions were observed.ResultsThere was no significant difference in pre-analgesia (T0) VAS scores between the two groups (P > 0.05). VAS scores of first stage of labor (T1), second stage of labor (T2) and third stage of labor (T3) in CSEA group were significantly lower than CEA group (P < 0.01). The onset time, T1 and total labor time in CSEA group were significantly shorter than CEA group (P < 0.01). There were no significant differences between T2 and T3 (P > 0.05). There were no significant differences in adverse pregnancy outcomes and Apgar scores at 1, 5 and 10 min after birth between the two groups (P > 0.05). The incidence of adverse drug outcomes in CSEA group was significantly lower than CEA group (P < 0.01). Maternal satisfaction in CSEA group was significantly higher than CEA group (P < 0.01).ConclusionConsidering ropivacaine combined with sufentanil for CSEA achieved a shorter onset time and labor period, significant analgesic effect, lower adverse drug reactions rates and higher subject satisfaction than CEA, it may be worthy of clinical promotion and application.