Effect Of Continuous Epidural Analgesia Research Articles

Severity of spinal degeneration does not affect the pain reduction under continuous epidural analgesia

PurposeTo outline clinical effectiveness of continuous epidural analgesia (CEA) in patients with failed back surgery syndrome (FBSS) or lumbar spinal stenosis (LSS) depending on severity of spinal degeneration.MethodsIn this retrospective cohort study, all patients with FBSS or LSS who underwent CEA within an inpatient rehabilitation program were evaluated. The pain reduction was measured by VAS on an hourly basis. Substantial pain reduction was defined as a minimal clinically important difference (MCID) > 50%. Severity of spinal degeneration, side effects and patient-specific characteristics were documented.ResultWe included a total of 148 patients with 105 patients suffering from FBSS and 48 with LSS. The average pain reduction was − 37.6 ± 19.2 in FBSS and − 38.1 ± 17.8 in LSS group (p < .001 and p < .001, respectively). In the FBSS group, sensory deficits (p = .047) and numbness (p = .002), and in the LSS group, a severe disability measured by ODI (38.2 ± 15.4 vs. 57.3 ± 11.3, p < .001) significantly contributed to a worse outcome. The severity of the spinal degeneration and psychological disorders did not affect the pain reduction in terms of MCID.ConclusionsThis study provides new evidence about CEA in the treatment of FBSS and LSS. CEA provides a significant pain reduction even under intensified physiotherapeutic exercising in patients with severe spinal degeneration and a broad variety of secondary diagnoses. Neurologic deficits in case of FBSS and severe disability in case of LSS may be risk factors for less favorable outcome.

Effectiveness of continuous epidural analgesia by bupivacaine 0.1% combined with fentanyl for pain attenuation during labor at Hue Central Hospital

ABSTRACT ntroduction: Epidural analgesia was an extremely effective and popular treatment for labor pain. This study aimed to assess the effectiveness and safety of combinational use of bupivacaine 0.1% and fentanyl in epidural anesthesia for pain relief during labor. Methods: A cross-sectional descriptive study was conducted on 270 parturients who required epidural anesthesia for pain relief during labor. All parturients received 06ml epidural solution of bupivacaine 0.1% with fentanyl (30μg). After 10 minutes, continuous epidural infusion (CEI) at 6 ml/h with bupivacaine 0.1% + fentanyl (2µg/ml). Extra boluses of 6ml solution of (bupivacaine + 0.1% fentanyl (2µg/ml) when VAS (Visual Analog Scale) score &gt;6 points. Measured variables included total bolus requests, pain Visual Analog Scale (VAS), modified Bromage scores, labor duration, delivery outcome, and maternal satisfaction after delivery. Results: The average analgesia induction was 4.32 ± 0.58 minutes. VAS score ≤ 3 points: 88.52% of parturients, VAS score = 3-6 points: 8.52% of parturients (1 rescued bolus) and VAS score&gt; 6 points 2.96% of parturients (2 rescued bolus). There were (208/270) 77.04% with normal labor. The average labor pain relief time was 161.98 ± 46.58 minutes. Side effects were as follows: Feeling numb in the leg (but still able to move): 8.15%; transient chills: 3.33%; nausea: 2.96%, itching: 1.85%. There were no cases of headache, hypotension, arrhythmia, respiratory failure and dural puncture. The average Apgar score at the 1st minute was 8.35 ± 0.24 and at the 5th minute was 8.79 ± 0.07, without cases of asphyxia. Regarding maternal satisfaction, very satisfied and satisfied levelsoccupied 74.04% and 25.96%, respectively. Conclusion: In our study, continuous epidural analgesia by combinational use of bupivacaine 0.1% and fentanyl(2µg/ml) provided effective labor pain relief, hemodynamic stability, and normal neonatal outcomes.

Continuous Epidural Analgesia and Continuous Femoral Nerve Block for Postoperative Pain after Unilateral Total Knee Arthroplasty: A Prospective Cohort Study

Introduction: Total Knee Arthroplasty (TKA) surgeries are associated with moderate to severe postoperative pain. Inadequate analgesia leads to patient distress, suboptimal knee mobilisation and complications due to delayed rehabilitation. Peripheral nerve blocks and central neuraxial techniques are in the vanguard of various analgesic strategies to minimise pain after TKA. Aim: To compare the effects of Continuous Epidural Analgesia (CEA) and Continuous Femoral Nerve Block (CFNB) on postoperative analgesia, knee rehabilitation and adverse effects after TKA surgeries. Materials and Methods: A prospective cohort study was conducted among 90 patients undergoing unilateral TKA at the Government Medical College, Kozhikode, Kerala, India. They were divided into two groups of 45 each. CEA (Group E) and CFNB (Group F) were given for postoperative pain management. Effectiveness of postoperative analgesia was measured by Numerical Rating Scale (NRS) scores at 6, 12, 24, 48 and 72 hours and also by need for rescue analgesics during the first 48 hours. Postoperative knee rehabilitation indices were measured on 1st, 2nd and 3rd Postoperative Days (POD). Incidence of adverse effects in each group was also noted. Continuous variables were analysed using students t-test, categorical variables using Chi-square test and NRS scores using Mann Whitney U test. Results: NRS scores were similar in both CEA (E) and CFNB (F) groups. On POD 1, 75.6% of group E and 71.1% of group F (p=0.630), on POD 2, 71.1% of group E and 68.9% of group F (p=0.818) and on POD 3, 62.2% of group E and 66.7% of group F (p=0.66) achieved specific rehabilitation indices. There was no statistically significant difference in pain scores, rescue analgesic requirement and rehabilitation indices between the two groups. No significant adverse effects were noted in either group. Conclusion: CFNB is as effective as continuous epidural block for postoperative analgesia and knee rehabilitation after TKA without any significant side-effects.

The Effect of Continuous Epidural Analgesia on Intracranial Pressure by Measuring the Optic Nerve Sheath Diameter Using Ultrasound in Pediatric Patients

The Effect of Continuous Epidural Analgesia on Intracranial Pressure by Measuring the Optic Nerve Sheath Diameter Using Ultrasound in Pediatric Patients

Effects of continuous epidural analgesia during labor on the early postpartum recovery of pelvic floor function

Objective To explore the effect of continuous epidural analgesia on the early postpartum recovery of pelvic floor function. Methods This retrospective analysis involves two hundred cases of maternal deliveries in our hospital, including 57 cases received continuous epidural analgesia and 143 cases did not. The pelvic floor muscle strength, fatigue and myoelectric value, pelvic and abdomen dynamics, POP-Q stage assessment of pelvic organ prolapse, and pelvic floor dysfunction were compared between the two groups 6 post partum. Results Postpartum pelvic floor muscle strength was significantly higher in cases received epidural analgesia than in those did not received analgesia. Muscle fatigue of maternal Ⅰ and Ⅱ fibers in the analgesia group was significantly worse than that in the non-analgesic group (P<0.05). The pelvic floor muscle electrical values of maternal Ⅰ fibers in the analgesia group were higher than those of the non-analgesia group (P<0.05). Compared with non-analgesia group, analgesia group showed significantly lower incidence of abnormality in vaginal dynamic pressure, pelvic floor muscle static tension, pelvic floor contraction, maternal pelvic organ prolapse, and pelvic floor function (P<0.05). Conclusions Continuous epidural anesthesia during labor has a positive impact on the early postpartum recovery of pelvic floor function. Key words: Epidural analgesia; Primipara; Pelvic floor function

Effectiveness of continuous epidural analgesia on acute herpes zoster and postherpetic neuralgia: A retrospective study.

Despite early treatment of herpes zoster (HZ), postherpetic neuralgia (PHN) can persist. This study was designed to compare the therapeutic and pain relief effects of continuous epidural analgesia (CEA) on the chronic phase as well as the acute phase of HZ with standard medical treatment.Medical records of 227 patients with moderate to severe zoster-associated pain that had not responded to standard medications were retrospectively reviewed. Patients received standard treatment alone (medical group) or standard treatment plus concurrent CEA (epidural group). The acute and chronic groups were classified according to a 4-week cut-off with regard to time between the onset of the rash and the first treatment. Four groups were studied: Group A (acute/medical group); Group B (acute/epidural group); Group C (chronic/medical group); and Group D (chronic/epidural group). Pain was assessed using the visual analog scale (VAS) and measured every 2 weeks for 6 months. We compared the pain rating at 6 months after the first treatment with the initial pain rating. Response to treatment was defined as a ≥50% reduction in pain severity since the initial visit. Remission was considered complete for patients whose VAS pain score was ≤2 for >3 successive visits and who no longer needed medical support.Patients who received a combination of standard treatment plus CEA (Groups B and D) had significantly higher response to treatment (P = .001) than patients receiving standard treatment alone (Groups A and C). The adjusted odds ratio (OR) for response to treatment in the epidural group versus the medical group was 5.17 (95% confidence interval [CI]: 1.75–15.23) in the acute group and 5.37 (95% CI: 1.62–17.79) in the chronic groups. The adjusted OR for complete remission in the epidural group versus the medical group was 3.05 (95% CI: 1.20–7.73) in the acute group and 4.46 (95% CI: 1.20–16.54) in the chronic group.CEA can effectively relieve pain caused by PHN and acute HZ and increase remission rates. Combining CEA with standard medical treatment may offer a clinical advantage in the management of pain caused by PHN as well as acute HZ.

The Effects of Continuous Epidural Analgesia on Doppler Velocimetry of Uterine Arteries during Different Periods of Labour Analgesia

The Effects of Continuous Epidural Analgesia on Doppler Velocimetry of Uterine Arteries during Different Periods of Labour Analgesia

The effects of continuous epidural analgesia on Doppler velocimetry of uterine arteries during different periods of labour analgesia

The transient effects of epidural bupivacaine 0.25-0.5% on the Doppler velocimetry of umbilical and uterine arteries had been reported, but the effects of continuous lower dose epidural bupivacaine (0.05-0.1%) infusion for labour analgesia have never been reported. In this study, we evaluated the effects of continuous epidural bupivacaine 0.075% on the Doppler velocimetry of uterine arteries. Twenty pregnant women for labour analgesia received continuous epidural bupivacaine 0.075% infusion. We used a 4-MHz continuous-wave Doppler probe (Multigon 500A) with a 200 Hz thump filter to detect uterine blood flow velocity. We recorded the velocimetry data for uterine relaxation and contraction during five time periods: pre-epidural insertion, 1, 2, and 4 h post-epidural infusion, and after delivery of fetus. Our data showed that the velocimetric indices of uterine vascular resistance were significantly increased 1, 2, and 4 h after epidural infusion when compared with the pre-epidural level; these returned to the baseline after delivery. Continuous epidural analgesia with bupivacaine 0.075% increases the resistance of uterine artery and therefore possibly reduces the uterine blood flow.

Effect of postoperative pain treatment on outcome-current status and future strategies.

The effect of postoperative pain relief on morbidity and hospital stay is reviewed. Beneficial effects of postoperative pain relief by patient-controlled analgesia (PCA) opioids on morbidity and hospital stay have not been documented. The clinical outcome effects of the 20%-30% opioid sparing by non-steroidal anti-inflammatory agents have not been defined, but recent data suggest hastened recovery in cholecystectomy and knee surgery. The effect of continuous epidural analgesia on morbidity and hospital stay remains controversial except for improved pulmonary outcome. However, existing randomised trials on continuous epidural analgesia have insufficient design due to predominantly opioid-based epidural analgesia and the lack of a revision of perioperative care programmes to take advantage of the beneficial physiological effects of balanced epidural analgesia. The effects of pain relief on outcome remains debatable, despite beneficial effects of pathophysiological responses. Future outcome studies are required where optimised dynamic pain relief is integrated with a multimodal rehabilitation programme.

Effect of Continuous Epidural Analgesia on the Progress of Labor

Effect of Continuous Epidural Analgesia on the Progress of Labor

The Effect of Continuous Epidural Analgesia on Postoperative Pain, Rehabilitation, and Duration of Hospitalization in Total Knee Arthroplasty

Efficacies of three alternate methods of postoperative analgesia were studied in 156 patients who had total knee arthroplasty (TKA). Forty-two of these patients received parenteral meperidine hydrochloride or morphine (Group 1), 58 patients received periodic epidural injections of morphine (Group 2), and 56 patients received continuous epidural infusions of bupivacaine hydrochloride and Duramorph (Group 3). The postoperative course of all patients was documented in terms of the incidence and severity of pain, range of joint motion, duration of hospitalization, and occurrence of complications. Although epidural analgesia increased the cost and duration of the operation, good-to-excellent pain relief was attained in 86% (Group 2) and 88% (Group 3) of cases with epidural analgesia compared with 61% of patients (Group 1) receiving conventional analgesia. Moreover, 67% of patients in Group 1 experienced frequent episodes of moderate-to-severe postoperative pain in contrast to 40% of patients in Group 2 and only 10% of patients in Group 3. As a result of diminished pain, greater joint motion was obtained within the first 72 hours in Groups 2 and 3. They also had shorter hospitalization (9.6 days versus 11.2 days for Group 1 and 10.8 days for Group 2). However, the use of epidural analgesia did not reduce the incidence of complications, including nausea. Continuous infusion of epidural bupivacaine and Duramorph provided good-to-excellent control of postoperative pain after TKA. However, better analgesics are needed to reduce the high incidence of side effects associated with various treatment methods.

The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women

Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. Comparison of 447 patients who received epidural analgesia in labor with 264 patients who received either narcotics or no analgesia was performed. The incidence of cesarean section for dystocia was significantly greater (p < 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p < 0.005) of cesarean section for dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of oxytocin, duration of oxytocin use, maximum infusion rate of oxytocin, duration of labor, presence of meconium, and birth weight. The incidence of cesarean section for fetal distress was similar (p > 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women. (Ann J OBSTET GVNECOL 1989;161:670-5.)