Epinephrine Markedly Improves Thoracic Epidural Analgesia Produced by a Small-Dose Infusion of Ropivacaine, Fentanyl, and Epinephrine After Major Thoracic or Abdominal Surgery: A Randomized, Double-Blinded Crossover Study With and Without Epinephrine

Section: Discussionmentioning

confidence: 99%

Serious complications associated with spinal and epidural anaesthesia in Finland from 2000 to 2009

Pitkänen

Aromaa

Cozanitis

et al. 2013

“…The most common side effect patients experience is mild pruritus over the abdomen and/or thorax, depending on the spread of the sensory block. Through a series of studies, Niemi and Breivik have tested the triple drug mixture with and without adrenaline or fentanyl . When adrenaline was omitted from the solution, more systemic effects of fentanyl and bupivacaine were registered.…”

Section: Discussionmentioning

confidence: 99%

Does chronic pre-operative pain predict severe post-operative pain after thoracotomy? A prospective longitudinal study

Hetmann

Schou-Bredal

Sandvik

et al. 2013

“…Epidural infusions can be continued for 48‐72, gradually reducing infusion rates and until the recovery of gastrointestinal function. Adding adrenaline (1.5–2.0 μg/ml) to epidural mixture of local anaesthetic and fentanyl improves postoperative analgesia, especially during mobilization and coughing, and reduces pruritus and nausea . Evidence on the analgesic efficacy of epidural clonidine is inconclusive and the risk of hypotension and sedation is increased .…”

Section: Part B Intraoperative and Postoperative Eras Elementsmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice

Feldheiser

Aziz

Baldini

et al. 2015

557

418

BackgroundThe present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme.MethodsStudies were selected with particular attention being paid to meta‐analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English‐language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature.ResultsThis consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations.ConclusionsBased on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ®) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi‐institutional prospective and adequately powered randomized trials.