Epidural Anesthesia for Lumbar Spine Surgery

Greenbarg, P E; Brown, Mark D.; Pallares, V S; Tompkins, J S; Mann, N H

doi:10.1097/00002517-198801020-00005

Cited by 57 publications

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“…4,[15][16][17] Epi du ral anesthe si a is an ef fec ti ve, well to le ra ted tech ni qu e with se ve ral po ten ti al ad van ta ges, and ac cep tab le in ciden ce of comp li ca ti ons, as com pa red to ge ne ral endot rac he al anest he si a for pa ti ents un der go ing de com pres si ve lum bar spi ne sur gery. 18 Ex pec ted di sad van ta ges of RA for lum bar spi ne sur gery inc lu des the ina bi lity to im me di a tely as sess lo wer ex tre mity mo tor func ti on and a pos sib le de lay in blad der func ti on. 3 Ho we ver, in this study, 55% of pa ti ents did not at ta in any deg re e of mo tor bloc k.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Des pi te a his tory of sa fety and ef fi cacy, epi du ral anest he si a is ra rely used in lum bar sur gery. 3,4,6 So me ins ti tu ti ons ro u ti nely and suc cess fully use both epi du ral and spi nal anest he sia for lum bar spi ne sur gery. [8][9][10] Be si des the ge ne ral ad van ta ges of re gi o nal anest he si a, this tech ni qu e allows the ne u ro sur ge on to ha ve ver bal con tact with the pa ti ent, which helps in pre ci se lo ca li za ti on of the ner ve ro ot com pres si on, re du ces pe ri o pe ra ti ve physi o lo gic res pon ses in ad di ti on to pro vi ding pa in re li ef.…”

mentioning

confidence: 99%

“…Pa ti ent's ver bal con tact with the sur ge on al so en su res de tec ti on of the preci se lo ca li za ti on of ner ve ro ot in vol ve ment. 4 So me anest he si o lo gists pre fer re gi o nal anesthe si a. It is be li e ved that re gi o nal anest he si a pro vides bet ter sur gi cal con di ti ons by lo we ring pe rip he ral ve no us pres su re which re du ces blo od loss in the ope ra ti ve fi eld.…”

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“…It has a long-term ef fect and can pro vide ef fec ti ve sen sory and mo tor block when used for epi du ral anal ge si a, but be ca u se of its high af fi nity for the myo car di al Na + chan nel, it can be car di o toxic. 13,14 Le vo bu pi va ca i ne was less car di o to xic than bu pi va ca i ne in prec li ni cal stu di es, and cli ni cal trials de mons tra ted a bet ter sa fety pro fi le [15][16][17][18] Le vobu pi va ca i ne is cur rently ava i lab le for cli ni cal use in anest he si a and pos to pe ra ti ve pa in ma na ge ment and has be en shown less to be to xic on cen tral nervo us system; the re we re al so less chan ges in di cating central nervous system (CNS) dep res si on on electroencephalography ra ce mic bu pi va ca i ne. 14 The du ra ti on of the anal ge sic ef fect is usu ally longer with bu pi va ca i ne and le vo bu pi va ca i ne than other lo cal anest he tics.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Levobupivacaine Plus Fentanyl Versus Bupivacaine Plus Fentanyl in Epidural Anesthesia for Lumbar Disc Surgery

Akarsu¹

2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Epidural anesthesia can be used successfully for lumbar disc surgery. Levobupivacaine,the S(-) isomer of bupivacaine, is less cardiotoxic than racemic bupivacaine. The aim of this study was to compare the clinical efficacy and safety of epidural anesthesia with levobupivacaine + fentanyl and bupivacaine + fentanyl in equivalent concentration and doses for elective lumbar laminectomy and discectomy. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Eighty ASA I-III cases undergoing lumbar laminectomy and discectomy were randomly divided into two groups. In the first group (Grup LF n=40) epidural block was achieved with 0.5% levobupivacaine (15 mL, 75 mg) + fentanyl 100 μg + 3 ml 0.9% NaCl solution, and in the second group (Grup BF n=40) 0.5% bupivacaine (15 mL, 75 mg) + fentanyl 100 μg + 3 ml 0.9% NaCl solution was used for epidural block . Surgery was started when sensory block reached to dermatomal level of T8. The onset time, and quality of sensory and motor block were evaluated. Blood pressure, heart rate, side effects and time to need for analgesic supplement (time to reach VAS 4) were recorded. R Re es su ul lt ts s: : Demographically both groups were similar. Onset of adequate sensory block (T8 dermatome) was similar in two groups (14.4 ± 5.9 min for Group LF, 11.4 ± 4.3 min for Group BF, respectively). Mean maximum block height was T5 in both groups (groupLF T2-T6 , group BF T4-T6). Complete regression of sensory block was significantly longer in group LF (296.7 ± 53.4 min) than Group BF (232.7 ± 37 min) (p<0.05). Motor block was evaluated by using modified Bromage scale. Degree of motor block in group LF was significantly lower than in group BF (p<0.05). The heart rate and mean arterial pressure values decreased in both groups but the decrease in group BF was significant between 30-60 min (p<0,05).The frequency of bradycardia and hypotension was higher in Group BF. C Co on nc cl lu us si io on n: : In conclusion, 0.375% levobupivacaine with fentanyl and 0.375% bupivacaine with fentanyl are suitable anesthetics for use in lumbar spine surgery but levobupivacaine provides less motor block and beter hemodynamic stability in comparison to bupivacaine. K Ke ey y W Wo or rd ds s: : Neurosurgery; discectomy; anesthesia, epidural; bupivacaine; levobupivacaine Ö ÖZ ZE ET T A Am ma aç ç: : Epi du ral anes te zi, lom ber disk cer ra hi si sı ra sın da ba şa rı lı bir se kil de uy gu lan mak ta dır. Bu ça lış manın ama cı, elek tif lom ber la mi nek to mi ve dis kek to mi ope ras yon la rın da epi du ral anes te zi de eşit doz ve kon santras yon da kul la nı lan le vo bu pi va ka in-fen ta nil ve bu pi va ka in-fen ta nil kom bi nas yon la rı nı kli nik et kin lik ve gü ve ni lir lik le ri açı sın dan kar şı laş tır mak tır. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: : Lom ber la mi nek to mi ve dis kek to mi uy gu la nacak ASA fi zik sel sko ru I-III olan 80 has ta ran do mi ze ola rak iki gru ba ay rıl dı. Epi du ral blok, le vo bu pi v...

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