Epidural Anaesthesia with Goal-Directed Administration of Ropivacaine Improves Haemodynamic Stability when Combined with General Anaesthesia in Elderly Patients Undergoing Major Abdominal Surgery

Qh, Zhou; Wp, Xiao; X, Yun

doi:10.1177/0310057x1304100114

Cited by 5 publications

(1 citation statement)

References 30 publications

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“…Conversely, use of rescue analgesics may cause hemodynamic fluctuations in such hypertensive patients and precipitate hemorrhagic or ischemic complications. Epidural analgesia is shown to improve hemodynamic stability and postoperative analgesia, alone [3] or combined with general anesthesia [4] in major abdominal surgery. We reviewed endovascular abdominal aortic aneurysm repair (EVAR) cases over a 2-year period and compared epidural anesthesia with general anesthesia in terms of perioperative hemodynamic stability and postoperative analgesia.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study

Şen

Erdivanlı

Özdemir

et al. 2014

BioMed Research International

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We reviewed our experience to compare the effectiveness of epidural analgesia and total intravenous analgesia on postoperative pain control in patients undergoing endovascular abdominal aortic aneurysm repair. Records of 32 patients during a 2-year period were retrospectively investigated. TIVA group (n = 18) received total intravenous anesthesia, and EA group (n = 14) received epidural anesthesia and sedation. Pain assessment was performed on all patients on a daily basis during rest and activity on postoperative days until discharge from ward using the numeric rating scale. Data for demographic variables, required anesthetic level, perioperative hemodynamic variables, postoperative pain, and morbidities were recorded. There were no relevant differences concerning hospital stay (TIVA group: 14.1 ± 7.0, EA group: 13.5 ± 7.1), perioperative blood pressure variability (TIVA group: 15.6 ± 18.1, EA group: 14.8 ± 11.5), and perioperative hemodynamic complication rate (TIVA group: 17%, EA group: 14%). Postoperative pain scores differed significantly (TIVA group: 5.4 ± 0.9, EA group: 1.8 ± 0.8, P < 0.001). Epidural anesthesia and postoperative epidural analgesia better reduce postoperative pain better compared with general anesthesia and systemic analgesia, with similar effects on hemodynamic status.

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Section: Introductionmentioning

confidence: 99%

Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study

Şen

Erdivanlı

Özdemir

et al. 2014

BioMed Research International

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Epidural Anesthesia in Abdominal Surgery

Smolin

Khrapov

2022

Vestn. anesteziol. reanimatol.

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The epidural anesthesia has found widespread application in abdominal surgical interventions. But the relevance of its use is the subject to some doubt and discussion in connection with developing surgical technologies and reduction of the degree of surgical aggression, and introduction of new approaches to the management of patients in the perioperative period. Often the risks of epidural anesthesia exceed expected benefits. This is a limiting factor for its use. Today, there is no uniform approach to the way epidural analgesia is administered in the intraoperative period. However, there is a correlation between the frequency of adverse events related to epidural block and the route of administration (speed of administration, volume, and concentration).Therefore, selecting the optimal method of epidural analgesia within the framework of combined anesthesia can minimize the risks and maximize its positive effects in abdominal surgery.

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Epidural Analgesia as a Part of Combined Anesthesia during Abdominal Oncological Surgeries (Results of the Survey among the Russian Anesthesiologists and Resuscitators)

Smolin

Khrapov

Miroshkina

2022

Vestn. anesteziol. reanimatol.

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The objective: to analyze the contemporary specific parameters of intraoperative management of epidural analgesia (EA) in combined anesthesia in abdominal oncological surgeries in different medical organizations of Russia.Subjects and Methods. The data necessary for analysis and statistical processing were obtained by developing a formalized questionnaire (21 questions, some of which with the possibility of choosing several answers at the same time – multiple choice), published on the official website of the Association of Anesthesiologists-Resuscitators (https://association-ar.ru/). The survey lasted for 16 days (from May 23, 2022 to June 7, 2022). The survey results were collected using the Google Forms online service and processed using the Google Spreadsheets. Multiple choice responses were processed as absolute numbers and presented as a percentage of the total number of responses to a particular question.Results. The total number of respondents who took part in the survey was 217 specialists from various medical organizations, mostly from the North-Western Federal District of the Russian Federation (34.1%) with more than 15 years of expertise in the specialty (44.7%). According to the survey results, the following specific features of EA during combined anesthesia practice in Russia have been identified: most participants perform EA in the sitting position (63.6%); ropivacaine is the drug of choice among local anesthetics (LA) (84.2%); as a rule, EA is initiated prior to incision (69.6%). During open surgical interventions, 44.7% use a combined EA method (continuous infusion and bolus injection – bolus-based mode), while during laparoscopic surgeries there is no preferred method (combined method – 33.1%; continuous infusion only – 35.5%; bolus injection only – 31.4%). Low concentrations of LA (0.2 ‒ 0.375%) combined with a low volume of administration (4‒10 ml for bolus, 4‒8 ml/h for infusion) are used more often both in open and laparoscopic surgeries. In most cases, achievement of effective EA is supported by lower doses of systemic opioid analgesics (65.4%). Insufficient degree of intraoperative analgesia is managed in different ways, such as using systemic opioids (68.7%), enhancing epidural analgesia (17.5%), and administration of non-opioid analgesics (13.8%).Conclusion. At present, there is no unified approach to the method of EA in combined anesthesia. The results of the survey showed the uncertainty of experts' opinions regarding the choice of LA concentrations for EA, the rate and volume of its administration into the epidural space. Finding the optimal method of intraoperative EA in abdominal oncological surgery is the most important clinical objective in terms of reducing perioperative complications.

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Epidural Anaesthesia with Goal-Directed Administration of Ropivacaine Improves Haemodynamic Stability when Combined with General Anaesthesia in Elderly Patients Undergoing Major Abdominal Surgery

Cited by 5 publications

References 30 publications

Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study

Efficacy of Continuous Epidural Analgesia versus Total Intravenous Analgesia on Postoperative Pain Control in Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Case-Control Study

Epidural Anesthesia in Abdominal Surgery

Epidural Analgesia as a Part of Combined Anesthesia during Abdominal Oncological Surgeries (Results of the Survey among the Russian Anesthesiologists and Resuscitators)

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