Epidural Analgesia In Patients Research Articles

The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis

BackgroundOpen liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate postoperative analgesia, the potential epidural-related adverse effects should be carefully considered. This study aims to compare the efficacy and safety of continuous epidural analgesia and intravenous analgesia in open liver resection.MethodsA retrospective study was conducted, collecting data from patients who underwent open liver resection between 2007 and 2017. Propensity score matching was implemented to mitigate confounding variables, with patients being matched in a 1:1 ratio based on propensity scores. The primary outcome was the comparison of postoperative morphine consumption at 24, 48, and 72 hours between the two groups. Secondary outcomes included pain scores, postoperative outcomes, and epidural-related adverse effects.ResultsA total of 612 patients were included, and after matching, there were 204 patients in each group. Opioid consumption at 24, 48, and 72 hours postoperatively was statistically lower in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). However, there was no significant difference in pain scores (p = 0.422). Additionally, perioperative hypotension requiring treatment, as well as nausea and vomiting, were significantly higher in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001).ConclusionsEpidural analgesia is superior to intravenous morphine in terms of reducing postoperative opioid consumption within the initial 72 h after open liver resection. Nevertheless, perioperative hypotension, which necessitates management, should be approached with consideration and vigilance.Trial registrationThe study was registered in the Clinical Trials Registry at www.clinicaltrials.gov/, NCT number: NCT06301932.

Comparison of Suprainguinal Fascia Iliaca Nerve Block and Epidural Analgesia in Patients Undergoing Periacetabular Osteotomy.

Adequate pain control and early mobilization are critical in the postoperative period after periacetabular osteotomy (PAO). Regional anesthesia can reduce postoperative pain, but certain techniques can increase the risk of postoperative motor block and delayed functional recovery. Continuous lumbar epidurals can provide excellent analgesia but also create challenges with early ambulation. Recently, suprainguinal fascia iliaca (SIFI) single-shot blocks have been shown to provide effective analgesia in PAO patients. The goal of this study was to compare opioid use, time to achieve inpatient physical therapy (PT) goals, and length of stay (LOS) between a cohort of patients receiving SIFI blocks and a cohort of patients receiving epidural analgesia (EA). This retrospective single-surgeon comparative cohort study included all patients who underwent a PAO between 2012 and 2022. Regional anesthetic technique (SIFI vs EA), length of hospital stay, intraoperative and postoperative opioid use, pain scores, and time to achievement of PT milestones before discharge were recorded. Patients were excluded if they had any preexisting neuromuscular syndrome or neurosensory deficit. All opioid use was converted to morphine-milligram equivalents using standard conversions. Two hundred four surgeries were done over the study period; 164 patients received EA, and 40 received a SIFI block. The average age of our cohort was 19.5 years (±6 yrs). The SIFI cohort had a significantly shorter mean LOS than the EA cohort (2.9 vs 4.1 days, P < 0.001). Patients in the SIFI cohort achieved all PT ambulation goals significantly sooner than the lumbar epidural group (P < 0.001), with lower total opioid use on each postoperative day. No notable differences were observed in sex, race, BMI, or pain scores at inpatient PT visits before discharge. After PAO surgery, the SIFI block is associated with shorter hospital LOS, reduced postoperative opioid use, and earlier mobilization when compared with those who were managed with an epidural.

Continuous Wound Irrigation and Intraoperative Methadone Decreases Opioid Use and Shortens Length of Stay After CRS/HIPEC.

Epidural analgesia is resource and laborintense and may limit postoperative management options and delay discharge. This study compared postoperative outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) with epidural analgesia versus continuous wound infusion system (CWIS) with/without intraoperative methadone. A single-institution, retrospective chart review was performed including all patients undergoing open CRS/HIPEC from 2018 to 2021. Patient demographics, surgical characteristics, length of stay, and in-hospital analgesic use were reviewed. In-hospital opioid exposure in morphine milligram equivalents (MME) was calculated. Multivariate analysis (MVA) for mean total and daily opioid exposure was conducted. A total of 157 patients were included. Fifty-three (34%) had epidural analgesia, 96 (61%) had CWIS, and 79 (50%) received methadone. Length of stay was significantly shorter with CWIS + methadone versus epidural (7 vs. 8 days, p < 0.01). MVA showed significantly lower mean total and daily opioid exposure with CWIS+methadone versus epidural (total: 252.8 ± 17.7 MME vs. 486.8 ± 86.6 MME; odds ratio [OR] 0.72, 95% confidence interval [CI] 0.52-0.98, p = 0.04; Daily: 32.8 ± 2.0 MME vs. 51.9 ± 5.7 MME, OR 0.72, 95% CI 0.52-0.99, p ≤ 0.05). The CWIS-only group (n = 17) had a significantly lower median oral opioid exposure versus epidural (135 MME vs. 7.5 MME, p < 0.001) and longer length of stay versus CWIS + methadone (9 vs. 7 days, p = 0.04), There were no CWIS or methadone-associated complications and one epidural abscess. CWIS + methadone safely offers better pain control with less in-hospital opioid use, shorter length of stay, and decreased resource utilization compared with epidural analgesia in patients undergoing CRS-HIPEC.

Morphine for epidural analgesia in patients with obesity and obstructive sleep apnea syndrome after knee arthroplasty

Morphine for epidural analgesia in patients with obesity and obstructive sleep apnea syndrome after knee arthroplasty

A Retrospective Comparison of Clinical Efficacy between Multimodal Analgesia and Patient-Controlled Epidural Analgesia in Patients Undergoing Total Knee Arthroplasty.

Background and Objectives: Adequate pain management during early rehabilitation is mandatory for improving the outcomes of patients undergoing total knee arthroplasty (TKA). Conventional pain management, mainly comprising opioids and epidural analgesia, may result in certain adverse effects such as dizziness, nausea, and motor blockade. We proposed a multimodal analgesic (MA) strategy involving the use of peripheral nerve block (NB), periarticular injection (PAI), and intravenous patient-controlled analgesia (IVPCA). This study compared the clinical efficacy and adverse effects of the proposed MA strategy and patient-controlled epidural analgesia (PCEA). Materials and Methods: We enrolled 118 patients who underwent TKA under spinal anesthesia. The patients followed either the MA protocol or received PCEA after surgery. The analgesic effect was examined using a numerical rating scale (NRS). The adverse effects experienced by the patients were recorded. Results: A lower proportion of patients in the MA group experienced motor blockade (6.45% vs. 22.98%) compared to those in the PCEA group on the first postoperative day. Furthermore, a lower proportion of patients in the MA group experienced numbness (18.52% vs. 43.33%) than those in the PCEA group on the first postoperative day. Conclusions: The MA strategy can be recommended for reducing the occurrence of motor blockade and numbness in patients following TKA. Therefore, the MA strategy ensures early rehabilitation while maintaining adequate pain relief.

Post-Operative Thoracic Epidural Analgesia and Incidence of Major Complications according to Specific Safety Standardized Documentation: A Large Retrospective Dual Center Experience.

(1) Background: Thoracic epidural analgesia is considered the gold standard in post-operative pain management following thoracic surgery. This study was designed to explore the safety of thoracic epidural analgesia and to quantify the incidence of its post-operative complications and side effects in patients undergoing thoracotomy for major surgery, such as resection of lung malignancies and lung transplantation. (2) Methods: This is a retrospective, dual-center observational study including patients that underwent major thoracic surgery including lung transplantation and received concurrent placement of thoracic epidural catheters for post-operative analgesia. An electronic system of referral and documentation of complications was used, and information was retrieved from our electronic critical care charting system. (3) Results: In total, 1145 patients were included in the study. None of the patients suffered any major complication, including hematoma, abscess, or permanent nerve damage. (4) Conclusions: the present study showed that in experienced centers, post-operative epidural analgesia in patients with thoracotomy is a safe technique, manifesting minimal, none-serious complications.

Efficacy of epidural analgesia for intractable cancer pain: Asystematic review.

Epidural analgesia is a common technique for managing perioperative and obstetric pain. Patients with cancer who cannot tolerate opioids or not responding to conventional treatment may benefit from epidural analgesia. Therefore, this systematic review aimed to analyze the efficacy and safety of epidural analgesia in patients with intractable cancer pain. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify studies on patients with cancer who received epidural analgesia. We assessed the quality of all included studies using the risk-of-bias tool or Newcastle-Ottawa scale. The primary outcome was pain relief after epidural analgesia, and the secondary outcome was quality of life, analgesic consumption, and adverse events. The studies were grouped based on the medications used for epidural analgesia. A descriptive synthesis was performed following the Synthesis Without Meta-analysis reporting guideline. Our systematic review included nine randomized controlled trials (n = 340) and 15 observational studies (n = 926). Two randomized controlled trials suggested that epidural opioids were not superior to systemic opioids in relieving pain. Epidural opioids combined with local anesthetics or adjuvants, including calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone, offered better analgesic effects. No significant difference in pain relief between an intermittent bolus and a continuous infusion of epidural morphine was observed. Epidural opioids had more analgesic effects on nociceptive pain than neuropathic pain. The methods used to evaluate the quality of life and the corresponding results were heterogeneous among studies. Six observational studies demonstrated that some patients could have decreased opioid consumption after epidural analgesia. Adverse events, including complications and drug-related side effects, were reported in 23 studies. Five serious complications, such as epidural abscess and hematoma, required surgical management. The heterogeneity and methodological limitations of the studies hindered meta-analysis and evidence-level determination. Coadministration of epidural opioids, local anesthetics, and adjuvants may provide better pain relief for intractable cancer pain. However, we must assess the patients to ensure that the benefits outweigh the risks before epidural analgesia. Therefore, further high-quality studies are required.

Postoperative effects and complications of intrathecal morphine compared to epidural analgesia in patients undergoing intracorporeal robot-assisted radical cystectomy: a retrospective study

BackgroundAnalgesia after robot assisted radical cystectomy aims to reduce postoperative pain and opioid consumption, while facilitating early mobilization and enteral nutrition and minimizing complications. Epidural analgesia is currently recommended for an open radical cystectomy, but it is unclear if intrathecal morphine is a suiting, less-invasive alternative for a robot-assisted radical cystectomy.MethodsThe analgesic method of choice changed from epidural anesthesia to intrathecal anesthesia for patients undergoing a robot-assisted radical cystectomy. This single-center retrospective study aims to investigate if there is a difference between epidural and intrathecal analgesia in postoperative pain scores, opioid consumption, length of hospital stays and postoperative complications. An Propensity Matched Analysis was added to conventional analysis to consolidate the findings.ResultsThe study population consisted of 153 patients of whom 114 received an epidural catheter with bupivacaine/sufentanil and 39 received a single shot of intrathecal bupivacaine/morphine. Mean pain scores on the first two postoperative days (POD) were slightly higher in the intrathecal analgesia group (epidural versus intrathecal analgesia, NRS POD0: 0(0–2)[0–8] versus 1(0–3)[0–5], p = 0.050; POD1: 2(1–3)[0–8] versus 3(1–4)[0–7], p = 0.058; POD2: 2(0–3)[0–8] versus 3(2–4)[0–7], p = 0.010). Total postoperative morphine consumption was similar over the first seven days: 15 mg (5–35)[0–148] in the epidural group versus 11 mg (0–35)[0–148] in the intrathecal morphine group, p = 0.167. Length of hospital stay and time until fit for discharge where slightly higher in the epidural group (respectively 7 days (5–9)[4–42] versus 6 days (5–7)[4–38], p = 0.006, and 5 days (4–8)[3–30]) versus 5 days (4–6)[3–34], p = 0.018). There was no further difference in postoperative course.ConclusionsThis study showed that the effects of epidural analgesia and intrathecal morphine are comparable and that intrathecal morphine may be a suiting alternative for epidural analgesia.

Comparative Evaluation of Levobupivacaine with Fentanyl Versus Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Patients Undergoing Gynae-Oncological Surgeries: A Randomised Clinical Study

Introduction: Epidural analgesia is one of the preferred mode of perioperative management. Neuraxial opioids like fentanyl when used in epidural offer advantage of augmenting local anaesthetic effect and reducing the anaesthetic and analgesic requirement. Aim: To compare the adequacy of analgesia, requirement of rescue analgesics between 0.125% bupivacaine with 2 mcg/cc fentanyl and 0.125% levobupivacaine with 2 mcg/cc fentanyl. Materials And Methods: The randomised clinical study was carried out from September 2016 to May 2017 in 70 patients (35 in each group) of American Society of Anaesthesiologists (ASA) 1 and 2 scheduled for elective gynae-oncological surgeries. The epidural analgesia in group Bupivacaine with Fentanyl (BF) was 0.125% Bupivacaine with 2 mcg/cc Fentanyl and group Levobupivacaine with Fentanyl (LF) was 0.125% Levobupivacaine with 2 mcg/cc fentanyl. All data was statistically analysed and compared using Student t-test, Chisquare/Fisher-Exact test. Results: Total of 70 patients were analysed, 35 each in Group BF (mean age: 50.06±7.19 years) and Group LF (mean age: 46.43±8.41 years). Both the groups were compatible with regard to demographic data and haemodynamic variables. The mean Visual Analogue Scale (VAS) score was higher in group BF compared to group LF at 0,1,4,6,1,2 and 18 hours but the observed difference in both the groups was not statistically significant except at 2nd (p-value: 0.016) and 24th hour (p-value 0.017). Number of rescue analgesics as epidural boluses (p-value=0.001) and paracetamol (p-value=0.044) requirement were more in group BF compared to group LF respectively. Conclusion: On account of adequate postoperative analgesia, haemodynamic stability, levobupivacaine with fentanyl is a better option than bupivacaine with fentanyl for epidural infusion.

Ultrasound-guided posterior transversus abdominis plane block versus epidural analgesia for postoperative pain relief in lower abdominal surgeries

Background: Among the regional anesthesia techniques used for postoperative analgesia for lower abdominal surgeries, epidural analgesia (EA) has been the gold standard and time-tested technique, but complications and contraindications for the same warrant the need for other equally good analgesic techniques. Aim: The present study compared posterior transversus abdominis plane (TAP) block to EA for postoperative analgesic efficacy in patients undergoing lower abdominal surgeries. Methods: Prospective, observational study in patients undergoing lower abdominal surgeries under general anesthesia. Patients received ultrasound-guided (USG) 20 ml 0.2% ropivacaine each side in TAP block (Group A, n = 50) or 10 ml of 0.2% ropivacaine was administered in epidural (Group B; n = 50) before extubation. The Visual analog scale (VAS) score, hemodynamic parameters, and ill effects were recorded. Results: The blood pressure was significantly lower in first 6 h of block in Group B. VAS score was significantly lower in Group A in first 6 h of surgery. It was observed that a significantly higher number of patients in the Group B required rescue analgesic and at higher dosages. Postoperative nausea and vomiting were found in 32% of Group B and 22% of Group A patients. Conclusion: TAP block has almost no complications, keeps the patient more hemodynamically stable, and offers a better early postoperative analgesia when compared to EA in patients undergoing lower abdominal surgeries.

Benefit of epidural analgesia for postoperative pain control after a Kasai Portoenterostomy: A ten-year retrospective cohort study.

Biliary atresia is a rare obstructive cholangiopathy that presents in infants. The Kasai portoenterostomy procedure, which reestablishes biliary drainage into the intestine, is a surgical procedure that has been found to improve survival with the native liver. The options for postoperative analgesia include systemic opioids and epidural analgesia. The primary objective of this study was to compare the postoperative systemic opioids used in morphine equivalents (mg/kg) on postoperative days 0 through 3 between patients who underwent a Kasai portoenterostomy and received a thoracic epidural infusion to those without thoracic epidural analgesia. We conducted a retrospective cohort study of 91 infants with biliary atresia undergoing a Kasai portoenterostomy between January 1, 2009, and September 1, 2019, at the Children's Hospital of Philadelphia. Sixty-three of the 91 patients (69%) had a continuous epidural catheter placed intraoperatively for postoperative analgesia. The total opioid requirement (morphine equivalents) for the first 72 h in the epidural group of (Mean (95% confidence interval): 0.52 mg/kg (0.38, 0.67 mg/kg) was lower than the non-epidural group (Mean (95% confidence interval): 1.15 mg/kg (0.8, 1.48 mg//kg) for a difference in mean opioid requirement (95% confidence interval) of 0.63 mg/kg (0.32, 0.94 mg/kg). Patients in the non-epidural group had higher rates of unplanned ICU admissions (36% non-epidural group vs. 3.3% epidural group, difference in proportion (95% confidence interval) 32.7% (13, 52%), p < .01). A higher percentage of patients in the non-epidural group had a postoperative oxygen requirement (32.1% vs. 11.3%, difference in proportion (95% confidence interval) 21% (2, 40%), p=.02). In our cohort study, continuous thoracic epidural analgesia in patients undergoing a Kasai portoenterostomy was associated with lower postoperative opioid use. We also observed that the epidural group had a lower ICU admission rate and a lower rate of postoperative supplemental oxygen requirement over the first three postoperative days.

Use of Epidural Analgesia in Children With Neuromuscular Conditions Following Hip Reconstruction.

Background: Neuromuscular conditions, such as cerebral palsy, are the most common motor disabilities in the pediatric population. Children with these conditions frequently have accompanying hip deformities that require pelvic and femur osteotomy to correct the spastic hip dislocations. However, postoperative pain management remains an elusive and challenging problem. The purpose of this study was to determine whether postoperative use of epidural analgesia in patients with neuromuscular conditions provided similar outcomes with regard to pain scores, length of stay, duration of foley placement, duration of pain control, and complications as compared to traditional pain management regimens. To our knowledge, this is the first study comparing the use of epidural analgesia to conventional pain relief modalities following hip reconstruction in patients with neuromuscular conditions.Methods: A retrospective cohort study was performed using records of pediatric patients with neuromuscular conditions treated at our tertiary care center between January 2009 and December 2019. Patients with neuromuscular conditions treated with epidural or non-epidural analgesia for pain relief following unilateral or bilateral proximal femoral osteotomies, pelvic osteotomies, or open hip reduction were eligible for study inclusion. Multiple linear regression was used to determine differences in length of stay, pain score, pain modality, duration of Foley placement, and complications between the two cohorts.Results: Seventy patients met the inclusion criteria for the study. In all, 58 patients underwent unilateral procedures, of which 30 (52%) received epidural analgesia, and 28 (48%) received non-epidural pain control modalities. Demographic and baseline characteristics were similar among the cohort, except for BMI, which varied slightly. Average pain scores and pain control duration were not statistically different between the pain control modalities. After controlling for demographics, procedure, and immobilization type, the epidural group experienced significantly increased length of stay (+3.18 days, P=0.032) and duration of Foley placement (+1.04 days, P=.013). Complication rates between the two groups were not statistically significant.Conclusions: The use of epidural analgesia in children with neuromuscular conditions was associated with comparable pain scores, despite the increased length of stay and duration of Foley placement. No statistically significant difference in complication rates was observed between patients receiving epidural anesthesia and those receiving traditional pain modalities.

Factors Associated With Rebound Pain After Patient-controlled Epidural Analgesia in Patients Undergoing Major Abdominal Surgery: A Retrospective Study.

Although patient-controlled epidural analgesia (PCEA) is an effective form of regional analgesia for abdominal surgery, some patients experience significant rebound pain after the discontinuation of PCEA. However, risk factors for rebound pain associated with PCEA in major abdominal surgery remain unknown. This study evaluated the incidence of rebound pain related to PCEA and explored potential associated risk factors. We performed a retrospective review of 236 patients using PCEA following hepatobiliary and pancreas surgery between 2018 and 2020 in a tertiary hospital in South Korea. Rebound pain was defined as an increase from well-controlled pain (numeric rating scale <4) during epidural analgesia to severe pain (numeric rating scale ≥7) within 24 hours of discontinuation of PCEA. Logistic regression analysis was performed to determine the factors associated with rebound pain. Patients were categorized into the nonrebound pain group (170 patients; 72%) and the rebound pain group (66 patients; 28%). Multivariable logistic regression analysis revealed that preoperative prognostic nutritional index below 45 (odds ratio=2.080, 95% confidential interval=1.061-4.079, P =0.033) and intraoperative transfusion (odds ratio=4.190, 95% confidential interval=1.436-12.226, P =0.009) were independently associated with rebound pain after PCEA discontinuation. Rebound pain after PCEA occurred in ~30% of patients who underwent major abdominal surgery, resulting in insufficient postoperative pain management. Preoperative low prognostic nutritional index and intraoperative transfusion may be associated with rebound pain after PCEA discontinuation.

Epidural analgesia and abnormal coagulation in patients undergoing minimal invasive repair of pectus excavatum.

Background:Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum (MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE.Methods:In this retrospective study, we identified 1,973 patients undergoing MIRPE at our center between 2001 and 2019. Complications related to EA were registered for all patients. Information on coagulation parameters was present in 929 patients. Patients with spontaneously elevated INR ≥1.5 were referred for assessment of coagulation factor VII in order to assess the cause of the elevated INR.Results:Of 929 patients with coagulation information available, 18 patients had spontaneously elevated INR ≥1.5 (1.9%). In patients with INR ≥1.5, 12 patients underwent further assessment of factor VII, with all patients having a slightly reduced factor VII close to the lower reference range. The majority of the 1,973 patients undergoing MIRPE received EA (99.6%) with very low complication rates (0.2%) and no incidence of epidural hematomas.Conclusion:In patients undergoing MIRPE, coagulation screening prior to EA should not be mandatory as it revealed no clinically relevant consequences. EA is safe with very low complication rates.

Efficacy and Safety of Thoracic Epidural Analgesia in Patients With Acute Pancreatitis: A Narrative Review.

Patients admitted to the intensive care unit with moderate to severe acute pancreatitis carry significant morbidity and mortality. A few unfortunate patients in whom the initial line of treatment fails to show clinical improvement develop multiorgan dysfunction involving lungs (adult respiratory distress syndrome), renal failure, intra-abdominal infections, sepsis, and septic shock, which ultimately leads to prolonged hospitalization and a substantial cost of treatment. The acute abdominal pain experienced by these patients is excruciating and requires multimodal analgesia. Continuous epidural analgesia has been found to provide good quality, opioid-sparing analgesia in these patients. A few studies have also demonstrated that segmental sympathectomy resulting from epidural blockade could lead to lowering of serum amylase and lipase levels improve paralytic ileus, and thus hastens the process of recovery. The present paper aims to discuss the advantages of continuous epidural analgesia in patients with acute pancreatitis of varying severity and to review the existing literature using specific keywords.

Feasibility of continuous epidural analgesia in patients with failed back surgery syndrome and spinal stenosis

PurposeThe purpose of this study was to outline the feasibility of continuous epidural analgesia in the treatment of failed back surgery syndrome (FBSS) or spinal stenosis.MethodsWe queried our prospective collected institutional database to include all consecutive patients, who underwent continuous epidural analgesia with accompanying intensive physiotherapeutic exercise within a timeframe of 4 years. Patients suffered from FBSS or spinal stenosis; protocolled continuous epidural analgesia was planned for 4 days within the framework of an inpatient multimodal pain therapy concept. The instillation technique of the epidural catheter, the capability to attend in accompanying physiotherapy, and the peri-interventional complications were evaluated.Results153 patients with an average age of 57.4 years (± 11.9) were enrolled in this study. 105 patients suffered from FBSS and 48 patients had spinal stenosis. Overall, 148 patients (96.7%) reported the pain reduction and were able to perform daily intensified physiotherapeutic exercise. There were no serious adverse events, neither infection nor bleeding, no cardiopulmonary complication or permanent neurological deficits. The most common side effect was neurological impairment, such as numbness, dysesthesia, or weakness of the lower limbs with complete regression after flow rate adjustment. Patients with FBSS were more likely to develop dysesthesia (p = 0.007).ConclusionsContinuous epidural analgesia is feasible in patients with FBSS or spinal stenosis. This treatment enables extensive physiotherapeutic treatment even in patients with severe pain conditions and can be considered as an alternative to epidural injections. An increased complication rate in comparison to short-term perioperative or perinatal application was not observed.

Impact of early thoracic epidural analgesia in patients with severe acute pancreatitis.

This study was designed to assess the impact of thoracic epidural analgesia (TEA) in patients with severe acute pancreatitis (SAP). This is a single-centre retrospective study. In this study, the outcomes of SAP patients were compared between patients received TEA (TEA group) and without TEA (NTEA group). Early TEA was defined as TEA performed within 48hours after onset. The main outcome was the mortality at 30days after ICU admission, and secondary outcomes included the incidence of acute respiratory distress syndrome (ARDS), the acute renal injury (AKI) and sepsis, the hospital stay and hospitalization expenses. The mortality of SAP patients in TEA versus NTEA was 8.0% and 13.3% (p=.1520). Multivariate regression analysis showed significant difference in mortality between the TEA and NTEA groups (OR, 0.387; 95% CI, 0.168-0.892; p=.026). The incidence of ARDS in TEA versus NTEA was 46.0% and 62.4% (p=.0044); the proportion of patients requiring invasive ventilator assisted ventilation in TEA, and NTEA was 22.6% and 39.2% (p=.0016). The incidence of AKI in TEA versus NTEA was 27.7% and 45.3% (p=.0044); the proportion of patients needing for continuous renal replacement therapy (CRRT) in TEA and NTEA was 48.2% and 74.0% (p<.0001). The mortality of SAP patients in early TEA versus NTEA was 4.8% and 15.3% (p=.0263). TEA was associated with low incidence of ARDS and AKI in patients with SAP. Early TEA may benefit mortality in SAP patients and is a possible protective factor for the mortality of SAP patients.

Transversus abdominis plane block with liposomal bupivacaine versus continuous epidural analgesia for major abdominal surgery: The EXPLANE randomized trial

ObjectiveCompare transversus abdominis plane (TAP) blocks with liposomal bupivacaine were to epidural analgesia for pain at rest and opioid consumption in patients recovering from abdominal surgery. BackgroundERAS pathways suggest TAP blocks in preference to epidural analgesia for abdominal surgery. However, the relative efficacies of TAP blocks and epidural analgesia remains unknown. MethodsPatients having major abdominal surgery were enrolled at six sites and randomly assigned 1:1 to thoracic epidural analgesia or bilateral/4-quadrant TAP blocks with liposomal bupivacaine. Intravenous opioids were used as needed. Non-inferiority margins were a priori set at 1 point on an 11-point pain numeric rating scale for pain at rest and at a 25% increase in postoperative opioid consumption. ResultsEnrollment was stopped per protocol at 3rd interim analysis after crossing an a priori futility boundary. 498 patients were analyzed (255 had TAP blocks and 243 had epidurals). Pain scores at rest in patients assigned to TAP blocks were significantly non-inferior to those given epidurals, with an estimated difference of 0.09 points (CI: −0.12, 0.30; noninferiority P < 0.001). Opioid consumption during the initial 3 postoperative days in TAP patients was not non-inferior to epidurals, with an estimated ratio of geometric means of 1.37 (CI: 1.05, 1.79; non-inferiority P = 0.754). However, the absolute difference was only 21 mg morphine equivalents over the 3 days. Patients with epidurals were more likely to experience mean arterial pressures <65 mmHg than those given TAP blocks: 48% versus 31%, P = 0.006. ConclusionPain scores at rest during the initial three days after major abdominal surgery were similar. Patients assigned to TAP blocks required more opioid then epidural patients but had less hypotension. Clinicians should reconsider epidural analgesia in patients at risk from hypotension.Trial Registration:ClinicalTrials.gov Identifier: NCT02996227.

Эффективность эпидуральной анальгезии у пациентов с доброкачественной гиперплазией простаты после чреспузырной простатэктомии

Целью данного исследования было проанализировать эффективность эпидуральной анальгезии в послеоперационном периоде у пациентов, перенесших открытую чреспузырную радикальную простатэктомию (ЧРПЭ) на базе Одесской областной клинической больницы в период с сентября 2013 по сентябрь 2018 года по поводу доброкачественной гиперплазии простаты. Материалы и методы. Ретроспективно была проанализирована обширная база данных всех пациентов, перенесших чреспузырную радикальную простатэктомию по поводу доброкачественной гиперплазии простаты с сентября 2013 по сентябрь 2018 года. 177 пациентов прошли ЧРПЭ на базе Одесской областной клинической больницы за этот период и были разделены на тех, кто получал, и тех, кто не получал эпидуральную анальгезию в послеоперационном периоде. Данные об адекватности послеоперационной анальгезии оценивались ретроспективно по данным жалоб и необходимости дополнения методики введением опиоидов. Осложнения регистрировали до 30 дней стационарного и амбулаторного лечения с использованием модифицированной системы Clavien. Статистическая обработка полученных данных проводилась при помощи программного обеспечения MATLAB. Результаты. Анализ данных медицинской документации 177 мужчин свидетельствует о тенденции к увеличению частоты использования эпидуральной анальгезии для купирования боли наряду со снижением среднего срока пребывания в стационаре. При разделении данных на ЧРПЭ с использованием эпидуральной анальгезии и без ее применения установлено, что среднее время пребывания в стационаре составляет 6 дней для пациентов, получающих эпидуральную послеоперационную анальгезию, по сравнению с 7 днями для тех, кто не получал эпидуральную анальгезию в послеоперационном периоде. Различия были статистически значимыми (р &lt; 0,038) и оставались такими после поправки на осложнения (р &lt; 0,0001). Выводы. По данным исследования, эпидуральная анальгезия у пациентов, перенесших чреспузырную радикальную простатэктомию по поводу доброкачественной гиперплазии простаты, снизила продолжительность пребывания в стационаре. Исходя из результатов, эпидуральная анальгезия, вероятно, может быть рекомендована мужчинам в послеоперационном периоде при данном объеме оперативного вмешательства и данной патологии. Однако, поскольку мини-инвазивные методы становятся все более распространенными, а применение эпидуральных методик остается дискутабельным вопросом среди наших коллег по всему миру, крупные рандомизированные исследования в Украине необходимы для детального изучения данной проблематики.

Comparison of the suprainguinal fascia iliaca compartment block with continuous epidural analgesia in patients undergoing hip surgeries: a retrospective study

Background and objectivePain control is one of the major concerns after major hip surgeries. Suprainguinal fascia iliaca compartment block (S-FICB) is an alternative analgesic technique that can be considered as an effective and less invasive method than epidural analgesia (EA). In this retrospective study, we compared postoperative analgesic efficacy of single shot ultrasound guided S-FICB and EA after major hip surgery. MethodsWe retrospectively examined 150 patients who underwent major hip surgeries and who received S-FICB or EA. Seventy-two patients submitted to EA and 78 patients who received S-FICB were included and their medical records retrospectively reviewed. Morphine consumptions, VAS scores, and side effects were recorded. Patients under antiplatelet or anticoagulant theraphy were also registered. Morphine consumption and VAS scores were the primary endpoints, succes rate and complications were the secondary endpoints of our study. P-values less than 0.05 were considered statistically significant. ResultsMorphine consumption was lower at the emergence in the EA group but there was no statistically significant difference between the two groups according to total opioid consumption (0 [0-0] vs 0 [0-0]; p = 0.52). There was no difference between VAS scores in the first 18 hours. Hypotension was significantly higher in the EA group (9 vs 21; p = 0.04). ConclusionIn conclusion, S-FICB can provide comparable analgesia with EA in the early postoperative period after hip surgery but VAS scores were found lower in the EA group than S-FICB group after 18th hour. Hypotension has occured more frequently in patients receiving EA.