Postoperative Enteroparesis by Patient-Controlled Analgesia Combined with Continuous Epidural Block for Patients After Posterior Lumbar Surgery

Koike, Masahiko; Ohmori, Kazuo; Yasuda, Taketoshi; Miaki, Kentaro; Matsui, Hisao; Sakurai, Toshihiko

doi:10.1097/00002517-200006000-00008

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…90,91 Pain scores at 24 hrs were decreased in 5 trials, 90Y92,94,97 whereas 4 found no benefit. 85,93,95,96 At 48 hrs after surgery, similar results were obtained, with 4 trials reporting benefit of the regimen 90,93,94,97 and 4 others reporting no benefit. 85,92,95,96 Local anesthetic 87Y89 and opioids, 84,92 when used alone, decreased postoperative pain for 48 hrs.…”

Section: Continuous Epidural Analgesiasupporting

confidence: 56%

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Beyond Opioid Patient-Controlled Analgesia

Sharma

Balireddy

Vorenkamp

et al. 2012

Regional Anesthesia and Pain Medicine

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Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. The pain from these structures may be more severe and can lead to neural sensitization and release of mediators both peripherally and centrally. The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.

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Section: Continuous Epidural Analgesiasupporting

confidence: 56%

“…87,95 The incidence of pruritus was decreased in 2 trials 88,89 and increased in 1. 92 One trial reported continuous epidural analgesia to cause bowel dysfunction, 97 whereas others reported earlier return of bowel function. 88 (40) 3.…”

Section: Continuous Epidural Analgesiamentioning

confidence: 99%

Beyond Opioid Patient-Controlled Analgesia

Sharma

Balireddy

Vorenkamp

et al. 2012

Regional Anesthesia and Pain Medicine

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“… 20 , 21 Patients with clinically relevant multiple injuries typically suffer gastrointestinal dysfunction, including a loss of appetite and indigestion, due to prolonged bed rest and limited mobility, which in turn affects their prognosis. 9 , 10 Currently, an animal model that accurately mimics this condition is lacking. Therefore, in this study, a mouse model of gastrointestinal dysfunction associated with multiple fractures was established.…”

Section: Discussionmentioning

confidence: 99%

“…As the gastrointestinal tract is responsible for digesting food, absorbing nutrients, and releasing waste, its normal functioning is fundamental for maintaining a healthy body 20,21 . Patients with clinically relevant multiple injuries typically suffer gastrointestinal dysfunction, including a loss of appetite and indigestion, due to prolonged bed rest and limited mobility, which in turn affects their prognosis 9,10 . Currently, an animal model that accurately mimics this condition is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 During the perioperative period, fracture patients often develop severe abdominal distension, constipation, nausea, vomiting, and other symptoms of disturbed gastrointestinal motility, which lead to a poor prognosis and low quality of life. [8][9][10][11][12] The pathogenesis of the gastrointestinal disturbances in fracture patients is thought to be mediated by the inhibitory sympathetic reflex system, which is activated by trauma; it increases the activity of the sympathetic nervous system in the gastrointestinal tract and inhibits gastrointestinal motility by suppressing excitatory neurons in the gastrointestinal plexus. 13 An increase in the blood glucose level, as a stress response to trauma, also inhibits gastrointestinal motility.…”

Section: Introductionmentioning

confidence: 99%

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An Innovative Model of ISS‐Based Multiple Fractures and Gastrointestinal Dysfunction Related to c‐Kit Protein Expression on Interstitial Cells of Cajal

Meng

Fan

Qian

et al. 2023

Orthopaedic Surgery

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Objective Gastrointestinal dysfunction seriously affects the prognosis and quality of life of patients with multiple fractures. However, experimental evidence of this relationship is lacking. Here we describe a newly developed mouse model of postoperative gastrointestinal dysfunction after multiple fractures. Methods Trauma severity was assessed using the injury severity score (ISS). Based on the ISS, a multiple fracture model was established in mice as follows: limb fractures with pelvic fractures and multiple rib fractures; limb fractures with multiple rib fractures; closed fracture of both forelegs with pelvic fracture and rib fractures; closed limb fractures; limb fracture with pelvic fracture; spinal fractures; hind leg fractures with pelvic fractures; pelvic fracture with multiple rib fractures; closed fracture of both fore legs with pelvic fracture; and closed fracture of both fore legs with multiple rib fractures. In each model group, gastrointestinal motility was assayed and the histopathology of the small intestine was examined. Western blot and immunohistochemical analyses of jejunal tissue were performed to detect c‐kit protein expression, the level of which was compared with that of a control group. The results of ANOVA are expressed as mean ± standard deviation. Results In mice with multiple fractures, food intake was greatly reduced, consistent with histopathological evidence of an injured intestinal epithelium. The jejunal tissue of mice in groups a, c, f, and h was characterized by extensively necrotic and exfoliated intestinal mucosal epithelium and inflammatory cell infiltration in the lamina propria. In the gastrointestinal function assay, gastrointestinal motility was significantly reduced in groups a, b, c, f, and g; these group also had a higher ISS ( p < 0.01). The expression of c‐kit protein in groups with gastrointestinal dysfunction was significantly up‐regulated ( p < 0.001) compared with the control group. The close correlation between c‐kit expression and the ISS indicated an influence of trauma severity on gastrointestinal motility. Conclusion Gastrointestinal dysfunction after multiple fractures was successfully reproduced in a mouse model. In these mice, c‐kit expression correlated with gastrointestinal tissue dysfunction and might serve as a therapeutic target.

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