Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

Standl, Thomas; Burmeister, Marc-Alexander; Ohnesorge, Henning; Wilhelm, S.; Striepke, M.; Gottschalk, André; Horn, Ernst-Peter; Esch, Jochen Schulte am

doi:10.1007/bf03017795

Cited by 26 publications

(12 citation statements)

References 28 publications

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“…This difference was especially notable for pain scores at rest. However, patients recovering from upper abdominal surgery in some studies reported pain scores both at rest and during effort [38,39] similar to our median scores [38,39].…”

Section: Discussionsupporting

confidence: 84%

“…As such, we cannot exclude the possibility that pain from an early spirometric maneuver impaired subsequent spirometric or manometric efforts. Yet, our measured pain increases between interventions (maximal 10 mm on POD 1) are not substantially different from other studies that compared two types of effort pain [39,40], suggesting that if there were an influence of early measures on subsequent measures, it was small.…”

Section: Discussioncontrasting

confidence: 45%

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Effect of effort pain after upper abdominal surgery on two independent measures of respiratory function

Kimball

Carwood

Chang

et al. 2008

Journal of Clinical Anesthesia

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Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 45%

Effect of effort pain after upper abdominal surgery on two independent measures of respiratory function

Kimball

Carwood

Chang

et al. 2008

Journal of Clinical Anesthesia

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“…B oth continuous epidural infusion (CEI) of local anaesthetics and patient‐controlled epidural analgesia (PCEA) have been shown to be safe and effective in the management of post‐operative pain (1–3). Although the use of such analgesic modalities has become commonplace, there is still controversy with regard to the relative effects of the mass, volume and concentration of local anaesthetic solution in both delivery modes.…”

mentioning

confidence: 99%

“…For CEI, Dernedde et al (12, 13) have demonstrated recently that a high concentration/low volume of local anaesthetic provides an equal quality of post‐operative analgesia as a low‐concentration/high‐volume infusion and induces less motor blockade and haemodynamic repercussions. In PCEA, a few studies have evaluated the influence of the volume and concentration of local anaesthetic for abdominal surgery, but the results are conflicting (3, 14–17). The question arises as to whether the mode of delivery influences the quality of post‐operative analgesia, and whether the volume and concentration of the local anaesthetic have a further impact.…”

mentioning

confidence: 99%

Low vs. high concentration of levobupivacaine for post‐operative epidural analgesia: influence of mode of delivery

Dernedde

Stadler

Bardiau

et al. 2006

Acta Anaesthesiol Scand

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“…For analgesic control, an initial epidural bolus of between 6 and 8 mL levobupivacaine 0.25 % is administered, with further hourly bolus of between 5 and 8mL, depending on pain assessment by usual parameters. It has been demonstrated that postoperative pain control is effective both as PCEA (Patient-controlled epidural analgesia) (14,15) as in CEI (continuous epidural infusion) (16,17) mode. As PCEA pumps are not available in our center, CEI was used.…”

Section: Management Of Patients Undergoing Lrpmentioning

confidence: 99%

Epidural analgesia in laparoscopic radical prostatectomy

Tejedor-Navarro

García-Martínez

Vendrell-Jordà

et al. 2017

Rev. Soc. Esp. Dolor.

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epidural en la prostatectomía radical laparoscópica / Epidural analgesia in laparoscopic radical prostatectomy. Rev. Soc. Esp. Dolor. 2017.Este es un archivo PDF de un manuscrito inédito que ha sido aceptado para su publicación en la Revista de la Sociedad Española del Dolor. Como un servicio a nuestros clientes estamos proporcionando esta primera versión del manuscrito en estado de prepublicación. El manuscrito será sometido a la corrección de estilo final, composición y revisión de la prueba resultante antes de que se publique en su forma final. Tenga en cuenta que durante el proceso de producción se pueden dar errores lo que podría afectar el contenido final. El copyright y todos los derechos legales que se aplican al artículo pertenecen a la Revista de la Sociedad Española de Dolor. ABSTRACT Introduction:Epidural analgesia is an effective technique for postoperative pain relief.Our aim in this retrospective study was to assess the postoperative pain control and complications relating to epidural technique in laparoscopic radical prostatectomy (LRP). Material and methods:A retrospective analysis of 193 patients who underwent LRP, in which epidural analgesia was the postoperative pain approach, was performed. The procedure is generally performed under combined anesthesia. Data collected was postoperative pain data; appearance of neurological disorders (Bromage scale was used for motor weakness assessment); data related to the epidural technique and possible difficulties when performing it; data on epidural infusion; catheter-related complications; hospital stay, postoperative complications, and outcome.Results: Firstly, average VAS at rest was 1.2 ± 1.6; and upon movement, average VAS was 1.9 ± 1.8 during the hospital stay. Secondly, complications related to epidural technique appeared in 37 % of patients. There were 3 cases of hematic puncture; 3 accidental catheter disconnections; 1 dural puncture, and 1 subdural block. As for neurological secondary effects of local anesthetics in the epidural technique, 56 patients (30.1 %) presented with motor block of one or both lower extremities after surgery, and 5 (2.7 %) with paresthesia. Statistical analysis showed that motor weakness was not related to age, weight, type of local anesthetic used, infusion rate, level of epidural puncture nor length of catheter within the epidural space (p > 0.05). Conclusion: Postoperative epidural analgesia offers excellent analgesic quality but it can be associated with several complications secondary to the use of local anesthetics, which could disagree with the terms of Fast-track surgery. New techniques like the TAP block could offer the same analgesic quality, without the epidural´s technique potential complications. Keywords: Laparoscopic prostatectomy, epidural analgesia, postoperative pain, neurologic complications. RESUMEN Objetivos: La analgesia epidural es una técnica eficaz para el control del dolor postoperatorio. Nuestro objetivo en este estudio retrospectivo fue evaluar el control del dolor postoperatorio mediante la ...

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Patient-controlled epidural analgesia reduces analgesic requirements compared to continuous epidural infusion after major abdominal surgery

Abstract: P Pu ur rp po os se e: : To compare the quality of pain relief and incidence of side effects between 24-hr postoperative continuous epidural infusion (CEI) and subsequent patient-controlled epidural analgesia (PCEA) with different analgesics after major abdominal surgery.

Cited by 26 publications

References 28 publications

Effect of effort pain after upper abdominal surgery on two independent measures of respiratory function

Effect of effort pain after upper abdominal surgery on two independent measures of respiratory function

Low vs. high concentration of levobupivacaine for post‐operative epidural analgesia: influence of mode of delivery

Epidural analgesia in laparoscopic radical prostatectomy

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