Epidural analgesia in the intensive care unit: An observational series of 121 patients

Jabaudon, Matthieu; Chabanne, Russell; Sossou, Achille; Bertrand, Pierre-Marie; Kauffmann, S.; Chartier, Christian; Guerin, R; Imhoff, Etienne; Zanre, Lassane; Brenas, François; Bazin, Jean-Étienne; Constantin, Jean-Michel

doi:10.1016/j.accpm.2014.12.002

Cited by 27 publications

(26 citation statements)

References 42 publications

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“…These indications are overall those applied by Jabaudon et al [10] in their report published in this issue of ACCPM with one interesting exception. The authors describe the use of epidural analgesia in 38 patients with pancreatitis although its usefulness (except from providing potent analgesia) has not yet been ascertained.…”

supporting

confidence: 55%

Epidural analgesia in ICU: Useful and effective probably, safe maybe

Figueiredo

Benhamou

2015

Anaesthesia Critical Care & Pain Medicine

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supporting

confidence: 55%

Epidural analgesia in ICU: Useful and effective probably, safe maybe

Figueiredo

Benhamou

2015

Anaesthesia Critical Care & Pain Medicine

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“…Because of insufficient evidence regarding the optimal duration of EA in ICU patients, 17 18 38 the total duration of EA will be chosen by participating physicians for each patient, given that it has been administered for at least 72 hours. Weaning of EA and removal of the epidural catheter will be conducted according to the recommendations and routine protocols of each participating centre.…”

Section: Methods: Participants Interventions and Outcomesmentioning

confidence: 99%

“…Several studies suggest that thoracic EA might be a safe procedure in centres comprising anaesthetists with expertise in EA, and thoracic EA has already been used for years to treat pain during AP in critically ill patients in some centres. 17–19 In addition, recent animal studies suggest that thoracic EA may decrease the severity of AP, with reduced respiratory, thromboembolic and abdominal complications. 20–22 EA further decreased the severity of metabolic acidosis and tissue injury in animals, thus preventing the progression from oedematous to necrotising AP.…”

Section: Introductionmentioning

confidence: 99%

Epidural analgesia in critically ill patients with acute pancreatitis: the multicentre randomised controlled EPIPAN study protocol

Bulyez

Pereira²,

Caumon³

et al. 2017

BMJ Open

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BackgroundAcute pancreatitis (AP) is associated with high morbidity and mortality in its most severe forms. Most patients with severe AP require intubation and invasive mechanical ventilation, frequently for more than 7 days, which is associated with the worst outcome. Recent increasing evidence from preclinical and clinical studies support the beneficial effects of epidural analgesia (EA) in AP, such as increased gut barrier function and splanchnic, pancreatic and renal perfusion, decreased liver damage and inflammatory response, and reduced mortality. Because recent studies suggest that EA might be a safe procedure in the critically ill, we sought to determine whether EA reduced AP-associated respiratory failure and other major clinical outcomes in patients with AP.Methods and analysisThe Epidural Analgesia for Pancreatitis (EPIPAN) trial is an investigator-initiated, prospective, multicentre, randomised controlled two-arm trial with assessor-blinded outcome assessment. The EPIPAN trial will randomise 148 patients with AP requiring admission to an intensive care unit (ICU) to receive EA (with patient-controlled epidural administration of ropivacaine and sufentanil) combined with standard care based on current recommendations on the treatment of AP (interventional group), or standard care alone (reference group). The primary outcome is the number of ventilator-free days at day 30. Secondary outcomes include main complications of AP (eg, organ failure and mortality, among others), levels of biological markers of systemic inflammation, epithelial lung injury, renal failure, and healthcare-associated costs.Ethics and disseminationThe study was approved by the appropriate ethics committee (CPP Sud-Est VI). Informed consent is required. If the combined application of EA and standard care proves superior to standard care alone in patients with AP in the ICU, the use of EA may become standard practice in experienced centres, thereby decreasing potential complications related to AP and its burden in critically ill patients. The results will be disseminated in a peer-reviewed journal.Trial registration numberNCT02126332.

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“…However, migration or spontaneous removal of the catheter can happen. Clinically significant movement of catheters was reported in approximately 30% of patients with postoperative epidural catheters [6, 7], while accidental removal was reported in approximately 17% of catheters [8]. Fibrinolytic therapy may be needed in specific situations.…”

Section: Discussionmentioning

confidence: 99%

Acute cerebral infarction in a patient with an epidural catheter after left upper lobectomy: a case report

et al. 2019

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Background There are several recent reports that left upper lobe lung resection is a risk factor for the development of postoperative thromboembolism. Although administering epidural analgesia is common in thoracic surgery, anesthesiologists should be alert when administering epidural analgesia to a patient undergoing left upper lobectomy, considering the increased risk of postoperative thromboembolism and the potential need for anticoagulation or fibrinolytic therapy in the immediate postoperative period. Case presentation A seventy-one-year-old female with a metastatic lung lesion developed a cerebral infarction approximately 30 h after video-assisted thoracoscopic left upper lobectomy. Cerebral intravascular therapy was indicated and the epidural catheter was removed immediately to avoid formation of an epidural hematoma. Approximately four hours after onset, reperfusion was successfully established by aspiration of endovascular thrombi. She recovered with mild residual paralysis of the left upper extremity and was transferred to a rehabilitation facility. Conclusions We present a patient with a cerebral infarction after left upper lobectomy. Left upper lobectomy is associated with an increased risk of postoperative thromboembolism. Although the exact mechanism of thrombosis after left upper lobectomy is unclear, a judicious decision should be made regarding epidural catheter placement for postoperative analgesia.

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Epidural analgesia in the intensive care unit: An observational series of 121 patients

Cited by 27 publications

References 42 publications

Epidural analgesia in ICU: Useful and effective probably, safe maybe

Epidural analgesia in ICU: Useful and effective probably, safe maybe

Epidural analgesia in critically ill patients with acute pancreatitis: the multicentre randomised controlled EPIPAN study protocol

Acute cerebral infarction in a patient with an epidural catheter after left upper lobectomy: a case report

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