Does the evidence support the use of spinal and epidural anesthesia for surgery?

Ballantyne, Jane C.; Kupelnick, Bruce; McPeek, Bucknam; Lau, Joseph

doi:10.1016/j.jclinane.2004.10.005

Cited by 53 publications

(31 citation statements)

References 109 publications

(80 reference statements)

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“…During the fi rst 3 POD, pain intensity was significantly lower at rest, on coughing and during POD = postoperative day Epidural analgesia has been widely found to be the most eff ective method of pain relief, both at rest and on movement, after major surgical procedures 19,[26][27][28] . Th e majority of studies involving open colorectal surgery 4,6,10,18,22 have reported that TEA with local anesthetics, with or without opioids, provides superior postoperative analgesia and reduces the frequency of moderate and intense pain, especially during mobilization compared with IV-PCA opioids.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Radovanović

Skoric-Jokic³

et al. 2017

acc

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SUMMARY -Th e aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. Th is prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. Th e secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side eff ects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p<0.001) and resumption of dietary intake was achieved earlier (p<0.001) in TEA group. Intensity of pain during the first 3 postoperative days was significantly lower at rest, on coughing and during mobilization (p<0.001), and mobilization was much more effi cient (p<0.005) in TEA than in IV-PCA group. Satisfaction scores were better in TEA group (p<0.001). Nausea, sedation and postoperative delirium occurred less frequently in TEA group (p<0.05, p<0.001 and p<0.05, respectively). TEA demonstrated significantly better eff ectiveness than IV-PCA after open colorectal cancer surgery and had a positive impact on bowel function, dietary intake, patient satisfaction and early mobilization. Th e results of this study demonstrated the importance of implementation of TEA as a preferred method for postoperative pain control after major open colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Radovanović

Skoric-Jokic³

et al. 2017

acc

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“…In world literature, the incidence ranges from 2.8% overall for all regional anesthesia techniques, up to 5 to 25% with techniques other than subarachnoid puncture (22).…”

Section: Failure In Blocks or Analgesiamentioning

confidence: 99%

“…Failure in the block or analgesia is an event that is immediately identified as the patient will refer pain and the surgical procedure cannot be performed. Failed blocks should not be dealt by repeating the technique, as the injection of more anesthetic in the subarachnoid space can lead to morbidity because of the high concentration in a subarachnoid space (22).…”

Section: Failure In Blocks or Analgesiamentioning

confidence: 99%

Neurological Complications of Regional Anesthesia

Navarro¹,

Eslava-Schmalbach²,

Estupiñán³

et al. 2012

Cesarean Delivery

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“…Darüber hinaus dämpfen epidurale Analgesieverfahren die postoperativ gesteigerte Sympathikusaktivität, reduzieren die Stressreaktion, verbessern die postoperativen Organfunktionen und reduzieren die Häu-figkeit postoperativer Komplikationen [4,25,26]. Thorakale Epiduralkatheter reduzieren nach abdominalchirurgischen Operationen die Dauer der postoperativen 7 gastrointestinalen Atonie [23] und verbessern die postoperative Lungenfunktion [3].…”

Section: Schmerztherapie Durch Epidurale Analgesieunclassified

Perioperative Schmerztherapie

Schwenk

Schinkel

2011

Chirurg

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Scientific studies have proven without doubt that an optimized perioperative pain therapy will improve patient comfort, reduce postoperative complications, enhance postoperative recovery and shorten the length of postoperative hospital stay. It is necessary to incorporate the acute pain therapy into a perioperative multimodal and interdisciplinary therapeutic concept. Local or regional anesthesia will provide the best analgesic effect after surgery and should be considered in all patients. Optimal treatment of patients with peripheral nerve blocks, spinal or epidural analgesia should be treated by a specialized acute pain service. However, only 15-20% of all surgical cases will be taken care of by such a pain service. Therefore, most surgical patients will only receive adequate analgesia if surgeons are familiar with the principles of postoperative pain therapy. Regular assessment of pain perception is the cornerstone of optimized pain therapy. Furthermore, pain assessment will allow the administration and to some extent dosage of analgesic therapy to be delegated to nursing personnel.

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Does the evidence support the use of spinal and epidural anesthesia for surgery?

Cited by 53 publications

References 109 publications

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Thoracic Epidural Versus Intravenous Patient-Controlled Analgesia after Open Colorectal Cancer Surgery

Neurological Complications of Regional Anesthesia

Perioperative Schmerztherapie

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