Non-epidural Group Research Articles

The Impact of Epidural Analgesia on Cesarean Section Rates and Neonatal Outcomes: A Retrospective Cohort Study

This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018. Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software. Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%). Findings align with previous research indicating no significant impact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even in high-risk pregnancies. This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence.

Association between epidural analgesia and postpartum psychiatric disorders: A meta-analysis

AimWomen during the postpartum period are at risk for psychiatric disorders such as postpartum depression (PPD), post-traumatic stress disorder (PTSD), and anxiety. It is controversial whether labour epidural analgesia have a protective role on PPD, PTSD, and anxiety or not. This study is a meta-analysis of previously published observational studies to investigate the association between epidural analgesia and PPD, PTSD, and anxiety. MethodsWe searched Cochran Library, PubMed, ProQuest, EMBASE, Scopus, Web of Science, PsycINFO, and MEDLINE from inception until December 2022. The outcome measures were positive screen of PPD, PTSD, and anxiety among women who received labour epidural analgesia. The Newcastle-Ottawa Scale was used to assess the quality of the observational studies. Statistical analysis was performed using Stata 17.0 software. The mean differences or odds ratios were pooled based on random effect. ResultsWe included 31 studies (12,064 women) in the review. The meta-analysis of PPD studies reported mean (standard deviation) showed no significant association between epidural analgesia and PPD (Mean Difference = 0.01; 95% Confidence Interval = −0.14 to 0.16; p-value = 0.88). The meta-analysis of PPD studies reported percentage showed no statistically significant difference in terms of the chance of depression between the exposed and non-exposed groups (Log Odds Ratio = −0.61; 95% CI = −1.48 to 0.26; p-value = 0.17). The meta-analysis of PPD studies reported OR showed indicate a lower chance of depression in the epidural group compared to the non-epidural group (Effect size = 1.01; 95% CI = 0.64 to 1.38; P-value = 0.00). In the case of PTSD, due to the heterogeneity of the tools and the methodology of the studies, it was impossible to reach a definitive conclusion and measure the studies in a meta-analysis. The meta-analysis of anxiety studies showed that no significant association between epidural analgesia and anxiety (MD = −1.36; 95% CI = −3.38 to 1.14; p-value = 0.29). ConclusionBased on the meta-analysis of observational studies, epidural analgesia for labour pain relief has no protective effect on postpartum psychiatric disorders.

Acute postoperative pain management techniques, their efficacy and complications after major gastrointestinal and hepato-pancreato-biliary cancer surgeries: An observational study.

Patients undergoing major gastrointestinal (GI) surgery including hepato-pancreato-biliary (HPB) surgeries have large incisions, which cause severe acute postoperative pain that, if untreated, is associated with a higher incidence of postoperative morbidity and delayed recovery. Our study included all patients who underwent elective major upper GI and HPB surgeries from 1 January 2018 to 31 December 2018. The patients were divided into two groups: the epidural and the non-epidural group. The average and worst pain scores at rest and movement were compared between both groups. We also studied the effect of pain relief in the two groups and associated postoperative outcomes, resumption of feeding, ambulation, hospital stay and intensive care unit stay. A total of 566 patients were included in the study, out of which 490 received epidurals, and the rest, 76, belonged to the non-epidural group (transversus abdominis plane, rectus sheath block or no regional analgesia technique). The median average pain score at rest and movement was 2.0 and 3.0, respectively, in the epidural and non-epidural groups. The postoperative outcomes showed no statistical difference. The epidural group and the non-epidural group had similar pain scores, and the postoperative outcomes were also comparable.

Audit of Pain Management After Colorectal Surgeries in a Tertiary Care Cancer Hospital.

Surgery for gastrointestinal malignancy is associated with severe post-operative pain, which if inadequately treated, can lead to pulmonary complications and, in addition, delayed mobilization leading to delayed recovery and discharge. We audited our practices looking at the various pain modalities used and their effects on the post-operative recovery in colorectal surgeries, in a tertiary care cancer centre during the era of ERAS. The primary aim of the study was to assess the average pain score on movement in the first 72 h of post-operative period among patients. The secondary aim was to study the various modalities of pain management used and complications, perioperative vasopressor requirement, post-operative resumption of enteral feeding, ambulation, duration of hospital stay, duration of ICU/HDU stay, and worst pain scores in the first 72 h. We analyzed a total of 174 patients who underwent colorectal surgeries for the period of 1 year from 1st January 2018 till 31st December 2018. Out of the 174 patients, 86 (49.4%) patients received epidural analgesia and 88 (50.6%) patients who did not receive epidural analgesia, belong to the non-epidural group. Average pain scores on movement at 72 h in the epidural group was 2 [2, 3] and 2 [1, 2] in the non-epidural group (p < 0.001). Worst pain score at post-operative 72 h in epidural group was 3 [3, 4] and 3 [2, 4] in the non-epidural group (p = 0.016). In conclusion, we conclude, that the analgesic efficacy of epidural analgesia was not found to be superior in our study in patients undergoing major colorectal surgeries.

Thoracic epidural analgesia as part of an enhanced recovery program in gynecologic oncology: a prospective cohort study

ObjectiveTo evaluate the safety and the effectiveness of thoracic epidural analgesia as part of the enhanced recovery after surgery (ERAS) multimodal analgesic protocol in patients with gynecologic oncology who have...

Prevalence and Risk Factors of Pelvic Floor Disorders After Delivery in Japanese Women Using the Pelvic Floor Distress Inventory: A Retrospective Cohort Study.

Introduction Female pelvic floor disorders (PFDs) include clinical conditions such as urinary and fecal incontinence and pelvic organ prolapse. Disease-specific questionnaires like the Pelvic Floor Distress Inventory-20 (PFDI-20) have facilitated pelvic floor disorder assessment. We aimed to investigate the prevalence of pelvic floor disorders in Japanese women after different modes of delivery and the association of pelvic floor disorders with epidural anesthesia. Material and methods We included 212 women who gave birth at our institution. The PFDI-20 questionnaire (validated in Japanese) was used to evaluate the symptoms of pelvic floor disorders 6-15 months postpartum. Results Out of the 212 postpartum women who participated in this study, 156 (73.6%) had symptoms of pelvic floor disorder; the most prevalent symptom was urinary distress inventory in 114 (53.8%) women [79 (37.3%) of them experienced urine leakage related to increased abdominal pressure]. A comparison of the epidural and non-epidural groups to determine the association between pelvic floor disorder and delivery mode revealed a higher disease burden score of 8.67 points in the epidural group. Conclusion The prevalence of pelvic floor disorder symptoms is relatively high, affecting 156 (73.6%) of 212 women. Accurate diagnosis of women and appropriate and regular follow-up until improvement of their symptoms are crucial. Furthermore, healthcare workers should advise pregnant women on whether to choose vaginal delivery with or without anesthesia. To the best of our knowledge, our study is the first to investigate postpartum pelvic floor disorder in Japan.

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

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

Compare Second Stage of Labour with or without Epidural Analgesia

Background: Epidural analgesia involves the injection of a local anesthetics agent into spinal cord. Delayed pushing has found association between epidural analgesia, instrumental deliveries and prolongation of second stage of labour. Objective: To compare second stage of labour with or without epidural analgesia at Aga Khan University Hospital. Study Design: Cohort study Setting: The Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi. Duration: From 1st March, 2020 to 1st August, 2020 Material and Methods: Total 80 patients were included and equally divided into group who received epidural analgesia and group who did not get epidural analgesia. Dependent variable was epidural analgesia and Independent variables are labor outcome as prolonged 2nd stage of labour with or without epidural analgesia. Stratification was done. Post stratification chi-square test was applied. P-value ≤0.05 was taken as significant. Results: The mean mother’s age in epidural and non-epidural groups was 29.48±4.38 years and 28.08±4.68 years. Prolonged second stage of labour was observed in 12.5% patients of epidural group and 5% patients of non-epidural group. The results showed significant association of prolonged second stage of labour with exposed and unexposed groups. Conclusion: Our study results showed that, prolonged second stage of labour was observed more among women in epidural group as compared to them women in non-epidural group. Keywords: Second Stage Labour, With or Without Epidural Analgesia

Addition of Local Anesthetic Epidural Infusion Catheter to Intravenous Opioid Analgesia for Postoperative Pain Control in Children Undergoing Video Assisted Thoracoscopic Surgery (VATS)

PurposePostoperative analgesia following minimally invasive video assisted thoracoscopic surgery (VATS) in pediatric patients may involve intravenous opioid analgesics and continuous local anesthetic infusions via an epidural infusion catheter. The use of epidural catheters may avoid systemic side effects of intravenous opioids in this vulnerable population. DesignOur primary aim was to compare total morphine equivalents (MEQ) required, and pain scores between local anesthetic epidural infusion catheters combined with intravenous opioids, versus intravenous opioids alone in pediatric patients following VATS procedure. MethodsFollowing Institutional Review Board approval, we performed a retrospective chart review of children (ages 1 month to 18 years) who underwent VATS procedure for noncardiac thoracic surgery. Based on the postoperative analgesic technique used, the study population was divided into two groups that is, epidural group and nonepidural group. Both groups received intravenous systemic opioids. The primary outcome variables were total MEQ required and pain scores in the perioperative period. FindingsNinety-two patients were included in the study. Of these, 22 patients belonged to the epidural group versus 70 patients to the nonepidural group. There was no statistical difference in MEQ requirements or pain scores between the groups intraoperatively (P = .304), in the postanesthesia care unit (P = .166), or at postoperative time intervals of 24 hours (P = .805) and 48 hours (P = .844). The presence of infection or empyema was a significant factor for the avoidance of epidural placement by providers (P = .003). ConclusionsThere was no significant difference in the perioperative MEQ or postoperative pain scores between the epidural catheter group and the nonepidural group. More research is necessary to determine if this could be due to epidural catheter malposition and/or inadequate dermatomal coverage of surgical chest tubes.

The Effect of Epidural Analgesia on the Maternal and Fetal Outcomes in Mothers Undergoing Induction of Labour.

Elective labour induction is associated with more pain, intrapartum interventions, cesarean deliveries, as compared with spontaneous labour, necessitating the use of labour analgesia. Epidural analgesia is one popular method for control of pain. This study was to determine the effect of epidural analgesia on the maternal and fetal outcomes in women undergoing induction of labour, as adequate data in this specific population is relatively sparse. This was a cross-sectional study conducted over a period of 18months which included mothers with singleton term gestation with cephalic presentation admitted for induction of labour. A sample of 238 mothers were included in the study. Among the study population, 52.7% opted for epidural analgesia. The pain score was less than 3/10 (VAS) in 81% of mothers who opted for epidural analgesia. The cesarean section rate was 20.5% and 34.3% in the epidural and non-epidural groups, respectively. After adjusting the confounding factors, there was a positive effect noted in the caesarean section rate among the epidural group, which was lesser than the non-epidural group. However, a higher instrumental delivery rate (18.8% vs. 10.5%, p-value < 0.05) was noted in the epidural group. There was no significant difference in the duration of labour and fetal outcome in the two groups. Epidural analgesia providing good pain relief in the majority of the mothers was reinforced. In our study, epidural analgesia was associated with a reduction of caesarean section rate after adjusting the confounding factor. Epidural analgesia did not affect the duration of labour, cesarean section rate and fetal outcome independently, however, it was associated with increased risk of instrumental delivery. The outcomes mainly depend on the confounding factors. Therefore, mothers can be provided with an evidence-based information regarding the effect of epidural analgesia in induced labour and help those seeking epidural analgesia to make an informed choice. The online version contains supplementary material available at 10.1007/s13224-022-01622-1.

Evaluate and Outcome Safety of Epidural Analgesia in Surgical Practice for Labour Pain: Study on Tertiary Hospital in Bangladesh

Background: It is possible to use epidural analgesia as a standard and efficient, reducing labor pain. Nevertheless, it might interfere with the body's natural process of giving birth. We wanted to see how labor went on behalf of female epidural analgesic patients that worked well in labor time, delivery method, and baby's health. Methods: This quasi-experimental study was conducted in the Department of Anaesthesia, Rajshahi Medical College Hospital, and Tertiary Hospital in Rajshahi, Bangladesh. From June 2018 to December 2020. We used a non-probability handy sampling approach to pick one hundred pregnant ladies. It was more convenient to split the participants into two groups of 50 each. The study included women of any time between conception and delivery at 37-41 weeks of pregnancy as a potential data source. This study examined the impact on labor progress, delivery method, and Apgar ratings of newborns using epidural analgesia in group B and non-epidural in group A in the lumber area. The second stage was normal for 77 Among individuals who underwent treatment. However, the second stage was extended for 23. Result: The epidural group consisted of 18 patients (36%), whereas the non-epidural group had 5 patients (10%). 4 patients (8%) experienced intrapartum problems in terms of epidural anesthesia, whereas the non-epidural group did not. In all, 65 Mothers gave birth to their children naturally by vaginal delivery, while 35 women gave birth using artificial means. The epidural group consisted of 29 patients (58%), while the non-epidural group had just 6 individuals (12%). Both groups of newborns had the Apgar test results: 8/10 (74.3%) and 9/10 (24.8%) at five minutes, and none of the babies in either group required bag or mask resuscitation. The average Apgar score for both groups was 8/10 (74.3%) and 9/10 (24.8%). Conclusion: Epidural analgesia improves an instrument's rate of delivery while prolonging the stages of childbirth. Epidural analgesia has minimal..

Statistics on Epidural Analgesia Made on Admitted Patients for Normal Vaginal Delivery, Outcome Results and Benefits

Introduction: Childbirth can be extremely painful. Labor pain is multifactorial and very complex, as it is a combination of visceral pain and somatic pain, in addition to psychological factors. Thus, the provision of effective pain relief during labor is an important element for a positive maternal experience. Epidural anesthesia is the most frequently used method of pain control In normal vaginal delivery (NVD), labor epidurals provide effective analgesia for laboring parturient. Objective: of the present study was to review the maternal and fetal risks associated with epidural analgesia for pain relief during labor, and to investigate whether the use of epidural analgesia during labor was a risk factor for AVD and CS delivery. Methods: We performed a 1-year (2020) prospective cohort analysis of the patients presenting at four obstetricled maternity units part of major academic medical centers in Beirut, Lebanon from January 2020 until December 2020. All eligible patients were approached for the consenting process, and those who agreed to participate in the study were included in the analysis. Patients were stratified in two groups based on the type of pain control they opted for/received at the time of admission: epidural delivered anesthesia or intravenous infusion of pain medications. Results: A 100 eligible women consented to take part in the study, between January 1st, 2020 and December 31st, 2020. Maternal and fetal survival at the 30-days mark was 100.0% for both groups. Duration of labor was significantly 0.1h shorter in the epidural group with a mean of 6.7 ± 1.8 h as opposed to 6.8 ± 2.6 h in the nonepidural group. Use of forceps and/or vacuum was significantly higher in the epidural group 9 (17.3%) and 2 (3.8%) as opposed to 1 (2.1%) and 0 (0.0%) in the epidural group. A higher rate of severe perineal tears (grade 3 or more) was observed in women who received epidural anesthesia. Conclusion: Epidural anesthesia is a safe option for pain control during vaginal delivery, both for the mother and the infant no effect on the duration of labor, and thus does not increase the risk of maternal or fetal infection or conversion to CS is also safe for neonates and is not associated with increased short term neonatal morbidity such as admission to the NICU. Epidural anesthesia however remains a risk factor for AVD and thus the use of instruments Its role as for severe perineal lacerations remains unclear according to our data, as we did not account for confounding factors. This last point remains to be investigated in large population-based studies.

Short-term efficacy of epidural pain management in dogs undergoing cystoscopy.

BackgroundThe effects of epidural anesthesia in dogs undergoing cystoscopy are unknown.ObjectiveTo investigate the effect of epidural analgesia on postcystoscopy pain in dogs.AnimalsTwenty‐six dogs undergoing routine cystoscopy for lower urinary tract disease.MethodsProspective, randomized, blinded observational study. Dogs were assigned either to a treatment group that received epidural anesthesia (preservative free morphine sulfate, 0.09 mg/kg; 1% ropivacaine, 0.2 mg/kg; total volume delivered, 1 mL/4.5 kg of body weight to a maximum of 10 mL; n = 9) or to a nonepidural control group (n = 13). Vital signs were monitored for 24 hours, and sedation and pain scores, behavioral assessments, and presence or absence of complications was evaluated for 5 days postprocedure.ResultsAll dogs tolerated the epidural without complications. Four dogs were removed from the study because of status unblinding, lack of patient cooperation, or incomplete follow‐up. No significant differences were noted in postprocedural pain scores in dogs that received epidural analgesia. Significant differences in postprocedural pain scores were noted in the nonepidural control group. No significant differences were noted in vital signs, behavioral assessments, or the proportion of dogs with a 50% increase in pain scores between the epidural and nonepidural groups.Conclusions and Clinical ImportanceEpidural anesthesia was well‐tolerated. Dogs not receiving the epidural had poor postprocedural pain control. A consistent benefit for the epidural vs nonepidural group could not be identified. Additional studies are required to better assess the impact and efficacy of epidural anesthesia for cystoscopic procedures.

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.

Appropriate delivery method for cardiac disease pregnancy based on noninvasive cardiac monitoring.

Background There are numerous significant physiological changes occurring in circulation during labor. To detect these rapid hemodynamic changes, invasive and intermittent measurement techniques are not reliable. To suggest a suitable delivery method for pregnancy with cardiac disease, this study analyzed how each delivery method influences cardiac function using a noninvasive and continuous measurement technique. Methods A prospective study was accomplished at the National Cerebral and Cardiovascular Center in Japan from October 1, 2014, to November 30, 2018. The classification of the healthy heart pregnant women was according to the delivery method: vaginal delivery (VD) without epidural anesthesia, VD with epidural anesthesia, and caesarean section (CS). The hemodynamic parameters cardiac index (CI), stroke volume index (SI), and heart rate (HR) were evaluated regularly throughout delivery by noninvasive electrical cardiometry monitor. Results Ten cases were examined for each group. CI and HR were significantly increased before VD, while the increase in CI and HR was mild in the epidural group in comparison to the nonepidural group. SI was increased toward the delivery in the epidural group, and it was constant in the nonepidural group. However, there was no alteration in the level of outcomes of the two groups. In CS, SI increased and HR decreased before delivery. After delivery, SI continued to increase, while HR did not change but CI increased. Conclusion In VD, the increase in venous circulation according to the autotransfusion is managed by increasing HR. By epidural anesthesia, the increase in HR was suppressed and SI was increased. However, as epidural anesthesia increases the vascular capacity, the level of SI outcome was comparable. In CS, the HR was decreased because of the spinal anesthesia and the SI was increased because of many factors like hydration. As there are many factors to control in CS, VD with epidural anesthesia will be the first preference for most cardiac patients.

Effect of epidural labor analgesia on fetal heart rate and neonatal outcome

Introduction: Epidural analgesia does not affect the neonatal outcome as shown in this study by the similar APGAR scores and neonatal intensive care unit (NICU) admissions when compared with normal delivery without epidural analgesia. Aims: This study aims to find the fetal heart rate variability and neonatal outcome in women, who are opting for epidural anesthesia in comparison to women without any pain reliving modality. Subjects and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology at Datta Meghe Institute of Medical Sciences, Wardha, over period of 2 years from September 2017 to August 2019 after taking approval from Institutional Ethical Committee. One hundred women who fulfilled the inclusion criteria were included in the study, 50 women received epidural analgesia for relief of labor pain at =4 cm and 50 women were left for spontaneous delivery. The factors studied were fetal heart rate (FHR) variability and NICU admissions in both the groups. Statistical Analysis Used: SPSS version 19; Chi-square test and Student's t-test. Results: Epidural analgesia was associated with transient fetal heart variability which however was not statistically significant and was comparable with nonepidural group. Conclusions: Epidural analgesia is an effective method of pain relief and it must be an option available to all laboring women. There are no significant effects on FHR variability and does not affect neonatal outcome.

Epidural anesthesia for post-operative pain is associated with a higher incidence of complications following open ventral hernia repair.

Ventral/incisional hernia repair is a common procedure. Epidural anesthesia for post-operative pain control has been used to attempt to limit opioids. The complications associated with epidural anesthesia are starting to be recognized in open ventral hernia repair patients. Data were abstracted from the National Surgical Quality Improvement Program (NSQIP) participant use data file for 2015. Adult patients with an open ventral hernia repair were identified. In an effort to identify complex hernias, patients who required the implantation of mesh and remained inpatient for 2 or more days were included. Patients with epidural anesthesia and general anesthesia (epidural group) were compared to those with general anesthesia alone (non-epidural). Descriptive statistics and complications were recorded and compared. A total of 1943 patients met inclusion criteria: 1009 patients (51.9%) in the non-epidural group and 934 (48.1%) in the epidural group. There were fewer clean cases in the epidural group (63.2%) than the non-epidural group (68.8%, p = 0.007). Otherwise, there was no difference in gender, age, body mass index, American Society of Anesthesiologists physical status, and current smoking status. There were more pulmonary emboli in the epidural group (1.39%) compared to the non-epidural group (0.50%, p = 0.04). Urinary tract infection was also significantly higher in the epidural group (3.10%) compared to the non-epidural group (1.59%, p = 0.03). Transfusions were also administered to more of the epidural patients (5.14%) compared to non-epidural patients (2.78%, p = 0.007). The rates of other post-operative complications were not statistically significant between the two groups. Total length of stay in the hospital was also greater in the epidural group (6.7 vs. 5.0days, p < 0.0001). This is an association with the use of epidural anesthesia in open ventral hernia repairs and an increased incidence of pulmonary emboli, transfusions, and urinary tract infections, as well as an increased length of stay.

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes.

To explore the impact of epidural analgesia on maternal and neonatal outcomes, especially the relation between epidural analgesia and intrapartum fever. A retrospective cohort study was conducted in a tertiary hospital for all deliveries from November 2017 to December 2017. A total of 506 women were divided into epidural and non-epidural group by whether to receive analgesia or not. Univariate and multivariate analyses were performed with P < 0.05 as significant. Epidural analgesia was associated with higher risk of maternal intrapartum fever (relative risk [RR] = 3.28, 95% confidence interval, 1.55-6.95), more intravenous use of antibiotics (36.66% vs 17.04%, P<0.001), longer time of second stage (58.55 ± 33.75 vs 47.39 ± 28.36 min，P = 0.001) and longer total duration of labor (790.32 ± 433.71 vs 461.33 ± 270.39 min，P<0.001), but had no influence on mode of delivery, the amount of post-partum hemorrhage or hospital stay after delivery and all the neonatal outcomes we studied. Further time effect analysis found that epidural analgesia less than 6 h did not increase the risk of intrapartum fever (RR = 1.73, P = 0.15), however, when epidural analgesia lasted over 6 h, it significantly increased the risk of fever (RR = 5.23, P<0.001) but did not increase more adverse outcomes. Having epidural anesthesia 6 h or more increases the risk of developing fever, but the prognosis of mothers and children is less affected.

Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study

ObjectivesPrevious studies showed reductions in recurrence and mortality rate of several cancer types in patients receiving perioperative epidural analgesia. This study aimed to investigate the effects of thoracic epidural analgesia...

Enoxaparin administration within 24 hours of caesarean section: a 6-year single-centre experience and patient outcomes

A caesarean section (CS) is a major risk factor for a venous thromboembolism, and enoxaparin, a low-molecular-weight heparin, has been widely used for thromboprophylaxis. However, it remains unclear whether an enoxaparin thromboprophylaxis has an acceptable safety profile when given early after CS compared to delayed administration, especially in the presence of an epidural catheter. This study aimed to survey cases in which enoxaparin administration was performed within 24 hours of CS and to evaluate patient outcomes with or without epidural anaesthesia. The number of eligible cases were 578: 328 patients received an epidural anaesthesia (epidural group), and 250 did not (non-epidural group). In both groups, no patient developed a spinal epidural haematoma. A wound or a subcutaneous bleeding occurred in 22 (6.7%) and 20 (8.0%) cases in the epidural and non-epidural groups, respectively. One patient developed a mild pulmonary embolism, and one case of asymptomatic deep vein thrombosis was detected. An enoxaparin administration within 24 hours of CS appears to be reasonable, regardless of an epidural anaesthesia.Impact statementWhat is already known on this subject? A venous thromboembolism (VTE) after a caesarean section (CS) remains a significant cause of maternal morbidity and mortality. Therefore, a thromboprophylaxis using enoxaparin, a low-molecular-weight heparin, has been widely recommended and accepted. However, there is no consensus regarding the optimal timing to initiate an enoxaparin administration after CS in the presence of an epidural catheter.What do the results of this study add? This is the largest study that has collected cases receiving enoxaparin within 24 hours of a CS. Irrespective of the presence of an epidural catheter, no patient developed a spinal epidural haematoma after an early administration of enoxaparin. Furthermore, the incidence of haemorrhagic complications did not increase.What are the implications of these findings for clinical practice and/or further research? Given the significant incidence of VTE after CS and the extremely low frequency of spinal epidural haematomas, it can be justified to initiate thromboprophylaxis with enoxaparin soon after CS. However, appropriately designed, large clinical trials are necessary to examine the safety and efficacy of an early enoxaparin administration after CS. Based on such studies, the starting time of thromboprophylaxis after a CS should be decided.