Continuous infusion epidural analgesia in obstetrics

Ewen, Alastair; McLeod, Danae; MacLeod, D. M.; Campbell, Alison M.; Tunstall, M.E.

doi:10.1111/j.1365-2044.1986.tb12853.x

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…The analgesia produced by such regimens is, however, often disappointing [2]. Most work on epidural infusions of local anaesthetic without added opioid has been done on parturient women, in whom it has been found that the quality of analgesia can be improved greatly by diluting the local anaesthetic and infusing a higher volume [3,4]. The purpose of this study was to determine whether this is also true in elderly high-risk patients undergoing aortic surgery.…”

Section: Introductionmentioning

confidence: 99%

Epidural bupivacaine for aortic surgery The effect of dilution on the quality of analgesia

Slade

1994

Anaesthesia

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SummaryTwenty patients undergoing elective abdominal aortic aneurysm repair were randomly allocated to two groups and studied for 24 h following surgery. Postoperative analgesia was provided by epidural bupivacaine infusion and intravenous patient-controlled 0.05 mg boluses of alfentanil. One treatment group received 7 m1.h-l of a 0.25% solution of bupivacaine, the other 25 m1.h-' of a 0.07% solution. The rate of infusion was thus 17.5 mg.h-' in both groups. Patients receiving 7 m1.h-I of epidural infusate required more doses of alfentanil (median 26.5, range 0-50) than the group receiving 25 m1.h-I of the dilute infusion (median 3.0, range 0-16). It is concluded that 17.5 mg.h-' of bupivacaine infused into the epidural space produces better analgesia when infused in a volume of 25 m1.h-I (0.07%) than when given in a volume of 7 ml.h-' of solution (O.tS%). Key wordsAnaesthetic techniques, regional; epidural. Analgesics; alfentanil. Surgery; cardiovascular.Injection of local anaesthetic into the epidural space is an established technique for providing postoperative analgesia. To minimise the risk of total spinal anaesthesia as a result of catheter migration [I], and the hypotension caused by sudden reduction in sympathetic tone, a continuous infusion of local anaesthetic solution can be used. The analgesia produced by such regimens is, however, often disappointing [2]. Most work on epidural infusions of local anaesthetic without added opioid has been done on parturient women, in whom it has been found that the quality of analgesia can be improved greatly by diluting the local anaesthetic and infusing a higher volume [3,4]. The purpose of this study was to determine whether this is also true in elderly high-risk patients undergoing aortic surgery. In these patients, who are most often over 60 years old, coexistent disease is almost invariable [5]. MethodApproval was obtained for the study from the local ethics committee, and informed written consent was obtained from all patients. The entire study was carried out over a period of 8 months at the Royal Bournemouth General Hospital. Thirty-five ASA 1-3 patients, aged 18-75 years, weighing c 90 kg who were scheduled for repair of an abdominal aortic aneurysm and who were suitable for epidural analgesia were studied. Patients were not studied if surgical considerations necessitated other than a transverse incision, if epidural block could not be demonstrated on recovery from anaesthesia, if the patient was unable to make appropriate use of a patient-controlled analgesia (PCA) device, or if, despite an effective epidural block and use of the PCA device, the patient was felt to have inadequate pain control. This was defined as an analogue pain score of 3 or above on a scale of 1-5 at the end of an hour in which six or more boluses of alfentanil had been administered. On entering the study, patients were randomly allocated to one or other of the treatment groups according to a block randomisation sequence (with four patients per block), generated by computer before comme...

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Section: Introductionmentioning

confidence: 99%

Epidural bupivacaine for aortic surgery The effect of dilution on the quality of analgesia

Slade

1994

Anaesthesia

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Prevention and Treatment of Hypotension During Central Neural Block

McCrae¹,

Wildsmith²

1993

British Journal of Anaesthesia

149

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Hypotension during central neural block may occur by three main mechanisms: decrease in venous return (in turn influenced by posture, bleeding and inferior vena cava compression), vasodilatation and decreased cardiac output. It is also important to recognize that, occasionally, other factors play a part. Bladder distension during central nerve block has been shown to produce hypotension inappropriate to the level of block [48, 62] and vagal overactivity may contribute in the unsedated patient. Preventive measures to reduce the likelihood of hypotension include correction of hypovolaemia, restriction of the upper level of block, use of a slight head-down tilt to maintain venous return and judicious use of sedation, especially in anxious patients. In the obstetric patient, the single most important factor in eliminating hypotension is the use of full left-lateral tilt. Mechanical methods to improve venous return by compressing the legs are not particularly helpful. Volume loading does not guarantee maintenance of arterial pressure and excessive fluid may be harmful in patients with bladder neck obstruction or at risk of pulmonary oedema. The administration of up to 1 litre before surgery may be particularly advisable if significant blood loss is expected (no matter what the anaesthetic technique), but colloid solutions do not have clear proven benefit over crystalloid. The prevention or treatment of hypotension induced by central block by administration of large volumes of fluid is a more contentious subject, although the practice is widespread. Review of the literature has shown that many studies have been poorly designed and the results have often been contradictory, even in such basic principles as the incidence of hypotension in control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

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Comparison of continuous and intermittent administration of extradural bupivacaine for analgesia after lower abdominal surgery

Duncan¹,

Fried²,

Lee³

et al. 1998

British Journal of Anaesthesia

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We have compared intermittent bolus and continuous infusion of extradural local anaesthetic for pain relief in a randomized, double-blind study of 48 patients who underwent major abdominal gynaecological surgery. Each patient received 5 ml of 0.375% bupivacaine hourly, either as a bolus over 5 min or as a constant infusion. Patients who received the intermittent administration technique maintained a more extensive sensory block, reported marginally better analgesia and had a lower requirement for rescue medication. The intermittent bolus technique was not associated with an increase in side effects.

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Continuous infusion epidural analgesia in obstetrics

Cited by 3 publications

References 2 publications

Epidural bupivacaine for aortic surgery The effect of dilution on the quality of analgesia

Epidural bupivacaine for aortic surgery The effect of dilution on the quality of analgesia

Prevention and Treatment of Hypotension During Central Neural Block

Comparison of continuous and intermittent administration of extradural bupivacaine for analgesia after lower abdominal surgery

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