Effects Of Continuous Epidural Infusion Research Articles

Comparison of Epidural Dexmedetomidine Versus Ropivacaine Infusion Effectiveness in Preventing Erection Following Reconstructive Urethral Surgery: A Randomized Clinical Trial.

BackgroundOne of the most common devastating problems that occur after urethroplasty is erection, which causes surgical complications (fistula, wound dehiscence, and surgical graft failure) and the need for repairing the complications. We attempted to compare the effect of continuous epidural infusion of dexmedetomidine and ropivacaine as a post-surgical erection prevention strategy.ObjectivesIn this study, we aimed to compare the effect of dexmedetomidine and ropivacaine epidural infusion on the incidence of erection after reconstructive urethral surgery.MethodsAn RCT was conducted on 45 patients who were scheduled for reconstructive urethral surgery. They were randomly divided into three groups: (1) control (n = 15), (2) epidural dexmedetomidine (n = 15), (3) and epidural ropivacaine (n = 15). The control group received oral medication after surgery according to the conventional method (cyproterone compound tablets 50 mg BD and diazepam tablets 2 mg TDS for a week) to prevent erection. The DEX group received dexmedetomidine as continuous epidural infusion, and the ROP group received ropivacaine in addition to the conventional method. The occurrence of erection during day and night was recorded separately until the seventh day after surgery. Due to the long-time interval between case selection, participants from different groups were not matched with each other.ResultsThe incidence of erection in the dexmedetomidine group was lower than that in the ropivacaine group per person (0.87) and significantly lower than in the control group (2.8 per person). Also, there was significantly less erection in the ropivacaine group (1.2 per person) than in the control group. Our study showed that erection after surgery significantly decreased with the continuous epidural infusion of dexmedetomidine and ropivacaine.ConclusionsDexmedetomidine seems to have a significant preventive effect on erection after reconstructive urethral surgery.

A clinical study of the effects of neonatal weight gain and breastfeeding following lower segment cesarean section under general or spinal anaesthesia with or without post-operative continuous epidural infusion of bupivacaine

Aim and Objective: We investigated the effect of continuous epidural infusion of bupivacaine following lower segment cesarean section under general or spinal anesthesia on breastfeeding and neonatal weight gain. Methods: The study enrolling 80 female patients of ASA grade I or II, age between 19-35 years were randomly allocated into 4 groups of 20 each. Group I received general anesthesia (Thiopentone sodium) + IM diclofenac 75 mg every 8 hours, post-operatively for three days. Group II received general anesthesia (Thiopentone sodium) + post-operative epidural analgesia (3-4 ml/hour of 0.125% bupivacaine for 3 days). Group III received spinal anesthesia (2.5 ml of 0.5% bupivacaine) + IM diclofenac 75 mg every 8 hours, post-operatively for three day. Group IV received spinal anesthesia (2.5 ml of 0.5% bupivacaine) + post-operative epidural analgesia (3-4 ml/hour of 0.125% bupivacaine for 3 days). The effects of anesthesia on the neonatal outcome, amount of breastfeeding and the infant weight were measured for 10 days after cesarean section. Results: The parturients who received epidural bupivacaine after the cesarean section initiated breastfeeding earlier as compared to those who received intramuscular diclofenac. The neonatal outcome was significantly better in the groups that received regional anesthesia (group III and IV) as compared to the groups that received general anesthesia. In group II and IV, the visual analog pain score after surgery was significantly lower and both the weight of milk fed by breast and the infant weight during the study were significantly more than the respective values in the group I and III.Conclusion: It is concluded that the groups that received post-cesarean analgesia with continuous epidural bupivacaine provided satisfactory pain relief which leads to increase in the frequency of breastfeeding and neonatal weight gain.

Effects of Continuous Epidural Infusion after Thoracic Epidural Anesthesia for Mastectomy on Postoperative Pain, Nausea and Vomiting

Background: Breast cancer is the most common cause of tumors in Korean women. Until recently, oncologic breast surgery was performed by using general inhalation anesthesia. However, this anesthetic method is associated with incomplete postoperative pain control and significantly more postoperative nausea and vomiting (PONV). Therefore, this study examinated the value of thoracic epidural anesthesia (TEA) for a mastectomy, and evaluated the effects of a continuous epidural infusion on postoperative pain control and the PONV, which is known to be a better method than general anesthesia with intravenous patient controlled analgesia (IV PCA). Methods: Sixty five patients scheduled for a mastectomy were randomly assigned and divided into two groups. The GA group underwent general anesthesia using O2-N2O-sevoflurane with IV PCA. The TEA group was injected with 20 ml of 0.375% ropivacaine with fentanyl 50μg at T4－5. After surgery the visual analogue scale (VAS) score of postoperative pain and nausea was checked. Results: The postoperative pain intensity was significantly (P ＜ 0.05) lower in the TEA group at the postoperative period and during 6 hours compared with the GA group. Postoperative nausea intensity was significantly (P ＜ 0.05) lower in the TEA group during 6 hours. Conclusions: These results suggest that TEA is a method suitable of regional anesthesia for a mastectomy and a continuous epidural catheter infusion is more effective on postoperative pain control than general anesthesia with IV PCA. In addition, it is a good method for decreasing the PONV to a similar level as IV PCA with antiemetics. (Korean J Anesthesiol 2007; 52: 396~402)

Anesthetic management for the minimally invasive Nuss procedure in 21 patients with pectus excavatum

The aim of this study was to assess the anesthetic management and postoperative analgesic effect of continuous epidural infusion for the minimally invasive Nuss procedure. A total of 21 operated cases were analyzed retrospectively. Thoracoscopy was used in all cases. General anesthesia with endotracheal intubation was induced and maintained with oxygen, air, sevoflurane, and fentanyl in all cases. Thoracic epidural anesthesia was performed after induction at the level between Th4 and 12. When the bar was placed via insertion under the sternum, six patients exhibited sinus tachycardia and one showed premature atrial contraction for 2-4 beats before recovering spontaneously within 1 min. Operations were uneventful. The mean operating time was 115 min and anesthetic time was 193 min. In X-ray findings, residual pneumothorax and pleural effusion were found in seven (33.3%) and eight (38.0%) patients, respectively. In all cases, these symptoms were resolved spontaneously within 5 days. Epidural fentanyl (0.3 microg.kg(-1).h(-1)) in 0.125% bupivacaine (0.15 ml.kg(-1).h(-1)) or 0.2% ropivacaine (0.15 ml.kg(-1).h(-1)) were used for 3 days to relieve postoperative pain. Postoperatively, 12 (57.1%) patients required no additional analgesics, and 4 (19.0%) patients required a single dose of dicrofenac sodium or pentazocine. Although the Nuss procedure is minimally invasive, we should pay attention to the possibility of many intra- and postoperative complications. Continuous epidural infusion of fentanyl with local anesthetics provides effective postoperative pain relief and prevents complications such as bar displacement after the Nuss procedure.

Optimum Pain Relief With Continuous Epidural Infusion of Local Anesthetics Shortens the Duration of Zoster-Associated Pain

To investigate effects of continuous epidural infusion (CEI) of 0.5% bupivacaine added to intermittent epidural boluses (IEB) on the duration of zoster-associated pain (ZAP), as compared with continuous infusion of normal saline placebo added to IEB. A prospective, double-blind, randomized, placebo-controlled study. A university hospital and an affiliated clinic in Japan from 1996 through 1999. 56 immunocompetent herpes zoster (HZ) patients, 50 years or older, within 10 days of rash onset and with severe pain and eruption. Patients were hospitalized and randomly allocated into 2 groups. CEI group given CEI of 0.5% bupivacaine (0.5-1.0 mL/h) plus IEB of 0.5% bupivacaine 4 times daily (n = 29). IEB group given normal saline infusion plus IEB of 0.5% bupivacaine 4 times daily (n = 27). All patients received oral acyclovir 800 mg, 5 times daily, for 7 days. The number of days required for complete cessation of ZAP and the proportion of subjects with allodynia beyond 30 days. The median time to cessation of ZAP was significantly shorter in the CEI group than in the IEB group (29 days vs. 40 days, P = 0.002). The number of patients whose allodynia persisted beyond 30 days of treatment was significantly lower in the CEI group than in the IEB group (10% vs. 37%, P = 0.027). CEI of 0.5% bupivacaine plus IEB was associated with a shorter duration of ZAP and fewer patients with allodynia beyond 30 days, compared with IEB plus normal saline infusion. Patients at high risk for developing postherpetic neuralgia (PHN) can be managed with intensive therapies at the early stage of disease, such as CEI, which maintains effective analgesia and may reduce the burden of PHN.

Analgesic effects of continuous epidural infusion of morphine and bupivacaine after cesarean section

Analgesic effects of continuous epidural infusion of morphine and bupivacaine after cesarean section

Continuous epidural infusion for postoperative mechanical ventilation.

We evaluated in analgesic and sedative effects of continuous epidural infusion of two analgesic regimens in ventilated patients following esophagectomy. Forty-six patients, divided into two treatment groups, received postoperative continuous epidural infusion of morphine, or that of a combination of bupivacaine and morphine. Assessments were made with the following indices: pain relief score, somnolence score, patient ventilator coordination score, and the number of supplemental administrations of analgesics and sedatives. No significant differences occurred in somnolence scores or patient ventilator coordination scores between the two groups, which revealed satisfactory sedation for mechanical ventilation. Patients receiving the combination of bupivacaine and morphine had significantly less pain postoperatively, requiring a smaller number of supplemental administrations of analgesics and sedatives ( P < 0.05). It is concluded that: 1) continuous epidural infusion of analgesics gives potent analgesia and sedation of ventilated patients following esophagectomy; 2) the combination of bupivacaine and morphine gives pain relief superior to morphine alone.

Ventilatory Effects of Continuous Epidural Infusion of Fentanyl

Renaud, B.; Brichant, J. F.; Clergue, F.; Chauvin, M.; Levron, J. C.; Viars, P. Author Information

Ventilatory Effects of Continuous Epidural Infusion of Fentanyl

The effects of a continuous epidural administration of fentanyl on pain and on ventilation were studied in eight patients scheduled for orthopedic surgery of the knee. In each subject, epidural fentanyl was given by a bolus dose of 1 microgram.kg-1, followed by a continuous infusion of 1 microgram.kg-1.h-1 over 18 hours. Ventilatory measurements were performed during quiet breathing and during CO2 stimulation tests before surgery. After surgery measurements were made before epidural administration of fentanyl; 1, 2, 5, 18 hours after the start of epidural fentanyl infusion; and 6 hours after its discontinuation. Adequate pain relief was achieved in all patients during fentanyl administration. No significant change in ventilation was noted during quiet breathing. The slope of the ventilatory response to CO2 (VE/PaCO2) decreased significantly from 1.46 +/- 0.2 to 0.75 +/- 0.1 L.min-1.mm Hg-1 (mean +/- SEM; P less than 0.05) one hour after the onset of fentanyl administration, and remained stable throughout the infusion. Eighteen hours after the onset of epidural fentanyl infusion, VE/PaCO2 was still 0.76 +/- 0.14 L.min-1.mm Hg-1. At the end of fentanyl administration, plasma fentanyl levels measured in six patients had progressively increased from 0.42 +/- 0.02 ng.ml one hour after the onset of the infusion to 1.54 +/- 0.19 ng.ml at the end of the infusion. These results suggest that a continuous epidural administration of fentanyl is a technique of analgesia that can provide adequate pain relief but which is associated with ventilatory depression. However, with the doses used in this study, the ventilatory depression remained moderate and of no demonstrable clinical consequence.