The use of epidural block in acute pancreatitis: A report of eight cases

Browne, R. A.; Ashworth, E. J.

doi:10.1007/bf03004486

Cited by 5 publications

(14 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of particular interest to anaesthetists is the pain leading to ventilatory disturbances, such as that following upper abdominal surgery and trauma, an interest reflected in the large number of publications on the subject (7,12,13,14,15,21,34,48,59,72,82,83).…”

Section: Introductionmentioning

confidence: 99%

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

Wahba¹,

Craig²,

Don³

et al. 1973

Survey of Anesthesiology

View full text Add to dashboard Cite

The cardio-respiratory effects of a thoracic epidural anaesthetic as is given for pain relief following upper abdominal surgery were examined in thirteen surgical patients studied in the immediate pre-operative period.following an overnight fast and without premedication.The focus of interest was on its effects on FRC and on gas exchange (measured as A-aD02 and OS/OT%), waich have not been previously reported. AlI subjects were given 10 ml/Kg glucose in saline I.V. during the pre-epidural periode Lidocaine 1.5% was used in aIl cases, plain lidocaine for the first eight and lidocaine with epinephrine 1/200,.000 in the other five subjects. This agent was given to achieve a sensory block to both pin-prick and ice up to T4. Neither FRC nor gas exchange showed any consistent changes following the epidural anaesthetic. These findings are in keeping with what was anticipated from a consideration of the basic physiology and pharmacology concerned and with a review of the pertinent literature. following an overnight fast and without premedication.The focus of interest was on its effects on FRC and on gas exChange (measured as A-aD02 and OS/OT%), which have not been previously reported. All subjects were given 10 ml/Kg glucose in saline I.V. during the ~re-epidural periode Lidocaine 1.5%was used in all cases, plain lidocaine for the first eight and lidocaine with epinephrine 1/200~OOO in the other five subjects. This agent was given to achieve a sensory block to both pin-prick and ice up to T4. Neither FRC nor gas exchange showed any consistent Changes following the epidural anaesthetic. These findings are in keeping with what was anticipated from a consideration of the basic physiology and pharmacology concerned and with a rev~ew of the pertinentliterature.w. MELEIKA~WAHBA' M.Sc. Exp. Red.

show abstract

Section: Introductionmentioning

confidence: 99%

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

Wahba¹,

Craig²,

Don³

et al. 1973

Survey of Anesthesiology

View full text Add to dashboard Cite

show abstract

“…However, we noted a much lower incidence of post-epidural hypotension (6.6%). The earlier high incidence of hypotension may be a result of the empiric large volumes of local anesthetic that were used in contrast to titrated and diluted local anesthetic in our study 24 . Use of titrated dilute concentration of local anesthetic along with opioid to decrease the requirement and judicious fluid and vasopressor administration could help to avoid hypotension.…”

Section: Discussionmentioning

confidence: 76%

“…The two major concerns could be the associated hypotension and infective neuraxial complications. An earlier reported incidence of hypotension following use of epidural in patients with acute pancreatitis was 37.5% 24 . However, we noted a much lower incidence of post-epidural hypotension (6.6%).…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Effect of Segmental Thoracic Epidural Block on Pancreatitis Induced Organ Dysfunction: A Preliminary Study

Tyagi

Gupta

Das

et al. 2019

Indian Journal of Critical Care Medicine

View full text Add to dashboard Cite

Background This preliminary randomized controlled study evaluated effect of thoracic epidural block (TEB) on progression of acute pancreatitis induced organ dysfunction/failure. Materials and Methods Patients with predicted severe acute pancreatitis, without contraindication to TEB were randomized to receive (group TE) or not receive a TEB (group NTE) (n = 16 each). For group TE, TEB was performed at T8-9 or T9-10 vertebral level, with infusion of ropivacaine (0.2%) along with fentanyl 2 µg/mL; in group NTE, intravenous morphine was used instead, both interventions titrated to NRS of <4. SOFA score was assessed daily till discharge from ICU, and aggregate SOFA calculated by summing worst scores for each of organ system during ICU stay as primary outcome measure. Other surrogate measures of patient outcome were recorded as secondary objectives. Results Aggregate SOFA score was statistically similar between both groups (group NTE: 3 [2 - 4]; group TE: 5 [2 - 6]) ( P = 0.379); but there was trend of improvement in SOFA score in group TE versus a worsening in group NTE. Duration of hospital stay, and number of patients requiring mechanical ventilation were statistically similar; mortality was insignificantly lesser for group TE (12.5% versus 6.6%; p = 1.000). Fall in serum procalcitonin was significantly greater for group TE. Conclusion Thoracic epidural was associated with insignificant clinical trend towards better organ functions and lesser mortality; along with significantly greater fall in serum procalcitonin. These are encouraging results that could guide future use of thoracic epidural in acute pancreatitis for its non-analgesic benefits. How to cite this article Tyagi A, Gupta YR et al. Effect of Segmental Thoracic Epidural Block on Pancreatitis Induced Organ Dysfunction: A Preliminary Study. Indian J of Crit Care Med 2019;23(2):89-94.

show abstract

“…Among the nonrandomized studies, 1 had moderate risk of bias, 10 whereas 5 had high risk of bias. The risk of bias was mainly from the risk of confounding 5–9 . The overall evidence level was low.…”

Section: Resultsmentioning

confidence: 91%

Thoracic Epidural Analgesia in Acute Pancreatitis

Hui

Leung

2022

Pancreas

View full text Add to dashboard Cite

A bdominal pain is a cardinal feature of acute pancreatitis (AP), and thoracic epidural analgesia (TEA) has been studied as an advanced analgesic strategy in AP. 1 Aside from analgesia, TEA has secondary effects of sympathetic blockade, which may lead to splanchnic vasodilation and improvement of pancreatic microcirculation. 2 Thoracic epidural analgesia has hence been evaluated as a disease-modifying therapy for AP in clinical studies. 3,4 We performed a systematic review to assess the safety of TEA and its impact on clinical outcomes in AP. MATERIALS AND METHODSThis systematic review was performed in accordance to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO (CRD42021281548). A literature search was performed on MEDLINE, Embase, and the Cochrane Li-brary from inception until September 15, 2021, with the MeSH terms and synonyms of (1) "epidural analgesia" and (2) "acute pancreatitis." Original studies on TEA in AP patients were included, with no limit on publication date. The articles were independently screened by 2 reviewers for inclusion and data extraction.Risk of bias and level of evidence were assessed with the Cochrane Risk of Bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation system, respectively.

show abstract

The use of epidural block in acute pancreatitis: A report of eight cases

Cited by 5 publications

References 8 publications

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

The Cardiorespiratory Effects of Thoracic Epidural Anaesthesia

Effect of Segmental Thoracic Epidural Block on Pancreatitis Induced Organ Dysfunction: A Preliminary Study

Thoracic Epidural Analgesia in Acute Pancreatitis

Contact Info

Product

Resources

About