Continuous Epidural Group Research Articles

POSTOPERATIVE ANALGESIA IN KIDNEY TRANSPLANT LAPAROTOMY: QUADRATUS LUMBORUM BLOCK AS AN ALTERNATIVE

Objective: Effective postoperative pain management promotes better recovery. Continuous epidural (CE) is the standard postoperative analgesia for kidney transplantation; however, patients still report pain and unfavorable side effects. This present study compares the effectiveness of quadratus lumborum block (QLB) versus CE for managing pain and reducing morphine requirements following kidney transplantation.
 Methods: This randomized-controlled study compared 37 kidney transplant patients: a QLB group (N=19) who received 20 ml 0.375% ropivacaine injection bilaterally and a CE group (N=18) who received 0.2% ropivacaine epidurally by infusion at 6 ml/h. Participants were assessed at 2, 6, 12, and 24h postoperatively for morphine requirements and with a visual analogue scale (VAS) for pain while resting and moving.
 Results: The VAS scores when resting and moving were similar for both QLB and CE at all-time points (p>0.05 for both treatments). Postoperative morphine requirements also did not differ (p>0.05) between the two groups at any time point. Both groups had similar first-time morphine requirements (802.63 min for QLB vs 871.39 min for CE, p=0.814). Both groups achieved 100% blockade at the level of T10–L1 and had comparable Bromage and Ramsay scores.
 Conclusion: QLB appears to be a viable alternative approach to CE for pain management after kidney transplantation.

Continuous epidural versus continuous adductor canal block for postoperative pain management in total knee arthroplasty

Background: The aim of the study was to compare the study of continuous epidural and continuous adductor canal block for postoperative pain management in total knee arthroplasty (TKA). Materials and Methods: A total of 150 cases were recruited with 75 cases in each group; patients participated in the study were divided into the adductor canal block (ACB) group and continued epidural group. All the patients received the standardized anesthesia and analgesia on hospitalization. Outcome evaluations included the visual analog scale (VAS) scores during activity and at rest, range of motion, quadriceps strength, complication occurrence, total opioid consumption and sleep disruptions caused by pain, postoperative hospital stay, and postoperative nausea and vomiting (PONV) before discharge in all groups. Results: The lateral VAS scores of the knee were lower in the continuous epidural group at rest and during activity as compared with the ACB group. However, the overall knee VAS score, complication occurrence, total opioid consumption and sleep disruptions caused by pain, and PONV were similar between ACB and epidural groups. The urinary retention in patients receiving continuous epidural was common compared to no retention in the adductor group, early mobilization in the adductor group, and no muscle weakness in the ACB group. Conclusion: The ACB does not relieve the lateral knee pain at an early stage but offers comparable analgesic effect and enhanced effectiveness of the early rehabilitation compared to an epidural in patients who underwent TKA.

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.

Comparison of IL-6 and CRP Concentration Between Quadratus Lumborum and Epidural Blockade Among Living Kidney Donors: A Randomized Controlled Trial

BackgroundAn adequate anesthesia technique generates appropriate postoperative analgesic properties and decreases the patient’s stress response. This will lead to decreased morbidity and mortality associated with immunology disturbances, such as infection, prolonged wound healing, and sepsis.ObjectivesThe aim of this study was to compare interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations, as the markers of the stress response, between continuous epidural and quadratus lumborum (QL) block as postoperative analgesia techniques among living kidney donors.MethodsSixty-two patients were randomly divided into two equal groups: continuous epidural and QL block. A group received bilateral QL block with 20 mL of bupivacaine 0.25% and the other received 6 mL/hour of bupivacaine 0.25% continuously via an epidural catheter. Prior to extubation, the QL block group received bilateral QL block with the same dose and the continuous epidural group was administered with 6 mL/hour of bupivacaine 0.125%. Blood samples were drawn to compare IL-6 and CRP concentrations after intubation (preoperatively), directly after surgery, 24 hours postoperatively, and 48 hours postoperatively. Postoperative pain was measured with the numerical rating scale (NRS). Morphine requirement and duration of catheter usage were also measured postoperatively. Side effects within 24 hours postoperatively were noted. Data were analyzed with independent t-test or Mann-Whitney test.ResultsNo difference was observed between the groups in the plasma concentration of IL-6 either after surgery or 24 hours postoperatively (P = 0.785 and P = 0.361, respectively) although the mean IL-6 concentration 24 hours postoperatively was lower in the QL block group than in the continuous epidural group. CRP concentration was not significantly different between the groups either after surgery or 48 hours postoperatively (P = 0.805 and P = 0.636, respectively).ConclusionsThere was no significant difference in IL-6 and CRP concentrations between continuous epidural and QL block among living kidney donors. Both continuous epidural and QL block techniques showed comparable postoperative analgesic properties among living kidney donors undergoing laparoscopic nephrectomy.

Is continuous proximal adductor canal analgesia with a periarticular injection comparable to continuous epidural analgesia for postoperative pain after Total Knee Arthroplasty? A retrospective study.

The classic adductor canal block (ACB) is a regional technique that aims to introduce local anesthetic to the saphenous nerve as it traverses the adductor canal. It offers the benefit of preserved quadriceps strength, and is ideal for rehabilitation. Proximal ACB (PACB) allows the operator to place the block away from the surgical site, permitting preoperative placement. Our primary outcome was total opioid consumption; secondary outcomes included the highest numerical rating scale scores and total gait distance at the indicated time intervals. We asked: 1) Does a Continuous Proximal ACB block with Periarticular knee injection (PACB) provide better analgesia than a Continuous Epidural (CSE)?; 2) Do PACB catheter patients do better with physical therapy compared to CSE patients?; 3) Are PACB patients discharged earlier than CSE patients? With IRB approval we performed a retrospective chart review of patients who had underwent primary total knee arthroplasty between October 2015 and September 2016. The selected patients (n = 151) were divided into two groups: CSE group, 72 patients who received a continuous epidural catheter and the PACB group, 79 patients who received at PACB with Periarticular injection. The CSE group received a single-segment combined spinal epidural (CSE) in the operating room. The epidural catheter infusion was started with 0.1% ropivacaine at 8 mL/hour to 14 mL/hour during the post-operative period. The PACB group received a proximal adductor canal catheter with 20 ml of 0.5 % ropivacaine and maintained with ropivacaine 0.2% at 8 ml to 14 ml post operatively. Total opioid consumption, highest numeric rating scores and total gait distance travelled were recorded upon discharge from the PACU and completion of postoperative day (POD) 0, 1, and 2. We found that the median cumulative morphine consumption was significantly higher in the CSE group compared to the PACB group (194 (0-498) versus 126 (0-354) mg, p = 0.012), a difference that was most notable on POD 1 (84 (16-243) versus 60 (5-370) mg, p = 0.0001). Mean hospital length of stay was also shorter in the PACB group (2.6 ± 0.67 versus 3.0 ± 1.08 days, p = 0.01). PACB group used significantly lower morphine consumption compared to the CSE group; they were better participants during physical therapy and achieved longer gait distances. The mean hospital length of stay was also shorter in the PACB group.

Randomized comparison of continuous spinal anesthesia versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries

Background Continuous spinal anesthesia (CSA) is a reliable method for providing effective anesthesia and offers considerable advantages over ‘single-shot’ spinal or epidural anesthesia, as it provides the performance of well-controlled anesthesia using small doses of local anesthetics and a definite end point with less failure rate. Materials and methods A total of 100 patients of American Society of Anesthesiology grades III–IV were scheduled for elective major orthopedic lower limb surgeries. They were divided into two groups: one received CSA using spinocath set, and the other group received continuous epidural anesthesia (CEA). The doses of local anesthetic used, hemodynamic variables, a degree of technical difficulties, and the incidence of complications were recorded. Results The performance time was significantly shorter in the CEA group. The total dose of bupivacaine and number of top-up doses were significantly smaller in the CSA group than in the CEA group. The onset of sensory blockade level and motor blockade was significantly longer with CEA. Regarding the mean arterial pressure, there was a statistically significant difference between the two groups. The number of patients treated for hypotension and total dose of ephedrine was more in CEA group, but there was no statistical difference between the two groups. No major complications were observed in any patient in both groups. Conclusion We conclude that CSA is an effective and safe choice with hemodynamic stability and negligible failure rate, for prolonged procedures in elderly high-risk patients and in those with possible difficulties in administration of general anesthesia.

Comparison of the effects of programmed intermittent epidural bolus and continuous epidural infusion of ropivacaine for labor analgesia in latent phase

Objective To compare the efficacy of programmed intermittent epidural bolus and continuous epidural infusion of ropivacaine in labor analgesia. Methods From May 2014 to May 2017, 170 patients, 24-32 years, for full-term primipara in the Maternal and Child Health Care Hospital of Quzhou were selected as study objects, and they were randomly divided into intermittent epidural injection group(T group) and continuous epidural pump group(C group) by computer random software, with 85 cases in each group.All patients were epidurally injected 2% lidocaine 3mL and 0.2% ropivacaine 2mL at the opening of the uterus, less than 3cm.T group was given programmed intermittent epidural bolus 0.1% ropivacaine 6mL/h.C group was given continuous epidural infusion 0.1% ropivacaine 6mL/h.The pain of maternal(NRS score) and motor block situation of maternal (Bromage score) were monitored.The number of PCEA, PCEA pressure times, the rate of instrumental delivery and APGAR score were also recorded. Results The number of Bromage score≥2 in C group was higher than that of T group at 4-10h after labor analgesia (3 cases vs.11 cases, 3 cases vs.15 cases, 4 cases vs.17 cases, 4 cases vs.18 cases, 6 cases vs.19 cases, 6 cases vs.21 cases, 7 cases vs.22 cases; χ2=4.982, 8.947, 9.182, 10.230, 7.926, 9.907, 9.354, all P 0.05). The number of PCEA, PCEA pressure times and the rate of instrumental delivery in T group were lower than those in C group [8 cases vs.18 cases, 22 cases vs.41 cases, (3.5±1.5)times vs.(4.9±2.2)times; χ2=4.541, 9.104; t=2.666, all P 0.05). Conclusion Compared with continuous epidural infusion, programmed intermittent bolus of ropivacaine for labor analgesia exerts good analgesic effect, it has minor effects on exercise function and can decrease the rate of instrumental delivery. Key words: Parturition; Analgesia, obstetrical; Analgesia, epidural; Analgesia, patient-controlled; Programmed intermittent bolus; Continuous epidural infusion; Apgar score

Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy.

BackgroundPostoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action.ObjectivesThis study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy.MethodsA prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded.ResultsPatients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001).ConclusionsThe three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.

Clinical effects of continuous spinal anesthesia with sufentanil for labor analgesia

Objective To evaluate the clinical effects of continuous spinal anesthesia (CSA) with sufentanil for labor analgesia when compared with the effects of combined spinal-epidural analgesia (CSEA) and continuous epidural analgesia (CEA).Methods One hundred ASA Ⅰ or Ⅱ nulliparous patients who were at full term and who requested labor epidural analgesia,were randomly divided into 3 groups (n =40 each):continuous spinal analgesia group (group S),combined spinal-epidural analgesia group (group C) and continuous epidural analgesia group (group E).Labor analgesia was performed when the cervical dilation was 2-3 cm.In group S,the spinal catheter was placed at L3,4 interspace,and patient-controlled analgesia (PCA) with sufentanil was performed after a loading dose of sufentarnil 8 μg.PCA solution contained sufentanil 100 μg in 100 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose,a 10 min lockout interval (volume was limited to 14 ml/h) and background infusion at a rate of 2 ml/h.In group C,CSEA was performed at L2,3 interspace,the patients received intrathecal sufentanil 8 μg via a spinal needle,the PCA solution contained 0.1％ ropivacaine 200 mg and 0.5 μg/ml sufentanil 100 μg in 200 ml of normal saline.The CSEA pump was set up with a 6 ml bolus dose,a 10 min lockout interval (volume was limited to 40 ml/h) and background infusion at a rate of 6 ml/h.In group E,CEA was performed at L2,3 interspace and the method was the same as in group C.The systolic pressure,diastolic pressure,HR,fetal heart rate (FHR) and intensity of uterine contraction were recorded beforeanalgesia and 5,10,15,30,60 and 120 min after beginning of analgesia,when the cervical dilation was 7-8 cm,and when the uterine cervix dilated absolutely.The side effects were recorded.Bromage scale was assessed at 10 min of analgesia.Apgar scores of the neonates were recorded at 1,5 and 10 min after birth.The analgesic effect was evaluated 24 h after birth.Results In group S,the hemodynamic parameters,FHR and intensity of uterine contraction were within the normal range,the analgesic effect was excellent or good,Bromage scale was 0,two cases had post-dural puncture headache,the incidence of pruritus was 42 ％ and pruritus was mild,Apgar scores of the neonates were 9.1 ± 0.4,9.6 ± 0.4 and 10 at 1,5 and 10 min after birth,respectively,no cardiovascular events occurred.There was no significant difference in the parameters mentioned above between groups C and S and between groups E and S (P ＞ 0.05).Conclusion CSA with sufentail is effective and suitable for labor analgesia and the efficacy is comparable with that of CSEA and CEA. Key words: Subarachnoid space; Sufentanil; Parturition; Analgesia

Effects of modified intercostal nerve freezing technique on postoperative recovery of traditional thoracotomy

Objective To explore the application value and advantages of modified intercostal nerve freezing technique on postoperative recovery of traditional thoracotomy. Methods 100 patients undergoing conventional thoracotomy incision patients were randomly divided into 2 groups, group A as the modified intercostal nerve freezing group (n = 50) using the Beijing K001AND company JT-Ⅰ treatment only in the off-type freezer chest incision locating on intercostal and upper and lower intercostal space and the indwelling chest tube where the intercostal nerves were frozen;group B, continuous epidural analgesia group (n=50), using the Japanese company's electronic pump wells, plus droperidol with morphine-line continuous epidural analgesia (Patient control epidural analgesia, PCEA). All patients in two groups were using a visual analogue scale (Visual analogue scale, VAS) assessment of postoperative pain,observing patients 2 hours, 4 hours, 12 hours, 24 hours and 48 hours after surgery when the VAS score, nausea,vomiting, respiratory depression, itching, the incidence of intestinal paralysis. Results The post-operative pain of group A was better than that of group B, and the incidence rate of side effect was also lower than that of group B.Conclusions It suggested that the modified intercostal nerve freezing technique could effectively promote postoperative recovery after thoracotomy. Key words: Intercostal nerve freezing; Epidural; Postoperative analgesia; Thoracotomy

Comparison of the effectbetween combined spinal epidural anesthesia and continous epidural anesthesia for electivecesarean section

：Objective To investigatethe feasibility and superiority of combined spinal epidural anesthesia incesareansection.Methods 100 lying-in women who experienced cesarean section were collected anddivided into combined spinal epidural anesthesia group(CSEA,n=50)and continuous epiduralanesthesia group(CEA,n=50).The change of heart rate(HR),blood pressure(BP)and saturationof peripheral oxygen(SpO2),HR and BP of lyingin womeu in pre-anesthesia,5min,15minpost-anesthesia and the time of taking effect,time between beginning of anesthesia andlaboar of newborn were observed.The side effects of surgical anesthesia and Apgar score ofnewborn were compared between the two groups.Results There were no difference in clinicaldata,change of HR,BP and spO2 between two groups.The anaesthetic time of taking effect andthe time between beginning of anesthesia and labour of newborn in group CSEA were shorterthan in group CEA(all P＜0.05).Conclusion The combined CSEA and CEA was safe and efficient in cesareansection,and CSEA had greater efficacy than CEA in cesarean section. Key words: Anesthesia; Cesarean section

Continuous Spinal Anesthesia with a Microcatheter and Low-Dose Bupivacaine Decreases the Hemodynamic Effects of Centroneuraxis Blocks in Elderly Patients

This prospective randomized study was designed to investigate the hemodynamic effects and quality of continuous spinal anesthesia (CSA) after rapid injection of a low dose of 0.5% bupivacaine through a 32-gauge microcatheter. The method was compared with continuous epidural (CEA) and single-dose spinal anesthesia (SSA). Seventy-seven elderly patients (ASA II-III) ranging from 57 to 94 yr old and undergoing lower limb surgery were assigned to CSA (n = 26), CEA (n = 26), and SSA groups (n = 25). In all three groups, mean arterial pressure (MAP) and heart rate (HR) were assessed continuously for 30 min after initial injection, as well as after every reinjection of local anesthetic in the CSA and CEA groups. Bupivacaine (0.5%) was used as a local anesthetic. The initial doses were 1 mL of CSA, 10 mL of CEA, and 3 mL of SSA. The reinjection doses were 1 mL of CSA and 5 mL of CEA. In the CSA group, MAP did not decrease, whereas in the CEA group, the maximum decrease was 15% +/- 3% (mean +/- SEM) for the initial injection, 12% +/- 2% for the first repetition, and 13% +/- 2% for the second repetition. In the SSA group, the largest decrease of MAP was 19% +/- 2%. All changes of MAP in the CEA and SSA groups were significantly larger compared with CSA group (P < 0.05). A total of seven patients in these two groups needed vasopressors due to a decrease of MAP of more than 30% from baseline values. Heart rate did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence de l'anesthésie péridurale sur l'épargne azotée postopératoire en chirurgie viscérale majeure

In order to determine the role of epidural anaesthesia on protein sparing, eighteen patients undergoing major visceral surgery were randomly divided into three different groups according to the mode of anaesthesia used (general anaesthesia, epidural anaesthesia, continuous epidural anaesthesia for 24 h). These patients were intravenously fed for five days postoperatively; their nitrogen balance was studied. Compared with the « general anaesthesiagroup, only the daily averages of nitrogen balance of the « continuous epiduralgroup were significantly better. In order to correlate stress with nitrogen saving, the early evolution of several parameters (cortisol, glucose, prolactin) used as « stress markerswas studied : there was no evidence of any significant difference between the three groups.