Purpose: To compare analgesic efficacy and occurrence of motor block and other side effects during patient supplemented epidural analgesia (PSEA) with either ropivacaine/fentanyl or bupivacaine/fentanyl mixtures. Methods:In a prospective, randomized, double-blind study, 32 ASA I-III patients undergoing major abdominal surgery received an epidural catheter at the T 8 -T 10 , followed by integrated general epidural anesthesia. Postoperative epidural analgesia was provided using a patient controlled pump with either ropivacaine 0.2%/2 µg·ml -1 fentanyl (group Ropivacaine, n = 16) or bupivacaine 0.125%/2 µg·ml -1 fentanyl (group Bupivacaine, n = 16) [background infusion 4 -6 ml·hr -1 , 1.5 ml Incremental Doses and 20 min lock out]. Verbal pain rating score, number of incremental doses, consumption of epidural analgesic solution and rescue analgesics, sedation (four-point scale), and pulse oximetry were recorded by a blind observer for 48 hr after surgery. Conclusion: Using a ropivacaine 0.2% / 2 µg·ml -1 fentanyl mixture for patient supplemented epidural analgesia after major abdominal surgery provided similar successful pain relief as bupivacaine 0.125%/2 µg·ml -1 fentanyl, but patients receiving bupivacaine/fentanyl requested more supplemental.Objectif : Comparer l'efficacité analgésique, l'occurrence de blocage moteur et autres effets secondaires pendant une analgésie épidurale complétée (AEC) avec un mélange de ropivacaïne/fentanyl ou de bupivacaïne/fentanyl.Méthode : L'étude prospective, randomisée et à double insu a porté sur 32 patients d'état physique ASA I-III qui devaient subir une intervention chirurgicale abdominale majeure. Un cathéter épidural a été mis en place à T 8 -T 10 et une anesthésie générale/péridurale intégrée a suivi. L'analgésie épidurale postopératoire, administrée par une pompe contrôlée par le patient, comprenait soit un mélange de ropivacaïne à 0,2 %/2 µg·ml -1 de fentanyl (groupe Ropivacaïne, n = 16) soit un mélange de bupivacaïne à 0,125 %/2 µg·ml -1 de fentanyl (groupe Bupivacaïne, n = 16) [perfusion de base de 4-6 ml·h -1 , doses en incréments de 1,5 ml et période réfractaire de 20 min]. Le score verbal d'estimation de la douleur, le nombre de doses incrémentielles, la consommation d'analgésique épidural et de doses d'appoint, la sédation (selon une échelle en quatre points) et l'oxymétrie de pouls ont été enregistrés par un observateur impartial pendant 48 h après l'opération.Résultats : Aucune différence intergroupe n'a été observée quant au soulagement de la douleur, au blocage moteur, au degré de sédation, à l'oxymétrie de pouls et aux autres effets secondaires. Conclusion : Un mélange de ropivacaïne à 0,2 %/2 µg·ml -1 de fentanyl, comme analgésie épidurale d'appoint à la suite d'une intervention chirurgicale abdominale majeure, a fourni un soulagement de la douleur d'efficacité similaire à un mélange de bupivacaïne à 0,125 %/2 µg·ml -1 de fentanyl, mais ce dernier a nécessité plus de doses d'appoint.Patient supplemented epidural analgesia after major abdominal surgery with bupi...

No abstract

This prospective, randomized, controlled study demonstrates that laparoscopic colorectal surgery results in less postoperative pain and earlier recovery of bowel function than conventional laparotomy but does not reduce the risk for perioperative hypothermia. Accordingly, active warming must be provided to patients also during laparoscopic procedures.

Introduction. Post-operative pain control improves surgical outcome and many hospitals created multidisciplinary teams, called "Acute Pain Services" (APS). We collected APS data on 10,760 adult patients over a five year period, including complications, side effects and patient satisfaction.

Background Pain management after surgery is crucial to decrease perioperative morbidity and mortality. Acute pain services (APS) are multidisciplinary teams that represent a modern strategy to address pain inside hospitals. The APS defines and applies pain treatment protocols specific for each surgery. To evaluate the performance of the APS at our institute, we performed a large retrospective cohort study focusing on complications of epidural analgesia and IV opiates. Methods Data from the 10 years of activity of the APS were collected. Pain was assessed using the VAS at rest (VASr) and during movement (VASm) at each daily visit; the presence of side effects and complications was also assessed. Results A total of 17,913 adult patients were followed by APS during the study period. Epidural analgesia was used in 7,776 cases (43%), while 9,239 (52%) patients used IV patient‐controlled analgesia (PCA). A combination of the 2 was used in 87 patients (0.5%). A total of 456 perineural catheters (2.6%) were placed, while 442 patients(2.5%) used other analgesic techniques. We recorded 163 dural punctures during catheter placement, with no epidural hematoma, epidural abscess, or meningitis, and no permanent modification in sensitive or motor functions. Conclusions In our large case series, APS was confirmed safe and effective in treating postoperative pain, using both epidural analgesia and IV PCA with morphine.

No abstract