Update in thoracic epidural anaesthesia

Effect of intercostal nerve block combined with general anesthesia on the stress response in patients undergoing minimally invasive mitral valve surgery

“…Minimally invasive mitral valve surgery (MIMVS) may alleviate surgical trauma, shorten the duration of ICU stay, reduce blood loss and lower costs compared with median sternotomy (7,8). However, a strong perioperative stress response still occurs following MIMVS, as do effects on different body systems due to incision, femoral artery and vein catheterization and hemodilution (9,10). Thoracic epidural blockage and its contraindications, such as coagulation disorders, further limit the application of minimally invasive cardiac surgery (9,10).…”

“…However, a strong perioperative stress response still occurs following MIMVS, as do effects on different body systems due to incision, femoral artery and vein catheterization and hemodilution (9,10). Thoracic epidural blockage and its contraindications, such as coagulation disorders, further limit the application of minimally invasive cardiac surgery (9,10). The use of anesthesia is a potential method of improving operative conditions and regulating the stress response.…”

The Impact of Epidural Analgesia on Postoperative Outcome After Major Abdominal Surgery

“…Taking into account that the effects on respiratory muscle function are complex, it has been suggested that epidural analgesia for pulmonary function might be unfavorable during early postoperative period due to potential paralysis of intercostals or abdominals and changes in bronchial tone (Liu & Wu, 2007;Waurick & Van Aken, 2005). However, it has been demonstrated that epidural analgesia does not impair respiratory muscle strength or airway flow even in patients with end-stage chronic obstructive pulmonary disease, resulting, by contrast, in better ventilatory mechanics and optimal respiratory muscle force generation (Groeben et al, 2002;Gruber et al, 2001;Waurick & Van Aken, 2005).…”

Effects of Preoperatively or Postoperatively Initiated Thoracic Epidural Analgesia in Patients Undergoing Elective Lung Surgery

“…1 Tho ra cic epi du ral anal ge si a (TE A) pro vides op ti mal pe ri o pe ra ti ve anest he si a and anal ge si a af ter tho ra cic sur gery, and dec re a ses pos to pe ra ti ve mor bi dity and mor ta lity. 3 Ac cor ding to se ve ral studi es, TE A using a lo cal ana est he tic com bi ned with an opi o id can be con si de red as a com monly used stan dard met hod in the ma na ge ment of acu te posttho ra co tomy pa in. [4][5][6] The ma jo rity of stu di es ha ve shown that the use of a lo cal ana est he tic-opi o id com bi na ti on is as so ci a ted with sig ni fi cantly bet ter dyna mic pa in re li ef af ter tho ra cic sur gery than the com po nents of the mix tu re in fu sed alo ne.…”

“…[4][5][6] The ma jo rity of stu di es ha ve shown that the use of a lo cal ana est he tic-opi o id com bi na ti on is as so ci a ted with sig ni fi cantly bet ter dyna mic pa in re li ef af ter tho ra cic sur gery than the com po nents of the mix tu re in fu sed alo ne. 3 The aim of pos to pe ra ti ve pa in ma na ge ment is to pro vi de go od sub jec ti ve com fort, to con tri bu te early re co very and to have a go od out co me af ter sur gery. Ef fec ti ve co ug hing is ne ces sary for a suf fici ent bronc hi al cle a ran ce to pre vent ate lec ta sis and bronc ho pul mo nary in fec ti on.…”