Abstract:In our single-centre study of thoracic epidural analgesia, serious adverse events occurred in 0.1% cases (1 : 1000), whereas long-term outcome was compromised in 0.014% (1.4 : 10 000) which is similar to the serious adverse event rates and outcomes reported in the current literature.
“… 19 Our data compare favorably with previously published series. 21 – 23 We recorded a low rate of accidental catheter removal, similar to the 3.3% reported by Hösslin, 30 who adopted our technique of securing the catheter to the skin with a transfixing silk suture. In addition, to prevent outward movement, we also threaded the catheter into the epidural space for at least 5 to 7 cm.…”
Section: Discussionsupporting
confidence: 81%
“…In accordance with current recommendations, we left both catheter fragments in situ. 30 – 32 Figure 4 Thoracic spine CT showing the retained catheter fragment. …”
Purpose
Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications.
Patients and Methods
Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml
−1
fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects.
Results
A total of 3126 patients received TEA. The median age was 65 years (range, 18–94) and the duration of catheter placement was 3.5 days (range, 2–8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded.
Conclusion
Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.
“… 19 Our data compare favorably with previously published series. 21 – 23 We recorded a low rate of accidental catheter removal, similar to the 3.3% reported by Hösslin, 30 who adopted our technique of securing the catheter to the skin with a transfixing silk suture. In addition, to prevent outward movement, we also threaded the catheter into the epidural space for at least 5 to 7 cm.…”
Section: Discussionsupporting
confidence: 81%
“…In accordance with current recommendations, we left both catheter fragments in situ. 30 – 32 Figure 4 Thoracic spine CT showing the retained catheter fragment. …”
Purpose
Thoracic epidural analgesia (TEA) has been shown to reduce postsurgical morbidity and mortality; nevertheless, major and minor complications can occur. We report our 10-year experience with TEA and incidence of complications.
Patients and Methods
Patients received continuous infusion TEA (0.2% ropivacaine and 2 µg ml
−1
fentanyl) to control postoperative pain. Every 8 hours, the acute pain service recorded the analgesia regimen and occurrence of side effects. The initial infusion rate was tapered daily in response to improvement in pain symptoms or occurrence of side effects.
Results
A total of 3126 patients received TEA. The median age was 65 years (range, 18–94) and the duration of catheter placement was 3.5 days (range, 2–8). Three major complications were identified (1:1042): two subarachnoid blocks and one epidural abscess which led to permanent sequela (1:3126). Minor complications were hypotension (4.8%), pruritus (4.4%), accidental catheter removal (3.7%), insertion site inflammation (2.5%), motor weakness (2.0%), postoperative nausea and vomiting (1.8%), catheter disconnection (1.9%), catheter occlusion (0.3%), post-dural puncture headache (0.5%), and catheter fragment retention (0.06%), which were the reasons for a 7.4% rate of early discontinuation of epidural analgesia. No occurrence of epidural hematoma, local anesthetic systemic toxicity, and cardiovascular/respiratory depression was recorded.
Conclusion
Postoperative TEA is an advanced technique that poses certain difficulties that can subvert its great potential. While serious complications were rare, minor complications occurred more often and affected the postoperative course negatively. A risk/benefit evaluation of each patient should be done before employing the technique.
“…На сегодняшний день выполнение паравертебральной блокады чаще всего осуществляется в условиях ультразвуковой навигации, основными ориентирами для которой служат ребра, париетальная плевра и поперечные отростки позвонков. Отсутствие таких специфических осложнений центральной блокады, как эпидуральная гематома и абсцесс [25], постоянный неврологический дефицит [26], а также нежелательных последствий в виде гипотензии и электрической нестабильности миокарда вследствие абсорбции местного анестетика в кровоток способствует сравнительно быстрому распространению этого метода аналгезии в кардиоторакальной хирургии. Как известно, при кардиохирургических вмешательствах требуется системная гепаринизация, что влечет за собой повышенный риск развития эпидуральной гематомы при катетеризации эпидурального пространства [25].…”
РЕЗЮМЕ В статье дано определение понятия послеоперационной боли, описаны особенности болевого синдрома после кардиохирургических вмешательств. Основное внимание уделено методам и методикам обезболивания в послеоперационном периоде: рассмотрен стандартный метод обезболивания опиоидами и нестероидными противовоспалительными средствами, его недостатки и побочные эффекты, оценены регионарные методики, применимые к кардиохирургии. Изложены современные представления о мультимодальной аналгезии, адъювантах, нашедших применение в кардиохирургии, таких как габапентиноиды, лидокаин, дексмедетомидин и кетамин.
“…[5] Though continuous t-PCEA remains the gold standard for treating acute pain after open thoracic surgery, [1–4,6,7,12,14,15] thoracic epidural catheterization is an invasive procedure that may cause pain and takes time to perform. [1] The technique can lead to devastating complications, such as neurological deficits [1,12,16] or epidural hematoma, [1,4,6,12,16,17] and cannot be used with anticoagulated patients or those with severe spinal deformities. [1,2,4,6] Technical failures are also common.…”
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