Scoliosis correction and epidural analgesia

Purnell, R. J.

doi:10.1111/j.1365-2044.1982.tb01758.x

Cited by 15 publications

(4 citation statements)

References 5 publications

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“…This situation would allow for possible early diagnosis and prompt revision [24,25]. Furthermore, the normal clinical examinations and invariably unchanged SCEPs found in this study after 0.125% bupivacaine and 0.2% ropivacaine advocated in favor of their use so as to prevent transient motor blocks encountered with 0.25% bupivacaine, as reported by Purnell [8] and Sucato et al [6], or with 0.3% ropivacaine reported by Blumenthal et al [7]. The absence in variation of SCEPs after epidural injection of 5 mg morphine might be explained by the fact that morphine has no important inhibitory effect on fast-conducting nerve fiber activity [26], but it blocked the substance P neurons in the layers of the substantia gelatinosa.…”

Section: Discussionsupporting

confidence: 56%

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Epidural analgesia after scoliosis surgery: electrophysiologic and clinical assessment of the effects of bupivacaine 0.125% plus morphine versus ropivacaine 0.2% plus morphine

Dang¹,

Delécrin²,

Péreón³

et al. 2008

Journal of Clinical Anesthesia

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Section: Discussionsupporting

confidence: 56%

“…There is persisting concern with a postoperative motor block after epidural administration of LA [6,8], which may interfere with neurologic examination.…”

Section: Introductionmentioning

confidence: 95%

Epidural analgesia after scoliosis surgery: electrophysiologic and clinical assessment of the effects of bupivacaine 0.125% plus morphine versus ropivacaine 0.2% plus morphine

Dang¹,

Delécrin²,

Péreón³

et al. 2008

Journal of Clinical Anesthesia

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“…[41] A side effect of epidural local anesthetics used in patients undergoing posterior spinal fusion surgery is thigh numbness. [39] Purnell [42] reported a case in 1982 in which a patient received epidural bupivacaine 0.25% (divided doses for a total of 60 mL over approximately 6-7 hours) that resulted in motor block lasting for 9.5 hours.…”

Section: Discussionmentioning

confidence: 99%

Pain management with epidural catheter and epidural analgesia after spinal dorsal instrumentation of lumbar spine

et al. 2023

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Spinal dorsal instrumentation (SDI) is an established treatment for degenerative spinal diseases. Adequate and immediate postoperative pain control is important for patient recovery and may be compromised by uncertainty about its efficacy and concern about early postoperative surgical complications or adverse events. The aim of the current study was to compare the use of epidural analgesia (EA) with systemic analgesia (SA) as regards pain reduction and early postoperative complications after SDI. Pain management with epidural or systemic analgesia in patients undergoing SDI by posterior approach between January 2019 and July 2020 was evaluated by clinical functional testing, measuring total opioid amounts used, and evaluating numerical rating scale values 24 and 96 hours postoperatively. The following were also monitored: demographic data, number of affected segments, length of hospital stay, inflammatory markers (leukocytes and serum C-reactive protein), early postoperative surgical complication rates, and adverse events. In total 79 patients were included (33 in the EA and 46 in the SA group). The SA group had significantly lower numerical rating scale values at days 1 to 4 after surgery (P ≤ .001) and lower cumulative opioid use than the EA group (P < .001). We found no difference in infection parameters, length of hospital stay or surgery-related complication rates. Our data demonstrate that epidural anesthesia was inferior to an opioid-based SA regime in reducing postoperative pain in patients undergoing spinal surgery. There is no benefit to the use of epidural catheters.

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“…Historically, epidural anesthesia is not preferred for lumbar surgery because of its slower onset and mixed success rate, likely due to incomplete puncturing of the ligamentum flavum by inexperienced performers [11][12][13][14][15] and compromising intra-operative neuro-monitoring such as SSEP, MEP. Another issue with epidural anesthesia that causes relatively high failure rates is the inconsistency of the cranial extent of epidural extension.…”

Section: Introductionmentioning

confidence: 99%

<p>Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery</p>

Kang¹,

Kashlan²,

Singh³

et al. 2020

JPR

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Background: With the increase in life expectancy seen throughout the world, the prevalence of degenerative spinal pathology and surgery to treat it has increased. Spinal surgery under general anesthesia leads to various problems and complications, especially in patients with numerous medical comorbidities or elderly patients. For this reason, there is a need for safer anesthetic methods applicable to unhealthy, elderly patients undergoing spinal surgery. Purpose: To report our experience with utilizing fluoroscopy-guided epidural anesthesia in conjunction with conscious sedation in spinal surgery. Patients and Methods: We performed a retrospective review of 111 patients at our institution that received fluoroscopy-guided epidural anesthesia for lumbar surgery from February to September 2018. Patients' records were evaluated to evaluate patient demographics, American Society of Anesthesiology Physical Classification System (ASA) class, and pain numerical rating scores (NRS) preoperatively and throughout their recovery postoperatively. Intraoperative data including volume of epidural anesthetic used, extent of epidural spread, and inadvertent subdural injection was collected. Postoperative recovery time was also collected. Results: The mean age of our patients was 60 years old with a range between 31 and 83 years old. All patients experienced decreases in postoperative pain with no significant differences based on age or ASA class. There was no association between ASA class and time to recovery postoperatively. Older patients (age 70 years or greater) had a significantly longer recovery time when compared to younger patients. Recovery also was longer for patients who received higher volumes of epidural anesthesia. For every 1 mL increase of epidural anesthetic given, there was an increase in the extent of spread of 1.8 spinal levels. Conclusion: We demonstrate the safety and feasibility of utilizing conscious sedation in conjunction with fluoroscopy-guided epidural anesthesia in the lumbar spinal surgery.

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Scoliosis correction and epidural analgesia

Cited by 15 publications

References 5 publications

Epidural analgesia after scoliosis surgery: electrophysiologic and clinical assessment of the effects of bupivacaine 0.125% plus morphine versus ropivacaine 0.2% plus morphine

Epidural analgesia after scoliosis surgery: electrophysiologic and clinical assessment of the effects of bupivacaine 0.125% plus morphine versus ropivacaine 0.2% plus morphine

Pain management with epidural catheter and epidural analgesia after spinal dorsal instrumentation of lumbar spine

<p>Advantages of the Combination of Conscious Sedation Epidural Anesthesia Under Fluoroscopy Guidance in Lumbar Spine Surgery</p>

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