Improvement of Diaphragmatic Function by a Thoracic Extradural Block After Upper Abdominal Surgery

Mankikian, B.; Cantineau, J. P.; Bertrand, M.; Kieffer, Édouard; Sartene, R.; Viars, P.

doi:10.1097/00000542-198803000-00010

Cited by 173 publications

(23 citation statements)

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“…Epidural analgesia improves respiratory function following upper abdominal and thoracic surgery [16] as a result of improved pain relief and better cooperation with chest physiotherapy. Moreover, epidural analgesia may relieve diaphragmatic dysfunction [17]. Since epidural analgesia has beneficial effects on respiratory function following upper abdominal and thoracic surgery, it is logical to presume that it should have a similar effect following cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Thoracic epidural analgesia started after cardiopulmonary bypass

et al. 1997

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SummaryThe effects of thoracic epidural analgesia started after cardiopulmonary bypass were studied on the subsequent adrenergic, cardiovascular and respiratory responses. Sixteen cardiac surgical patients received either a standardised general anaesthetic (control group) or a standardised general anaesthetic and thoracic epidural analgesia (epidural group). The epidural catheter was sited before surgery and heparinisation. Following discontinuation of cardiopulmonary bypass, patients in the epidural group were given 15 ml bupivacaine 0.5% down the catheter followed by an infusion of bupivacaine 0.375% at 5-8 ml.h ¹1 after surgery. The control group received an intravenous morphine infusion on completion of surgery. The adrenergic response was assessed by measuring arterial catecholamine concentrations. Respiratory function was determined by spirometry, peak expiratory flow and arterial partial pressure of oxygen while breathing air. Pain scores were also obtained. After cardiopulmonary bypass the increases in catecholamine concentrations were effectively inhibited in the epidural group for the remainder of the study (p < 0.05). Postoperative respiratory function was less impaired in the epidural group, with higher forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow (p < 0.05). Pain scores were also significantly lower in the epidural group (p < 0.05). There were no significant differences in cardiovascular parameters.

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Section: Discussionmentioning

confidence: 99%

Thoracic epidural analgesia started after cardiopulmonary bypass

et al. 1997

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“…A redução da mobilidade diafragmática ocorreu na colecistectomia por laparotomia possivelmente, porque durante a cirurgia abdominal o movimento do músculo diafragma pode ficar comprometido, devido à inibição do nervo frênico por estimulação visceral ou somática aferente durante a cirurgia, ao decúbito dorsal prolongado, 31 à incisão cirúrgica e a dor cicatricial, que também podem limitar a mobilidade do diafragma após a cirurgia. 32 Ayoub et al 14 sugerem que a disfunção diafragmá-tica é secundária não só pela irritação das vias aferentes viscerais, mas também por um reflexo mecânico para atenuar a dor da região incisional, reduzindo, desse modo, a mobilidade respiratória no local cirúrgico.…”

Section: Discussionunclassified

Effects of laparotomy or laparoscopicprocedures for cholecystectomy on diaphragmatic and thoracoabdominal mobility

Pedrini¹,

Saltiél²,

Gonçalves³

et al. 2016

Medicina (Ribeirão Preto)

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Design of the study: Observational descriptive and cross sectional study. Objective: To verify the effects of laparotomy or laparoscopicprocedures for cholecystectomy on lung function, diaphragmatic and thoracoabdominal mobility. Methods: We evaluated 18 individuals who underwent cholecystectomy by either laparotomy (CLG n=9) or by a laparoscopic procedure (LCG, n=9). The participants were evaluated in preoperative and in the 2nd postoperative day: anthropometrics measures, cardiorrespiratory parameters, intensity of pain, pulmonary function, diaphragmatic mobility and thoracoabdominal mobility. For statistical analysis, the Wilcoxon test was applied to compare the pre and postoperative of both groups, Mann-Whitney test was applied to comparison between groups (p≤0.05). Results: Diaphragmatic mobility was reduced in both groups whereas thoracoabdominal mobitity al all levels were reduced only in CLG (p<0.05). In LCG, there was a significant decrease of thoracoabdominal mobility only in the umbilical region (p<0.008). By comparing the values of thoracoabdominal mobility between groups postoperatively, there was a difference only in umbilical mobility (p=0.02). We found a significant reduction in vital capacity (VC) in LCG only (p=0.05). Conclusion: Laparotomy and laparoscopic procedures for cholecystectomy reduce the mobility of the diaphragm, but only laparotomy impairs thoracoabdominal mobility in the three levels, axillary, xiphoid and umbilical

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“…[19][20][21][22] Patients undergoing LC have also been shown to have a decrease in postoperative pulmonary function tests for up to 24 hr following surgery. 23' 24 Our study, which used the lowest oxygen saturation while breathing room air before PACU discharge as a marker of respiratory problems demonstrated an advantage of laparoscopy over laparotomy for cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%