scholarly journals Controlo de Dor, Infeção Local, Satisfação, Efeitos Adversos e Dor Residual no Pós-Operatório de Cirurgia Abdominal Major: Epidural versus Infusão Contínua da Ferida Cirúrgica (PAMA Trial)

2017 ◽  
Vol 30 (10) ◽  
pp. 683 ◽  
Author(s):  
Rita Araújo ◽  
Céline Marques ◽  
David Fernandes ◽  
Emanuel Almeida ◽  
Joana Alves ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Postoperative Analgesia ◽  
Standard Technique ◽  
Hemodynamic Instability ◽  
Pain Scale ◽  
Major Abdominal Surgery ◽  
Continuous Epidural Infusion ◽  
Infusion Group

Introduction: The Management of postoperative pain after abdominal surgery is a major challenge to the anesthesiologist. The optimization of postoperative analgesia improves prognosis contributing also to patient satisfaction and reducing morbidity and mortality. The aim of this randomized control study is to perform the comparative analysis in terms of effectiveness of an unconventional and still poorly technique implemented, continuous wound infusion, and the currently most applied and gold standard technique, epidural analgesia, in the postoperative period after abdominal surgery.Material and Methods: Fifty patients, previously subjected to abdominal surgery by median laparotomy with xifo-pubic incision were randomized to receive postoperative analgesia via epidural (n = 25) or via continuous wound infusion (n = 25) during 48 hours. The primary outcome was analysis of pain at rest (< 4/10 numerical pain scale) after 24 hours postoperatively. Scores of pain at six, 12 and 48 hours and three months after surgery were also evaluated, as well as the incidence of adverse effects 48 hours postoperatively.Results: The proportion of patients with successful control of postoperative pain was 84% against 60% with epidural analgesia and continuous wound infusion, respectively. Within the continuous wound infusion group with uncontrolled pain, all patients rated the pain below 6/10 24 hours postoperatively. The incidence of nausea, vomiting, pruritus or íleus was lower in the continuous wound infusion group, with statistically significant results for recovery of intestinal function. There was one case of systemic local anesthetic toxicity with an episode of frequent ventricular extrasystoles without hemodynamic instability, which ceased after suspension of continuous epidural infusion of local anesthetic.Discussion: This study suggests that continuous wound infusion is the technique with most efficacy and safety, being even better than epidural analgesia in postoperative pain control after major abdominal surgery. This technique is associated with better analgesia, lower incidence of side effects, high level of satisfaction and no residual pain, contributing to enhanced recovery.Conclusion: Continuous wound infusion is an effective technique, which should be implemented for analgesia after major abdominal surgery, with advantages when compared with epidural analgesia, especially low incidence of adverse effects.Registration: Trial not registered.

A Direct Search Procedure to Optimize Combinations of Epidural Bupivacaine, Fentanyl, and Clonidine for Postoperative Analgesia

2000 ◽  
Vol 92 (2) ◽  
pp. 325-325 ◽  
Author(s):  
Michele Curatolo ◽  
Thomas W. Schnider ◽  
Steen Petersen-Felix ◽  
Susanne Weiss ◽  
Christoph Signer ◽  
...  
Keyword(s):  
Side Effects ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Optimization Model ◽  
Infusion Rate ◽  
Optimization Procedure ◽  
Direct Search ◽  
Major Abdominal Surgery

Background The authors applied an optimization model (direct search) to find the optimal combination of bupivacaine dose, fentanyl dose, clonidine dose, and infusion rate for continuous postoperative epidural analgesia. Methods One hundred ninety patients undergoing 48-h thoracic epidural analgesia after major abdominal surgery were studied. Combinations of the variables of bupivacaine dose, fentanyl dose, clonidine dose, and infusion rate were investigated to optimize the analgesic effect (monitored by verbal descriptor pain score) under restrictions dictated by the incidence and severity of side effects. Six combinations were empirically chosen and investigated. Then a stepwise optimization model was applied to determine subsequent combinations until no decrease in the pain score after three consecutive steps was obtained. Results Twenty combinations were analyzed. The optimization procedure led to a reduction in the incidence of side effects and in the mean pain scores. The three best combinations of bupivacaine dose (mg/h), fentanyl dose (microg/h), clonidine dose (microg/h), and infusion rate (ml/h) were: 9-21-5-7, 8-30-0-9, and 13-25-0-9, respectively. Conclusions Given the variables investigated, the aforementioned combinations may be the optimal ones to provide postoperative analgesia after major abdominal surgery. Using the direct search method, the enormous number of possible combinations of a therapeutic strategy can be reduced to a small number of potentially useful ones. This is accomplished using a scientific rather than an arbitrary procedure.

scholarly journals Bilateral Transversus Abdominis Plane Block versus Epidural analgesia for Postoperative Pain Relief in Lower Abdominal Surgery

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N M Aly ◽  
S M Talaat ◽  
M A Menshawi ◽  
E R Mohammed
Keyword(s):  
Blood Pressure ◽  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Epidural Block ◽  
Tap Block ◽  
Caudal Analgesia ◽  
Internal Oblique

Abstract Background epidural and caudal analgesia have been considered the gold-standard techniques after abdominal surgery for adults and children, respectively. The techniques consist of injecting the local anesthetic within the epidural space, between the ligamentumflavum and the dura mater. Depending on the surgical site and the level of injection, cervical, thoracic, or lumbar nerve roots are blocked after their emergence from the neural foramen. Epidural and caudal analgesia have technical drawbacks with epidural local anesthetic associated with hypotension secondary to the sympathetic blockade.In the last decade, a new abdominal truncal block, called the tranversusabdominis plane (TAP) block, was described consisting of local anesthetic injection between the internal oblique and transversusabdominis muscle. This block provides analgesia by blocking the 7th to 11th intercostal nerves (T7–T11), the subcostal nerve (T12), and the ilioinguinal nerve and iliohypogastric nerve (L1–L2). Aim of the Work to compare the analgesic efficacy of epidural analgesia and transverse abdominis plane (TAP) block to provide postoperative analgesia after abdominal surgery. Methods sixty patients undergoingLower Abdominal Surgery were randomly divided into 2 equal groups by Closed Envelope Method. patients scheduled for Lower Abdominal surgery were assessed preoperatively in the form of evaluation of their medical history, their laboratory investigations and for fulfilling the above inclusion criteria.Patients Preparation was done by 2 mg Dormicum IV injection as a sedation preoperatively. After obtaining baseline vital signs, All patients received GA; sevoflurane was used for induction and maintenance of anesthesia, IV cannula was inserted and laryngeal mask airway (LMA) to secure the airway.Patients were divided randomly into two groups, each group consists of 30 patients. Group A: Patients in this group received Epidural analgesia, patients were placed in sitting position, Epidural block was administered under sterile conditions with a 18 G Touhy needle using a standard loss of resistance technique. After negative aspiration, 1ml/kg of 0.25% bupivacaine was injected. Group B: Patients in this group received US guided TAP block on the same side of surgery, patients were placed in supine position, linear US probe (high frequency probe 10–12 MHz) connected to a portable US unit (SonoSite, USA) was placed in the mid-axillary plane midway between the lower costal margin and the highest point of iliac crest. After skin disinfection, a 23-G 50-mm needle with an injection line was inserted in plane with the probe. Once the tip of the needle was placed in the space between the internal oblique abdominal muscle and transverses abdominis muscle, and after negative aspiration, 0.5 ml/kg 0.25% bupivacaine was injected. The following parameterswas assessed and recorded Hemodynamic monitoring, Assessment of postoperative painUsing visual analogue scale score, Any case of failed block was recorded, Doses of analgesics required intraoperatively and during the first 2 hours postoperatively were recorded. In case of failed block, 1 mic/kg Fentanyl IV was given. Complications During and after the procedurewere recorded. Results There was no significant differences regarding Demographic data, Heart Rate, SPO2 and duration of surgerybetween both groups. There were significant difference between both group regarding systolic blood pressure, Diastolic blood pressure, visual analogue score, need of analgesic, mobilization postoperative, pain on coughing and hospital stay Conclusion The current study revealed that Epidural block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements compared with Ultrasound guided TAP Block in patients undergoing lower abdominal surgery. Both analgesic techniques are safe.

scholarly journals Epidural Dexamethasone Influences Postoperative Analgesia after Major Abdominal Surgery

2017 ◽  
Vol 4 (20;4) ◽  
pp. 261-269
Author(s):  
Hyeon-Jeong Lee
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Urinary Retention ◽  
Normal Saline ◽  
Major Abdominal Surgery ◽  
Double Blind Study ◽  
Epidural Administration ◽  
Rescue Analgesia ◽  
Group D

Background: Epidurally administered dexamethasone might reduce postoperative pain. However, the effect of epidural administration of dexamethasone on postoperative epidural analgesia in major abdominal surgery has been doubtful. Objectives: To investigate the effects and optimal dose of epidural dexamethasone on pain after major abdominal surgery. Study Design: A prospective randomized, double-blind study. Setting: University hospital. Methods: One hundred twenty ASA physical status I and II men, scheduled for gastrectomy, were enrolled. Patients were randomly assigned to receive one of 3 treatment regimens (n = 40 in each group): dexamethasone 5 mg (1 mL) with normal saline (1 mL) (group D) or dexamethasone 10 mg (2 mL) (group E) or 2 mL of normal saline (group C) mixed with 8 mL of 0.375% ropivacaine as a loading dose. After the surgery, 0.2% ropivacaine - fentanyl 4 μg/mL was epidurally administered for analgesia. The infusion was set to deliver 4 mL/hr of the PCEA solution, with a bolus of 2 mL per demand and 15 minutes lockout time. The infused volume of PCEA, intensity of postoperative pain using visual analogue scale (VAS) during rest and coughing, incidence of postoperative nausea and vomiting (PONV), usage of rescue analgesia and rescue antiemetic, and side effects such as respiratory depression, urinary retention, and pruritus were recorded at 2, 6, 12, 24, and 48 hours after the end of surgery. Results: The resting and effort VAS was significantly lower in group E compared to group C at every time point through the study period. On the contrary, only the resting VAS in group D was lower at 2 hours and 6 hours after surgery. Total fentanyl consumption of group E was significantly lower compared to other groups. There was no difference in adverse effect such as hypotension, bradycardia, PONV, pruritis, and urinary retention among groups. Limitations: Use of epidural PCA with basal rate might interrupt an accurate comparison of dexamethasone effect. Hyperglycemia and adrenal suppression were not evaluated. Conclusions: Epidural dexamethasone was effective for reducing postoperative pain. Especially, an epidural dexamethasone dose of 10 mg was more effective than a lower dose in patients undergoing gastrectomy which was associated with moderate to severe postoperative pain. IRB approval: D-1507-019-042 Clinical trials registration: KCT0001754 Key words: Patient controlled epidural analgesia, opioid, fentanyl, local anesthetic, ropivacaine, dexamethasone Pain Physician 20

scholarly journals Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

2003 ◽  
Vol 50 (3) ◽  
pp. 258-264 ◽  
Author(s):  
Thomas Standl ◽  
Marc-Alexander Burmeister ◽  
Henning Ohnesorge ◽  
Stephan Wilhelm ◽  
Martina Striepke ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Epidural Infusion ◽  
Major Abdominal Surgery ◽  
Continuous Epidural Infusion
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