Epidural Infusion Research Articles

Application of dural puncture epidural technique for labor analgesia

Objective: To investigate the effects of dural puncture epidural technique for labor analgesia on mothers and neonates. Methods: From January to June 2019, one hundred healthy and nulliparous women, scheduled for elective labor analgesia in the Second Affiliated Hospital of Wenzhou Medical University, met inclusion criteriaand were recruitedin this prospective study. The inclusion criteria are as follows: American Society of Anesthesiologists physical statusⅠorⅡ, New York Heart Association gradeⅠorⅡ,150-175 cm in height,50-90 kg in weight and 37-45 weeks of gestation. They were randomly divided into epidural analgesia group(group P, n=50)and dural puncture epidural group(group D, n=50) by using random number table. Parturients in group D received epidural catheterization immediate after successful epidural puncture, while parturients in group P received a single dural puncture into subarachnoid space with a 27 gauge needle (successful puncture: outflow of cerebrospinal fluid) before epidural catheterization. Epidural labor analgesia was performed with epidural infusion of 0.1% ropivacaine plus 0.25 μg/ml sufentanil in both groups. The VAS scores were evaluated at the following time points: before epidural infusion, each uterine contraction within 30 min after infusion, 30 min, 60 min and 90 min after infusion and withdrawal of infusion. Labor process, mode of delivery, cases of increased oxytocin using, effective PCA pressings, sufentanil and ropivacaine dosages, complications of analgesia, neonatal status were recorded, as well. Results: There were no significant differences in labor duration, mode of delivery, analgesia complications (nausea and vomiting, itching, headache after delivery and Bromage score for motor block), deceleration of fetal heart rate and neonatal Apgar score between the two groups (P>0.05). The number of effective PCA pressings, sufentanil dosage, ropivacaine dosage and cases of increased using of oxytocin were significantly more in group P(t=8.663,7.024,6.509,χ(2)=4.159,all P<0.05), with (8.6±2.5) times, (29±4) μg,(105±15) mg,28% in group P, compared with (4.6±2.1) times,(23±4) μg,(88±12) mg,10% in group D, respectively. The first four VAS scores of uterine contraction after analgesia in group P(VAS=7.9±1.1,6.8± 0.9, 5.6±0.8, 4.5±0.8)were significantly higher than those in group D (VAS=6.8±0.7,4.7±0.8,3.5±0.8,2.9±0.7,t=5.966,12.332,13.125,10.643,all P<0.05). The VAS scores at 90 min after analgesia and withdrawal of analgesia (VAS=2.7±0.6, 2.9±0.7) in group P were significantly higher than those in group D (VAS=2.4±0.6, 2.5±0.6, t=2.500, 3.068, all P<0.05). Conclusion: Compared with traditional epidural technique, dural puncture epidural technique can provide a rapid and effective analgesia with less analgesics, but without increasing adverse effects on mother and infant.

Anaesthesia for Mitrofanoff Procedure in a young male patient with exstrophy-epispadias complex

Purpose: One of the most challenging tasks of an anaesthesiologist is intraoperative and postoperative pain management. The exstrophy-epispadias complex is a congenital distortion not only of the genito­urinary system but also the muscles of the wall of the abdomen and structures of the pelvis. The focus of surgical repair remains on bladder reconstruction and its surrounding structures with cosmesis and a better quality of life. Features: A twenty-year-old male, known case of exstrophy-epispadias complex, presented for Mitrofanoff repair for recurrent urinary tract infections. This case report highlights the use of lumbar epidural infusion of local anaesthetic bupivacaine and opioid fentanyl with general anaesthesia for Mitrofanoff procedure in urinary bladder exstrophy-epispadias surgery. Conclusion: Regional anaesthesia along with general anaesthesia has advantages such as decreased use of anaesthetic drugs intraoperatively, better haemodynamics, effective analgesia both intraoperatively and postoperatively. Although there have been differences in opinion on the usage of opioids in epidurals, it has been shown to facilitate early gastric motility, better analgesia and better recovery profiles.

The Effect of Epidural Magnesium Sulfate as An Adjuvant to Fentanyl for Postoperative Analgesia after Lower Limb Orthopedic Surgery

Background Magnesium, a physiological antagonist of calcium and N-methyl-D-aspartate receptors (NMDA), has a role in the prevention of pain in patients undergoing surgeries. Patients and Methods A prospective randomized double-blinded controlled study was conducted on 60 patients undergoing lower extremities arthroscopic surgery. Spinal anesthesia was given an epidural catheter inserted prior to surgery for postoperative pain management. Postoperatively, patients were randomly allocated into three equal groups. Group I (S group; n 20 patients) patients received epidural saline at a rate of 1ml/h for 24 hours. Group II (MI; n 20 patients) patients received 50mg magnesium sulfate followed by continuous epidural infusion of 100mg at a rate of 4mg/h. Group III (M II; n 20 patients) patients received 50mg magnesium sulfate followed by 500mg at a rate of 20 mg/h. All patients will be provided an infusion of fentanyl 3 mic/ml at a rate of 10 ml/h) via an epidural catheter. The visual analog score, vital signs, time of the first request for rescue analgesia, motor block, need for supplemental analgesic and adverse effects were recorded in the postoperative period. Results VAS scores were significantly lower in both MI and MII groups as compared with the control group at the 1st hour and the 2nd hour of the postoperative course. Conclusion The addition of epidural magnesium sulfate for postoperative analgesia provided a pronounced significant reduction in postoperative rescue analgesia with no significant difference between the two magnesium doses and minimal side effects. Keywords: Lower extremities, orthopedic surgeries, magnesium sulfate, and epidural.

Efficacy of continuous epidural infusion with epidural electric stimulation compared to that of conventional continuous epidural infusion for acute herpes zoster management: a retrospective study

BackgroundContinuous epidural infusions are commonly used in clinical settings to reduce the likelihood of transition to postherpetic neuralgia via pain control. The purpose of this study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion in which the catheter is guided by electric stimulation to areas with neurological damage for the treatment of zoster-related pain and prevention of postherpetic neuralgia.MethodsWe analyzed the medical records of 114 patients in this study. The patients were divided into two groups: contrast (conventional continuous epidural infusion) and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2 and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure.ResultsAfter adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. After adjustment, the odds of complete remission were 1.9-times higher in the stimulation group than in the contrast group (95% confidence interval [CI]: 0.81–4.44, P = 0.14). Patients in the contrast group were significantly more likely to require other interventions within 6 months of the procedure than patients in the stimulation group (odds ratio: 3.62, 95% CI: 1.17–11.19, P = 0.03).ConclusionEpidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in the acute phase of herpes zoster.

Comparative evaluation of continuous epidural infusion of 0.0625% Bupivacaine + 0.0002% Fentanyl and 0.1% Ropivacaine + 0.0002% Fentanyl for labour analgesia

Aim&amp; Objectives: To compare the total dose of Fentanyl and Bupivacaine with total dose of Ropivacaine and fentanyl in terms of total volume delivered-loading, infusion and top ups. Also, to compare Analgesic efficacy (VAS score) and adverse events if any. Methods: 60 ASA physical status I or II parturients in labour who were either primigravidae or gravida 2 were included in a randomized, single blind, prospective study. After a bolus dose of 0.125 % Bupivacaine and 25 mcg Fentanyl, the group BF received a continuous epidural infusion of 0.0625% Bupivacaine and 0.0002% Fentanyl whereas the group RF received a bolus of 0.2% Ropivacaine and 25 mcg Fentanyl followed by an infusion of 0.1% Ropivacaine and 0.0002% Fentanyl. Results: The Group BF and Group RF were comparable with respect to their physical parameters. It was seen that the pain relief in the group BF was excellent for 8 out of 30 patients (26.67%) whereas for the group RF it was excellent for 9 of 30 patients (30%). After that till delivery, both the groups had a comparable mean maternal pulse rate (p value &gt;0.05). None of the parturient in study or control group ever had an episode of bradycardia. Throughout the remaining period of analgesia, the mean foetal heart rate was comparable between the two groups. In the present study groups only 2 parturients from group BF and only one parturient from group RF underwent caesarean section due to foetal distress. 6 parturients (20%) from group BF and 5 parturients (16.67%) from group RF developed hypotension. Conclusion: Continuous infusion of 0.1% Ropivacaine + 0.0002 % Fentanyl provides equipotent labour analgesia and maternal satisfaction as 0.0625% Bupivacaine + 0.0002% Fentanyl infusion can provide.

Comparison of the Analgesic Effect of Ropivacaine with Fentanyl and Ropivacaine Alone in Continuous Epidural Infusion for Acute Herpes Zoster Management: A Retrospective Study.

Background and Objectives: Currently, few studies have reported the effects of opioids during continuous epidural infusion (CEI) to control pain owing to herpes zoster (HZ). This study aimed to retrospectively compare the effectiveness of epidural opioids in the treatment of acute HZ pain. Materials and Methods: We reviewed medical records of 105 patients who were divided into two groups: R group (CEI with ropivacaine) and RF group (CEI with ropivacaine and fentanyl). Clinical efficacy was evaluated using the numeric rating scale (NRS) score for 6 months after the procedures. We compared the percentage of patients with complete remission in each group. We investigated the complication rates during CEI. Results: No significant differences in the NRS scores were observed between the two groups in the 6-month period. The adjusted odds ratio (OR) for patients included in the complete remission was 0.6 times lower in the RF group than in the R group (95% confidence interval: 0.22–1.71, p = 0.35). The OR for complications during CEI was higher in the RF group than in the R group. However, the difference was not statistically significant. Conclusions: No difference was observed in the management of HZ pain and the prevention of postherpetic neuralgia between the two groups. The incidence of complications tended to be higher in the RF group than in the R group.

Quantifying influence of epidural analgesia on entropy guided general anaesthesia using sevoflurane - A randomised controlled trial.

Background and Aims:Minimum alveolar concentration (MAC) of inhalational agent denotes the requirement of it to maintain adequate plane of general anaesthesia. The precision to the maintenance of anaesthesia can be further guided by use of entropy to titrate the depth of anaesthesia. Regional anaesthesia and the concomitant deafferentation will decrease the need of general anaesthetics. We conducted a randomised double-blind trial to quantify the effect of addition of regional anaesthesia to sevoflurane based general anaesthesia technique guided by entropy to achieve satisfactory depth of anaesthesia.Methods:Forty patients posted for elective laparotomies were randomised to two groups. All patients received a bolus followed by an epidural infusion. Group GE (general anaesthesia + epidural bupivacaine) received 0.25% epidural bupivacaine and Group GS received epidural saline. Both groups received narcotic, relaxant and sevoflurane anaesthesia guided by entropy monitoring. The state entropy (SE) was maintained at 40–60 by titrating end tidal sevoflurane concentration (ETsevo). Heart rate, blood pressure, SpO2, end tidal carbon dioxide (ETCO2) and sevoflurane were recorded.Results:Both groups were similar in heart rate and mean blood pressure during anaesthesia maintenance. The minimum ETSevo required to maintain entropy between 40 and 60 in group GE was 0.53% compared to 0.95% in group GS the epidural saline group (P < 0.001). The end-tidal sevoflurane requirement to maintain adequate depth of anaesthesia dropped by 44.2% in group GE.Conclusion:Lower concentrations of volatile anaesthetic are required when entropy-guided general anaesthesia is combined with regional blockade.

Comparison of postoperative analgesia and opioid requirement with thoracic epidural vs. continuous rectus sheath infusion in midline incision laparotomies under general anaesthesia - A prospective randomised controlled study.

Background and Aims:To assess and compare the effect of bilateral continuous rectus sheath infusion (CRSB) for postoperative analgesia with continuous thoracic epidural infusion (TEA) in patients undergoing midline incision laparotomies.Methods:A prospective, randomised study involving sixty patients with Indian Society of Anesthesiologists (ASA) grade I to III, planned for elective laparotomy were enrolled for the study. Patients were randomly allocated into two groups. In the TEA group, an epidural was sited before induction of general anaesthesia (GA), whereas in the CRSB group, bilateral ultrasound-guided RSB catheters were placed at the end of the surgical procedure, before extubation. Both groups received continuous 0.2% Ropivacaine infusion for postoperative analgesia. They were followed for two post-operative days (POD), for the opioid requirement and post-operative pain at rest, coughing, and moving. Age and body mass index (BMI) were compared using independent t-test and visual analogue scale (VAS) scores were compared by the Mann–Whitney test between the two groups. Opioid consumption, gender, and type of surgery were compared using the Chi-Square test. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0).Results:Opioid consumption in both groups was comparable, for the first two post-operative days with no statistically significant difference. Pain scores were comparable among the groups at all times except postoperative day (POD) 0 (4 h and 12 h postop) and POD 2 (8 AM and 12 PM), where lower pain scores were observed in CRSB Group.Conclusions:As a part of the multimodal analgesia technique, CRSB offers a reliable, safe, and effective alternative to TEA.

Efficacy of intermittent epidural dexamethasone bolus for zoster-associated pain beyond the acute phase.

Herpes zoster develops when latent varicella zoster virus is reactivated in the trigeminal or dorsal root ganglions. Zoster-associated pain (ZAP) is neuropathic pain caused by the herpes zoster virus. Histological studies of postherpetic neuralgia patients suggest that inflammation is involved in ZAP. The effectiveness of local anesthetic and steroid epidural injections in ZAP patients has been reported. However, most studies included patients with acute herpes zoster, and the safety and therapeutic effects of different doses of epidural steroids in ZAP patients remain elusive. In this study, we randomly assigned 42 patients with severe ZAP beyond the acute phase, as determined by a numeric rating scale (NRS) score ≥7, to receive continuous epidural infusion of local anesthetics with either a one-time 5-mg dose or intermittent repeated doses (15 mg total) of dexamethasone. We found that intermittent repeated epidural dexamethasone bolus resulted in reduced NRS scores and an increased likelihood of complete remission in ZAP patients without any adverse effects. Thus, our results suggest that intermittent repeated epidural dexamethasone administration is safe and effective for treatment of ZAP beyond the acute phase.

Comparative study of continuous thoracic epidural infusion of ropivacaine-fentanyl v/s bupivacaine-fentanyl in upper abdominal surgery for post operative analgesia

Comparative study of continuous thoracic epidural infusion of ropivacaine-fentanyl v/s bupivacaine-fentanyl in upper abdominal surgery for post operative analgesia

A Comparative Study of Pain Control and Early Rehabilitation after Total Knee Replacement: Local Wound Infiltration versus Epidural Bupivacaine in the Immediate Postoperative Period

Aim: To study the efficacy and safety of a periarticular analgesic cocktail injection for early rehabilitation after total knee replacements. Patients and Methods: One hundred patients who are included for TKR were posted for unilateral total knee arthroplasty. This prospective randomized controlled study compared pain relief and functional recovery in immediate postoperative patients (initial 72 h) of total knee replacement where one group of patients are given local analgesia and the other group are given epidural analgesia. The patients were randomized into two arms by block randomization. In one arm, the patients received epidural analgesia for 48 h postoperatively. In the other arm, the patients received periarticular injection of an anesthetic cocktail of drugs. Results: The pain relief on the day of surgery (day 1) was significantly better in patients who received pericapsular injection as compared to those who used the epidural injection for postoperative pain relief. The postoperative range of motion and the distance walked in on the day of suture removal (day 14) was marginally better in the epidural group though the difference was not significant. Side effects including nausea, vomiting, pruritus, urinary retention, and respiratory depression were significantly higher in the epidural group as compared to those who received the analgesic cocktail injection. Conclusion: Patients who received epidural infusion for postoperative pain control required more medications as supplements, as evidenced by higher incidence of bolus injections/increased infusion rates/tramadol injections. There were no surgical site infections in either group.

Continuous preperitoneal infusion of ropivacaine for postoperative analgesia in patients undergoing major abdominal or pelvic surgeries. A prospective controlled randomized study.

Background and Aims:This study was conducted to compare continuous preperitoneal infusion (CPI) with continuous epidural infusion (CEI) of ropivacaine for pain relief and effect on pulmonary functions after major abdominal and pelvic surgeries.Material and Methods:One hundred patients were randomized into two equal groups. Patients in CPI group (n = 50) received analgesia by continuous infusion of 0.2% ropivacaine, whereas those in the CEI group (n = 50) received continuous epidural infusion of 0.2% ropivacaine. The primary outcome was the first request of analgesia. The secondary outcome was the influence on the pulmonary functions.Results:The time for the first request of analgesia was longer in the CPI group compared with that in the CEI group (7.3 ± 1.6 vs. 4.1 ± 1.1 h with P value = 0.001). The daily dose of morphine was lesser in CPI versus CEI group (11.3 ± 1 against 17.4 ± 0.9 mg). The pulmonary function tests were comparable except peak expiratory flow rate, which was better in CPI (170 ± 5.4) than CEI group (148.1 ± 5.8; with P value = 0.001).Conclusion:Continuous preperitoneal infusion provides a superior analgesic effect than the continuous epidural infusion as regards delayed first request of analgesia, better pain scores, lesser usage of additional analgesics with better respiratory function.

Pattern of utilization of facilities in the intensive care unit by elective surgical patients in a tertiary care institution: Can the services be provided by high dependency units in surgical wards?

Introduction Intensive care is indicated for patients requiring intensive monitoring and/or organ support. It is a costly and time limited resource utilized by those with reversible pathologies and reasonable likelihood of survival. Patients awaiting elective surgery with preoperative intensive care unit (ICU) bookings need to compete with emergency and unanticipated admissions leading to cancellation and postponement of elective surgery, a disadvantage to both the patient and the institution. Hence this study is aimed at evaluating the extent of ICU care utilized by elective surgical patients and to analyse the indications vs. utilization of ICU care by them. Methods This was a retrospective cross-sectional study carried out in the surgical ICU of Colombo South Teaching Hospital, enrolling 47 elective surgical patients admitted to the ICU over a period of 3 months. Data was collected using a pre structured data collection form. Results Majority of the patients were middle aged, belonged to the American Society of Anaesthesiologists Physical Status 2 (68.1%) and underwent colorectal (26%), upper gastrointestinal (GI) (15%) or hepatobiliary (13%) surgeries. Main comorbidities amongst the study population were diabetes and hypertension. Mean duration of ICU stay was 2 days. Most patients were monitored non-invasively within the ICU (68%). Organ support was required by only 17% of patients. Most frequent indication for preoperative ICU booking was the surgical/anaesthetic complexity determined by British United Provident Association (BUPA) schedule of procedures (83%). However, ICU resources were mainly utilized for provision of analgesia particularly in the form of epidural infusions (52%). Recommendations We recommend the development of level 2 care/high dependency units to reduce the burden on the ICU and a unit-based policy for ICU resource allocation for surgical patients.

A Literature Review of Intrathecal Morphine Analgesia in Patients Undergoing Major Open Hepato-Pancreatic-Biliary (HPB) Surgery.

ContextThe optimal analgesic method for patients undergoing major open hepato-pancreatic-biliary surgery remains controversial. Continuous epidural infusion at the thoracic level remains the standard choice, however concerns have been raised due to associated complications. Single shot intrathecal morphine has emerged as a promising alternative offering similar analgesia with an enhanced safety profile.Evidence AcquisitionThis review aimed to evaluate the literature comparing intrathecal morphine analgesia to other analgesic modalities following major open hepato-pancreatic-biliary surgery. The primary outcome was pain scores at rest and on movement 24 h after surgery. Secondary outcomes were postoperative opioid consumption within 72 postoperative hours, length of stay (LOS), intra-operative fluid administration and post-operative fluid administration within 72 postoperative hours, and overall systemic complication rate within 30 postoperative days.ResultsEleven trials matching the inclusion criteria were analysed. Intrathecal morphine resulted in equivalent or lower pain scores when contrasted to alternative techniques, but required higher amounts of postoperative opioid. Intrathecal morphine also offered reduced LOS and reduced fluid administration requirements to epidural analgesia, and there was no difference observed in major complication rate between analgesic modalities.ConclusionsIn summary the evidence suggests that intrathecal morphine may be a better first-line analgesic modality than epidural analgesia in the context of major open hepato-pancreatic-biliary surgery, but high-quality evidence supporting this is limited.

Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery.

A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain control. Multiple methods to address pain post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain control. A retrospective cohort design was used to compare pain medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain. Descriptive and univariate statistics were used to detect differences. The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain between the 2 groups (P = .661). Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.

PO-171: Epidural infusion for making palliative radiotherapy possible in patients with intractable pain

PO-171: Epidural infusion for making palliative radiotherapy possible in patients with intractable pain

Bolus epidural infusion improves spread compared with continuous infusion in a cadaveric porcine spine model

BackgroundThe administration of epidural anesthesia during labor is a common technique used to reduce the pain of childbirth. We sought to compare standard infusion strategies of continuous epidural infusions (CEI)...

Pitfalls of a Shared Neuraxial Space: Wandering Epidural Catheter.

Children with severe spasticity with indwelling baclofen pumps often present for extensive orthopedic procedures to improve mobility and comfort. Procedural pain can be effectively managed by epidural infusions. Epidurals are sited at surgically congruent levels either above or below the level of insertion of the intrathecal catheter.1,2The three-dimensional reconstructed view demonstrates the course of epidural catheter traveling caudally in the epidural space (image). The catheter travels from the L4 level coursing antero-laterally at the L5 level, “wandering” toward the left L5–S1 foramen to lie anterior to the sacrum.The epidural catheter is placed in the L4–L5 interspace with the bevel of the Touhy needle directed cephalad in a patient with a longstanding intrathecal catheter at the L3 level.Risks of placing an epidural with an existing intrathecal catheter include catheter damage with interruption of baclofen delivery and subsequent baclofen withdrawal syndrome, intrathecal migration of the epidural catheter, and misdirected epidural catheter due to a scarred epidural space. Any one of these scenarios would lead to suboptimal pain control in a patient population that is often nonverbal or cognitively delayed.This image underscores the potential for epidural catheter malposition in a scarred epidural space and make a case for routine postepidural placement epidurogram in patients with intrathecal catheters. A computed tomography scan conspicuously displays small-caliber epidural catheters and may be further augmented by contrast.3The authors declare no competing interests.

118.7: Pain management in living donor hepatectomy.

Introduction: Organ donation from living family members still composes the majority of organ source in our country. Living donor hepatectomy (LDH) is often associated with significant acute and chronic postoperative pain and postoperative outcomes are effected by pain perception. Our postoperative analgesia regimen includes a thoracic epidural (bupivacaine 0.125%, fentanyl 0.1 mg/mL; 4 mL/h, bolus 5 mL, lockout 30 min) or intravenous (morphine, bolus 0.1mg/kg, lockout 10 min,) patient-controlled infusion. Two anaesthesiologists are dedicated to the Acute Pain Service and have the postoperative patients visited 4 times a day. Pain intensity is evaluated daily with an 11-point-numeric-scale (0–10) and prospectively registered in an electronic database. In case of ineffective epidural analgesia despite an additional bolus of local anaesthetic, the technique is changed to intravenous patient-controlled morphine infusion. We aimed to investigate our clinics pain management protocols effectiveness in LDH patients. Methods: We retrospectively investigated our pain management records from 2014 to 2019. Mode of analgesia technique, pain intensity, complications and side effects are recorded. Results: A total of 20 patients were (women n:6, men n:14) analysed. The mean age was 27,5 years (IQR: 22,75-37). Patients were followed for 2-3 days postoperatively for acute pain management and values obtained for the first two days are evaluated (Figure 1). Dural puncture happened in two patients but headache did not develop in both. Patients with intravenous patient controlled analgesia (n:3) had severe nausea (n:1) and constipation (n:1). None of the patients had hypotension or bradycardia in the postoperative period. Pain scores were higher in IV-PCA group. Conclusions: The donors are healthy adults who must be taken care of intensely. As stated in ERAS (enhanced recovery after surgery) protocols high epidural catheter placement is an effective mode of acute postoperative analgesia technique in LDH.

Programmed intermittent epidural bolus decreases the incidence of intra-partum fever for labor analgesia in primiparous women: a randomized controlled study.

To evaluate whether programmed intermittent epidural bolus (PIEB) reduces the incidence of maternal intra-partum fever compared with continuous epidural infusion (CEI) during labor. Parturients were randomized to receive CEI (CEI group) or PIEB (PIEB group) with 10ml per hour for epidural labor analgesia with 1500 subjects in each group. The maintaining dose of two groups is 0.08% ropivacaine with 0.4μg/ml sufentanil, with patient-controlled epidural analgesia (PCEA) dose of 5ml and lockout interval of 30min. The incidence of maternal fever, pain score, epidural sensory levels, the number and proportion of PCEA demand, anesthetics consumption, satisfaction score, neonatal Apgar scale, and maternal and neonatal side effects were recorded. It was significantly lower of the incidence of maternal fever beginning at 4h post-analgesia and continuing until delivery in the PIEB group than the CEI group (4h: 2.6% vs. 4.2%; 5h: 7.3% vs. 10.2%; delivery: 5.6% vs. 7.9%; 1h post-delivery: 3.9% vs. 6.2%; 2h post-delivery: 2.1 vs. 3.5%; total: 5.8% vs. 8.4% in PIEB and CEI, respectively). Compared with CEI group, pain scores at 3, 4, 5h post-analgesia and delivery (3h: 2 [1, 2] vs. 2 [1-3]; 4h: 2 [2, 3] vs. 3 [2-4]; 5h: 2 [2, 3] vs. 3 [2-4]; delivery: 3 [2-4] vs. 4 [3, 4] in PIEB and CEI, respectively), the number and proportion of PCEA demand (number: 0.7 ± 0.9 vs. 2.2 ± 1.9; proportion: 42.0% vs. 80.3% in PIEB and CEI, respectively), and anesthetics consumption significantly decreased in the PIEB group (Ropivacaine: 60 ± 13mg vs. 76 ± 17mg; Sufentanil: 26 ± 4mg vs. 32 ± 6mg in PIEB and CEI, respectively), without severe maternal and neonatal side effects and any difference in neonatal Apgar scale. The epidural sensory levels 2h post-analgesia (2h: 8[8, 9] vs. 9[8, 9] in PIEB and CEI) and satisfaction score (9 [9, 10] vs. 7 [6, 7] in PIEB and CEI) were significantly higher in the PIEB group compared with those in the CEI group. PIEB with 10ml of 0.08% ropivacaine and 0.4μg/ml sufentanil hourly provided a lower incidence of intra-partum fever with a better analgesic effect compared with CEI, without any severe maternal and neonatal adverse reactions.