Epidural Block In Patients Research Articles

Comparison of the Efficacy of Postoperative Pain Relief in Ultrasound Guided Fascia Illiaca Compartment Block versus Epidural Block on Quality of Recovery (QOR-15) in Patients Undergoing Femoral Surgery

Background: The occurrence of femoral fractures is quite high. The quality of life gets affected to a large extent due to pain and post-operative delirium. Various regional block techniques like Fascia illiaca compartment block, lumbar epidural analgesia, femoral nerve block, etc. have been described for femoral fractures. In this study, we compared the efficacy of post-operative pain relief FICB and Epidural block on quality of recovery (QOR-15) in patients undergoing femoral surgery. Methods: This study included 40 patients wherein 20 patients were given FICB and 20 patients were given Epidural block. The patients were followed up for post-operative pain relief, Quality of Recovery, occurrence of delirium, disability and fraility. Results: Quality of recovery QOR-15 was similar for both the groups preoperatively as well as at 24 hour and 48 hours post-operatively. Additionally, there was no difference in the time taken to administer the block, postoperative VAS score on movement and rest, requirement of additional analgesia and opioid consumption. Moreover, there were no significant differences in WHO disability assessment, modified frailty score, prevalence of delirium, mortality, morbidity and side effects of techniques. However, the total duration of hospital stay (in days) was found to be significantly more in the epidural group as compared with the FICB group (5.75±1.61 vs 4.75±1.16; P=0.38). Conclusion: Ultrasound guided fascia iliaca compartment block is a tangible alternative to epidural block in patients undergoing femoral fracture repair.

Efficacy of Ultrasound-guided Transverse Abdominis Plane Block versus Epidural Block in Nephrectomy Patients: A Randomised Controlled Study

Introduction: Partially controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, like respiratory complications, delirium, myocardial ischaemia, prolonged hospital stays, and chronic pain later on. A good postoperative recovery depends greatly on a proper analgesic regimen. While epidural analgesia has been used to provide postsurgical abdominal pain relief, peripheral nerve blockade is a good alternative. Aim: To compare the analgesic efficacy of Transverse Abdominis Plane (TAP) block and Epidural block in patients undergoing nephrectomy. Materials and Methods: In this single-blinded parallel-group randomised controlled study was conducted in the Department of Urology at the Institute f Postgraduate Medical Education and Research in Kolkata, West Bengal, India from November 2021 to October 2022. A total of 78 patients (18-65 years) with American Society of Anaesthesiologists (ASA) Grade-I and II were randomly assigned to Group-EA (Epidural) and Group-TA (TAP Block). Group-EA received 11 mL of 0.125% bupivacaine, and Group-TA received 11 ml of 0.125% bupivacaine, both given at an 8-hour interval for 24 hours. The primary outcome was to compare postoperative pain using the Visual Analogue Scale (VAS) score at 1, 8, 12, and 24 hours after surgery. Secondary outcome measures included assessing motor function using the Bromage Score, monitoring haemodynamic parameters (pulse rate, mean arterial pressure), and evaluating Postoperative Nausea and Vomiting (PONV). A p-value <0.05 was considered statistically significant when comparing the data. Results: The authors found that the distribution of male and female patients (p=0.650), ASA Grades (I:II) (p=0.515), mean age (p=0.899), and mean SpO2 (p=0.404) were comparable between the two groups (p>0.05). The pain scores between the EA and TA groups at 1, 8, 12, and 24 hours (0.10 vs. 0.08, 0.74 vs. 0.82, 1.00 vs. 1.31, 1.80 vs. 1.92) showed no significant difference at the specified times. However, the comparison of the mean Bromage scores in the EA and TA groups at the same time intervals (1 vs. 1.15, 1.08 vs. 2.51, 1.97 vs. 3.21, 1.97 vs. 4.74) revealed a significantly higher value in the TAP block group compared to the Epidural block group. The Epidural group had significantly lower blood pressure and pulse rate but experienced more PONV (15.4 vs. 2.6) compared to the TAP block group. Conclusion: Epidural block resulted in hypotension, bradycardia, shivering, and PONV as side-effects, which were negligible in the TAP block group. However, postoperative analgesia was quite comparable between the two groups. Postoperative pain, as assessed by VAS score, changed significantly in the TAP block group (intragroup p-value=0.0063), whereas it remained constant in the epidural group (intragroup p-value 0.094), and the difference between the two groups was statistically insignificant. The occurrence of hypotension, bradycardia, and PONV was significant in the epidural group, whereas postoperative mobility was better in the TAP group.

Efficacy of Ultrasound-guided Transverse Abdominis Plane Block versus Epidural Block in Nephrectomy Patients: A Randomised Controlled Study

Introduction: Partially controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, like respiratory complications, delirium, myocardial ischaemia, prolonged hospital stays, and chronic pain later on. A good postoperative recovery depends greatly on a proper analgesic regimen. While epidural analgesia has been used to provide postsurgical abdominal pain relief, peripheral nerve blockade is a good alternative. Aim: To compare the analgesic efficacy of Transverse Abdominis Plane (TAP) block and Epidural block in patients undergoing nephrectomy. Materials and Methods: In this single-blinded parallel-group randomised controlled study was conducted in the Department of Urology at the Institute f Postgraduate Medical Education and Research in Kolkata, West Bengal, India from November 2021 to October 2022. A total of 78 patients (18-65 years) with American Society of Anaesthesiologists (ASA) Grade-I and II were randomly assigned to Group-EA (Epidural) and Group-TA (TAP Block). Group-EA received 11 mL of 0.125% bupivacaine, and Group-TA received 11 ml of 0.125% bupivacaine, both given at an 8-hour interval for 24 hours. The primary outcome was to compare postoperative pain using the Visual Analogue Scale (VAS) score at 1, 8, 12, and 24 hours after surgery. Secondary outcome measures included assessing motor function using the Bromage Score, monitoring haemodynamic parameters (pulse rate, mean arterial pressure), and evaluating Postoperative Nausea and Vomiting (PONV). A p-value <0.05 was considered statistically significant when comparing the data. Results: The authors found that the distribution of male and female patients (p=0.650), ASA Grades (I:II) (p=0.515), mean age (p=0.899), and mean SpO2 (p=0.404) were comparable between the two groups (p>0.05). The pain scores between the EA and TA groups at 1, 8, 12, and 24 hours (0.10 vs. 0.08, 0.74 vs. 0.82, 1.00 vs. 1.31, 1.80 vs. 1.92) showed no significant difference at the specified times. However, the comparison of the mean Bromage scores in the EA and TA groups at the same time intervals (1 vs. 1.15, 1.08 vs. 2.51, 1.97 vs. 3.21, 1.97 vs. 4.74) revealed a significantly higher value in the TAP block group compared to the Epidural block group. The Epidural group had significantly lower blood pressure and pulse rate but experienced more PONV (15.4 vs. 2.6) compared to the TAP block group. Conclusion: Epidural block resulted in hypotension, bradycardia, shivering, and PONV as side-effects, which were negligible in the TAP block group. However, postoperative analgesia was quite comparable between the two groups. Postoperative pain, as assessed by VAS score, changed significantly in the TAP block group (intragroup p-value=0.0063), whereas it remained constant in the epidural group (intragroup p-value 0.094), and the difference between the two groups was statistically insignificant. The occurrence of hypotension, bradycardia, and PONV was significant in the epidural group, whereas postoperative mobility was better in the TAP group.

Serratus anterior plane block versus thoracic epidural block in patients undergoing thoracotomy: a randomized double-blind trial

Background & Objective: Standard pain management technique after thoracic surgery is thoracic epidural analgesia, parentral analgesics and nerve blocks. Thoracic epidural analgesia (TEA) has many known complications, including respiratory depression and urinary retention. Serratus anterior plane block (SAPB) is a simple procedure, which provides postoperative pain relief by blocking the lateral cutaneous branches of T2–T9 spinal neurons. We compared the analgesic efficacy of both of these techniques in thoracotomy patients in this randomized trial.
 Methodology: The study involved 74 cancer patients scheduled for thoracotomy. The patients were randomly divided into two groups. The patients in Group SAPB underwent ultrasound-guided serratus anterior plan block (SAPB) with catheter insertion. The second group (Group TEA) underwent TEA with preoperative indwelling catheter insertion. In both groups blocks were activated before induction of routine general anesthesia (GA) by a bupivacaine bolus dose, then continued as bupivacaine infusion in ICU for postoperative analgesia. Hemodynamic monitoring was started. Intraoperative fentanyl consumption, postoperative morphine consumption, and time to first request for analgesic were noted including MAP in the two groups.
 Results: Both groups were statistically comparable regarding intraoperative fentanyl consumption, postoperative morphine consumption, and time to first request for analgesia in the two groups. Hypotensive episodes were significantly more frequent (P < 0.001) in the TEA group (n = 17; 45.9%) compared to the Group SAPB (n = 2; 5.4%). Ramsey sedation scores (RSS) were comparable in the two groups immediately postoperatively and after 2 h. After 4 h after recovery all patients in both groups had an RSS of 2.
 Conclusion: Ultrasound-guided serratus anterior plane block is associated with reduced intraoperative and postoperative fentanyl consumption, but the Ramsey sedation scores were equivalent in the two groups after recovery and upto 4h.
 Abbreviations: GA: General Anesthesia; PTPS: Post-Thoracotomy Pain Syndrome: RSS: Ramsey Sedation Score; SAPB: Serratus Anterior Plane Block; TEA: Thoracic Epidural Analgesia; VATS: Video-Assisted Thoracoscopic Surgery
 Key words: Pain, Postoperative; Serrataus plane block; Thoracotomy; Ultrasound; Thoracic epidural
 Citation: Gamal RM, Bossily SS, Ali AR, Samy SF, Seif NE, Ahmed HI. Serratus anterior plane block versus thoracic epidural block in patients undergoing thoracotomy: a randomized double-blind trial. Anaesth. pain intensive care 2023;27(3):389−395.
 DOI: 10.35975/apic.v27i3.2243
 Received: March 06, 2023; Reviewed: March 31, 2023; Accepted: April 01, 2023

The use of transforaminal epidural block in patients with herniated discs and radicular pain

Objective. To study the efficacy and safety of transforaminal epidural block (TEB) in patients with herniated intervertebral discs, as well as to compare the results of their treatment with those achieved in patients who were treated with other methods.Material and Methods. The results of treatment of 248 patients with herniated intervertebral discs and persistent radicular pain syndrome, who had indications for surgical treatment, were studied. In 70 cases, the TEB was performed, and in case of its low efficacy (less than 50 % reduction in pain severity), surgical intervention was suggested. In 178 cases, surgical treatment was performed – microsurgical or endoscopic discectomy. The state of patients was followed-up during two years using VAS, Oswestry questionnaire and MRC scale for motor dysfunction in the limb.Results. After 1 month, a decrease in the intensity of radicular pain (by 50 % or more) was determined in the TEB group with a lower frequency (84.3 %) than in the surgical treatment group (93.8 %), without a statistically significant difference (p = 0.526). At the same time, a stable reduction in radicular pain (by 50 % or more) without the need for surgical treatment was achieved in 62.9 % of patients in the TEB group. Also, there was not significant difference in VAS score for local low back pain (p = 0.179) and ODI score (p = 0.348) between groups. After 24 months, the benefits of functional outcomes in the TEB group as compared with the surgical treatment group were confirmed by median ODI (4 [0; 8] vs 12 [4; 20], respectively) and median VAS for low back pain (0 [0; 1] vs 1 [0; 3], respectively), p < 0.001. A significant (50 % or more) decrease in VAS score for radicular pain was achieved in all patients of the TEB group, while in the surgical treatment group – in 88.8 % (p > 0.05). In the TEB group, a stable analgesic effect without subsequent surgical intervention was achieved in 42 (60.0 %) patients, and the number of repeated surgical interventions performed for various reasons was significantly lower (p = 0.001), with a comparable incidence of disc herniation recurrence among operated patients who required repeated surgical treatment (p > 0.05).Conclusion. The use of transforaminal epidural block (TEB) in the treatment of patients with herniated intervertebral discs at the lumbar level and persistent radicular pain makes it possible to avoid surgical treatment in 62.9 % of patients in the short term, and in 60.0 % during two year follow-up after the procedure, while maintaining a high quality of life.

Effect of Epidural Block in the Incidence of Postherpetic Neuralgia: A Population-Based Matched-Cohort Study.

Incidence of postherpetic neuralgia (PHN) increases with age. Epidural block in patients with herpes zoster (HZ) is expected to decrease the risk of PHN. The purpose of this study was to evaluate the effectiveness of epidural block on PHN incidence in a population-based study. This was a retrospective matched cohort study and data were sourced from the Korean National Health Insurance Service. The study cohort comprised 427 patients diagnosed with HZ who received epidural block within 30 days after a diagnosis of HZ. The matched control cohort included 427 patients without epidural block and were randomly matched to the study cohort at a 1:1 ratio based on covariates such as sociodemographic factors. The log-rank test was used to assess differences in the incidence of PHN. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) for subsequent PHN, while controlling for potential comorbidities. Among the 854 sampled patients, 30 (7.03%) from the study cohort and 18 (4.22%) from the match-control developed PHN during follow-up. There were no significant differences in the incidence of PHN between the two cohorts (p=0.08). Cox proportional hazard regressions showed that the HR for PHN in patients with epidural block was 1.66 (95% confidence interval, 0.91-3.02; p=0.10). Our study indicates that epidural block did not effectively prevent PHN. However, further studies are needed to determine the effect of epidural block in patients with HZ for the prevention of PHN.

Abstract No.: ABS0738: Comparison of Analgesic Effect of Ropivacaine Versus Ropivacaine with Dexmedetomidine Used for Caudal Epidural Block in Patients Undergoing Lumbosacral Spine Surgery Under General Anaesthesia; A Randomised Double Blind Interventional Study

Background & Aims:Challenging aspect of spine surgery is to provide extended postop analgesia.In this study we aimed to determine the analgesic effects of Dexmedetomidine as an adjuvant to Ropivacaine versus Ropivacaine alone for caudal epidural block in patients undergoing lumbosacral spine surgery under general anaesthesia.Methods:Hospital based, prospective, randomized double blind interventional study. A sample of 30 cases in each group was adequateat 95% confidence and 80% power to verify the expected minimum difference of 0.8(±0.7) in VAS score at 8 hourspostoperative period in both groups. Patients were divided in two groups.Group A: (n=30):patients received 18 ml of 0.2% Inj. ropivacaine with 2 ml of normal saline in caudal epidural space.Group B: (n=30): patient received 18 ml of 0.2% Inj. ropivacaine with 2 mL (1 µg/kg) of Inj. dexmedetomidine in caudal epidural space.Results:There were no statistically significant difference observed with respect to demographic data (age, sex, weight), ASA, haemodynamic parameters, sedation and side effects in both groups.The time to first rescue analgesia was significantly prolonged(hours) (mean±SD) in Group B (25.00±4.33) as compared to Group A (15.13±1.74) with P value <0.001. Mean VAS scores were significantly lower in Group B as compared to Group A at 4,8 and 12 hours postoperatively with P value <0.001Conclusion:Inj. Dexmedetomidine 1 µg/kg added to 0.2% ropivacaine provided longer postoperative analgesia than 0.2% ropivacaine alone.Hence we concluded that Dexmedetomidine is an effective analgesic as an adjuvant to 0.2% ropivacaine in caudal epidural blockGroup AGroup BResult (P) MeanSDMeanSDJust after extubation0.000.000.000.00-30 min0.000.000.000.00-1 h0.000.000.000.00-2 h0.000.000.000.00-4 h0.330.480.000.00P<0.001(S)8 h1.500.630.030.18P<0.001 (S)12 h3.130.781.000.87P<0.001 (S)24 h0.530.512.371.79P<0.001 (S)Time of rescue analgesia (h)

Clinical utility of epidural volume extension following reduced intrathecal doses: a randomized controlled trial

Background and objectivesEpidural Volume Extension (EVE) involves instillation of normal saline into the epidural space soon after an intrathecal injection, with the aim to augment the sensory block height. Its clinical relevance lies in the possibility of using reduced intrathecal dose and yet achieving the desired sensory block level. Intrathecal dose is a known determinant of the level of sensory block. Whether EVE is dependent on intrathecal dose is not known. MethodsWe conducted a randomized, controlled, double-blind study to compare the maximum sensory level (Smax) achieved with or without application of EVE to two different reduced intrathecal doses. Eighty four adult male patients of ASA status I or II with body weight between 50–70kg and height in the range of 150–180cm, scheduled for orthopedic lower limb surgery using combined spinal epidural anesthesia were randomized to receive, either intrathecal dose (5 or 8mg) with or without EVE, in accordance to group allocation. ResultsSmax was lowered by application of EVE to 5mg intrathecal bupivacaine (T8.9±4.3 vs. T6.4±1.9 with and without EVE respectively; p = 0.030). Smax was similar when EVE was applied to 8mg intrathecal bupivacaine than without it (T5.8±1.8 vs. T6.4±2.2 respectively; p= 0.324). ConclusionEVE should not be applied to 5mg plain bupivacaine during a combined spinal epidural block in patients undergoing lower limb orthopedic surgery as it may result in a decrease in the maximum sensory level.

Comparison of intraoperative hemodynamic stability between quadratus lumborum and epidural block in patients who underwent laparoscopic nephrectomy

Laparoscopic nephrectomy has become the standard procedure for living donor renal transplant in Indonesia. The anesthesia technique used for this procedure is general anesthesia combined with regional anesthesia. Among many techniques available, epidural block is often performed. This study aims to compare hemodynamic stability between Quadratus Lumborum (QL) block, as a new alternative block, and epidural block for laparoscopic nephrectomy. Patients were randomized to receive epidural block (n=13) or QL block (n=13) for intraoperative analgesia during laparoscopic nephrectomy. Patients in epidural group received continuous bupivacaine 0.25% infusion 6 ml/hours and patients in QL group received 20 ml of bupivacaine 0.25% bilaterally. Hemodynamic variables consisting of mean arterial pressure (MAP), heart rates (HR), as well as fentanyl consumption between the two groups were compared. There were significant differences in intraoperative MAP between epidural block group and QL block group (p = 0.001). However, there were no significant differences in HR (p = 0.114) and fentanyl consumption (p = 0.593) between two groups. QL block produced a relatively steadier MAP compared to epidural block; however intraoperative HR and fentanyl consumption between two groups had no significant difference.

Unilateral Epidural Blockade for Lower Limb Fracture Surgery: Parasagittal Epidural Versus Midline Epidural Anesthesia.

Objective:To compare the efficacy of parasagittal interlaminar (PIL) and midline interlaminar (MIL) approaches for epidural block in patients with lower limb orthopedic surgery. Methods:This double-blind randomized clinical trial was performed on 40 patients undergoing tibial shaft fracture surgery. In PIL group, an 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L2-3 or L3-4 intervertebral spaces and pushed forward in a posteroanterior (PA) direction vertical to the body surface. After determining the most lateral place for needle arrival in an anteroposterior (AP) view, needle was pushed forward into the epidural space. For the MIL group, needle was pushed forward from the midline interspinous space with the same method. After confirmation of needle position, 1 mL of contrast was injected to confirm the epidural space distribution and then 15 ml lidocaine 2% was injected. The sensory and motor block level, onset, duration, heart rate (HR), mean arterial pressure (MAP), and arterial oxygen saturation (SPO2), and success rate were recorded. Results:Mean patients’ baseline characteristics showed no statistically significant difference between the two groups.p>0.05). Outcome measures were statistically different and significantly higher in PIL group (p-values for sensory block level <0.001, motor block level <0.001, duration of sensory block: <0.001 and duration of motor block <0.001 and success rate: <0.001). Hemodynamic variables didn’t show statistically significant difference between the two groups (p-values for Systolic pressure: 0.997, diastolic pressure:0.579, MAP:0.585, HR:0.710).Conclusion:Epidural anesthesia with parasagittal interlaminar approach provide deep motor block, high sensory level block, and hemodynamic stability.Clinical trial registry: IRCT2017041615515N2

Comparative study between thoracic epidural and ultrasound-guided thoracic paravertebral block in perioperative pain management for mastectomy

Objectives To compare between ultrasound-guided thoracic paravertebral block (PVB) and thoracic epidural block in patients undergoing mastectomy for pain control, intraoperative hemodynamics, and postoperative patient satisfaction. Background Thoracic PVB and thoracic epidural appears promising when combined with general anesthesia in reduction of postoperative pain. Patients and methods Between mid-2016 and December 2017, this prospective clinical study included 60 female patients scheduled for a unilateral mastectomy in Menoufia University Hospitals and divided into two groups, 30 each. Patients in group A were given single shot ultrasound-guided PVB at T4 level using 0.3 ml/kg of 0.5% bupivacaine. Patients in group B were given single shot epidural block at T4 level using 2 ml/segment of 0.5% bupivacaine. Results A total of 60 patients were included, of them, 30 patients received PVB and 30 received thoracic epidural. Heart rate was significantly higher in paravertebral group than in thoracic epidural group (P Conclusion Ultrasound-guided PVB is an effective technique showing greater hemodynamics stability and pain control compared with epidural analgesia for mastectomy.

Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.

Comparison of Postoperative Analgesic Efficacy between Continuous Transversus Abdominis Plane Block, Lumbar Paravertebral and Epidural Blocks after Abdominal Surgeries

Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single-blind study in 120 patients divided into four equal groups, 30 patients in each group. Methods: 120 patients randomly assigned into four equal groups, with 30 patients in each group. Group T received ultrasound-guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received continuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl 1 - 2 μg/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg. At the end of the surgical procedure, we activated the regional block with recording of parameters in the postoperative period each patient was assessed for visual analog scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T, re-garding complications as nausea and vomiting more recorded in epidural than the other two groups. Conclusion: Regarding postoperative analgesic efficacy, the continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there was a higher incidence in epidural group than other two groups.

Comparing epidural block and intercostal block in patients with 3–4 broken ribs following chest cage blunt trauma

Introduction: Pain in trauma patients with injuries due to rib fractures and chest trauma is one of the primary goals of management. Through various methods including oral medications, intravenous and intramuscular and different techniques of regional analgesia such as block intercostal, par vertebral block, and epidural block are performed. This study aimed to compare the efficacy of epidural block and block intercostal among patients with rib fractures. Methods: This study was a randomized, double-blind clinical trial involving 82 patients with fractures of the ribs 4-3 visit to Valiasr Hospital, and no pneumothorax as well as hemothorax was carried out. They were randomly divided into two groups of 41 people intercostal block and epidural blocks. In the first group in the thoracic epidural block, using the Marcaine 0.25% 0.3 cc/kg was given. In the second group, posterior dose 0.2 cc/kg Marcaine 0.25% block was given through intercostal. Results: The mean pain score (vascular-space-occupancy, the pain before surgery) was not significantly different between the two groups with respect to P ≥ 0.05. However, compared to the pain in 15 min, 1 h, 2 h, 12 h, and 24 h after block was significantly different between the two groups, according to P ≤ 0.01 and the pain was lower in the epidural block. In terms of age, sex, and chest X-ray changes, there was no significant difference between the two groups (P ≥ 0.05). Conclusion: The results of our study showed the effectiveness of thoracic epidural block in patients with 3–4 intercostals rib fracture which results in blunt trauma.

The Dynamics of Acute Renal Impairment Markers During a Surgery for Kidney Cancer

The purpose of the study is to investigate the effect of epidural block on the functional state of the kidneys in patients with localized cancer during kidney resection under the conditions of warm ischemia. Materials and methods. We examined 45 patients (25 men and 20 women) with a localized kidney cancer (T1N0M0) aged 56.5±8.7 years. All the patients underwent kidney resection performed under conditions of warm ischemia (15—20 minutes). Patients were divided into 2 groups: the main group (25 subjects) in which the perioperative epidural block was applied and the reference group (20 patients) without the epidural block. The following parameters were tested in blood and urine using the ELISA technique: cystatin C, L-FABP, KIM-1 , IL-18, and GFR. The test was carried out 1 hour prior to surgery, 20 minutes after the warm ischemia stage, and on Days 1 and 3. Based on the baseline cystatin С level, the patients in each group were divided into 2 subgroups: subgroup 1 —cystatin C is 1000 ng/ml and lower; subgroup 2 — more than 1000 ng/ml. The statistical processing of the findings was performed using the Statistica 6.0 software based on the t-test for two independent samples. Differences were considered to be statistically significant at P<0.05. Results . It has been demonstrated that functional parameters of kidneys were recovered to the baseline values by the 3rd day after the kidney resection under the warm ischemia due to perioperative epidural block. Impairment of the tubulointerstitium and glomerular apparatus were observed in the reference group. GFR values in the patients of the main group were within normal limits by Day 3, whereas in the patients of the GFR was lower by 38.8% as compared to the baseline (P<0.05). Conclusion. The use of the perioperative epidural block in patients with localized kidney cancer who underwent the organ resection under the warm ischemia demonstrated the nephroprotective effect, while maintaining the functional parameters of kidneys at the baseline level.

Clinical observation of anesthesia combined with epidural block for patients with COPD surgery

Objective To observation the clinical effect of anesthesia combined with epidural block for patients with COPD surgery.Methods 262 cases with COPD needed to line the chest and abdominal surgery and urology surgery patients.Patients were divided into control group and observation group according to the time sequence,underwent general anesthesia and anesthesia combined with epidural anesthesia,contrast observed in patients with operative time,postoperative extubation time,wake time and the analgesic effect of anesthesia (VAS score) was measured in patients with FVC,FEV1/FVC and FEF25％ to 27％ lung function,clinical efficacy and complication rate of two anesthesia methods.Results The patients extubation time,recovery time and VAS scores were significantly lower than those of control group,the differences were statistically significant(all P ＜0.05).Group of postoperative patients with FVC,FEV1/FVC and FEF25％ to 27％,such as lung function test results were significantly better than those of control group,and the difference was statistically significant (all P ＜0.05).Anesthesia control group total effective rate of 87.0％ observed in patients anesthesia total effective rate was 96.9％.Compared with the control group,the anesthesia clinical effect of the observation group was statistically significant (P ＜0.05).Operative time and postoperative complication rate of the two groups of patients showed no significant difference(P ＞0.05).Conclusion Anesthesia combined with epidural anesthesia used in surgery in patients with COPD can effectively improve the clinical effects of anesthesia,to enhance the safety of anesthesia,which will help the rehabilitation of patients and worth of clinical practice. Key words: Anesthesia, general; Anesthesia, epidural; Pulmonary disease, chronic obstructive

The Prognostic Factors of Selective Transforaminal Epidural Block in Patients with Low Back Pain

Background: Selective transforaminal epidural block (STEB) has showen effectiveness as a diagnostic and therapeutic option for the management of patients with low back pain or sciatica. This study was carried out in order to determine the short-term effects and prognostic fac tors associated with STEB in patients with low back pain or sciatica. Methods: Ninety-seven patients were selectedfor participation in this study. Their diagnosis were based werewason the clinical symptoms and MRI findings. We performed STEB under fluoroscopic guidance and injected 3 ml of radio opaque dye in order to confirm the techn ical success of the procedure. We then injected 20 mg of triamcinolone mixed into 3 ml of 0.5% mepivacaine. One month later, we classified the patient outcomes as excellent, good, moderate or poor, according to the degree o f reduction in VAS score from baseline. The independent variables assessed included symptom duration, block level, number of blocks, primary diagnosis, prior caudal block, anterior epidural space filling of dye, medication history, demographic data, radiating pain, back surgery and spondylolisthesis. Results: At a mean follow-up period of 1 month after STEB, excellent results were noted in the patients diagnosed with herniated lumbar disc (70%), non-specific spondylosis (54%), spinal stenosis (44%), and failed back syndrome (28%). The patients with epidural adhesion and combined spondylolisthesis were associated with poorer outcomes. Combined caudal block, symptom duration and the extent of epidural spread of the drug were not related to the effectiveness of the treatment. Conclusions: Selective transforaminal epidural block is effective in treating patients with radiculopathy, such as herniated lumbar disc, but it isrelatively ineffective in treating patients with structural deformities, such as failed back syndrome and spondylolisthesis. (Korean J Pain 2007; 20: 54�� 59)

Levobupivacaína versus bupivacaína em anestesia peridural para cesarianas: estudo comparativo

JUSTIFICATIVA E OBJETIVOS: O anestésico local bupivacaína é encontrado na forma de dois enantiômeros: levobupivacaína - S (-) e dextrobupivacaína - R (+). Baseado em estudos que demonstram que a cardiotoxicidade é menor com o enantiômero S(-), foi difundido o uso deste agente na prática clínica. Este estudo teve por objetivo comparar a eficácia e a efetividade do uso de bupivacaína racêmica com levobupivacaína em anestesia peridural de pacientes submetidas à cesariana eletiva. MÉTODO: Ensaio clínico aleatório, duplamente encoberto, com gestantes estado físico ASA I e II. As pacientes foram alocadas para receber 20 mL de bupivacaína a 0,5% racêmica ou 20 mL de levobupivacaína a 0,5%, ambas com 10 µg de sufentanil e vasoconstritor. RESULTADOS: Participaram do estudo 47 pacientes, 24 no grupo da levobupivacaína e 23 no grupo da bupivacaína. Os grupos eram comparáveis entre si quanto às características materno-fetais. Decorridos 15 minutos após o término da punção peridural, 62,5% das pacientes do grupo da levobupivacaína tinham Bromage 2 ou 3 versus 72,7% no grupo da bupivacaína (p = 0,83). Aos 20 minutos, 66,7% das pacientes do grupo da levobupivacaína tinham Bromage 2 ou 3 versus 86,3% do grupo da bupivacaína (p = 0,21). A complicação mais freqüente foi a hipotensão arterial, encontrada em 16 (66,7%) pacientes do grupo da levobupivacaína e em 10 (43,5%) pacientes do grupo da bupivacaína (p = 0,11). CONCLUSÕES: A levobupivacaína e a bupivacaína foram igualmente efetivas no bloqueio peridural de pacientes submetidas à cesariana.

Significance of patient-controlled analgesia in combination with continuous epidural block for patients who underwent posterior lumbar surgery.

The purpose of the study was to evaluate the efficiency of patient-controlled analgesia (PCA) combined with continuous epidural block in patients who underwent lumbar spine surgery. In group 1 (postoperative PCA group), 23 patients were administered postoperative continuous epidural block in combination with analgesics, which was self-regulated by the patient using a device. In contrast, the 22 patients in group 2 (control group) received suppositories or intramuscular injections of analgesics on request. The following factors were compared between the two groups: pain relief according to the visual analog scale for pain assessment, the frequency of administration of analgesics, and side effects of the postoperative analgesia. The patients in group 1 had more satisfactory relief of pain according to the visual analog scale for pain assessment and needed suppositories and intramuscular injection of analgesics less frequently on the 1st, 2nd, and 3rd postoperative day. The time spent by nurses on pain management in group 1 was less than that in group 2. No patient had any serious complications in either group. In conclusion, the present patient-controlled method combined with postoperative continuous epidural block could decrease the intensity of postoperative pain and the amount of time spent by nurses on the administration of postoperative analgesics after lumbar spine surgery.