Epidural Anesthesia in Abdominal Surgery

Smolin, N. S.; Khrapov, K. N.

doi:10.21292/2078-5658-2022-19-2-64-73

Vestn. anesteziol. reanimatol.

2022

DOI: 10.21292/2078-5658-2022-19-2-64-73

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Epidural Anesthesia in Abdominal Surgery

N. S. Smolin

K. N. Khrapov

Abstract: 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… Show more

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Cited by 5 publications

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Effectiveness of ESP-block and epidural analgesia in spinal surgery: a prospective randomized study

Morunova,

Ezhevskaya,

Prusakova

et al. 2024

Rus. J. Anes. Reanim.

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Effectiveness of ESP-block and epidural analgesia in spinal surgery: a prospective randomized study

Morunova,

Ezhevskaya,

Prusakova

et al. 2024

Rus. J. Anes. Reanim.

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Erector spinae plane block as a component of intensive care for acute pancreatitis: a prospective randomized pilot study

Shapkin,

Sholin,

Cherpakov

et al. 2024

Regional Anesthesia and Acute Pain Management

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BACKGROUND: Analgesia is crucial in the treatment of patients with acute pancreatitis, which includes the increased use of regional analgesia. In recent years, less-invasive and safer methods of pain relief, particularly erector spinae plane block (ESP-block), has drawn attention from the anesthesiological community. However, studies on its use in acute pancreatitis are rare. OBJECTIVE: Our aim was to make a clinical evaluation of bilateral erector spinae plane block in patients with acute pancreatitis. MATERIALS AND METHODS: A pilot prospective randomized study was conducted. The patients were divided into two groups: group 1 (n=7), ESP blockade was used, and group 2 (n=12), epidural analgesia (EA) was used. The primary points were considered to be an assessment of pain syndrome intensity and the need for analgesics. Additional results were liver and kidney function, acid-base condition, inflammatory response level, and the time of onset of peristalsis. RESULTS: The decrease in pain intensity in both groups was unidirectional: after 8 h, it was 3.57±1.98 points to the NRS in group 1 and 2.91±1.97 points to the NRS in group 2, and after 24 h, it was 1.42±1.27 and 1.75±2.3 points to the NRS, respectively. No significant difference was found in pain intensity between the groups (р 0,05). The average consumption of ketorolac was 78.2±16.3 mg in group 2 — 63.28±17.23 mg for 1 patient. The average need for narcotic analgesics, that is, morphine, per patient was 22±8 mg in group 1 and 36.3±17.2 mg in group 2 (р 0,05). During the therapy, blood α-amylase, diuresis rate, creatinine level, and glomerular filtration rate did not have a significant difference between the groups, as well as pH, BE, and blood lactate levels (р 0,05). Peristalsis was noted after 12.49±19.73 h in the ESP-block group and after 16.9±21.3 h in the 2nd group (р 0,05). The ICU length of stay between the groups did not differ and was 62±3 and 62±7 h, respectively (р 0,05). CONCLUSION: Bilateral erector spinae plane block is a simple and safe method that induces analgesic effect and effect on homeostasis in acute pancreatitis, similar to epidural blockade. Further study of the role and location of erector spinae plane block in treating pain in acute pancreatitis is required.

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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 Anesthesia in Abdominal Surgery

Cited by 5 publications

References 46 publications

Effectiveness of ESP-block and epidural analgesia in spinal surgery: a prospective randomized study

Effectiveness of ESP-block and epidural analgesia in spinal surgery: a prospective randomized study

Erector spinae plane block as a component of intensive care for acute pancreatitis: a prospective randomized pilot study

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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