Thoracic Epidural Analgesia Augments Ileal Mucosal Capillary Perfusion and Improves Survival in Severe Acute Pancreatitis in Rats

Abstract

Thoracic epidural analgesia attenuated systemic response and improved survival in severe acute pancreatitis. These effects might be explained by improved mucosal perfusion.

The effects of epidural bupivacaine on ischemia/reperfusion-induced liver injury

“…Recently, TEA has also been shown to ameliorate organ injury and improve outcome in sepsis, cardiovascular mortality and necrotizing pancreatitis (12)(13)(14). In the present study, it was hypothesized that TEA would increase liver blood fl ow due to the increase in splachnic perfusion and thus reduce the IR damage.…”

Thoracic epidural anesthesia: Effects on splanchnic circulation and implications in Anesthesia and Intensive care

“…Animal models of acute pancreatitis treated with thoracic epidural blockade [13,16] , showed reduced histologic signs of pancreatic necrosis and a restoration of continuous capillary perfusion and arteriolar blood flow, moreover, survival rate was significantly higher in both of the studies. The microcirculatory effects induced by TEA could contribute in interrupting the ischemic injury involved in the beginning and progression of pan creatic lesions.…”

“…Freise et al [13] in a rodent model of acute pancreatitis, found a decrease in ileal mucosa interca pillary area, IL6 and lactate levels, in animals treated with both immediate or delayed epidural injection of local anesthetic. These results indicate that a thoracic epidural block improved local perfusion.…”

“…Bachmann et al [16] , evaluated a porcine model of acute pancreatitis finding that TEA enhanced [13] 2006 [23] 1997…”

“…The six studies using surrogate hemodynamic parameters had conflicting results. Tanaka et al [23] used PDRicg as indirect measure of hepatic blood [7] Hogan et al [8] Sielenkämper et al [10] Adolphs et al [12] Adolphs et al [11] Schwarte et al [15] Kosugi et al [9] Freise et al [13] Daudel et al [14] Bachmann et al [16] Tanaka et al [23] Väisänen et al [25] Spackman et al [26] Gould et al [20] Michelet et al [22] Kortgen et al [27] Meierhenrich et al [21] Trepenaitis et al [24] Treatment Meissner et al [4] Ai et al [6] Vagts et al [5] Shäper et al [3] Freise et al [17] Freise et al [18] Treatment allocation Siniscalchi A et al . Thoracic epidural anesthesia flow, finding that TEA reduced blood flow to the liver, fluid resuscitation alone could not reverse this effect but had to be associated with dopamine infusion.…”