Epidural analgesia: first do no harm

‘Thoracic epidural anaesthesia – first do no harm’

“…Firstly, I refer Dr Scott to a review done the same year on the same topic with very similar references [1] to the one that he has quoted. It found very little benefit of epidural analgesia in colorectal surgery.…”

“…As an exercise in caution in the use of epidurals the New Year editorial 'Thoracic epidural anaesthesia -first do no harm' [1] was largely disappointing and misleading for the following reasons. Firstly, I refer the authors and your readers to an excellent review article on epidural anaesthesia and colonic surgery outcomes published last year [2] and the papers by Carli and Basse that contradict their statement re-anastomotic dehiscence based on old data [3,4].…”

Falling after epidural analgesia: lessons from obstetric anesthesia

“…8 This has been challenged by those who argue that TEA may increase the incidence of postoperative hypotension, lowerlimb motor blockade, and urinary retention, which in turn can delay mobilization and ambulation. 9,10 The key to improved TEA that is almost devoid of side effects resulting in impaired ambulation and increased risk of falls lies partly within the medical literature. After reviewing studies in several meta-analyses suggesting an increased incidence of hypotension with TEA, we found that, in virtually all of these trials, the investigators used bupivacaine or ropivacaine concentrations that were higher or equal to 0.125% or 0.2%, respectively.…”

“…8 Cela a été remis en cause par ceux qui affirment que la TEA pourrait augmenter l'incidence des hypotensions postopératoires, des blocs moteurs des membres inférieurs et de la rétention urinaire, événements qui risquent de retarder la mobilisation et la reprise de la marche. 9,10 L'élément essentiel pour une TEA améliorée pratiquement dénuée d'effets indésirables entraînant un trouble de la marche et une augmentation du risque de chutes se trouve en partie dans la littérature médicale. Après avoir examiné les études dans plusieurs méta-analyses suggérant une augmentation de l'incidence de l'hypotension avec la TEA, nous avons constaté que dans quasiment tous ces essais, les investigateurs avaient utilisé des concentrations de bupivacaïne ou de ropivacaïne qui étaient égales ou supérieures à, respectivement, 0,125 % ou 0,2 %.…”

Jonnesco: um século de história da anestesia raquídea

“…Reading the works cited in the reference list, we believe that this method should only be employed at present if the anesthesiologist could answer "yes" to the following question: "Would you allow the use of these blocks in yourself, your wife, son, daughter or siblings?" [53][54][55][56] .…”