Epidural Group Research Articles

Comparison of percutaneous nephrolithotomy under epidural anesthesia versus general anesthesia: A randomized prospective study.

Introduction:PCNL has revolutionized the treatment of renal calculi putting almost an end to the era of open stone surgery. The procedure can safely be carried out under general anesthesia (GA) or regional anesthesia viz. spinal anesthesia (SA), epidural anesthesia (EA) or combined spinal and epidural anesthesia (CSE).Aims and Objectives:We evaluated the surgical outcome after PCNL in two groups of patients randomly divided to undergo procedure under GA or EA.Patients and Methods:Two hundred and thirty patients with American Society of Anesthesiologists (ASA) score <3 were randomly divided into two groups according to the type of anesthesia: i.e. GA (n=110) or EA (n=120). All patients underwent PCNL in prone position. Puncture was done using Bulls eye technique under fluoroscopic guidance and tract dilated using serial dilators up to 24Fr-28 Fr. Demographics, perioperative and postoperative parameters were noted and data analysed.Results:The two groups were comparable in terms of mean age, distribution of stone location, and stone burden. The stone free rate was 90.9% in GA group and 89.2% in EA group and the difference was statistically insignificant (P= 0.659). The requirement for auxiliary procedures was similar between the two groups. A significant difference in pain score was seen in favor of EA group during early post-operative period (P< 0.05).Conclusion:It seems that PCNL can be performed safely and effectively under regional epidural anesthesia with results comparable to general anesthesia with the added advantage of less immediate postoperative pain and analgesic requirement.

Comparative Study between Ultrasound-Guided Serratus Anterior Plane Block and Thoracic Epidural Analgesia for Breast Surgery

Background: Breast surgery is a common procedure and associated with an increased incidence of acute and chronic pain. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Objective: To compare the difference between the anesthetic effect of thoracic epidural versus serratus anterior plane block in breast surgery. Patients and methods: This study conducted on 60 adult patients scheduled for elective breast surgery divided into three groups. Each group contains twenty patients. Group A (n. 20) received general anesthesia only, Group B (n. 20) received combined general anesthesia and thoracic epidural analgesia, by receiving 6–8 ml of 0.25% bupivacaine and 0.05 mg fentanyl via the epidural catheter and Group C (n. 20) received serratus anterior plane block combined with general anesthesia. Results: The results of the present study demonstrated that SAP block caused hemodynamic stability, decreased the intensity of postoperative pain, reduced postoperative analgesic requirement, prolonged the time needed for the first request of analgesia, Therefore it can be considered as a safe procedure and effective for intraoperative and postoperative pain control in breast surgeries. Also, this study demonstrated that there is no difference between the groups according to nausea and vomiting. Conclusion: SAP block can produce excellent pain relief during the first six postoperative hours. It has a great promise due to its simplicity, easy-to-learn techniques, and relative lack of contraindications and complications.

Comparison of intraoperative and postoperative analgesic properties of ilioinguinal/iliohypogastric and sacral epidural block in pediatric unilateral inguinal hernia operations

Central blocks such as caudal, spinal, and sacral epidural are frequently used in pediatric inguinal surgeries. Furthermore, peripheral blocks have been used and successful results have been obtained in pediatric inguinal surgeries. In this study, we aimed to compare the intraoperative and postoperative analgesic efficacy of the ilioinguinal/iliohypogastric (IL/IH) block under general anesthesia with the sacral epidural block. This study was carried out in Gazi University Faculty of Medicine, Department of Anesthesiology and Reanimation, after obtaining permission from the Ethics Committee of Gazi University Faculty of Medicine and the Central Ethics Committee of the General Directorate of Pharmaceuticals and Pharmacy of the Turkish Ministry of Health, numbered B.10.0.İEG.011.00.01. Sixty patients in the American Society of Anesthesiologists I-II group between the ages of 1 and 8 years who will undergo elective unilateral inguinal hernia operation under general anesthesia were randomly divided into two groups. Group S (n=30) sacral epidural block and group I (n=30) IL/IH nerve block were planned. Hemodynamic values were found to be statistically significantly lower than control values in both groups. The minimum alveolar concentration values for sevoflurane were statistically significantly lower values in both groups at all surgery periods. In terms of additional analgesic requirement, the group I was found to be statistically significantly lower than the group s at the 8th-12th h. When the first analgesic intake hours were examined, no significant difference was found between the two groups. In our study, group I and group S analgesic efficacy was found to be similar.

Comparative Study between Ultrasound-Guided Serratus Anterior Plane Block and Thoracic Epidural Analgesia for Breast Surgery

Background: Breast surgery is a common procedure and associated with an increased incidence of acute and chronic pain. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Objective: To compare the difference between the anesthetic effect of thoracic epidural versus serratus anterior plane block in breast surgery. Patients and methods: This study conducted on 60 adult patients scheduled for elective breast surgery divided into three groups. Each group contains twenty patients. Group A (n. 20) received general anesthesia only, Group B (n. 20) received combined general anesthesia and thoracic epidural analgesia, by receiving 6–8 ml of 0.25% bupivacaine and 0.05 mg fentanyl via the epidural catheter and Group C (n. 20) received serratus anterior plane block combined with general anesthesia. Results: The results of the present study demonstrated that SAP block caused hemodynamic stability, decreased the intensity of postoperative pain, reduced postoperative analgesic requirement, prolonged the time needed for the first request of analgesia, Therefore it can be considered as a safe procedure and effective for intraoperative and postoperative pain control in breast surgeries. Also, this study demonstrated that there is no difference between the groups according to nausea and vomiting. Conclusion: SAP block can produce excellent pain relief during the first six postoperative hours. It has a great promise due to its simplicity, easy-to-learn techniques, and relative lack of contraindications and complications.

Effect of auricular magnetic bead pressing on maternal body temperature, inflammatory response and placental pathological results in labor analgesia

To observe the effects of auricular magnetic bead pressing on maternal body temperature, inflammatory response and placental pathological results in epidural labor analgesia. 180 parturient who volunteered for labor analgesia were randomly divided into epidural group (n=90, epidural labor analgesia) and auricular pressing group (n=90, epidural labor analgesia combined auricular pressing). The tympanic temperature before labor analgesia (T1), 2 h (T2), 4 h (T3) and 4 h after labor analgesia (T4) were recorded. The total duration of labor, duration of labor analgesia, PCEA compression times, labor analgesia dose, cesarean section rate was counted, and the changes in serum IL-6 level and placental pathologyresults of the two groups were analyzed. There was no significant difference in age, BMI, gestational age, duration of labor, duration of analgesia and rate of cesarean section between groups(P>0.05). Times of PCEA compressions and labor analgesic dose in auricular group were lower than that in epidural group (P<0.05). There was no difference in tympanic temperature between two groups at T1 (P>0.05), and the tympanic temperature at T3 and T4 was higher than that at T1 (P<0.05). The tympanic temperature in T3 and T4, and incidence of intrapartum fever in the auricular group was lower than that in the epidural group (P<0.05).There was no difference in the prenatal serum IL-6 level between groups (P>0.05), and the postpartum serum IL-6 level was higher than that before labor in either group (P<0.05).The postpartum serum IL-6 level and the incidence of HCA in the auricular point group were lower than those in epidural group (P<0.05). Magnetic beads auricular pressing therapy has advantages in reducing intrapartum fever by modulating maternal inflammation and reducing the dosage of local anesthetics effectively during epidural labor analgesia.

To study the effect of epidural analgesia on second stage of labor and mode of delivery

Epidural analgesia is regional anaesthesia that blocks pain in a particular region of the body. The use of epidural analgesia (EA) in labor is widespread in modern labor ward practice, and its benefits in terms of pain relief are well-recognized. Aims: To study the effect of epidural analgesia on second stage of labor, maternal and neonatal outcomes and its efficacy in labor. Study Design: This is Prospective Cohort Study was carried at Dr. L. H. Hiranandani Hospital. All the women admitted in labour room for delivery were divided into 2 groups. Case Group: Included 84 women who opted for epidural analgesia. Control Group: Included 90 women who did not take epidural analgesia. Results: The 2nd stage of labor in epidural group was 54.61 (± 37.24) mins and 37.36 (± 26.79) mins in the non epidural analgesia group. By using unpaired t-test, it was found that the data was significant (p=0.032). The incidence of caesarean section in the epidural group was 16.66% and the in non-epidural group was 12.22%. It was observed that epidural analgesia did not increase the rate of instrumental delivery or caesarean section. The mean VAS Score before epidural analgesia was 6.2 (± 1.07) whereas it was 3.95 (± 1.46) after epidural analgesia. On applying Wilcoxon Matched Pair test, it was found that the pain was reduced significantly in the mothers after receiving the epidural analgesia. Conclusion: Epidural analgesia can be safely recommended as a method of labor analgesia. Epidural analgesia has no significant adverse effects on maternal and neonatal outcomes Keywords: Epidural analgesia, VAS – Visual analogue score, 2nd stage of labour, Caesarean sect.

The effects of epidural analgesia in normal labor

Introduction: Labor pain is the most severe pain a women would experience and several treatment modalities have been adopted since decades. Labor analgesia using epidural technique is considered as the efficient and effective treatment options available. Parturients in India especially rural areas are less aware regarding labor analgesia using epidural technique. Aim: To study the effects of labor analgesia using epidural technique in nulliparous women. Materials and Methods: Sixty full term nulliparous women with singleton vertex pregnancy were made aware of labor analgesia using epidural technique and included, those willing were grouped epidural(n=30), those not keen were grouped control(n=30). In 1st stage labor, parturients in epidural group received bupivacaine and fentanyl, whereas in control group received intramuscular Inj. tramadol, and Inj. pethidine if needed. Duration of 1st and 2nd stage labor, pain relief, maternal satisfaction, adverse effects, instrumental deliveries, 1st and 5th minute Apgar score and NICU admission were recorded. Results: The mean duration of first stage labor was shorter (p=0.071) in epidural group (250.17±106.33 minutes) compared with control group (302.0±111.99 minutes) and statistically insignificant prolongation (p=0.892) (18.73±6.82 minutes) of 2nd stage labor as compared to control (18.33±14.53 minutes). Pain relief in epidural group was statistically significant (pst (p=0.306) and 5th minutes (p=1.00), NICU admission rate were statistically insignificant (p=0.143) between groups. Conclusion: Labor epidural analgesia using Inj.bupivacaine and Inj.fentanyl provides good pain relief, safe for mother and baby. It does not affect labor duration, instrumental delivery rate or neonatal outcome. Keywords: Labor analgesia, Epidural, Bupivacaine, Fentanyl, Labor stages, Apgar score, NICU admission.

Comparison of epidural technique with combined spinal epidural technique for labor analgesia

Introduction: For pain relief during labor, regional analgesia is considered the most preferred technique; nevertheless the best method is yet to be determined. We carried out a randomized study to assess efficacy, safety & maternal satisfaction with standard epidural and combined spinal epidural (CSE) analgesia technique among 40 primigarvida. Materials and Methods: Healthy primigarvida in labor having cervical dilatation between 3 to 5 cm were assigned randomly to receive either epidural or CSE for labor analgesia. Analgesia was established in Epidural group with 12ml of 0.0625% bupivacaine added with 2µg/ml fentanyl & in CSE group with intrathecal injection of 2.5mg 0.5% heavy bupivacaine plus fentanyl 25µg (total 2 ml). In both groups whenever patient’s VAS>3, 2nd dose was given in form of epidural bolus 10ml 0.0625% bupivacaine + 2µg/ml fentanyl, followed by infusion of same concentration at 8 ml/h. Results: The onset of labor analgesia was significantly faster in CSE group (5.5±1.9 vs. 13±5.9 minutes, p

Liposomal Bupivacaine Decreases Postoperative Length of Stay and Opioid Use in Patients Undergoing Radical Cystectomy

To analyze differences in length of stay, opioid use, and other perioperative outcomes in patients undergoing radical cystectomy with urinary diversion who received either liposomal bupivacaine (LB) or epidural analgesia. This was a single center, retrospective cohort study of patients undergoing open radical cystectomy with urinary diversion from 2015-2019 in the early recovery after surgery (ERAS) pathway. Patients received either LB or epidural catheter analgesia for post-operative pain control. LB was injected at the time of fascial closure to provide up to 72 hours of local analgesia. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative opioid use, time to solid food, time to ambulation, and direct hospitalization costs. Multivariable Cox proportional hazards regression was used to determine associations between analgesia type and discharge. LB use was independently associated with shorter post-operative length of stay compared to epidural use (median (IQR) 4.9 days (3.9-5.8) vs 5.9 days (4.9-7.9), P<.001), less total opioid use (mean 188.3 vs 612.2 OME, P <.001), earlier diet advancement (mean 1.6 vs 2.4 days, P <.001), and decreased overall direct costs ($23,188 vs $29,628, P <.001). 45% of patients who received LB were opioid-free after surgery, none in the epidural group. On multivariable Cox proportional hazards regression modeling, LB use was independently associated with earlier discharge (HR 2.1, IQR 1.0-4.5). Use of LB in open radical cystectomy is associated with reduced LOS, less opioid exposure, and earlier diet advancement.

General Versus Regional Anesthesia for Emergency Cesarean Delivery in a High-volume High-resource Referral Center: A Retrospective Cohort Study.

ObjectiveThe choice of anesthesia for emergency cesarean delivery (CD) is one of the most important choices to make in obstetric anesthesia. In this study, we examine which type of anesthesia was used for emergency CD in our hospital, and how the choice affected the time from entry to the operation room until incision (TTI), time until delivery (TTD), and maternal/neonatal outcomes.MethodsRetrospectively, we examined all emergency CD’s performed in Shaare Zedek Medical Center between January–December 2018. Results: 1059 patients met the inclusion criteria, of which 7.7% underwent general anesthesia (GA), 36.2% – conversion from labor epidural analgesia to surgical anesthesia, 52% – spinal anesthesia and 4.1% – combined spinal epidural. We did not find a significant difference between the GA and conversion epidural groups in terms of TTI or TTD. Nevertheless, GA was found to be correlated to a high rate of blood-products requirement and ICU admission. The rate of newborns with an APGAR score of less than 7, in both first and fifth second after birth, was significantly higher in the GA group, as well as the need for NICU admission.ConclusionThis study clearly emphasizes that the TTI are shortest when using GA or conversion of labor epidural analgesia to surgical anesthesia. Meanwhile, GA is also linked to higher rates of admissions to ICU as well as poorer neonatal outcomes compared to the other groups. Additionally, our study uncovered a low rate of GA, and relatively low rate of regional anesthesia failure, which meets the accepted standards.

The Effect of Perioperative Lidocaine Infusion on Postoperative Pain and Postsurgical Recovery Parameters in Gynecologic Cancer Surgery.

The primary objective of this prospective nonblinded randomized study was to investigate the effect of perioperative systemic lidocaine infusion on pain control after major gynecologic oncology surgery. Patient-reported outcomes, postoperative recovery parameters, and complications were secondary endpoints of the study. Seventy-five patients with American Society of Anesthesiologists I-III were divided into 3 groups based on perioperative analgesia methods-(1) opioid group: patient-controlled analgesia (PCA) with morphine; (2) lidocaine group: perioperative intravenous lidocaine infusion, plus PCA with morphine; and (3) the epidural group: PCA with bupivacaine. The Visual Analog Scale (VAS) was recorded postoperatively. In addition, nausea-vomiting, time to first oral intake, time to first ambulation, time to first flatus, and length of hospital stay were recorded. VAS scores (rest) at 24 hours and VAS scores (cough) at 12 and 24 hours were significantly lower in the epidural group than in the opioid group (P<0.05). VAS scores were found to be similar between the lidocaine and epidural group. The nausea-vomiting incidence was lower in the lidocaine group than in the opioid group (P˂0.05). Compared with the other 2 groups, the first flatus time was shorter in the lidocaine group (P<0.05). Perioperative lidocaine infusion is effective as epidural analgesia, which is often advocated as the gold-standard analgesic technique for abdominal surgery and is superior to the others in terms of time to first flatus and the incidence of nausea-vomiting.

The influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study

BackgroundEpidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data. MethodsWe included healthy parturients at a cervical dilation ≥2 cm, with or without a request for epidural analgesia (n=32 per group). Ultrasound studies of the uterine arteries, umbilical artery and fetal middle cerebral artery were performed before insertion of the epidural catheter, and 30, 60 and 90 min after; the same time-points were assessed in the non-epidural control group. Maternal blood pressure was measured by a continuous non-invasive arterial pressure monitor. ResultsUltrasound studies detected no significant differences in pulsatility indices over time in any blood vessel. In contrast to the control group, maternal blood pressures were significantly lower for all measures after the onset of analgesia compared with baseline values (mean systolic pressure decreased from 132.7 ± 15.9 mmHg to 123.1 ± 14.4 mmHg at 30 min, P=0.003). The mean pH value of the umbilical arterial blood was 7.29 (±0.06) in the epidural group versus 7.31 (±0.08) in the control group (P=0.33). The median Apgar score at 5 min was 10 in both groups. ConclusionsPre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.

A Randomized Study Comparing the Efficacy of Ultrasound Guided Lumbar Plexus Block and Epidural Anesthesia for Postoperative Analgesia in Patients Undergoing Total Hip Replacement.

Patients undergoing total hip replacement (THR) experience severe postoperative pain. The advantage of pain relief by continuous epidural anesthesia (CEA) is offset by various adverse effects. Ultrasound guided (USG) continuous lumbar plexus block (LPB) has emerged as an alternative approach for postoperative analgesia in patients undergoing THR, especially where epidural is difficult or contraindicated. This randomized controlled trial compared USG-LPB with CEA for postoperative pain relief until 48 hours in patients undergoing THR, with 0.5% ropivacaine (15 mL) used as boluses for both CEA and LPB. The mean time to the first bolus was 380.60 ± 77.66 min in the LPB group whereas it was 307.40 ± 83.60 min in the epidural group (P = 0.002). Thus, patients in the LPB group took more than one hour longer than the epidural group to take their first bolus, which is clinically meaningful besides being statistically significant. The pain score on movement was also significantly lower, and patient satisfaction higher, in the LPB group. There were no significant intergroup differences about motor power, pain at rest, total ropivacaine consumption, and adverse effects. USG-LPB is an effective alternative to CEA combined with general anesthesia for postoperative analgesia after THR.

Ultrasound increases the success rate of spinal needle placement through the epidural needle during combined spinal-epidural anaesthesia: A randomised controlled study.

Combined spinal-epidural anaesthesia (CSEA) using a needle-through-needle technique is currently widely used. However, successful epidural needle placement does not mean a successful spinal needle placement during CSEA. Whether ultrasound assistance could increase the first-pass success rate of spinal needle placement for CSEA remains unknown. The aim of this study was to investigate if ultrasound assistance could increase the first-pass success rate of spinal needle placement through the epidural needle during CSEA performed by experienced anaesthesiologists in patients undergoing caesarean section. A prospective, randomised, double-blind study. Single centre, Department of Anaesthesiology, Shengjing Hospital, China Medical University, China, from June 2019 to September 2019. A total of 185 patients (aged 24 years to 52 years, American Society of Anesthesiologists grade (ASA) II-III, 38 to 40 weeks gestation) scheduled to undergo elective caesarean section under CSEA were enrolled. The patients were randomised to either an ultrasound group (patients received a preprocedural ultrasound scan, and the puncture site was identified by ultrasound imaging) and a palpation group (patients received a sham procedural ultrasound scan, and the puncture site was identified by conventional palpation). The primary outcome measure was the first-pass success rate for spinal needle placement through the epidural needle. Secondary outcome measures were total duration of CSEA, time required for successful epidural needle and spinal needle placement, number of epidural needle redirections and complications. Preprocedural ultrasound imaging significantly increased the first-pass success rate of spinal needle placement through the epidural needle compared with conventional palpation (93.8 vs. 68.8%, P < 0.001). Preprocedural ultrasound imaging also decreased the total duration of CSEA (186.9 ± 37.1 vs. 213 ± 60.4 s, P = 0.0015) and the time required for successful spinal needle placement (78.3 ± 22.9 vs. 100.1 ± 53.7 s, P < 0.01) compared with conventional palpation. Fewer patients in the ultrasound group needed epidural needle redirections during the spinal needle placement procedure than in the palpation group (four patients vs. 20 patients, P < 0.01). For experienced anaesthesiologists, preprocedural ultrasound imaging significantly increased the first-pass success rate of spinal needle placement through the epidural needle for obstetric patients undergoing caesarean section under CSEA. chictr.org.cn, identifier: ChiCTR1900024132.

Neuroaxial methods analgesia of labour

The aim of study is a comparative evaluation of the efficacy and safrty of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief.&#x0D; Material and methods. Four groups of 40 women tookpart in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia. The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia. The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative inluence of the anesthesia, the effect of analgesia on the fetus were also registered.&#x0D; Results. Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an inrease in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealrd. There were no cfses with score of 2 of Bromage scale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of 1 and 2 were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia.&#x0D; Conclusion. Neuroaxialmethods provide a sufficient level of analgesia can reduse anomalies of labor and do not affect negatively the fetus. All presented methods of analgesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.

Assessment of Inflammatory Markers in the Epidural Infusion of Bupivacaine-Fentanyl Compared to Morphine Bolus Injection in Gastrointestinal Cancer Surgeries

Background: Gastrointestinal surgery is one of the procedures that result to produce inflammatory reactions and pain to patients. Administrate of high-safe analgesia in surgery is very essential, to reduce pain and improve inflammatory reactions. Objectives: The present study compared inflammatory markers and pain relief with the epidural infusion of bupivacaine-fentanyl and intravenous morphine bolus in gastrointestinal cancer surgeries. Methods: This randomized control clinical trial study was carried out from December 2018 to October 2020, on ASA I and II patients aged between 30-80 years who referred for gastrointestinal cancer surgery. Cases were randomly distributed into two groups. Group I received epidural catheter with bupivacaine (18 cases), and group II received fentanyl and morphine bolus injection (18 cases). On the first and second days post-operation, data on pain scores based on visual analogue scale (VAS) score, inflammatory markers (procalcitonin [PCT] and C-reactive protein [CRP]), platelet (PLT), white blood cells (WBCs), and erythrocyte sedimentation rate (ESR) was recorded. Results: The mean age was 52.21±16.13 years (41.6% male, 58.4 female). The mean of ESR, CRP and PCT postoperative were significantly higher than preoperative (P 0.05). The mean of pain was less in the epidural group than in the morphine group postoperative (P = 0.02). Conclusion: The results showed that epidural fentanyl-bupivacaine infusion was more effective in pain reduction than the intravenous infusion of morphine in cases undergoing gastrointestinal cancer operation. However, both analgesic approaches were similar in inflammatory functions.

Comparison of regional analgesia techniques for pleurodesis pain in pediatric patients.

Mechanical pleurodesis can prevent recurrence of spontaneous pneumothorax but is associated with significant postoperative pain. Adequate pain control is not only beneficial for patient comfort but also critical for mobilization and pulmonary recovery. Thoracic epidural catheters and paravertebral blocks have been used to alleviate pain after thoracoscopic surgery. However, no studies have evaluated the safety and efficacy of paravertebral block vs epidural analgesia vs no block in children undergoing pleurodesis. In this retrospective case series review, data were extracted from a single institution's integrated patient outcome database on children who underwent thoracoscopic pleurodesis from 2013 to 2018. Demographics, operative indication, procedure performed, and perioperative pain management were assessed by chart review. Patients whose operation was converted to thoracotomy, who had an underlying diagnosis of chronic pain, or who underwent pleurodesis for other indications were excluded. The primary outcomes were postoperative pain scores and opioid consumption. Secondary outcomes included psot anesthesia care unit length of stay, hospital length of stay, functional outcomes during recovery, and any adverse events. 66 patients met inclusion criteria: 23 received thoracic epidurals, 34 received paravertebral blocks, and 9 received no epidural/paravertebral block. Patient characteristics did not significantly differ among groups. Although mean pain scores were statistically significantly lower in the epidural group on post-op day 1, all three groups' pain scores were in the 1 to 3 out of 10 range during the entire postoperative period. Thus, this statistical significance had little clinical significance as all groups had good pain control. The epidural group had significantly lower opioid consumption on post-op days 0 - 2 compared to paravertebral block. No adverse events related to epidural or paravertebral block were noted. We present the an analysis of epidural vs paravertebral block (with comparison to no regional analgesia) following pleurodesis in children. Pain is well managed, regardless of the method; however, additional systemic opioid consumption was decreased in the epidural analgesia cohort. Prospective trials and comparisons with other analgesic techniques for pediatric thoracic surgeries are needed. Thoracic epidural analgesia offers a reduction in opioid use in the first two post-op days after pleurodesis but did not produce a clinically significant reduction in pain scores in comparison with paravertebral block or no block.

In Response.

We would like to thank Professor Steer1 for his letter in response to our editorial regarding epidural-related maternal fever (ERMF).2 He quite rightly points out that there is indeed an association between incidence of ERMF and duration of epidural local anesthetic infusion. The majority of studies have reported the development of ERMF within 6 hours of onset of labor epidural analgesia.3 This time appears to be consistent with the recently described immunomodulatory effects, which are likely to occur in relation to local anesthetic–mediated changes.4,5 However, we believe the association between duration of local anesthetic infusion is a relatively minor contributor to the incidence of ERMF, compared to the presence or absence of epidural analgesia itself. There is likely to be some difference in temperature (and therefore ERMF incidence) between patients experiencing exposure times of 8 vs 12 hours of labor epidural analgesia, for example. However, the greatest determinant of development of ERMF still remains the use or absence of labor epidural analgesia utilization. For example, using data from the original article describing ERMF by Fusi et al,6 the difference in temperature between 8 and 12 hours in women receiving labor epidural analgesia was 0.5°C (37.3°C vs 37.8°C).6 However, the greatest difference was still seen between the nonepidural and epidural groups at each time point (0.7°C at 8 hours and 1.1°C at 12 hours). Similarly, in a large randomized controlled trial of early versus late epidural initiation, Wang et al7 found no difference in temperature in the 2 groups, despite large differences in epidural exposure (4.8 vs 12.6 hours).7 Therefore, we would like to acknowledge the relationship between duration of labor epidural infusion and ERMF; however, the greatest determinant remains the presence or absence of labor epidural usage when used for durations in the clinical setting. Pervez Sultan, MBChB, FRCA, MD (Res)Department of Anesthesiology, Perioperative and Pain MedicineStanford University School of MedicineStanford, California Scott Segal, MDDepartment of AnesthesiologyWake Forest University School of MedicineWinston-Salem, North Carolina

Inflammatory and oxidative alterations of water immersion and epidural analgesia during the labor

Objective: Water immersion and epidural analgesia are both pain relief methods used to perceive less pain during the labor process. There are concerns about the maternal and fetal outcomes, although studies presented no significant complication directly related to these methods. We aimed to compare the IL-1 and 6 levels, Total serum oxidant (TOS), antioxidant (TAS) and catalase levels of births with epidural analgesia, water immersion and conventional birth without analgesia.&#x0D; Material and Methods: A total of 88 patients were included in the study (The water immersion group included 29 patients, while the epidural analgesia and control group included 30 and 29 patients respectively). Umblical cord IL-1, IL-6, catalase, TAS, TOS levels, neonatal Apgar scores, duration of birth process and demographic data were compared between three groups&#x0D; Results: There was no significant difference between the three groups in terms of age, Body mass index (BMI), gravidity, parity, gestational week, and birth weight (p&gt;0.05). TOS and IL-6 levels were significantly lower in epidural group than others (p=0.031, p=0.019 respectively). Apgar scores were significantly lower in epidural group (p&lt;0.001).&#x0D; Conclusion: The water immersion and epidural analgesia were found to have no adverse effect on oxidative status and infection parameters of women.

Importance of neuroaxial methods of analgesia in modern obstetric practice

The aim of the study is a comparative evaluation of the efficacy and safety of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief. Material and methods . Four groups of 40 women took part in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia, The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia.The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative influence of the anesthesia, the effect of analgesia on the fetus were also registered. Findings . Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an increase in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealed. There were no cases with score of ‘2’ of Bromagescale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of ‘1’ and ‘2’ were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia. Conclusion . Neuroaxialmethods provide a sufficient level of analgesia can reduce anomalies of labor and do not affect negatively the fetus. All presented methods of anesthesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.