6 Optimal epidural analgesia: importance of drug combinations and correct segmental site of injection

Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients

“…Unfortunately, the ideal combination of local anaesthetic and opioid is still undetermined. The safety of epidural opioid combinations of low-concentration local anaesthetics with sufentanil or fentanyl has already been demonstrated for regular hospital wards [2,17]. Pain relief is not impaired, but the risk of side-effects is reduced if sufentanil 0.75 mg mL À1 and not 1 mg mL À1 , is combined with ropivacaine 0.2% [16].…”

Paraplegia after thoracotomy – not caused by the epidural catheter

“…Since the epidural catheter was placed in the midthoracic area, and the infusion rate was 5 ml per hour, one would expect segmental analgesia with no affection of the lower limbs (12,13). The injection of Marcain 0.5% 5 ml during the operation could have given some weakness in the lower limbs, and although total paralysis was highly unlikely, this was the apparent main reason for the diagnostic delay.…”

“…Epidural analgesia has found an increasing application in recent years, providing a high-quality postoperative pain relief and promoting early mobilization (12,(19)(20)(21). Perioperative epidural analgesia is safe only if monitored regularly by trained nurses for sensory level and degree of motor blockade.…”

Focus on mobilisation after lower abdominal surgery. A double‐blind randomised comparison of epidural bupivacaine with morphine vs. lidocaine with morphine for postoperative analgesia

“…E PIDURAL administration of morphine in combination with a local anaesthetic agent has been used successfully in the treatment of postoperative pain after major surgery (1). Experimental studies and studies in patients have shown that bupivacaine causes less motor blockade than lidocaine (2,3), and bupivacaine has become the local anaesthetic of choice for postoperative epidural analgesia (4,5). On the other hand, lidocaine has a shorter duration of action and is less toxic than bupivacaine.…”

“…Bupivacaine is considered to be the local anaesthetic of choice for postoperative epidural analgesia due to its longer duration and lower motor blockade than, for instance, lidocaine (5). However, the view that choice of local anaesthetic may favourably influence the postoperative course after lower abdominal surgery is not supported by clinical studies.…”