Comparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia

Hurford, William E.; Dutton, Richard P.; Alfille, Paul H.; Clément, D; Wilson, Roger S.

doi:10.1016/1053-0770(93)90306-6

Cited by 32 publications

(7 citation statements)

References 17 publications

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“…At this level, in this position, the spinous processes are almost horizontal, making a midline approach to the extradural space easier. Other groups have found satisfactory analgesia from lumbar-placed catheters 34 after surgery. 5 Most UK units (personal survey) use opioid and low-dose bupivacaine combinations, often with a patient-controlled mode to maintain analgesia during recovery.…”

Section: Pre-induction Of Anaesthesiamentioning

confidence: 99%

Anaesthesia for the surgery of emphysema

Conacher¹

1997

British Journal of Anaesthesia

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Thoracic anaesthesia is now established in a third age. The first age related to surgery for infective conditions, predominantly tuberculosis, the second was defined by surgery for bronchogenic cancer and the third is surgery for respiratory failure. The anaesthetic imperatives of this latest age are epitomized by emphysema, with some variants treated with lung transplantation and, recently, surgery for the oxymoron, lung volume reduction. Small areas of emphysematous changes are common in the general population, occasionally resulting in pneumothoraces; a significant number of these patients require surgical intervention. The presence of large cystic areas or bullae, and bilateral, widespread diffuse areas of enlarged air spaces distal to terminal bronchioles 32 are much rarer and their management fraught with risk. Until the advent of lung volume reduction surgery, the anaesthetic literature was sparse, with mostly case reports and series involving small numbers. Personal experience of managing cases with moderate to severe respiratory failure, as a result of end-stage emphysematous disease, serves as an illustrative framework (table 1) and has much to teach about the dangers, how anaesthesia may contribute to morbidity and mortality, and where risks can be reduced. An early specimen of emphysema, purportedly the lung of Dr Samuel Johnson, is illustrated in Mathew Baillie's The Morbid Anatomy of Some of the Most Important Parts of the Human Body (London, Bulmer, 1812). 47 Laennec 42 described the clinical condition of dyspnoea, cyanosis, dry cough, over-inflated chest, cardiac hypertrophy and quiet respiratory sounds on auscultation. He recognized the continuum from the small areas of enlarged air cells, illustrated in his book, to the giant cyst or bulla. He foresaw pathognomonic features now so often seen on chest x-rays and CT scans, 74 noting that: "When this disease occupies only one side, or exists much more in one lung than the other, this side is evidently enlarged, and the intercostal spaces wider...........and instead of its natural compressed shape it (the chest)

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Section: Pre-induction Of Anaesthesiamentioning

confidence: 99%

Anaesthesia for the surgery of emphysema

Conacher¹

1997

British Journal of Anaesthesia

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“…[19][20][21] Data do not support catheter placement in one region over another, thoracic versus lumbar, with regard to pain control, side effects, or complications after thoracotomy. 21,22 Some patients with endobronchial lesions will have associated pulmonary artery involvement necessitating partial pulmonary artery resection or reconstruction with an intraoperative dose of heparin. Recent guidelines state that the risk of spinal hematoma with intraoperative intravenous administration of heparin is low and not itself prohibitive; however, discussion with the surgeon about the appropriate risk-benefit decision should precede catheter placement.…”

Section: Anesthetic Considerations Pain Controlmentioning

confidence: 99%

Techniques of Bronchial Sleeve Resection

Weyant

2012

Semin Cardiothorac Vasc Anesth

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A bronchial sleeve resection can be considered for lesions arising from a lobar bronchus so as to preclude a standard lobectomy, yet without enough distal involvement as to warrant a pneumonectomy. Limited bronchial resection allows maximal conservation of pulmonary function in patients with benign or malignant disease, without compromising oncologic outcome. This article defines the indications and preoperative management of candidate patients and discusses key anesthetic considerations and surgical techniques for this complex airway reconstruction. The essential component of a successful operation is a tension-free bronchial anastomosis. Open communication and careful discussion of airway management between anesthesiologist and surgeon will help ensure a good outcome.

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“…Far lipophile Opioide wfire die Lage des Epiduralkatheters danach yon geringer Bedeutung. Wie in einigen Arbeiten beobachtet wurde, k6nnen Opioidinfusionen tiber einen lumbalen Epiduralkatheter erfolgreich zur Schmerztherapie nach Thorakotomien eingesetzt werden [122][123][124]. Andere Studien zeigen dagegen, daB die Analgesie besser ist, wenn das Opioid tiber einen thorakalen anstelle des lumbalen Epiduralkatheter injiziert wird [98, 1251. In separaten Studien konnten Salomaki und Ramsey zeigen, dab eine geringere Dosis epiduralen Fentanyls ftir Post-Thorakotomie-Schmerzen ben6tigt wurde, wenn der Katheter thorakal und nicht lumbal plaziert war [98,125].…”

Section: Neurotoxisches Potentialunclassified

Klinischer Einsatz der rückenmarknahen Opioidanalgesie, Teil 1

Rawal

1996

Schmerz

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Spinal opioids are effective analgesics for surgical and non-surgical pain. Central and systemic side effects are less frequent than with epidural local anaesthetics or parenteral opioids. This review focuses on the analgesic efficacy of spinal opioids and their combination with local anaesthetics for postoperative analgesia, including patient-controlled epidural analgesia. Intrathecal administration of opioids has some advantages over their administration by the epidural route. Several factors may influence selection of the opioid; however, in most situations morphine is the drug of choice. Thoracic epidural administration of opioids seems to have no clinically important advantages over the lumbar route in terms of quality of analgesia, adverse effects, doses required or pulmonary function. However, evidence suggesting that effective postoperative analgesia can significantly improve postoperative morbidity in patients at risk is accumulating. In such patients, combined use of epidural local anaesthetics and opioids may become the technique of choice for postoperative analgesia. However, there is no evidence that this would have any clinically relevant benefit in low-risk patients.

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Comparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia

Cited by 32 publications

References 17 publications

Anaesthesia for the surgery of emphysema

Anaesthesia for the surgery of emphysema

Techniques of Bronchial Sleeve Resection

Klinischer Einsatz der rückenmarknahen Opioidanalgesie, Teil 1

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