Efficacy of drugs in regional anesthesia: A review

Allegri, Massimo; Delazzo, Marco G.; Grossi, Paolo; Borghi, Battista

doi:10.1016/j.eujps.2009.08.004

Cited by 5 publications

(3 citation statements)

References 160 publications

(153 reference statements)

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“…5 Beberapa obat anestesi lokal, yaitu ropivakain dan levobupivakain dapat menjadi obat pilihan pada blokade neuroaksial karena memiliki toksisitas yang rendah meskipun diberikan dalam jumlah yang banyak. 6 Bupivakain merupakan obat anestesi lokal yang sangat kardiotoksik, namun masih menjadi obat anestesi lokal yang paling banyak digunakan oleh dokter anestesi 7 termasuk di Jawa Barat. Hal ini dikarenakan harganya yang lebih murah dan mudah didapat dibanding dengan ropivakain maupun levobupivakain.…”

Section: Pembahasanunclassified

Penggunaan Anestesi Lokal dan Adjuvan pada Analgesi Epidural di Wilayah Jawa Barat Tahun 2015

Yadi¹,

Ibnu²,

Oktaliansah³

2017

jap

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AbstrakAnalgesi epidural yang optimal akan menghasilkan penanganan nyeri yang baik dengan efek samping minimal dan meningkatkan kepuasan pasien. Sampai saat ini belum terdapat data di Indonesia khususnya di wilayah Jawa Barat mengenai penggunaan anestesi lokal dan adjuvan pada analgesi epidural. Tujuan penelitian ini mecari data mengenai penggunaan anestesi lokal dan adjuvan yang digunakan oleh dokter spesialis anestesi di wilayah Jawa Barat pada tahun 2015. Penelitian ini dilakukan pada bulan Agustus hingga September 2016 di Departemen Anestesiologi dan Terapi Intensif RSUP Dr. Hasan Sadikin Bandung. Penelitian ini bersifat deskriptif dengan pengambilan data menggunakan kuesioner dan pendekatan cross sectional. Kuesioner dikirimkan kepada 120 dokter spesialis anestesi di Jawa Barat melalui jasa pos dan 30 kuesioner diberikan langsung kepada dokter spesialis anestesi yang bekerja di RSUP Dr. Hasan Sadikin Bandung. Angka respons yang didapatkan sebesar 47,3%. Hasil penelitian ini didapatkan dokter spesialis anestesi di Jawa Barat yang masih melakukan analgesi epidural pada tahun 2015 sebesar 73,2%. Obat anestesi lokal yang paling banyak digunakan untuk analgesi epidural adalah bupivakain sebesar 94,23%. Konsentrasi terbanyak 0,125% sebesar 82%. Adjuvan yang paling banyak digunakan adalah fentanil sebesar 96,9%. Simpulan penelitian ini sebagian besar dokter spesialis anestesi masih menggunakan epidural sebagai analgesi sehingga bupivakasin dan fentanil menjadi obat terbanyak yang digunakan. Kata kunci: Analgesi epidural, anestesi lokal, adjuvan Local Anesthetics and Adjuvants Use for Epidural Analgesia in West Java in 2015 AbstractUncontrolled postoperative pain may cause significant complication on many organs. Adequate postoperative, labor, and chronic pain relief has always been the goal of an anesthesiologist. This goal, however, is not always achieved and continues become a challenge for anesthesiologist. Optimum epidural analgesia should promote effective pain relief with minor adverse event and it can increase patient's satisfaction.

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Section: Pembahasanunclassified

Penggunaan Anestesi Lokal dan Adjuvan pada Analgesi Epidural di Wilayah Jawa Barat Tahun 2015

Yadi¹,

Ibnu²,

Oktaliansah³

2017

jap

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“…Improvement in patient outcomes has been achieved with the use of regional anesthesia techniques, both neuraxial and peripheral nerve blocks. Mortality, major morbidity, and patient‐oriented outcomes have been demonstrated to improve with neuraxial techniques, particularly with epidural anesthesia and continued epidural analgesia (Grossi et al, 2010; Allegri et al, 2009; Capdevila et al, 1999; Liu et al, 1995) Meta‐analyses have also reported improved surgical outcomes (without a reduction in mortality or morbidity) associated with single‐injection and continuous plexus and peripheral analgesic techniques (Capdevila et al, 1999; Maier et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Regional anesthesia and anticoagulant drugs: A survey of current Italian practice

Bugada

Allegri

Zadra

et al. 2011

European Journal of Pain Supplements

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Improvement in patient post‐operative outcomes has been widely demonstrated with regional anesthesia (RA), both with epidural anesthesia and peripheral nerve blocks. However, these techniques can relate to serious complications; hemorrhagic problems are the most feared also for peripheral nerve blocks. In fact, even though complications of peripheral nerve blocks are less serious than central neuraxial blockade, there are several reports of extensive retroperitoneal haematoma following lumbar plexus block in patients using anti‐thrombotic drugs. Introduction of more potent anti‐thrombotic drugs has increased the risk of bleeding after RA. Hence, in the last years several national anesthesiological societies tried to define guidelines in order to reduce risk of bleeding after RA. As the International Guidelines are very heterogeneous and in Italy we have not recent guidelines, it is important to evaluate how anti‐hemostatic drugs are used in clinical practice in Italy. The purpose of our survey is to evaluate how Italian anesthesiologists use different anti‐thrombotic drugs in relation with different RA techniques, both neuraxial and peripheral nerve blocks. Data were collected from a questionnaire sent, in March 2011, to anesthesiologists from 66 hospitals, with response rate of 45.45%. The sample size include a wide variety of great hospitals (they performed a total of 203.542 surgical procedures in 2010) with all different surgical settings. Regional analgesia/anesthesia was used in 38.9% of the procedure. We identified a huge variety of responses regarding management of RA and anti‐thrombotic drugs. Not all the responders strictly follow guidelines, also because, in many cases, authors from different countries don't agree each other and suggest different behaviors. Most of responders don't follow a common approach and more the agreement between different guidelines, less the differences in anesthetists behavior. In many cases, particularly with ASA and NSAIDs, new drugs (fondaparinux, thienopyridine derivates) and warfarin, the lack of common suggestions in literature leads to a very confused situation, in which everyone has different ways to approach the problem, particularly in time interval they wait between drug administration and block performance/catheter manipulation (also in the same hospital and with the same patient); thus leading, sometimes, to go against main advices coming from different authors (sometimes the only on which they agree), creating dangerous situation for the patient (concomitant use of two anti‐thrombotic drugs in people undergoing RA). In conclusion, more studies and guidelines are required to provide a better knowledge on the use of anti‐thrombotic drugs, in order to lead to more accurate guidelines and to reduce hemorrhagic risk.

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“…Regional anesthesia (RA) encompasses both central neuraxial blockade and peripheral nerve block techniques that can use effective and safe drugs such as local anesthetics, opioids, and other adjuvants (Ilfeld et al, 2008; Allegri et al, 2009). These techniques can be used as the sole anesthetic technique or in conjunction with general anesthesia or sedation (Ballantyne et al, 2005), and in recent years the continuous (epidural and peripheral) blocks have been used for postoperative pain (POP) management.…”

Section: Introductionmentioning

confidence: 99%

Regional analgesia in Italy: A survey of current practice

Allegri

Niebel

Bugada

et al. 2010

Eur Journal of Pain Supp

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Two decades of attention have focused on regional anesthesia, both central neuraxial blockades as well as peripheral blocks. Though there are a considerable number of recent publications on the topic, the complex issues around the effect of regional anesthesia on outcome have not been completely resolved, possibly because the data are often not procedure‐specific. In this survey, we tried to focus on current Italian practice and therapeutical criteria in the management of postoperative pain. We also evaluated how the clinical practice of the respondents follows the international and national guidelines for postoperative pain. A questionnaire was mailed to 64 anesthesiologists who had been identified from a database kept by the RICALOR Group (Registro Italiano Complicanze Anestesia LOcoRegionale — Italian Registry of Complications during Locoregional Anesthesia). The survey requested information regarding demographic data and general management, postoperative pain management and guidelines, and specific questions on epidural analgesia and on peripheral blocks. Only 35 of the 64 anesthesiologists answered the questionnaire and sended it back for analysis. Basing on these 35 returns, data from 51 surgical units (some respondent referred data of more surgical units) leading to 135 departments (surgical units may be constituted by more departments) were analyzed. A total of 245,382 surgical procedures were analyzed. Regional analgesia was used in 46.71% of the procedures. In university and teaching‐hospitals, protocols concerning regional anesthesia were attended and shared with the whole staff more often than in non‐teaching hospitals (P = 0.0001). For postoperative pain management 31.48% of responders used <10% of regional analgesia, 20.37% used 10–30%, 25.93% used 30–50%, 14.81% used 50–75% and 7.41% used >75% of regional analgesia. We identified a huge variety of responses regarding therapeutical protocols but the majority of responders used the drugs with the best safety/efficacy profile. In conclusion, we demonstrated an improvement in the management of postoperative pain compared to previous studies, but still efforts should be made to standardize daily practice in order to avoid complications and improve safety.

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Efficacy of drugs in regional anesthesia: A review

Cited by 5 publications

References 160 publications

Penggunaan Anestesi Lokal dan Adjuvan pada Analgesi Epidural di Wilayah Jawa Barat Tahun 2015

Penggunaan Anestesi Lokal dan Adjuvan pada Analgesi Epidural di Wilayah Jawa Barat Tahun 2015

Regional anesthesia and anticoagulant drugs: A survey of current Italian practice

Regional analgesia in Italy: A survey of current practice

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