Quality Of Epidural Analgesia Research Articles

Simultaneous Brachial Plexus Block and Combined Two-Segment Spinal-Epidural Anesthesia with Fixation of an Epidural Catheter in the Subcutaneous Canal in a Patient with Polytrauma

The article reports an example of the simultaneous use of brachial plexus block and combined two-segment spinal-epidural anesthesia with fixation of an epidural catheter in the subcutaneous canal in an 81-year-old patient after receiving a household injury - closed fracture of the olecranon of the right ulna with displacement of fragments and closed transtrochanteric fracture with a fracture of the right femur fragments. After preoperative preparation and examination, the patient underwent two consecutive surgical interventions within a day: open reduction of comminuted transtrochanteric fracture of the right hip, dynamic femoral screw osteosynthesis and open reduction of fracture of the right olecranon, Weber’s osteosynthesis. Surgical interventions were carried out under regional anesthesia: block of the brachial plexus via supraclavicular access and combined two-segment spinal-epidural anesthesia with a method developed in our clinic for fixing an epidural catheter in the subcutaneous canal using a modified spinal needle. After the operation, the patient underwent postoperative pain relief in the form of epidural analgesia for 72 hours. The postoperative period passed without complications. On the 13th day, the patient was discharged for outpatient treatment by a traumatologist. The use of local anesthesia in the form of two methods of regional anesthesia during two consecutive surgical interventions, in an elderly patient with a high anesthetic risk, followed by long-term postoperative anesthesia in the form of epidural analgesia with a reliable method of epidural catheter fixation in the subcutaneous canal without the use of narcotic analgesics, contributed to the successful carrying out two surgical interventions at once, early activation of the patient, absence of complications in the postoperative period. Reliable catheter fixation is very important for the quality of epidural analgesia. Dislocation of catheters by more than 2 cm can lead to migration of catheters from the epidural space, changing the course of anesthesia, deteriorating its quality, or even interrupting it altogether. The new method of catheter fixation in the subcutaneous canal developed by us made it possible to prevent catheter dislocation.

Sambo YT, Adamu SA, Mahdi BM, Esin A, Nuhu AM | p 52-57

Sambo YT, Adamu SA, Mahdi BM, Esin A, Nuhu AM | p 52-57

Efficacy of fentanyl versus sufentanil for labour analgesia and its comparative evaluation with intramuscular tramadol

Introduction: Knowledge about relative merits and demerits of different techniques of administration of drugs through epidural route is needed for optimum management of labour pain. Primary objective of this study is to assess the efficacy of fentanyl and sufentanil for labour analgesia in comparison with intramuscular tramadol. Materials and Methods: This prospective randomized control study included 90 primigravida parturients who were randomly allocated to three groups of 30 each; Fentanyl group (group BF) received 50 mg of epidural fentanyl with 10 ml of 0.125% bupivacaine, Sufentanil group (group BS) received 10mg epidural sufentanil with 10 ml of 0.125% bupivacaine and Tramadol group (group T), the control group received 100mg intramuscular tramadol with 50 mg repeat dose after 4 hours. Results: Epidural groups were comparable in their visual analogue scale (VAS) score satisfaction score, characteristics of sensory and motor blockade, mode of delivery, side effects, haemodynamic stability and neonatal outcome. Value of VAS did not exceed 3 in the epidural group during the entire study period. Onset of analgesia was early with sufentanil (10.52.1 mins, p used was also less (44.16 mg, p =0.002). Higher VAS scores (>4), delayed onset and decreased total duration of labour was seen in tramadol group. Epidural and tramadol group were comparable in mode of delivery and neonatal outcome. Conclusion: Quality of epidural analgesia with either fentanyl or sufentanil using intermittent bolus technique was comparable. Duration of first and second stage of labour was significantly prolonged in parturients receiving labour epidural analgesia. Keywords: Bupivacaine, Fentanyl, Sufentanil, Labour, Analgesia.

Impact of thoracic epidural catheter threading distance on analgesia during the first 24 hours following thoracotomy: a randomized controlled trial

The purpose of this prospective randomized controlled trial was to determine the impact of thoracic epidural catheter threading distance on analgesia quality after thoracotomy. We randomly assigned 120 elective thoracotomy patients to a thoracic epidural catheter threading distance of 3, 5, or 7 cm (groups 3CM, 5CM, and 7CM, respectively). Epidural bupivacaine 0.1% with fentanyl 2 µg·mL(-1) was administered according to a standardized protocol. Epidural analgesia quality was assessed at 60 min and 24 hr postoperatively for four measures: incidence of non-functioning epidurals; numerical rating score (NRS) < 4 at rest, while coughing, and during wound palpation; cold perception at the wound site; and cumulative dose of analgesic medication used. Our primary hypothesis was that, compared to threading distances of 3 and 5 cm, a threading distance of 7 cm was not inferior at providing an NRS < 4 while coughing at 60 min postoperatively, with a non-inferiority margin of 25% (absolute value) being significant. The incidence of NRS < 4 while coughing at 60 min was 74% (29/39) in group 7CM compared with 68% (54/80) in the combined 3CM and 5CM groups (absolute difference 7%; 95% confidence interval -11 to 23; P = 0.29). At both 60 min and 24 hr, differences between groups were similar regarding the number of non-functioning epidurals, NRS < 4, and suppressed cold sensation. Analgesic doses were similar in the three groups. This study found that a thoracic epidural catheter threading distance of 7 cm in the epidural space was not inferior to distances of 3 cm and 5 cm with respect to pain scores at 60 min postoperatively. This study was not powered to examine differences that could have clinical significance that were less than our a priori 25% non-inferiority margin.

Epidural analgesia in labor: specific characteristics, dilemmas and controversies

Epidural analgesia has become the most popular method for labor pain relief. Analgesia in Labor: Yes or No? Labor pain is a complex phenomenon with sensory, cognitive, motivational, emotional, social, and cultural variables. Pain and anxiety lead to adrenergic hyperactivity, hyperventilation, hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity, so pain relief is recommended and even indicated in cases of maternal comorbidity. Analgesia in Labor: Method of Choice. The quality of epidural analgesia is better than the one achieved by parenteral or inhalation agents, with increased uteroplacental blood flow and improved fetal-maternal oxygenation. Epidural Analgesia in Labor: What is Specific? The increased weight, lumbar lordosis, soft tissue edema and engorgement of epidural veins make it more difficult to perform epidural block in pregnancy. Epidural puncture should be performed by medial approach, at L2-3 or L3-4 level by loss of resistance technique between contractions. Epidural Analgesia in Labor: What With? Local anesthetics, bupivacaine, levobupivacaine, ropivacaine, are used and they can be combined with small doses of opioids (fentanyl or sufentanyl). Epidural Analgesia in Labor: How? Available techniques are epidural, spinal and combined spinal--epidural analgesia. Epidural Analgesia in Labor: Controversies. The most important controversy is the influence ofepidural analgesia on operative or instrumental delivery rate. Low concentrations of local anesthetic in combination with small doses of opioids, together with active management of labor by an obstetrician, would lead to increased spontaneous delivery rate. Although there still are some difficulties, complications and controversies, epidural analgesia provides safe and effective labor pain control.

The effect of injection of two vs 10 mL saline on the subsequent spread and quality of epidural analgesia in parturients

The effect of injection of two vs 10 mL saline on the subsequent spread and quality of epidural analgesia in parturients

The Effect of Injection of Two vs 10 mL Saline on the Subsequent Spread and Quality of Epidural Analgesia in Parturients

Obstetric Anesthesia Digest: September 2007 - Volume 27 - Issue 3 - p 165 doi: 10.1097/01.aoa.0000288306.52188.2d

The Effect of Injection of Two vs 10 mL Saline on the Subsequent Spread and Quality of Epidural Analgesia in Parturients

The Effect of Injection of Two vs 10 mL Saline on the Subsequent Spread and Quality of Epidural Analgesia in Parturients

The effect of injection of two vs 10 mL saline on the subsequent spread and quality of epidural analgesia in parturients

Objective To determine whether two vs 10 mL of saline injected into the epidural space affects the subsequent spread and quality of epidural analgesia in parturients. Design Randomized, double-blinded, placebo-controlled study. Setting Delivery room. Patients 105 ASA physical status I and II parturients requesting epidural analgesia. Interventions After identification of the epidural space by the loss-of-resistance technique using normal saline, two mL of saline was then injected into the epidural space in the 2-mL group (n = 53) and 10 mL in the 10-mL group (n = 52). Five minutes after the test dose, patients received 10 mL of bupivacaine (0.1%) with fentanyl two μg mL −1. Measurements 25 minutes after the initial bolus of bupivacaine and fentanyl, spread of block, subsequent pain relief, and influence of the volume of the injected saline on the ease of epidural catheter insertion and on the incidence of blood vessel trauma and paresthesia were evaluated. Results The total number of dermatomes blocked for cold and pinprick sensation in the 10-mL group was significantly more than in the 2-mL group (19 [6-29] vs 15 [4-27] for cold sensation, P = 0.000; and 15 [3-29] vs 11.5 [3-26] for pinprick sensation, P = 0.001). However, the visual analog pain scale and need for supplemental analgesia were similar between the two groups. The epidural catheter was easily inserted in 94.2% of the 2-mL group and 100% of the 10-mL group. The incidence of blood vessel trauma was low and the incidence of paresthesia was high without any significant difference between the two groups. Conclusions 10 mL saline was associated with a higher total number of dermatomes blocked for both cold and pinprick sensation than the two mL saline. However, the pain relief was adequate in both groups, and two mL saline was as effective as the 10 mL in the ease of catheter insertion and prevention of intravascular cannulation.

Continuous Epidural Infusions for Obstetric Analgesia

A prospective study was conducted to assess the quality of analgesia provided by a continuous epidural infusion of 0.25% bupivacaine during labor and delivery. Ninety-seven consecutive parturients had a lumbar epidural catheter inserted, and 0.25% bupivacaine was infused by a volumetric infusion pump. The mean infusion rate was 25 mg/hr which produced a mean high sensory level of T8.7 (range T3 to T12). The bupivacaine infusion lasted a mean of 4.2 ± 0.3 hrs. (range 35 minutes to 16 hrs). Parturients rated the quality of epidural analgesia as satisfactory in 97% of the cases. No episodes of local anesthetic toxicity, tachyphylaxis, nor any neurological sequelae were noted. Twelve patients had transient hypotensive episodes during the course of the labor of which only one instance could be related to the bupivacaine infusion. In the series, 92 had 5 minute Apgar scores ⩾ 7. Plasma concentrations of the local anesthetic were determined at delivery in 13 parturients and in the newborns. The mean plasma concentrations were 0.76 μg/ml and 0.17 μg/ml, respectively, with a U/M ratio of 0.22. We conclude that the continuous epidural infusion technique utilizing a volumetric infusion pump is both technically feasible and practical for use in obstetrics. Furthermore, a marked saving in physicians9 time is accrued by elimination of the repetitive ‘top-up’ injections of local anesthetic.