Epidural Patients Research Articles

Analgesic efficacy of erector spinae block in comparison to thoracic epidural anesthesia in patients undergoing transthoracic esophageal surgical procedure

Background The ultrasound-guided erector spinae plane block is a new regional anesthetic technique providing long-lasting excellent analgesia in addition to hemodynamic stability and minimal rescue analgesic request. Materials and methods Following ethics committee approval, a total of 80 patients aged 36–65 years, American Society of Anesthesiologists physical status I and II undergoing elective transthoracic esophageal surgical procedures were enrolled in this prospective study. The patients were randomized into epidural group: patients who received thoracic epidural anesthesia with injection of 15 ml of bupivacaine 0.25% combined with general anesthesia, followed by 7 ml/h of 0.125% bupivacaine and bilateral erector spinae block group, which were performed with an injection of a total of 15 ml of bupivacaine 0.25% on either side combined with general anesthesia and then 7 ml/h of 0.125% bupivacaine was injected in each catheter 2 h for 24 h postoperatively. The primary end point included postoperative minor complications (hypotension, vomiting, urinary retention) and major complications (mortality). Secondary end points included the extubation time, hospital stay length, pain scores at 4, 8, 12, 18, and 24 h postoperatively, rescue analgesic consumption and patient satisfaction scores. Results Pain scores and the total dose of rescue analgesic were comparable in the two groups. The length of hospital stay was significantly longer in the epidural group compared with the erector group. Satisfaction scores were significantly higher in the erector group compared with the epidural group. There was no significant difference between the study groups regarding time to perform the block, time to extubation, and incidence of postoperative complications except for hypotension which was significantly higher in the epidural group. Conclusion Erector spinae plane block has an outstanding beneficial effect in reducing pain and providing better satisfaction scores with less incidence of complications compared with thoracic epidural anesthesia.

Comparison of spinal and segmental epidural anesthesia in patients undergoing inguinal hernia repair

Comparison of spinal and segmental epidural anesthesia in patients undergoing inguinal hernia repair

Modified ultrasound-guided epidural anesthesia for patients with spine malformation (one case report)

Spinal anesthesia keeps the patient′s autonomous respiration, has less influence on cardio-pulmonary function and is suitable for elder people with femoral neck fracture. But it is very difficult and dangerous to complete the epidural anesthesia for patients with spine malformation. In this study, this article described a novel ultrasound-guided technique for epidural access through a para-median transverse scan at the level of articular process, and compared it with the ultrasound-guided long axis scan. Following the in-plane technique under para-median transverse US scanning, this article completed the epidural anesthesia for a patient with spine malformation. This article observed the depth and angle of the spinal needle, the target structure and the structure of adjacent tissue, the diffusion of drugs. The pictures were recorded and stored. Compared with the sagittal scan, the oblique scan is easier to handle. Ultrasound-guided erector spinae plane block is a safe and effective method for spine malformation patients. Key words: Ultrasound-guided; Epidural access; Spine; Malformation; Para-median transverse US scanning

EFFECTIVENESS OF CAUDAL EPIDURAL ANAESTHESIA IN ANORECTAL SURGERY.

Objectives: To assess the effectiveness of caudal epidural anaesthesia in patients with anorectal surgical condition. Study Design: Prospective randomized study. Setting: Department of Surgery, Jinnah Hospital, Lahore. Period: 1st August 2016 to 31st July 2017. Materials and Methods: One hundred and eighty patients with general anorectal surgical conditions were recruited in this study with their consent. Patients were subject to surgery planned beneath caudal block. Results: One hundred and fifty eight patients (87%) satisfy with the technique of anaesthesia and one hundred sixty six (92.22%) patients demonstrate satisfaction with the postoperative pain control. One hundred and fifty two patients (84.44%) were resisted with pre-operative information and 158 (87%) patients show their consent to select this kind of anaesthesia if needed again. In 20 patients there was block failure caused about 11.11% failure rate. Conclusion: Satisfactory anaesthesia, minimal requirements, cost effectiveness and high patients acceptability make caudal anaesthesia a suitable choice for trivial and surgery.

A STUDY TO COMPARE THE EFFECT OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO ROPIVACAINE FOR EPIDURAL ANESTHESIA IN INFRAUMBILICAL SUGERIES

Background: Alpha-2 adrenergic agonists have both analgesic and sedative properties and can be used as an effective adjuvant in epidural anaesthesia. The aim of our study to compare the efficacy and clinical profile of α-2 adrenergic agonists dexmedetomidine and clonidine, when used as adjuvants in epidural anaesthesia in patients undergoing infraumbilical surgeries with special emphasis on their sedative properties and ability to provide smooth intra-operative and post- operative analgesia.
 Methods: This Hospital Based, double blind, randomized, comparative, interventional Study was carried out in 60 patients undergoing infra umbilical surgeries. After obtaining permission from Institutional Ethics Committee and Research Review Board. All patients randomly allocated in two groups of 30 patients in each group. Group A patient received 15 ml 0.75 % ropivacaine + 1 microgram/kg dexmedetomidine, Group B received 15 ml 0.75 % ropivacaine + 1 microgram/kg clonidine.
 Results: The time of onset of sensory block with dexmedetomidine was earlier compared to clonidine (8.3+1.26 min versus 11.6+1.81min). Mean time to attain highest sensory level was 13.3± 1.4 minutes in group A and 17.6± 1.9 minutes in group B. Mean duration of sensory block was 306.1 ± 8.32 minutes in group A and 285.2 ± 17.4 minutes in group B. Mean time to motor onset was 17.7±3.3 minutes in group A and 18.8±2.9 minutes in group B. Mean duration of motor block was 241.1 ± 4.81 minutes in group A and 216.9± 7.17minutes in group B. There was no significant difference in VAS score till half an hour and after one hour we got significant difference in both groups.
 Conclusion: We concluded that when used with ropivacaine (0.75%) as an adjuvant dexmedetomidine (1microgram/kg) and clonidine (1microgram/kg) shortens the onset of sensory block, prolongs the duration of sensory and motor blockade and provides the effective and prolonged post operative analgesia with adequate sedation and without major adverse effects and hemodynamic changes.
 Keywords: Clonidine, dexmedetomidine, epidural, ropivacaine.

Application of sevoflurane inhalation combined with epidural anesthesia in patients with colorectal cancer and its effect on postoperative perceptual function.

Effect of sevoflurane inhalation combined with epidural anesthesia on postoperative perceptual function in patients with colorectal cancer (CRC) was investigated. The clinical data of 78 patients undergoing laparoscopic CRC radical surgery in The Second Cancer Hospital of Heilongjiang Province from June 2016 to June 2017 were retrospectively analyzed and divided into 2 groups: Sevoflurane inhalation combined with epidural anesthesia (observation group, n=40); propofol intravenous general anesthesia (control group, n=38). The mean arterial pressure and heart rate before anesthesia (T0), immediate intubation (T1), 30 min after surgery started (T2), end of surgery (T3), 10 min after extubation (T4) were compared between the two groups. The recovery conditions were also compared between the two groups. The cognitive functions were evaluated by mini-mental state scale (MMSE). The mean arterial pressure and heart rate in the observation group were significantly lower than those in the control group at T2, T3 and T4 (P<0.05). The recovery time, extubation time, anal exhaust time, eating time, urinary catheter removal time and hospital stay in the observation group were significantly lower than those in the control group (P<0.05). There was a significant difference in cognitive function between the two groups at different time points (P<0.001). Postoperative cognitive function showed a trend of decreasing first and then increasing; the scores of cognitive function in both groups 1 day after surgery were at trough level, and recovered gradually from 3 days after surgery. The mean arterial pressure and heart rate during the perioperative period are more stable in the elderly patients with sevoflurane inhalation combined with epidural anesthesia; the recovery time is shorter and more rapid, and the recovery time of postoperative cognitive function is also faster. Therefore, it provides a reference for patients undergoing CRC radical surgery to select high-quality and appropriate anesthetic protocols.

Comparison of the Effects of Thoracic Epidural Anesthesia with General Anesthesia on Hemodynamic Changes and its Complications in Patients Undergoing Laparoscopic Cholecystectomy.

Background:Epidural anesthesia (EA) today has been used extensively in surgical procedures and the management of pain associated with midwifery and chronic pain. This type of anesthesia can be done in different technical, physiological, and pharmacological ways. The aim of this study was to compare the effects of thoracic EA with general anesthesia (GA) on hemodynamic changes and its complications in patients underwent laparoscopic colonoscopy.Materials and Methods:This clinical trial study was conducted on 80 patients undergoing laparoscopic cholecystectomy with EA or GA based on inclusion and exclusion criteria. The patients were randomly divided into two groups of 40 and changes in blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and arterial blood oxygen saturation were measured. The incidence of nausea, vomiting, chills, and itching in the two groups was recorded. The analysis was performed descriptively and also using t-test and Chi-square tests.Results:The results showed that the mean of SBP and DBP, HR, and arterial blood oxygen saturation and the incidence of nausea and vomiting was statistically significant (P < 0.05) between the two groups at 4, 6, and 12 h after anesthesia and it was higher in a group of GA. There was no significant difference in shivering and itching between the two groups (P > 0.05).Conclusion:The results of this study indicated that thoracic EA in patients with laparoscopic cholecystectomy has significant effects on factors such as SBP and DBP and arterial blood oxygen saturation. Furthermore, EA has fewer complications than GA, and it is the preferable approach.

Lusutrombopag (Mulpleta\xae) treatment in a patient with thrombocytopenia complicated by cirrhosis prior to continuous epidural anesthesia during renal artery embolization: a case report

BackgroundThe oral thrombopoietin (TPO) receptor agonist lusutrombopag (Mulpleta®) was developed to improve thrombocytopenia in patients with chronic liver disease prior to elective invasive medical procedures. Mulpleta® was first approved for use in Japan in 2015 and in the USA in 2018. In the present report, we discuss a case in which pain management was performed during left renal artery embolization via continuous epidural anesthesia following oral administration of lusutrombopag. To our knowledge, this is the first report to discuss the use of lusutrombopag prior to epidural anesthesia.Case presentationThe patient was a 78-year-old woman scheduled to undergo renal artery embolization to address a 3-cm aneurysm of the left renal artery. Fourteen days prior to the scheduled embolization procedure, the urologist was asked to insert an epidural catheter for perioperative and postoperative analgesia. Type C chronic cirrhosis was observed, and platelet count was 5.6 × 104/μL. Eleven days prior to embolization, oral lusutrombopag was initiated at a dosage of 3 mg/day (day 1). Oral lusutrombopag therapy was continued for 5 days, and platelet count on day 11 (i.e., the day prior to surgery) was 12.6 × 104/μL. An epidural catheter was inserted on day 12, following which embolization was performed. Platelet count on day 13 was 11.0 × 104/μL, and the catheter was removed on day 14. No symptoms of epidural hematoma or thrombosis were observed during the patient’s disease course.ConclusionsAs lusutrombopag is a relatively safe platelet-increasing agent, we believe that this drug can serve as a potential treatment option when performing elective epidural anesthesia in patients with chronic liver disease complicated by thrombocytopenia.

Surveying the Literature

Surveying the Literature

Phantom limb syndrome induced by combined spinal and epidural anesthesia in patients undergoing elective open gynecological surgery.

Background:During regional anesthesia, including combined spinal and epidural anesthesia (CSEA), patients may develop a perceptual alteration of limb position known as phantom limb syndrome (PLS). We aimed to identify factors that influence the PLS onset, to explore whether PLS predisposes to other postoperative symptoms, and to document the relationship between PLS and sensorimotor impairment during recovery.Methods:Psychological questionnaires for anxiety and depression were completed beforehand, then multimodal tests of sensory and motor function, especially tests of proprioception, were performed regularly afterward. Two hundred participants undergoing elective gynecological surgery under CSEA reported their experiences of PLS and other symptoms using Likert rating scales.Results:Prolonged preoperative fasting (odds ratio (OR) 2.34; 95% confidence intervals (CI) 1.21–4.52), and surgical history (OR 2.56; 95% CI 1.16–5.62) predisposed to PLS, but patients with more extensive anesthetic histories may be at lower risk (OR 0.57; 95% CI 0.31–1.08). Furthermore, significant correlations were observed between the recovery from PLS and the perception of joint movement within the deafferented area (R = 0.82, P < .01) and motor functions (R = 0.68). PLS increases the chance of experiencing postoperative fatigue, physical discomfort, and emotional upset.Conclusion:This study is the first to have identified the risk factors for PLS, assessed the relationship between PLS and postoperative sensorimotor impairment, and its influence on postoperative complications.

Perioperative epidural use and survival outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer

ObjectiveEpidurals are associated with improved outcomes in some solid tumors, presumably due to their effect on surgical stress response. There are limited data on the prognostic significance of epidural anesthesia in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. We sought to assess the impact of epidural anesthesia on the survival outcomes of patients undergoing PDS for advanced ovarian cancer. MethodsIn this retrospective study, consecutive patients with stage IIIB-IV epithelial ovarian, fallopian tube, or peritoneal carcinoma who underwent PDS at our institution from 01/2005–12/2013 were identified. Progression-free survival (PFS) and overall survival (OS) with regard to epidural use were analyzed. ResultsOf 648 patients, 435 received an epidural and 213 did not. Patients in the former group were more likely to have higher stage disease (stage IV disease, 26% vs. 16%, respectively; P = .005), carcinomatosis (87% vs. 80%, respectively; P = .027), and bulky upper abdominal disease (66% vs. 58%, respectively; P = .046). Complete gross resection was achieved in 48% and 32%, respectively (P < .001). For the epidural vs. non-epidural groups, median PFS was 20.8 months and 13.9 months, respectively (P = .021); median OS was 62.4 months and 41.9 months, respectively (P < .001). After controlling for confounding factors, including residual disease, epidural use was independently associated with a decreased risk of progression (HR = 1.327; 95% CI, 1.066–1.653) and death (HR = 1.588; 95% CI, 1.224–2.06). ConclusionsPerioperative epidural use was independently associated with improved PFS and OS in these patients. Epidural anesthesia at the time of PDS may be warranted in this setting.

Discussion of: Efficacy and safety of transversus abdominis plane block versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resections: A prospective, randomized controlled trial

Discussion of: Efficacy and safety of transversus abdominis plane block versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resections: A prospective, randomized controlled trial

Hysterotomy Under Epidural Anesthesia In Patient With Peripartum Cardiomyopathy, Pregnancy Induced Hypertension and Acute Renal Failure

Peripartum cardiomyopathy is a type of left ventricular systolic heart dysfunction with an unknown cause. We report a case of a 32-year-old female patient of 50 kg, known case of hypertension since 1.5 year. An epidural, catheter was inserted at the level of L3 and L4 intervertebral spaces. After confirmation 7 ml of 0.5% bupivacaine was injected into epidural space with two top-up doses of 2 ml of 0.125% bupivacaine. Echocardiography demonstrated findings suggested of peripartum cardiomyopathy with mild tricuspid regurgitation and mild mitral regurgitation. Key words Hysterotomy, Epidural anesthesia, Cardiomyopathy.

Efficacy and safety of transversus abdominis plane blocks versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resections: A prospective, randomized controlled trial

BackgroundThe purpose of this study was to compare patient outcomes for thoracic epidural anesthesia (TEA) with transversus abdominis plane (TAP) blocks. MethodsA prospective, randomized trial was performed for patients undergoing abdominal oncologic surgeries. ResultsThere were 32 TAP and 35 TEA subjects. The TEA group demonstrated increased episodes of hypotension in the first 24 h (3 v 0.6, p = 0.02). There was no difference in 24–48 h fluid balance between the groups. Overall parenteral morphine equivalents of opioids administered for the TEA group were higher for each postoperative day (p < 0.05). The post-operative survey did not demonstrate any difference in subjective pain between the TAP and TEA groups (6 v 6 p = 0.35). There was no attributable morbidity associated with either technique. ConclusionsTAP block use was associated with lower parenteral morphine equivalent usage and decreased incidence of hypotension in the early post-operative period compared to TEA.

Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml) and bupivacaine 0.5% (20ml) for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries.Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset.Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects.Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief.

Hypotensive epidural anesthesia in patients with preoperative renal dysfunction presenting for hip arthroplasty

Objective To investigate the benefits and safety of hypotensive epidural anesthesia (HEA) in comparison with normotensive epidural anesthesia in patients with preoperative renal dysfunction presenting for hip arthroplasty. Background HEA is one of the anesthetic techniques used to reduce perioperative blood loss for total hip replacement. The technique includes a combination of an extensive epidural block and an intravenous infusion of low-dose epinephrine (1–5 μg/min) to adjust and control the mean arterial blood pressure together with preserving central venous pressure and cardiac output. Patients and methods Forty adult patients of both sexes undergoing primary unilateral hip arthroplasty, ranging in age from 60 to 74 years, ASA II–III with mild renal dysfunction were divided into two groups: group I received epidural anesthesia with strict preservation of the mean arterial blood pressure (65–90 mmHg) during surgery using vasopressors, fluids, and/or blood transfusions and group II received epidural anesthesia and hypotension was induced by maintaining the mean arterial blood pressure at 55–60 mmHg during the entire surgery. Results The heart rate and the mean arterial blood pressure showed a significant difference between the two groups at 15, 30, 45, 60, and 90 min intraoperatively (P Conclusion HEA is superior to normotensive epidural anesthesia in patients with renal impairment undergoing hip arthroplasty in the form of decreased blood loss and the need for blood infusion, provides a clear surgical field, and leads to an improvement in cement fixation and decreased incidence of postoperative deep vein thrombosis and blood loss, with no evidence of acute kidney injury postoperatively.

Epidural anesthesia in a patient with lung aplasia and skeleton deformation undergoing abdominal hysterectomy: a case report

Pulmonary agenesis combined with other malformations of the skeleton and internal organs in humans is a rare pathology. The choice of method of anesthesia before surgery in this patient may be some difficulties and limitations. We report the successful completion of surgery under epidural anesthesia. Ultrasound-guided epidural anesthesia allowed to take into account individual anatomicalfeatures ofthe patient and to avoid complications. This case demonstrates the ability to safely conduct epidural anesthesia in patients with malformations of the skeleton and internal organs.

Spinal and Epidural Anesthesia in Patients With Recent Stable Fractures of Vertebral Column.

The use of central neuraxial block (CNB) in patients with spinal injuries with or without spinal cord injury continues to be a contentious issue due to paucity of evidence supporting or refuting its use. There are only a few case reports reporting the use of the technique in these patients. We performed a retrospective record review of patients who underwent neuraxial blockade for lower limb orthopedic surgery in the presence of coexisting recent spine injury (defined as spine injury within 1 month) to assess the occurrence of postoperative deterioration of spinal cord function or occurrence of new spinal cord dysfunction. The hospital records of patients with recent stable traumatic fractures of the vertebral column who underwent lower limb orthopedic surgery under CNB from January 2010 to December 2013 were reviewed. Data collected included age, sex, level of fracture, number of vertebrae injured, presence of neurological deficits, interval between injury and surgery, number of surgeries, level of CNB, number of vertebral segments between the site of injury and CNB, position of patient used for CNB and surgery, and perioperative adverse hemodynamic events. All patients underwent detailed postoperative neurological examination and any deterioration or occurrence of new spinal cord dysfunction was noted. Nineteen patients underwent 21 CNBs for lower limb orthopedic procedures. There were 12 men and 7 women. Thoracolumbar area (18/19) was the commonest site of fractures. Two patients had neurological deficits due to cervical spine trauma. More than 50% of the patients had multiple bone fractures and nearly 30% had associated nonorthopedic trauma. Six patients underwent surgery within the first week (4 to 7 d) after trauma. In 80% of the patients, there was a gap of atleast 2 vertebrae between the level of injury and CNB administration. There were no perioperative adverse hemodynamic events requiring prolonged inotropic support. None of the patients had neurological deterioration or new changes. Spinal and epidural anesthesia in patients with recent stable fractures of the spine was not associated with adverse neurological events. The findings of this study may be particularly relevant to patients with recent stable vertebral fractures who require surgery but present with conditions that place them at high risk for general anesthesia.

A comparative study on combined general anesthesia with either continuous fascia iliaca block or epidural anesthesia in patients undergoing lower limb orthopedic surgeries

Introduction The purpose of this study was to compare between epidural anesthesia and continuous fascia iliaca block in adults patients undergoing fixation of neck femur or knee arthroplasty including comparison of analgesic efficacy, side effects, and complications. Patients and methods The study was performed upon 60 patients, aged 20-60 years, and randomly distributed among two groups. Group A included 30 patients who received lumber epidural anesthesia, using Tuohy needle 18 G and epidural catheter 20 G, injected initially with 15 ml bupivacaine HCl 0.25% then 6-8 ml/h bupivacaine HCl 0.125% as continuous epidural infusion for 12 h postoperatively. Group B included 30 patients who received fascia iliaca block using Tuohy needle 18 G, injected initially with 20 ml bupivacaine HCl 0.25%, then an epidural catheter 20 G was threaded through the needle and another 20 ml of local anesthetic was injected, followed by 8-10 ml/h bupivacaine HCl 0.125% injected as continuous epidural infusion into the plane for 12 h postoperatively. Results Regarding the technique time, the fascia iliaca group B was significantly faster than the epidural group A. The results showed that performing continuous fascia iliaca block was a significantly faster technique, providing fewer complications such as hypotension, postoperative vomiting, and urinary retention and more patient satisfaction in comparison with epidural anesthesia. Conclusion Continuous fascia iliaca block provided effective unilateral analgesia in patients undergoing fixation of fractured femur neck or shaft or knee arthroplasty with a high patient satisfaction rate, low incidence of hemodynamic instability, and low incidence rate of complications when compared with epidural analgesia.

Thoracic combined spinal epidural anesthesia in patient of dilated cardiomyopathy undergoing laparoscopic cholecystectomy.

Thoracic combined spinal epidural anesthesia in patient of dilated cardiomyopathy undergoing laparoscopic cholecystectomy.