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Anilakumari D, Singla D, Agarwal A, Kumari R. Comparative efficacy of Micropore™ surgical dressing, Tegaderm™ and Lockit plus® for lumbar epidural catheter fixation in children: a prospective parallel group randomized controlled trial. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:429-437. [PMID: 37683972 DOI: 10.1016/j.redare.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/29/2022] [Indexed: 09/10/2023]
Abstract
BACKGROUND Proper fixation of an epidural catheter is necessary for desired drug effect and to prevent catheter displacement. Different techniques have been used for epidural catheter fixation. The aim of the study was to compare the relative efficacy of Micropore™ surgical dressing, Tegaderm™, and Lockit plus® in preventing lumbar epidural catheter migration in children. METHODS We studied 167 patients aged 5-16 years, for up to 48 h. After the elective abdominal or lower limb surgery. Patients were randomly assigned to one of three groups: (1) Micropore™ surgical dressing (group M), (2) Tegaderm™ (group T), or (3) Lockit plus® (group L). Incidence and extent of epidural catheter migration in centimetres (cm); was compared at 24 and 48 h post epidural fixation. Correlation between epidural catheter migration and patient characteristics, and relative incidence of complications in three groups was also analysed. RESULTS Incidence of catheter migration was 9.6% at 24 h (group M: 7.1%, group T: 21.1% and group L: 0%) and 45.5% at 48 h (group M: 66.1%, group T: 45.6% and group L: 24.1%). After 48 h, absolute migration (mean migration rounded off to the nearest 0.5 cm) was least in patients in group L: 0.34 cm (1.39) compared to group M 1.22 cm (SD: 1.85) group T: 0.94 cm (1.94) (p = <0.001). CONCLUSION Up to 48 h after surgery, the Lockit plus® device demonstrated the less epidural catheter migration when compared to micropore surgical dressing or tegaderm in children undergoing elective abdominal or lower limb surgery.
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Affiliation(s)
- D Anilakumari
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - D Singla
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India.
| | - A Agarwal
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India
| | - R Kumari
- Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India
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Diebels OR, Baheri B, Gios J, Dierick A, Hans G. The Importance of Initial Epidurography Prior to Any Drug Administration in Three-Day Adhesiolysis Procedure. Int Med Case Rep J 2022; 15:615-620. [PMID: 36353053 PMCID: PMC9639397 DOI: 10.2147/imcrj.s370185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/01/2022] [Indexed: 11/05/2022] Open
Abstract
Percutaneous epidural adhesiolysis (PEA) is a minimal invasive procedure to relieve sciatalgia caused by post lumbar surgery syndrome (PLSS). Fluoroscopic-guided contrast-epidurography is essential to ensure a safe procedure. We present a case of a 28-year-old male patient who underwent a PEA which was complicated by a dural puncture. We highlight the dangers of such complications and discuss associated risk factors.
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Affiliation(s)
- Owen Ray Diebels
- University of Antwerp (UA), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Babak Baheri
- Department of Anesthesiology and Pain Management, Antwerp University Hospital (UZA), Edegem, Belgium
- Correspondence: Babak Baheri, Email
| | - Jens Gios
- Department of Anesthesiology and Pain Management, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ann Dierick
- Department of Anesthesiology and Pain Management, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Guy Hans
- Department of Anesthesiology and Pain Management, Antwerp University Hospital (UZA), Edegem, Belgium
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Gautam S, Agarwal A, Das PK, Khuba S, Kumar S. Prevention of epidural catheter migration: a comparative evaluation of two tunneling techniques. Korean J Anesthesiol 2020; 74:59-64. [PMID: 32668834 PMCID: PMC7862929 DOI: 10.4097/kja.20131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/05/2020] [Indexed: 12/01/2022] Open
Abstract
Background Epidural analgesia failure episodes can be reduced by catheter fixation techniques with a lower incidence of catheter migration. In this clinical study, we compared the roles of two epidural catheter tunneling techniques for the prevention of epidural catheter migration. Methods Patients undergoing major abdominal surgery were randomized into three groups of 50 patients each based on the method used to secure the epidural catheter. In the control group (CG), the epidural catheter was secured without tunneling. Tunneling groups 1 and 2 (TG1 and TG2) were defined as tunneling with and without a catheter loop, respectively. The primary outcome measure was the migration of the epidural catheter, while the secondary outcome measures were the adequacy of analgesia and signs of inflammation. All patients were followed up by the acute pain service team twice daily in the postoperative period until the epidural catheter was removed. The results were analyzed by the one-way analysis of variance (ANOVA), chi-square test, and Fisher’s exact test. P values <0.05 were considered significant. Results The three groups were similar with respect to patient characteristics. Catheter migration was significantly reduced in TG2 (two patients) compared to those in the other two groups, i.e., TG1 (eight patients) (P = 0.045) and CG (17 patients) (P = 0.001). No differences were found amongst the three groups in analgesia adequacy and catheter site inflammation (P > 0.05). Conclusions Catheter migration was significantly reduced by tunneling without a catheter loop in TG2 as compared to the other two groups. Therefore, we suggest routine use of tunneling without a catheter loop technique in anesthesia practice and look forward to future studies with larger sample sizes.
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Affiliation(s)
- Sujeet Gautam
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, Lucknow, India
| | - Anil Agarwal
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, Lucknow, India
| | - Pravin Kumar Das
- Department of Anesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Uttar Pradesh, Lucknow, India
| | - Sandeep Khuba
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, Lucknow, India
| | - Sanjay Kumar
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, Lucknow, India
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Hakim M, Froyshteter AB, Walia H, Tumin D, Veneziano G, Bhalla T, Tobias JD. Optimizing the securement of epidural catheters: an in vitro trial. Local Reg Anesth 2018; 11:31-34. [PMID: 30046251 PMCID: PMC6054289 DOI: 10.2147/lra.s172799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Epidural anesthesia is frequently used to provide postoperative analgesia following major surgical procedures. Secure fixation of the epidural catheter is necessary to prevent premature dislodgment and loss of epidural analgesia. Using an in vitro model, the current prospective study evaluates different types of dressings for securement of an epidural catheter by quantifying the force in Newtons (N) required for dislodgment using a digital force gage. Methods Four methods of epidural catheter securement were used on a simulator mannequin: 1) Suresite® Window Clear Dressing, 2) Op-Site Post-Op® Visible Dressing, 3) Steri-Strips® and Suresite Window Clear Dressing, and 4) Steri-Strips and Op-Site Post-Op Visible Dressing. Each method of securement was assessed 10 times to calculate the mean force required to dislodge the catheter. Mean force of dislodgment for each method was compared using parametric tests. Results The force (mean ± SD) required for catheter dislodgment for the four methods was 14.0±2.9, 2, 10.7±1.5, 8.6±2.3, and 9.6±2.2 N, respectively. The pairwise difference showed that the Suresite Window Clear Dressing was the best securement method when compared with other methods. Conclusion Our study demonstrates the advantage of the Suresite Window Clear Dressing in securing the epidural catheter. Future clinical trials are needed to validate these findings.
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Affiliation(s)
- Mohammed Hakim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | | | - Hina Walia
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Giorgio Veneziano
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Tadokoro T, Kakinohana M, Navarro M, Goya M, Odo Y. The Effectiveness of Applying Soft Tissue Bonding Adhesive Composed of 2-Ethyl Cyanoacrylate to Epidural Catheter Fixations Using Film Dressings: An Open-Label, Randomized, Parallel-Group Comparative Study. Anesth Analg 2018. [PMID: 29533260 DOI: 10.1213/ane.0000000000003326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Insufficient fixation of an epidural catheter may result in migration of the catheter and eventual catheter failure. However, the best fixation method remains to be established. Aron Alpha A (2-ethyl cyanoacrylate) adhesive is approved for clinical use and can be used for surgical adhesion to both skin and blood vessels. We hypothesized that the addition of Aron Alpha A adhesive to film dressing would result in consistent and dependable catheter fixation. METHODS In this study, 58 women who were scheduled for cesarean delivery under spinal and epidural anesthesia were recruited. Patients were randomly assigned to a control or treatment group. In the control group, the catheter was fixed solely by film dressing. In the treatment group, a small amount of Aron Alpha A was applied at 2 sites along the catheter. The fixation area was then covered by film dressing. The catheter insertion length was recorded after fixation (T0), immediately postoperatively (T1), on postoperative day 1 (T2), and when the catheter was removed (T3). The change in insertion length from T0 to T3 between the 2 groups was the primary outcome measure. The incidence of catheter failure was also recorded. For all comparisons, P < .05 was considered statistically significant. RESULTS Initially, 58 women were enrolled; however, 3 patients were excluded. From the remaining 55 patients, 27 and 28 were assigned to the control and treatment groups, respectively, and were evaluated. The change in insertion length from T0 to T3 was significantly more in the control group compared with the treatment group (-1.9 ± 2.2 vs 0 ± 0 cm, respectively; P < .001). In the control group, 11 catheters (41%) failed; in the treatment group, all catheters provided effective analgesia throughout the study (P < .001). CONCLUSIONS Epidural catheter fixation using film dressing combined with 2-ethyl cyanoacrylate adhesive application at 2 sites along the catheter resulted in secure fixation in patients receiving postoperative epidural analgesia for cesarean delivery.
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Affiliation(s)
- Takahiro Tadokoro
- From the Department of Anesthesiology, Faculty of Medicine, University of the Ryukyus, Nishihara-cho, Japan.,Department of Anesthesiology, University of California, San Diego, California
| | - Manabu Kakinohana
- From the Department of Anesthesiology, Faculty of Medicine, University of the Ryukyus, Nishihara-cho, Japan
| | - Michael Navarro
- Department of Anesthesiology, University of California, San Diego, California
| | - Motoaki Goya
- Department of Anesthesiology, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Haebaru-cho, Japan
| | - Yuichiro Odo
- Department of Anesthesiology, Okinawa Red Cross Hospital, Naha-shi, Japan
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Odor PM, Bampoe S, Hayward J, Chis Ster I, Evans E. Intrapartum epidural fixation methods: a randomised controlled trial of three different epidural catheter securement devices. Anaesthesia 2015; 71:298-305. [DOI: 10.1111/anae.13351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 01/22/2023]
Affiliation(s)
- P. M. Odor
- Department of Anaesthesia; St. George's University Hospital; London UK
| | - S. Bampoe
- Department of Anaesthesia; St. George's University Hospital; London UK
| | - J. Hayward
- Department of Anaesthesia; St. George's University Hospital; London UK
| | - I. Chis Ster
- Institute of Infection and Immunity; St. George's University of London; London UK
| | - E. Evans
- Department of Anaesthesia; St. George's University Hospital; London UK
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Soto-Astorga RP, West S, Putnis S, Hebden JC, Desjardins AE. Epidural catheter with integrated light guides for spectroscopic tissue characterization. BIOMEDICAL OPTICS EXPRESS 2013; 4:2619-2628. [PMID: 24298420 PMCID: PMC3829555 DOI: 10.1364/boe.4.002619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/27/2013] [Indexed: 06/02/2023]
Abstract
Epidural catheters are used to deliver anesthetics and opioids for managing pain in many clinical scenarios. Currently, epidural catheter insertion is performed without information about the tissues that are directly ahead of the catheter. As a result, the catheter can be incorrectly positioned within a blood vessel, which can cause toxicity. Recent studies have shown that optical reflectance spectroscopy could be beneficial for guiding needles that are used to insert catheters. In this study, we investigate the whether this technique could benefit the placement of catheters within the epidural space. We present a novel optical epidural catheter with integrated polymer light guides that allows for optical spectra to be acquired from tissues at the distal tip. To obtain an initial indication of the information that could be obtained, reflectance values and photon penetration depth were estimated using Monte Carlo simulations, and optical reflectance spectra were acquired during a laminectomy of a swine ex vivo. Large differences between the spectra acquired from epidural adipose tissue and from venous blood were observed. The optical catheter has the potential to provide real-time detection of intravascular catheter placement that could reduce the risk of complications.
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Affiliation(s)
- R. P. Soto-Astorga
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | - S. West
- Department of Anaesthesia, University College Hospital, London, UK
| | - S. Putnis
- Department of Orthopaedics, University College Hospital, London, UK
| | - J. C. Hebden
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | - A. E. Desjardins
- Department of Medical Physics and Bioengineering, University College London, London, UK
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Asano M, Akatsuka M, Uda R, Son H, Nagano Y, Tatsumi T. Suspected migration of cervical epidural catheter into the brainstem after a difficult catheter insertion. J Anesth 2013; 28:447-51. [PMID: 24141810 DOI: 10.1007/s00540-013-1721-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Abstract
We report a case of diplopia during continuous epidural injection presumably caused by catheter migration. A 61-year-old woman underwent shoulder surgery under general anesthesia with cervical epidural anesthesia. The epidural catheter was placed in the C6-C7 epidural space with some difficulty before general anesthesia. The depth of the catheter placed under the skin was 10 cm. On POD 2, the patient noticed diplopia and developed dysarthria despite of good pain control so far. She complained of sudden headache after the rate of continuous epidural infusion was increased to relieve postoperative pain. Computed tomography and T2-weighted cerebral magnetic resonance imaging revealed an air image and surrounding edema in the pons. Diplopia and dysarthria disappeared after ceasing continuous epidural injection. A 15-cm-long mark under the skin and leak of colorless clear fluid from the puncture site were noted at removal of the catheter. On POD 13, diplopia recurred, which improved gradually. On the 9-month radiologic follow-up, we considered that the symptoms on POD 2 were caused by migration of the epidural catheter into the pons and that her later diplopia was induced by intracranial hypotension syndrome. One should be aware that such an unexpected migration of the catheter can occur following a difficult insertion.
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Affiliation(s)
- Maiko Asano
- Department of Anesthesia, Hirakata City Hospital, 2-14-1 Kinya-honmachi, Hirakata, Osaka, 573-1013, Japan,
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Chow L, Wahba R, Hong A, Walker A. Epidural catheter migration during labor: a comparison between standard and Epi-Guard fixation. Int J Obstet Anesth 2011; 20:366-7. [PMID: 21907566 DOI: 10.1016/j.ijoa.2011.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 06/23/2011] [Accepted: 07/04/2011] [Indexed: 12/01/2022]
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Marino M, Jennings RW, Seefelder C. Cephalad migration of a thoracic epidural catheter in a 15-month old. J Clin Anesth 2009; 21:538-9. [DOI: 10.1016/j.jclinane.2009.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 03/04/2009] [Accepted: 03/07/2009] [Indexed: 11/25/2022]
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Rudin A, Flisberg P, Johansson J, Walther B, Lundberg CJF. Thoracic Epidural Analgesia or Intravenous Morphine Analgesia After Thoracoabdominal Esophagectomy: A Prospective Follow-up of 201 Patients. J Cardiothorac Vasc Anesth 2005; 19:350-7. [PMID: 16130063 DOI: 10.1053/j.jvca.2005.03.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Thoracoabdominal esophagectomy is a major surgical procedure that carries significant postoperative morbidity and mortality. Because the choice of analgesic technique may influence outcome, the impact of thoracic epidural or intravenous analgesia was investigated after esophagectomy. DESIGN Prospective observational study during January 1996 until January 2002. SETTING University hospital. PARTICIPANTS All patients undergoing thoracoabdominal esophagectomy during the 6-year period. INTERVENTIONS Patients were prospectively monitored during a 6-year period. Duration of surgery, intraoperative blood loss, fluid administration, postoperative intubation time, intensive care unit (ICU) stay, pain relief and related side effects, postoperative complications, hospital stay, and in-hospital and long-term mortality were compared in relation with the analgesic technique. MEASUREMENTS AND MAIN RESULT Thoracic epidural analgesia with bupivacaine/morphine was used in 166 patients, and intravenous morphine analgesia was used in 35 patients. Postoperative intubation time and ICU stay were similar in both groups. Patients with epidural analgesia experienced less pain. Sedation, respiratory depression, hallucinations, and confusion were more common in the intravenous morphine group. Postoperative weight did not differ between the groups, despite fluid replacement that was higher in the epidural group during the first 24 hours. The in-hospital mortality rate was 0.5%. CONCLUSIONS No differences in morbidity/mortality rates depending on analgesic treatment were observed in patients undergoing thoracoabdominal esophagectomy. Thoracic epidural analgesia provided better pain relief with fewer opioid-related side effects than intravenous morphine analgesia. However, postoperative epidural analgesia was associated with more technical difficulties.
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MESH Headings
- Abdomen/surgery
- Adult
- Aged
- Aged, 80 and over
- Analgesia, Epidural/adverse effects
- Analgesia, Epidural/methods
- Analgesia, Patient-Controlled/methods
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/therapeutic use
- Anesthetics, Local/administration & dosage
- Bupivacaine/administration & dosage
- Esophagectomy/adverse effects
- Esophagectomy/mortality
- Female
- Fluid Therapy/methods
- Follow-Up Studies
- Humans
- Infusions, Intravenous/adverse effects
- Infusions, Intravenous/methods
- Intubation, Intratracheal/methods
- Length of Stay
- Male
- Middle Aged
- Morphine/administration & dosage
- Morphine/adverse effects
- Morphine/therapeutic use
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Prospective Studies
- Thoracic Surgical Procedures/methods
- Treatment Outcome
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Affiliation(s)
- Asa Rudin
- Department of Anesthesiology and Intensive Care, Lund University Hospital, Sweden.
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Flisberg P, Rudin A, Linnér R, Lundberg CJF. Pain relief and safety after major surgery. A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiol Scand 2003; 47:457-65. [PMID: 12694146 DOI: 10.1034/j.1399-6576.2003.00104.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adverse effects may still limit the use of continuous epidural and intravenous analgesia in surgical wards. This study postulated that postoperative epidural analgesia was more efficient, and had fewer side-effects than intravenous morphine. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large patient population. METHODS During a five-year period 2696 patients undergoing major surgery, received either epidural or intravenous analgesia for postoperative pain relief. The patients were prospectively monitored in surgical wards. Pain was evaluated with a numeric rating scale (0-10) at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/nightmares/confusion, nausea/vomiting, pruritus, orthostatism/leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest. RESULTS Epidural analgesia was used in 1670 patients, and intravenous morphine in 1026 patients. Patients with epidural analgesia experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism/leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the intravenous group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements. CONCLUSION In a large patient population the use of epidural and intravenous postoperative analgesia was considered safe in surgical wards, and the incidence of adverse effects was low. Patients with epidural analgesia experienced overall less pain, while opioid related side-effects were more common with intravenous morphine analgesia.
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Affiliation(s)
- P Flisberg
- Department of Anesthesiology and Intensive Care, Lund University Hospital, Lund, Sweden.
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13
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Cowan CM, Delarghy A, Barclay PM. Epidural fixation. Anaesthesia 2002; 57:514-5; author reply 515. [PMID: 12004819 DOI: 10.1046/j.1365-2044.2002.262622.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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